To determine the possible existence of differences in blood pressure change over time according to stature in Mexican adults.per capita family income, waist-to-height ratio, physical activity, alcohol consumption, smoking, and use of antihypertensive drugs.We analyzed the National Household Living Standards Survey databases following household members between 2005 and 2009. We selected participants who were between 20 and 40 years old . We estimated multilevel models with random intercept to analyze differences in blood pressure changes according to stature. We adjusted the models for age, locality size, geographic region, In both sexes, baseline blood pressure tended to be lower as stature decreased. The differences were maintained in both the crude and adjusted models. In men, the increases in systolic pressure over time tended to be higher as stature increased.Contrary to what studies observed in high-income countries, in Mexico blood pressure was positively associated with stature. It is the most common condition in primary care; in 2010, it was the main cause of death and disability adjusted life years. It is a risk factor for several of the main causes of mortality2. This contrasts with the fact that it is a preventable risk factor.Arterial hypertension is highly prevalent in Mexico, with almost one third of adults suffering from it in 20127. In different populations, an inverse association has been established between blood pressure and stature, tending to be higher in those who are shorter11.In recent years, cohort studies conducted in mainly European and Brazilian populations have established a negative association between stature and the risk of developing cardiovascular disease12. This theory holds that adversities present during early stages of life produce structural and physiological modifications in the organism. Part of these changes result in short stature; those who have deficiencies during development generally reach shorter stature in adulthood5.These studies are consistent with the hypothesis proposed by Barker, who postulated that adverse conditions during prenatal life and childhood increase the risk of suffering chronic diseases in adulthood14; they have a smaller number of capillaries and less elasticity of the large vessels14; as well as greater arterial intima-media thickness and greater incidence of atherosclerosis14. These mechanisms contribute to a decrease in vascular lumen, increasing peripheral resistance14.It possible to explain the inverse association between stature and blood pressure by different mechanisms: in shorter individuals the diameter of the blood vessels is smaller15. This characteristic is similar with populations from other Latin American countries such as Colombia, Honduras and Bolivia, which have an average stature similar to that of Mexico16. Differences in stature are probably the result of genetic characteristics and living conditions. Genetically, the Mexican population differs from the Brazilian and European populations because, although our population is a mixture of Amerindian, European and African genes, the Amerindian component predominates17. In addition to the above, there are genetic differences (higher proportion of indigenous population), differences in living conditions (less human development) and feeding patterns  making the Mexican population different from that studied populations16.The physical characteristics of the Mexican population are not comparable with the studied populations; therefore, it is not possible to assume that the results of these studies are valid for this population. For example, the average stature in Mexico is 156.8 and 169.0 cm for women and men, respectively; while in Brazil it is 160.9 and 173.6 cm; and in the United Kingdom it is 169.5 and 177.5 cm1, favoring short stature in adulthood5. Therefore, this study sought to determine the existence of differences in changes in blood pressure over time according to stature in Mexican adults, considering the hypothesis that individuals of shorter stature will have a greater increase in blood pressure.On the other hand, in Mexico, around 1.5 million children under five years old were chronically undernourished in 2012Encuesta Nacional sobre Niveles de Vida de los Hogares) conducted in Mexico. ENNViH is a cohort study following a sample of households with three surveys: 2002 (ENNViH-1), between 2005 and 2006 (ENNViH-2), and between 2009 and 2012 (ENNViH-3). During the follow-ups (2005 and 2009), the participants of the initial round were contacted again. The sample of the ENNViH has national, rural-urban and regional representativeness. This study used data from the second and third surveys; the 2005 information corresponds to our baseline measurement and the 2009 information corresponds to the follow-up. The ENNViH questionnaires were adapted to the Mexican population, and the ethics committee of the National Institute of Public Health approved the study. The informed consent was obtained from all participants18.To achieve the proposed objective, we carried out a secondary analysis of the databases of the National Household Living Standards Survey , considering that during this stage of life, stature remains stable. Those who, in baseline measurement (2005), were pregnant or breastfeeding (n = 323); those who did not have systolic or diastolic blood pressure record (n = 312) or whose values were outside the biologically possible range (n = 17); those who did not have a record of stature (n = 19); those whose sex was not specified (n = 201); and those whose follow-up time did not correspond to the time period in which the data were collected (n = 104) were excluded. Follow-up time was obtained from the age difference between the second and first cycle. The shortest follow-up was two years for those surveyed during 2006 after the day and month of their birth, with follow-up during 2009 before the day and month of their birth; while the longer was eight years for those surveyed during 2005 before the day and month of their birth, with follow-up during 2012 after the day and month of their birth. An analytical sample of 7,130 individuals was formed.During follow-up, 81.1% of the participants included in the initial round were contacted. However, blood pressure measurement was only recorded for 62.7% . Women who were pregnant or breastfeeding during the second time (n = 202) were not excluded, but only their baseline information was included for analysis, considering them as lost during follow-up. The comparison between those who had complete follow-up information with those who only had information from the first round showed that those who were followed up in general had short stature and higher blood pressure (Supplementary Table 1). Due to the type of analysis, we did not exclude losses in follow-up and those who had missing information, since the results of their first measurement were available.2, obtaining the results by means of an OMRON model HEM19 digital baumanometer, recorded in mmHg. We used the average of the two measurements for the analysis. We considered as implausible values those with measurements ≤ 60 or ≥ 300 mmHg for systolic and ≤ 30 or ≥ 150 mmHg for diastolic. We calculated the change in blood pressure by subtracting the values of the first moment from those of the second moment.We measured the blood pressure in the manner established in the guidelines for the detection of arterial hypertension, with the participants seated in a quiet environment after at least five minutes of rest, with the arm at heart level, recording two measurements in each participant20, obtained the anthropometric measurements. We measured the stature using a SECA wall stadiometer with a precision of 1.0 mm, with the individual standing barefoot, resting heels, calves, buttocks, back and head on the wall, reporting the results in centimeters and calculating quintiles for each sex.Specialized personnel trained for this activity, following standardized proceduresper capita family income from the sum of the income of the family members . We divided the total by the number of household members and reported in Mexican pesos. On the other hand, when data was available, we analyzed the father’s schooling; and when it was not available, we considered the mother’s schooling.The covariates considered were the participants’ age, socioeconomic position, as well as habits related to health and an indicator of adiposity, the geographic region and the size of the town where they lived. Age was taken in completed years recorded in the questionnaire and was grouped into five categories: 20.0–24.9 years old, 25.0–29.9 years old, 30.0–34.9 years old, 35.0–39.9 years old and 40.0 years old or more. To measure the socioeconomic position of the participants, we considered family income and parents’ schooling. We obtained the 20. We calculated the waist-height index (WHI) by dividing waist circumference by stature. We considered it as an indicator of adiposity, since it uses to be a good predictor in the evaluation of cardiovascular risk. It was considered as a possible mediator of the relationship between stature and blood pressure, since people of shorter stature tend to have greater adiposity and, in turn, adiposity is one of the strongest predictors of blood pressure21.For habits , dichotomous variables were generated, distributing the sample as positive or negative according to the responses. We considered physical activity positive for who reported that performs physical activity regularly. In addition, we classified as positive for alcohol consumption those who mentioned they usually drink alcoholic beverages in any of the situations mentioned in the questionnaire. In smoking, likewise, those who reported smoking or having smoked in the past were positive. Those who mentioned being hypertensive and under treatment were classified as positive for the use of antihypertensive drugs. We measured waist circumference with a fiberglass measuring tape 200 cm long and accurate of one decimeter, with the individual standing upright, feet together, abdomen relaxed and arms crossed in front of the chest. The anatomic reference was the iliac crest and the last rib. The measurement was reported in centimeters22, resulting in four regions: center, midwest, south-southeast and north (including northeast and northwest). We formed four categories according to the size of the locality: > 100,000; 15,001–100,000; 2,500–15,000; and < 2,500 inhabitants.We divided the regions according to the national development plan 2001–2006We used the Stata version 14 program for database cleaning and statistical analysis. We considered the expansion factor at the individual level to obtain weighted relative frequencies of the categorical variables for each moment in each sex. We used ANOVA testing to look for differences according to stature in baseline blood pressure and changes over time.23, considering participant identification as a random intercept, to look for differences in blood pressure (baseline and over time) according to stature. With multilevel models it is recognized that there is intra-subject correlation. The interaction of the cycle with stature allows us to recognize between cross-sectional and longitudinal differences. The intraclass correlation coefficient for systolic and diastolic pressure in men was 0.20 and 0.16; while in women it was 0.25 and 0.18, respectively. The cycle, which identifies to which round each measurement belongs, was included as a time variable. We added the quadratic term of stature and its interaction with cycle in each of the models to evaluate the quadratic effect of stature. We used crude models adjusted for sociodemographic data, WHI and health-related habits . The parental schooling variable had a high proportion of missing data , so models were estimated with and without it.To improve the understanding of the results, marginal means were estimated and plotted from the fitted modelsa. We performed the analysis stratifying by sex.We used multilevel modelsWomen participants were 56.1%. The mean age was 29.5 years at first, increasing to 35.0 years during follow-up. The average follow-up time was 4.3 years.In both sexes, half of the participants were between 30 and 39 years old during 2005 . For thePer capitafamily income was higher in men than in women in both cycles, but while in men an increase in average income is present, in women it decreased slightly. The average systolic and diastolic pressure in both years was higher in men than in women. Similarly, the increase in systolic pressure among men was greater than in women, while the increase in diastolic pressure was slightly greater in women. In men, the average stature was greater than in women, by 12.5 cm. In 2009 the average stature in women decreased by 0.8 cm, while in men it decreased by 0.6 cm.In both sexes, baseline blood pressure was lowest in the shorter stature quintile, while it was highest in the taller stature quintile . HoweverIn each of the multilevel models  and 4, iIn women (Table 4 and supplementary figure), baseline pressures were also lower as stature was shorter, especially after adjusting for WHI and habits related to health (models 2 and 3). No differences in changes over time were identified, nor when using quadratic terms (Supplementary table 2).The results of the models when adjusting for parental schooling (Supplementary tables 3 and 4) did not differ from those obtained without including it  and 4. T11 and the anatomical and physiological changes described14, an inverse relationship between stature and baseline blood pressure would be expected. However, in Mexican adults, baseline blood pressure tended to be higher as stature was taller in both sexes, with wider differences among men than among women. In the changes in blood pressure, we found differences only in men when evaluating the quadratic effects; contrary to expectations, as stature increased, the increase in blood pressure was higher.Considering the epidemiological evidence from other populations17 as well as with a higher risk of presenting cardiovascular disease24 compared to Amerindian ancestry. On the other hand, Amerindian ancestry is associated with a greater probability of having short stature25. In other words, it is possible that the Euro-descendant population in Mexico is the one that is taller and has higher blood pressure than the rest of the population, and this is what explains the positive relationship between these two variables observed in our analysis. Unfortunately, the ENNViH did not measured markers of ancestry, so it is not possible to evaluate this possibility. On the other hand, the relationship between blood pressure and stature may not be linear, so that in populations of smaller stature compared to European countries, it may be contrary to that reported in populations of taller stature.Differences in the genetic composition of the population could help explain why the behavior of blood pressure was not as expected. The ethnic mix of our country resulted from the combination of three ancestries: Amerindian, European and African. European ancestry has been associated with taller stature26. Ultra-processed foods have a higher sodium content compared to those of natural origin27, which explains why their consumption is associated with elevated blood pressure27. Therefore, it is possible that people with taller stature tend to have a higher socioeconomic level28 and thus may have a higher consumption of ultra-processed foods, favoring higher blood pressure as stature increases. We did not explore this possibility, since ENNViH has no information related to diet.In addition to genetics, diet quality could be another element that helps to explain why taller stature participants had higher blood pressure. In Mexico, the availability and consumption of ultra-processed foods differ according to geographic region and socioeconomic level (similar to what occurs with stature), with higher consumption in the north and by people with a higher socioeconomic level25. In the models where it was not included, the differences according to stature were smaller but, adding to the models, the relationship of stature with baseline systolic and diastolic pressure was stronger21.We confirmed the participation of WHC as a mediator in the relationship between stature and blood pressure. WHC was inversely related to stature; those with shorter stature had higher WHC, as reported in a study conducted in southern Mexico11. Finally, blood pressure changes over time may be significant at another stage of life. That is, differences in blood pressure changes were probably not identified because the follow-up period was at a time when blood pressure rises uniformly, regardless of stature. It is possible to identify the differences at earlier stages6 or at later ages than those included in the investigation41.Among the limitations of the study, it is important to point out that ENNViH was not designed to test our hypothesis, so it was necessary to adapt the available information. In addition, with the exception of anthropometric measurements, we obtained the information using questionnaires. The average follow-up time of this study was four years, while several of the studies conducted have a follow-up time of more than 15 years2. Although it may be useful to have more than two measurements29, the increase in the number of measurements has been of minimal benefit in the detection of cardiovascular risk30. In addition, we analyzed data from a nationally representative study with a longitudinal design. The use of multilevel models made it possible to distinguish between cross-sectional differences in changes over time. Therefore, the relationships found are causally stronger than those that could have been found in a cross-sectional study.Despite the aforementioned limitations, this study provided an overview of the association between stature and blood pressure in the Mexican population. We measured the blood pressure according to the recommendations of the guidelines for the detection of hypertensionIn summary, in the Mexican population, the effect of stature on blood pressure was contrary to the expected, since it was positively related. In the context of the epidemiological transition, the predominance of chronic undernutrition in Latin American populations could be a factor that increases the burden associated with chronic diseases. Our analysis shows that this may not be entirely true. In contrast to the above, in Mexican adults, blood pressure is related in the expected direction to traditional risk factors such as adiposity. Therefore, in order to address the problem of arterial hypertension and its consequences in the country, it is necessary to continue investigating other environmental, genetic and dietary factors, as well as to address the modifiable factors already known. It would be advisable to carry out studies with a similar design, but at different stages of life, to evaluate the blood pressure and identify the times when it shows a greater change. 1. Es la condición más común en la atención primaria, en el 2010 fue la principal causa de muerte y de discapacidad ajustada por años de vida. Es un factor de riesgo para varias de las principales causas de mortalidad2. Lo anterior contrasta con el hecho de que es un factor de riesgo prevenible.La hipertensión arterial en México tiene alta prevalencia, casi un tercio de los adultos la padecía en el 20127. En diferentes poblaciones se ha establecido una asociación inversa entre la presión arterial y la estatura, tendiendo a ser mayor en quienes tienen menor estatura11.En los últimos años, mediante estudios de cohorte desarrollados en poblaciones principalmente europeas y de Brasil, se ha establecido una asociación negativa entre la estatura y el riesgo de desarrollar enfermedades cardiovasculares12. Esta teoría sostiene que las adversidades presentes durante etapas tempranas de la vida producen modificaciones estructurales y fisiológicas en el organismo. Parte de estos cambios se traducen en estatura baja, quienes tienen deficiencias durante el desarrollo generalmente alcanzan menor estatura en la edad adulta5.Estos estudios hacen eco a la hipótesis planteada por Barker, quien postuló que las condiciones adversas durante la vida prenatal y la infancia aumentan el riesgo de padecer enfermedades crónicas en la edad adulta14; tienen menor número de capilares y menor elasticidad de los grandes vasos14; así como mayor grosor de la íntima media arterial y mayor afectación por aterosclerosis14. Estos mecanismos contribuyen a la disminución del lumen vascular, incrementando las resistencias periféricas14.La asociación inversa entre estatura y presión arterial podría explicarse por diferentes mecanismos: en individuos de menor estatura el diámetro de los vasos sanguíneos es más pequeño15. Esta característica es compartida con poblaciones de otros países latinoamericanos como Colombia, Honduras y Bolivia, las cuales tienen estatura promedio similar a la de México16. Las diferencias en estatura, probablemente, son producto de factores genéticos y condiciones de vida. Genéticamente, la población mexicana difiere de la población brasileña y poblaciones europeas debido a que nuestra población, aunque es una mezcla entre genes amerindios, europeos y africanos, predomina el componente amerindio17. Sumado a lo anterior, existen diferencias genéticas (mayor proporción de población indígena), en condiciones de vida (menor desarrollo humano) y patrones de alimentación  que hacen que la población mexicana sea distinta a las poblaciones que han sido estudiadas16.Las características físicas de la población mexicana no son comparables con las poblaciones que han sido estudiadas, por lo tanto, no es posible asumir que lo observado se puede extrapolar a esta población. Por ejemplo, la estatura promedio en México es de 156.8 y 169.0 cm para mujeres y hombres, respectivamente; mientras que en Brasil es de 160.9 y 173.6 cm; y en Reino Unido es de 169.5 y 177.5 cm1, lo que favorece tener estatura baja en la edad adulta5. Por lo tanto, este estudio buscó determinar si existen diferencias en los cambios de la presión arterial a lo largo del tiempo de acuerdo con la estatura en adultos mexicanos, teniendo como hipótesis que los individuos de menor estatura tendrán mayor incremento en la presión arterial.Por otra parte, en México, alrededor de 1.5 millones de niños menores de cinco años presentaban desnutrición crónica en el 201218.Para alcanzar el objetivo planteado, se realizó un análisis secundario de las bases de datos de la Encuesta Nacional sobre Niveles de Vida de los Hogares (ENNViH) realizada en México. La ENNViH es un estudio de cohorte que dio seguimiento a una muestra de hogares con tres levantamientos: 2002 (ENNViH-1), entre 2005 y 2006 (ENNViH-2), y entre 2009 y 2012 (ENNViH-3). Durante los seguimientos (2005 y 2009) se contactó de nuevo a los participantes de la ronda inicial. La muestra de la ENNVIH tiene representatividad nacional, rural-urbana y regional. Para este estudio, se utilizaron los datos del segundo y tercer levantamiento, la información del 2005 corresponde a nuestra medición basal y la del 2009 al seguimiento. Los cuestionarios de la ENNViH fueron adaptados a la población mexicana, el estudio fue aprobado por el comité de ética del Instituto Nacional de Salud Pública. Se obtuvo consentimiento informado de cada uno de los participantesPara el análisis se incluyeron a los individuos que tenían entre 20 a 40 años durante el primer momento , considerando que durante esta etapa de la vida la estatura permanece estable. Se excluyeron a quienes en la medición basal (2005) se encontraban embarazadas o en periodo de lactancia (n = 323); no contaban con registro de presión sistólica o diastólica (n = 312) o tenían valores fuera del rango biológicamente posible (n = 17); no tenían registro de estatura (n = 19); no especificaban el sexo (n = 201); y a quienes el tiempo de seguimiento no correspondía con el periodo de tiempo en que fueron levantados los datos (n = 104). Se obtuvo el tiempo de seguimiento a partir de la diferencia de edad entre el segundo y el primer ciclo. El seguimiento más corto fue de dos años para quienes se les encuestó durante el 2006 posterior al día y mes de su nacimiento, con el seguimiento durante el 2009 antes del día y mes en que nacieron; mientras que el máximo fue de ocho años para quienes se levantó la información durante el 2005 antes del día y mes en que nacieron, con el seguimiento durante el 2012 posterior al día y mes de su nacimiento. Se conformó una muestra analítica de 7,130 individuos.Durante el seguimiento se logró contactar al 81.1% de los participantes incluidos en la ronda inicial. Sin embargo, la medición de presión arterial solo se registró para el 62.7% . Las mujeres que estaban embarazadas o en periodo de lactancia durante el segundo momento (n = 202) no fueron excluidas, pero solo se incluyó su información basal para el análisis, considerándolas como pérdidas durante el seguimiento. Al comparar los que tenían información completa del seguimiento con quienes solo tenían información de la primera ronda, se identificó que quienes fueron seguidos en general tuvieron menor estatura y mayor presión arterial (Tabla complementaria 1). Por el tipo de análisis, no se excluyeron las pérdidas en el seguimiento, ni a quien tuviera información faltante, ya que se contaba con los resultados de su primera medición.2. Se obtuvo por medio de un baumanómetro digital marca OMRON modelo HEM19, registrándola en mmHg. Para el análisis se utilizó el promedio de las dos mediciones. Se consideraron valores implausibles aquellos con mediciones ≤ 60 o ≥ 300 mmHg para sistólica y ≤ 30 o ≥ 150 mmHg para diastólica. El cambio de la presión arterial se calculó sustrayendo los valores del primer momento de los del segundo momento.La presión arterial se midió de la forma establecida en las guías para detección de hipertensión arterial, estando los participantes sentados en un ambiente tranquilo después de al menos cinco minutos de reposo, con el brazo a la altura del corazón, registrando dos mediciones en cada participante20. La medición de la estatura se realizó utilizando un estadímetro de pared marca SECA con precisión de 1.0 mm, estando el individuo de pie, descalzo, recargando talones, pantorrillas, glúteos, espalda y cabeza en la pared. Se reportó en centímetros y se estimaron quintiles para cada sexo.Las medidas antropométricas fueron obtenidas por personal especializado y capacitado para esta actividad, siguiendo procedimientos estandarizadosFueron consideradas como covariables a la edad de los participantes, la posición socioeconómica, así como hábitos relacionados con la salud y un indicador de adiposidad, la región geográfica y el tamaño de la localidad donde residían. La edad se tomó en años cumplidos registrados en el cuestionario y se agrupó en cinco categorías: 20.0–24.9 años, 25.0–29.9 años, 30.0–34.9 años, 35.0–39.9 años y 40.0 años o más.per cápita se obtuvo de la suma de los ingresos de los integrantes de la familia . El total se dividió entre el número de miembros del hogar y se reportó en pesos mexicanos. Por otra parte, cuando se disponía de los datos, se analizó la escolaridad del padre; y cuando no se contó con ésta, se consideró la escolaridad de la madre.Para medir la posición socioeconómica de los participantes se consideró el ingreso familiar y la escolaridad de los padres. El ingreso familiar Para hábitos  se generaron variables dicotómicas, distribuyendo la muestra en positivo o negativo de acuerdo con las respuestas. Para actividad física se consideró positivo a quien reportó que realiza actividad física de forma rutinaria. Además, se clasificó positivo a consumo de alcohol quien mencionó que acostumbra ingerir alguna bebida con contenido de alcohol en cualquiera de las situaciones mencionadas en el cuestionario. En tabaquismo, por su parte, se consideró positivo a quien refirió fumar o haber fumado en el pasado. Quien mencionó ser hipertenso y estar con tratamiento se clasificó positivo para uso de antihipertensivos.20. El índice cintura-estatura (ICE) se calculó dividiendo la circunferencia de la cintura sobre la estatura. Este fue considerado como indicador de adiposidad, debido a que ha demostrado ser buen predictor en la evaluación de riesgo cardiovascular. Se consideró como posible mediador de la relación entre estatura y presión arterial ya que las personas con menor estatura tienden a tener mayor adiposidad y, a su vez, la adiposidad es uno de los predictores más fuertes de la presión arterial21.La medición de la circunferencia de cintura se realizó con una cinta métrica de fibra de vidrio con 200 cm de longitud y exactitud de un decímetro, estando el individuo de pie, derecho, con los pies juntos, abdomen relajado y brazos cruzados colocados al frente a la altura del pecho. Como referencia anatómica se utilizó la cresta iliaca y la última costilla, la medición se reportó en centímetros22, quedando cuatro regiones: centro, centro-occidente, sur-sureste y norte (incluyendo noreste y noroeste). De acuerdo con el tamaño de la localidad se formaron cuatro categorías: > 100.000, 15.001–100.000, 2.500–15.000 y < 2.500 habitantes.Las regiones se dividieron de acuerdo al plan nacional de desarrollo 2001–2006La depuración de las bases de datos y el análisis estadístico se realizaron utilizando el programa Stata versión 14. Se consideró el factor de expansión a nivel individual para obtener frecuencias relativas ponderadas de las variables categóricas para cada momento en cada sexo. Se utilizó la prueba ANOVA para buscar diferencias de acuerdo con la estatura en la presión arterial basal y los cambios a lo largo del tiempo.23 considerando a la identificación de los participantes como intercepto aleatorio. Con los modelos multinivel se reconoce que existe correlación intra-sujeto. La interacción del ciclo con la estatura permite reconocer las diferencias transversales y longitudinales. El coeficiente de correlación intraclase para la presión sistólica y diastólica en los hombres fue de 0.20 y 0.16; mientras que en las mujeres fue de 0.25 y 0.18, respectivamente. Como variable de tiempo se incluyó el ciclo, que identifica a qué ronda pertenece cada medición. Se agregó el término cuadrático de la estatura y su interacción con el ciclo en cada uno de los modelos para evaluar el efecto cuadrático de la estatura. Se utilizaron modelos crudos y ajustados por datos sociodemográficos, por ICE y por hábitos relacionados con la salud . La variable de escolaridad de los padres tuvo una elevada proporción de datos faltantes , por lo cual se estimaron modelos con y sin ella. Para mejorar la comprensión de los resultados, se estimaron y graficaron medias marginales a partir de los modelos ajustadosa. El análisis se realizó estratificando por sexo.Para buscar diferencias en la presión arterial  de acuerdo con la estatura, se utilizaron modelos multinivelEl 56.1% de los participantes eran mujeres. La edad promedio fue de 29.5 años en un primer momento, aumentando a 35.0 años durante el seguimiento. El tiempo de seguimiento promedio fue de 4.3 años.En ambos sexos, la mitad de los participantes tenían entre 30 y 39 años durante el 2005 . Para elper cápita fue mayor en los hombres que en las mujeres en los dos ciclos pero, mientras en hombres hubo un incremento en el ingreso promedio, en las mujeres disminuyó ligeramente. La presión sistólica y diastólica promedio en ambos años fue mayor en hombres que en mujeres. De igual forma, el aumento en la presión sistólica entre los hombres fue mayor que en las mujeres, mientras que el aumento de la presión diastólica fue ligeramente mayor en las mujeres. En los hombres el promedio de estatura fue mayor que en las mujeres por 12.5 cm. En el 2009 el promedio de estatura en las mujeres disminuyó 0.8 cm, mientras que en los hombres se redujo a 0.6 cm.El ingreso familiar En ambos sexos, la presión arterial basal fue menor en el quintil más bajo de estatura, mientras que la más alta fue en el quintil superior . Sin embEn cada uno de los modelos multinivel  y 4, en En las mujeres  no difirieron de los obtenidos sin incluirla  y 4. Por11 y los cambios anatómicos y fisiológicos que se han descrito14, se esperaría una relación inversa entre la estatura y la presión arterial inicial. Sin embargo, en adultos mexicanos la presión arterial basal tendió a ser mayor conforme la estatura fue más alta en ambos sexos, con diferencias más amplias entre los hombres que entre las mujeres. En los cambios de la presión arterial, solamente se encontraron diferencias en los hombres al evaluar los efectos cuadráticos, contrario a lo esperado, conforme la estatura fue mayor, el incremento de la presión arterial fue más alto.Considerando la evidencia epidemiológica de otras poblaciones17, así como con mayor riesgo de presentar enfermedades cardiovasculares24, en comparación con la ascendencia amerindia. Por el contrario, el tener ancestría amerindia se relaciona con mayor probabilidad de presentar estatura baja25. Es decir, es posible que la población euro descendiente de México es la que tiene mayor estatura y presión arterial respecto al resto de la población y eso es lo que explica la relación positiva entre esas dos variables observadas en nuestro análisis. Desafortunadamente en la ENNVIH no se midieron marcadores de la ancestría por lo cual no es posible evaluar esta posibilidad. Por otro lado, la relación de la presión arterial y la estatura podría no ser lineal, por lo cual, en poblaciones de menor estatura en comparación a países europeos el comportamiento sea contrario al que se ha reportado en poblaciones de mayor estatura.Las diferencias en la composición genética de la población podrían ayudar a explicar porque el comportamiento de la presión arterial no fue como se esperaba. El mestizaje de nuestro país resultó de la combinación de tres ancestrías: amerindia, europea y africana. La ascendencia europea se ha asociado con mayor estatura26. Los alimentos ultraprocesados tienen más alto contenido de sodio en comparación con los de origen natural27, lo cual explica porque su consumo se asocia con elevación de la presión arterial27. Por lo tanto, es posible que las personas con mayor estatura tiendan a tener nivel socioeconómico más alto28, por lo cual pueden tener mayor consumo de alimentos ultraprocesados, favoreciendo que la presión arterial sea más alta conforme la estatura sea mayor. Esta posibilidad no fue explorada ya que en la ENNViH no se registró información relacionada con dieta.Además de la genética, la calidad de la dieta podría ser otro factor que ayude a explicar porque los participantes de mayor estatura tuvieron mayor presión arterial. En México, la disponibilidad y el consumo de alimentos ultraprocesados tienen diferencias de acuerdo a la región geográfica y nivel socioeconómico (similares a lo que ocurre con la estatura), habiendo mayor consumo en el norte y por las personas con mejor nivel socioeconómico25. En los modelos donde no se incluyó, las diferencias de acuerdo con la estatura fueron menores pero, al agregarlo a los modelos, la relación de la estatura con la presión sistólica y diastólica basal se hizo más fuerte21.La participación del ICE como mediador en la relación entre la estatura y la presión arterial se confirmó. El ICE se relacionó inversamente con la estatura, quienes tenían menor estatura tuvieron mayor ICE, tal como se reportó en un estudio realizado en el sur de México11. Finalmente, cabe la posibilidad de que los cambios de la presión arterial a lo largo del tiempo sean significativos en otra etapa de la vida. Es decir, probablemente no se identificaron diferencias en los cambios de la presión arterial debido a que el periodo de seguimiento fue en un momento en el que la presión arterial se eleva uniformemente, independientemente de la estatura. Las diferencias podrían identificarse en etapas más tempranas6, o bien, en edades posteriores a las incluidas en la investigación4.Dentro de las limitaciones del estudio es importante señalar que la ENNViH no fue diseñada para probar nuestra hipótesis, por lo que fue necesario adaptar la información disponible. Además, a excepción de las medidas antropométricas, la información se obtuvo a través de cuestionarios. El tiempo de seguimiento promedio de este estudio fue de cuatro años, mientras que varios de los estudios realizados cuentan con un tiempo de seguimiento superior a 15 años2. Aunque podría ser útil contar con más de dos mediciones29, el incremento en el número de mediciones ha significado un mínimo beneficio en la detección de riesgo cardiovascular30. Además, se analizaron datos de un estudio con representatividad nacional y diseño longitudinal. El empleo de modelos multinivel permitió distinguir entre diferencias transversales de cambios a lo largo del tiempo. Por lo tanto, las relaciones encontradas son causalmente más sólidas que las que podrían haberse encontrado en un estudio transversal.A pesar de las limitaciones antes mencionadas, este estudio permitió tener un panorama general de la asociación entre la estatura con la presión arterial en la población mexicana. La presión arterial se midió siguiendo las recomendaciones de las guías de detección de hipertensión arterialEn resumen, en la población mexicana, el efecto de la estatura sobre la presión arterial fue contrario a lo que se esperaba, ya que se relacionó de forma positiva. En el contexto de la transición epidemiológica, se ha propuesto que el predominio de la desnutrición crónica en las poblaciones latinoamericanas podría ser un factor que incremente la carga asociada a las enfermedades crónicas. Nuestro análisis muestra que esto podría no ser completamente cierto. En contraste con lo anterior, en los adultos mexicanos la presión arterial se relacionó en la dirección esperada con factores de riesgo tradicionales como la adiposidad. Por ello, para enfrentar la problemática de la hipertensión arterial y sus consecuencias en el país, es necesario continuar investigando otros factores ambientales, genéticos y dietéticos; así como atender los factores modificables ya conocidos. Convendría realizar estudios con un diseño similar, pero en diferentes etapas de la vida, que permitan evaluar el comportamiento de la presión arterial e identificar los momentos en que se presenta un mayor cambio.


A maioria das evidências disponíveis sugere que vários distúrbios do sono  não são somente meros espectadores, mas podem contribuir no aumento do risco cardiovascular.        Nesta edição dos Arquivos de Brasileiro de Cardiologia, Lopes et al.        Os desfechos cardiovasculares propostos avaliados oito anos depois  foram relatados pelos participantes ou seus familiares, e confirmados por revisão dos prontuários médicos nas respectivas unidades de saúde. Durante o seguimento, 40 mortes e 48 eventos cardiovasculares (incluindo eventos cerebrovasculares) ocorreram no período. Os autores observaram que os homens apresentaram um risco 88% maior de morte em comparação às mulheres. Além disso, depressão , gravidade da insônia , e latência do sono de 16-30 minutos  e de 31-60 minutos  foram independentemente associados com risco aumentado de morte em idosos da comunidade. Os eventos cardiovasculares e cerebrovasculares foram preditos somente por hipertensão e diabetes. Os autores argumentaram que a maior mortalidade em homens está associada ao fato de eles apresentarem uma maior taxa de doenças crônicas, tais como doenças cardiovasculares. De fato, dados da população brasileira mostram a diferença na prevalência de doenças cardiovasculares e mortalidade entre os sexos, com maior taxa nos homens.        ,,,Além disso, o presente estudo reforça o papel negativo de vários distúrbios do sono        As principais contribuições do estudo estão relacionadas ao delineamento prospectivo do estudo e a localidade da população estudada. O padrão de sono e o estado de depressão da população do nordeste brasileiro são pouco explorados. A elevada porcentagem de pobreza, baixo nível de educação, e vulnerabilidade social em comparação a outras regiões do país podem ter afetado os resultados do estudo, mas destacaram a necessidade de políticas de saúde direcionadas. Apesar dos pontos fortes do estudo, é importante discutirmos suas limitações. Primeiramente, esta é uma amostra relativamente pequena de pacientes para se avaliar desfechos duros, tais como morte e doença cardiovascular. Segundo, o delineamento observacional pode não capturar potenciais fatores residuais que possam contribuir para os desfechos propostos. Terceiro, as queixas relacionadas ao sono foram baseadas em relatos subjetivos. É razoável se esperar algum viés de memória e percepções errôneas sobre o sono em uma proporção significativa de pacientes. A disponibilidade de análises objetivas da duração do sono e da apneia obstrutiva do sono ajudaria a determinar o real impacto dos distúrbios do sono nos idosos.        Concluindo, o presente estudo reforça o potencial papel dos distúrbios do sono e da depressão na modulação da mortalidade em idosos. Esses resultados também destacam a necessidade de mais colaboração entre especialistas do sono e psiquiatras no manejo desses pacientes. Mais estudos abordando intervenções apropriadas a respeito desses fatores importantes contribuirão para avanços significativos nessa importante área de pesquisa.                 –,–,The relationships between sleep disturbances, depression and cardiovascular disease have gained growing interest in the last decades. Most evidence available suggests that several sleep disturbances  are not only innocent bystanders, but may contribute to increase the cardiovascular risk.            In this issue of the Arquivos de Brasileiro de Cardiologia, Lopes et al.            The proposed cardiovascular endpoints evaluated eight years later  were self-reported by the participants or their families, and confirmed by reviewing the medical records in the respective health centers. Deaths were adjudicated using death certificates. In the follow-up, 40 deaths and 48 cardiovascular events (including cerebrovascular events) occurred in the period. The authors found that men had an 88% increased risk of death as compared to women. In addition, depression , the severity of insomnia , and sleep latency of 16-30 minutes  and 31-60 minutes  were independently associated with increased risk of death in community-dwelling elderly. Non-fatal cardiovascular and cerebrovascular events were predicted by hypertension and diabetes only. The authors argued that the association of higher mortality in men is associated with the fact that they have a higher rate of chronic diseases, such as cardiovascular diseases. Consistently, data from the Brazilian population demonstrate the difference in the prevalence of cardiovascular disease and mortality between genders, with a higher rate in men.            ,,,Additionally, the current study reinforces the negative role of several sleep disturbances            The major contributions of the current investigation are related to the prospective study design and the location of the study population. The sleep patterns and depression status of the Northeast Brazilian population are poorly explored. The high percentage of poverty, low education and social vulnerability in comparison to other regions in Brazil may have affected the results, but underscored the need of dedicated health policies. Despite the strengths, it is important to discuss limitations of the current study. First, this is a relative small sample of patients to evaluate hard endpoints such as death and cardiovascular disease. Second, the observational design may not capture potential residual factors that might help to contribute to the proposed endpoints; third, the sleep complaints were based on subjective reports. It is reasonable to expect some recall bias and sleep misperceptions in a significant proportion of patients. Ideally, the availability of objective analysis of sleep duration and obstructive sleep apnea would be helpful in determining the real impact of sleep disturbances in the elderlies.            In conclusion, the current study reinforces the potential role of sleep disturbances and depression in modulating mortality in the elderly. These results also underscore the need for more collaboration among sleep specialists and psychiatrists for managing these patients. Future investigations addressing appropriate interventions on these important factors will be helpful for significant advances in this important research area.


Prevalente mesmo em países desenvolvidos e em desenvolvimento, essa doença tem sido relacionada a eventos cardiovasculares, dislipidemia, diabetes tipo 2, distúrbios do sono e câncer. Recentemente, foi considerada um fator de risco para gravidade na doença causada pelo novo coronavírus-2019 (COVID-19).3 Um esforço colaborativo entre o governo, funcionários de saúde pública e equipe médica é necessário para lidar com o problema complexo e multifatorial da obesidade.No Brasil, a Pesquisa Nacional de Saúde, em parceria com o Ministério da Saúde, constatou que a obesidade tem aumentado gradativamente nos últimos 17 anos em mulheres  e homens  adultos. Sua prevalência mais do que dobrou entre 2003 e 2019.4Na prática clínica diária, a obesidade é avaliada por meio da medida do peso corporal e da gordura excessiva. Além do índice de massa corporal (IMC), índices antropométricos independentes, incluindo a circunferência da cintura (CC), relação cintura-quadril (RCQ) e índice de adiposidade corporal (IAC), são meios acessíveis para avaliar a obesidade abdominal. Apesar da disponibilidade e segurança na obtenção desses parâmetros, os índices adequados para prever o desenvolvimento de doenças cardiovasculares (DCV) em diferentes idades, sexos e etnias permanecem desconhecidos.5 A CC foi considerada a ferramenta alternativa de triagem mais adequada para identificar mulheres quilombolas com risco mais significativo de DCV.6 Outro estudo relatou que o IMC, a CC e a RCQ foram preditores viáveis de DCV em homens, enquanto o IMC foi o preditor mais confiável para mulheres.7 Hachbardt et al.8 recentemente demonstraram que o IMC estava associado à CC, relacionado ao risco de DCV, mas não à RCQ.8 Ao resolver os resultados conflitantes desses estudos, o indicador antropométrico padrão-ouro de adiposidade para predizer DCV pode ser estabelecido. Esses estudos foram realizados em diferentes períodos de tempo e seus tamanhos de amostra não eram representativos de toda a população do país.Vários estudos brasileiros obtiveram resultados conflitantes ao avaliar as medidas antropométricas e o risco de desenvolvimento de DCV em adultos. Barroso et al. descobriram que a obesidade central, mas não o IMC, foi um preditor de DCV em mulheres adultas.9 O parâmetro da circunferência do pescoço e o IAC foram propostos como preditores de um risco de 10 anos para o desenvolvimento de doença coronariana.11O Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) relatou a associação entre indicadores antropométricos de obesidade e DCV em uma grande amostra de mulheres e homens.12 foram o primeiro grupo a investigar a capacidade preditiva de parâmetros antropométricos individuais ou combinados para risco coronariano em 15.092 brasileiros.12 Além da análise individual dos parâmetros de obesidade, os autores criaram quatro combinações  para testar suas hipóteses. O segundo ponto positivo do estudo foi associar um parâmetro de obesidade geral a um indicador de obesidade central. Para caracterizar um risco aumentado para eventos cardiovasculares, os indivíduos foram classificados nos seguintes grupos: VHR20% - para aqueles com 20% ou mais de risco de doença arterial coronariana em 10 anos; e HR10%, para indivíduos com 10-20% de risco de doença arterial coronariana em 10 anos.Nesta edição dos Arquivos Brasileiros de Cardiologia, a equipe do ELSA-Brasil propôs um novo método de previsão de DCV baseado na combinação dos parâmetros antropométricos. O primeiro mérito do estudo foi que Almeida et al.12 Em resumo, as combinações de pelo menos um parâmetro de obesidade geral e um parâmetro de obesidade central foram os principais preditores de desenvolvimento de risco coronariano em 10 anos.Abaixo estão as principais conclusões do estudo: Para parâmetros individuais, a RCQ foi o parâmetro mais confiável para VHR20% em ambos os sexos. Ao analisar as combinações, RCQ mais IAC foi o preditor mais confiável para homens, enquanto RCQ mais IMC foi o preditor mais confiável para mulheres com VHR 20%. Além disso, indivíduos com HR10% tiveram um risco maior de doença coronariana em 10 anos quando um IAC ou IMC aumentado foi combinado com uma CC ou RCQ mais elevada.12 Assim, análises futuras devem incluir um tamanho de amostra representativo para melhor compreender esta doença e seu manejo. Além disso, a pesquisa de Almeida et al.12 pode abrir caminhos para novos estudos que identifiquem os marcadores ideais em outros grupos, como a população jovem brasileira, comparando a associação de parâmetros antropométricos combinados no desenvolvimento do risco de DCV.Esses dados destacaram a importância de incluir medidas agrupadas para analisar perfis de DCV. As informações obtidas neste estudo são essenciais para a revisão e atualização das diretrizes clínicas e das políticas públicas de saúde. A população brasileira é heterogênea em termos de condições sociais, econômicas e de saúde.É hora de agir para proteger nossos corações. stcentury. Prevalent even among developed and developing countries, this disease has been related to cardiovascular events, dyslipidemia, type 2 diabetes, sleep disorders, and cancer. It has recently been considered a risk factor for critical illness in coronavirus disease-2019 (COVID-19) pandemic.2The obesity pandemic is one of the most pressing health concerns of the 213 A collaborative effort between the government, public health officers, and medical staff is needed to manage the complex and multifactorial obesity issue.In Brazil, the National Health Survey , in partnership with the Ministry of Health, found that obesity has gradually increased over the last 17 years in adult women (14.5% to 30.2%) and men (9.6% to 22.8%). Its prevalence has more than doubled between 2003 and 2019.4In everyday clinical practice, obesity is assessed using body weight and excessive fat measurement. In addition to the body mass index (BMI), independent anthropometric indices, including the waist circumference (WC), waist-to-hip ratio (WHR), and body adiposity index (BAI), are accessible means for evaluating abdominal obesity. Despite the availability and safety when obtaining these parameters, the appropriate indices for predicting the development of cardiovascular disease (CVD) across different ages, genders, and ethnicity, remain unknown.5 WC was considered the most appropriate alternative screening tool to identify Quilombola women with the most significant risk for CVD.6 Another study reported that the BMI, WC, and WHR were viable predictors of CVD in men, while BMI was the most reliable predictor for women.7 Hachbardt et al.8 recently showed that BMI was associated with WC, related to CVD risk, but not WHR.8 By resolving the conflicting results of these studies, the gold standard anthropometric indicator of adiposity for predicting CVD can be established. These studies were conducted in different time periods, and their sample sizes were not representative of the country’s entire population.Several Brazilian studies have obtained conflicting results when evaluating the anthropometric measures and risk of CVD development in adults. Barroso et al. found that central obesity, but not BMI, was a predictor of CVD in adult women.9 The neck circumference parameter and BAI index have been proposed as predictors of a 10-year risk for developing coronary disease.11The Brazilian Longitudinal Study of Adult Health (ELSA-Brazil) has reported the association between anthropometric indicators of obesity and CVD in a large sample of women and men.Arquivos Brasileiros de Cardiologia , the ELSA-Brazil team has proposed a novel CVD prediction method based on the combination of the anthropometric parameters. The first merit of the study was that Almeida et al.12 were the first group to investigate the predictive ability of individual or combined anthropometric parameters for coronary risk in 15,092 Brazilian individuals.12 In addition to the individual analysis of obesity parameters, the authors created four combinations  to test their hypotheses. The second positive point of the study was to associate one overall obesity parameter with one central obesity indicator. To characterize an increased risk for cardiovascular events, individuals were classified in the following groups: VHR20% - for those with 20% or more of a 10-year coronary artery disease risk; and HR10%, for subjects with 10-20% of a 10-year coronary artery disease risk.In this issue of the 12 In summary, the combinations of at least one overall obesity parameter and one central obesity parameter were the main predictors of coronary risk development in 10 years.Below are the main findings of the study: For individual parameters, WHR was the most reliable parameter for VHR20% in both sexes. When analyzing combinations, WHR plus BAI was the most reliable predictor for men, while WHR plus BMI was the most reliable predictor for women with VHR20%. In addition, individuals with HR10% had a higher 10-year coronary disease risk when an increased BAI or BMI was combined with a higher WC or WHR.12 . Thus, future analyses should include a representative sample size to better understand this disease and its management. Also, the research of Almeida et al.12 can open up ways for new studies that will identify the ideal markers in other groups, as the Brazilian youth population, comparing the association of combined anthropometric parameters on CVD risk development.These data highlighted the importance of including grouped measures for analyzing CVD profiles. The information obtained in this study is essential for reviewing and updating the clinical guidelines and public health policies. The Brazilian population is heterogenous in terms of social, economic, and health conditions.It is time to act to protect our hearts.


A intervenção teve duração de 10 semanas (2 vezes por semana) para todos os grupos. O grupo WA foi composto por 23 mulheres (10 em uso de estatina e 13 sem uso de estatina); o grupo WR foi composto por 23 mulheres (9 em uso de estatina e 14 sem uso de estatina); e o GC foi composto por 23 mulheres (9 sem uso de estatina e 14 sem uso de estatina). Destacamos aqui o primeiro ponto positivo do estudo: randomização bem executada com n amostral igual em todos os grupos e distribuição correta de uso de estatina.LA). Já o grupo WR realizou os exercícios adotando velocidade máxima de execução, e também manteve um tempo fixo de 1 minuto e 20 segundos para cada exercício, enquanto o GC realizou um programa não periodizado de exercícios de relaxamento em imersão, com a finalidade de manter a mesma quantidade de sessões semanais dos outros grupos. O segundo mérito do trabalho foi controlar a intensidade de exercício pela FCLA, além de periodizar o treinamento físico, planejando o incremento da intensidade durante o seguimento.Em relação ao programa de treinamento físico aquático, as participantes dos grupos WA e WR realizaram 2 sessões de familiarização antes do início do seguimento. Além disso, a intensidade de exercício foi aumentada após 5 semanas de intervenção. As sessões de exercício tiveram duração de 45 minutos, sendo 8 minutos de aquecimento, 30 minutos de parte principal e 7 minutos de desaquecimento. Para o grupo WA, adotou-se o treinamento intervalado com intensidade entre 90% e 100% da frequência cardíaca correspondente ao limiar anaeróbio  (66.13±5.13 years) were analyzed.There is evidence on the importance of regular physical training as a form of primary or secondary prevention in the development or worsening of cardiometabolic diseases.Below are the main methodological points of the article: it is a randomized clinical trial with 3 groups . The intervention lasted 10 weeks (2 times a week) for all groups. The WA group included 23 women (10 using statin and 13 not using statin); the WR group consisted of 23 women (9 using statin and 14 not using statin); and the CG consisted of 23 women (9 not using statin and 14 not using statin). This is the first positive point of the study: well-executed randomization with equal sample n in all groups and correct distribution of statin use.AT). The WR group performed the exercises adopting a maximum execution speed, and maintained a fixed duration of 1 minute and 20 seconds for each exercise, while the CG performed a non-periodized program of immersion relaxation exercises in order to maintain the HART same number of weekly sessions as the other groups. The second merit of the study was to control exercise intensity by HRAT, in addition to periodizing physical training, planning an increased intensity during follow-up.Regarding the water training program, participants of the WA and WR groups attended 2 induction sessions before the beginning of follow-up. Besides, exercise intensity was increased after 5 weeks of intervention. The exercise sessions lasted 45 minutes, including 8 minutes of warm-up, 30 minutes of exercise and 7 minutes of cool-down. For the WA group, interval training was adopted with an intensity of 90% to 100% of the heart rate corresponding to the anaerobic threshold (HR−1; TC: −3.41 to 25.89 mg.dl−1; TC/HDL: −0.37 to 0.61 mg.dl−1, with significant p compared to non-medicated participants. This reduction is only statistically significant for the WR group. In general, the use of statins associated with strength water training seems to be the most effective strategy in reducing the lipid parameters evaluated in the study.Below are the main findings of the study: in summary, statin use associated with exercise training improves LDL, TC and TC/HDL. How much? Participants medicated for LDL: −5.58 to 25.18 mg.dlWe are aware of the importance of aerobic physical training, especially for its protection against multiple cardiovascular risk factors. However, there is evidence suggesting that strength training is the most effective tool to improve the lipid profile, especially increasing HDL, and consequently reducing TC/HDL.


To determine the prevalence and types of violence suffered by women and to identify the gender attitudes related to the situation.This was a descritive, cross-sectional study incluiding 343 women who were assisted at the Brazilian Public Health System in countryside city in northeastern of Brazil. All participants were volunteers and they invited to participate during consultation at a Basic Health Unit. As participants, they filled out the World Health Organization Violence Against Women Questionnaire and responded to a sociodemographic questionnaire.The victims were, on average, 20.3 years old, and 53.2% of them were married. There was a prevalence of 52.9% of psychological violence, 30.5% of physical violence, and 12.3% of sexual violence. Participants reported alcoholism (67%) and jealousy (60.8%) as triggers to violence. The main psychological abuses were insults and humiliation. In terms of physical violence, the major ones were pushes and slaps. The sexual violence most reportedwere sexual intercourse against the will of the woman and sexual intercourse because of fear of the partner. A portion of the participants justified violence due to women’s infidelity, refusal to have sex, and disobedience to her husband.Education in gender equality as a measure of opposition to the culture of female subjugation can reflect on the resignification of the violence suffered by them, and not on blaming the victim of violence by an intimate partner. Among the forms of violence, the intimate partner violence (IPV) is one of them that has an impact on human rights, which is commonly committed by men against their partners.,3The World Health Organization (WHO) considers violence against women a public health problem, with consequences for families and economy.The United Nations (UN) defines violence against women as any act of gender-based violence that results in physical, sexual, or psychological harm or suffering in any form, including threats, coercion, arbitrariness, and deprivation of liberty. It is estimated that one of every three women (30%) worldwide have suffered some form of violence.Intimate partner violence tends to lead women victims into isolation, decrease their productivity and family income, as well as cause damage to their mental and reproductive health, enhance their well-being, and dignity. This generates losses for society and may have a negative impact on the education of new generations. In the absence of data that allow an intervention on the IPV situation, women often manage alone the trauma of violence, and avoid to expose their relationship, an behavior that perpetuates the anonymity about such cases.In developing countries, data on violence suffered by women are scarce, either due to underreporting or to the violent behavior of the partner be not understood as such by the victim, or by the society. For this reason, studies are warranted to identify and report violence. in an attempt to improve the production of data on violence to establish more easily different public policies to prevent and eradicate such violence in the world. Among these policies there are the Convention of Belém do Pará, promoted by the Inter-American Commission on Human Rights, which indicates possible actions to punish and eradicate violence against women. In addition, the law #11.340 issued by the Brazilian government, namely Maria da Penha’s law that intensifies the rigor of punishments against violence suffered by women, and provide more support to Brazilian institutions to guarantee health and prevent violence.The United Nations General Assembly issued a document that characterizes violence against women,Sistema Único de Saúde) has an important role to receive and treat women victims of IPV. Primary Health Care (PHC), the front door of the Brazilian Public Health System, provides the first care for violence victims, in addition, PHC is responsible to provide the necessary treatments for them to recover from the violence suffered.Among these Brazilian institutions is the Brazilian Public Health System  protocol was used.Centro Universitário FMABC at a Basic Health Unit located in the city of Cajazeiras (PB), Northeast Region of Brazil. At the time of this study, the Human Development Index (HDI) of the region was 0.679. Data collection occurred between January 12 and December 20, 2018 in a specific office designated by the Basic Health Unit to ensure confidentiality of participants.The study was developed by the The sample size was calculated using the G*Power 3.1.9.4 program, considering the statistical tests used, and sample power of 90%, with p≤0.05. The minimum sample size indicated was 320 participants. However, a total of 350 women were invited, as an attempt to preview possible non-adherence to the study. Of women invited to the study, seven refused to participate because they were unavailable to talk about the topic.The inclusion criteria were to be a woman aged 18 or older and be alone at time of the interview. Women who were unable to participate and to respond autonomously to the survey were excluded. All participants were volunteers and they were invited to join the study at the Basic Health Unit where they were seeking medical care.,13 This is a specific questionnaire for violence indicated by the WHO that allows control over data collection, which include 12 independent sections that address various topics related to IPV. The instrument used includes a Likert type scale with two or three degrees . Sections of the questionnaire used were concerned women’s attitudes toward gender roles, the daily life of the interviewee and her intimate partner, characterization of the injuries suffered, and the impact and coping strategies used by women to face the situation of violence.We used the Brazilian validate version of the World Health Organization Violence Against Women (WHO-VAW) to access the variables that were object of the study (intimate partner violence and gender attitudes).For general characterization of participants, a sociodemographic questionnaire was used. This questionnaire included questions on marital status , age (in years), whether they experienced episodes of violence (yes or no), number of violence episodes , whether they lived with the aggressor (yes or no), and what type of violence they had suffered .Centro Universitário FMABC . An informed verbal consent form was signed that guaranteed the confidentiality of all information collected. At no time during the study, participants were identified, and an ID number was assigned to each participant. The signature of the consent form was waived to guarantee the anonymity of participants.The study was approved by the Research Ethics Committee of the A single researcher contacted the participants, she was trained not to express verbal and physical reactions to the participants’ answers, and to follow the standardized questions in the instruments to the interview. These measures were adopted to reduce biases during data collection. Answers were recorded in a research notebook using codes and without identifying respondents.2 test was used by following the numerical premise of the test. A 5% significance value was adopted in all statistical tests.Subsequently, all responses were transcribed into the (SPSS) program by two independent researchers. Possible transcription errors were verified and corrected. The missing values in data were checked and maintained because we considered that some participants decided not to answer some questions due to personal reasons. The valid percentage was adopted to the analyses in cases of categorical variables. Mean and standard deviations were used for continuous variables. For comparisons between categorical variables, the χThe sample was composed of 343 women with mean age of 20.3 (±8.82) years. Of participants, 77.5% reported living with their aggressor. Of participants, 39.6% of the reported to had suffered three or more episodes of psychological violence in last year, 42.0% reported physical violence at the same period, and 31.8% sexual violence within the last year .We observed that 52.9% of the participants suffered psychological violence, 30.5% physical violence, and 12.3% sexual violence . In terms of type of insult, 42.2% reported having suffered verbal insults and 25.9% to be pushed, in addition to 9.3% who reported to be forced into degrading sexual practices .Alcohol abuse (67%) and jealousy (60.8%) were indicated as possible triggers of violence. Although 36.5% of the participants reported that there were not clearly reason for an acting of violence, some of them considered that there were some possible justifications for a woman to be beat by her husband. Of participants, 19.4% believe that the justification was infidelity; for 8.5% suspicion of infidelity; for 3.2% disobedience to her husband; for 2.9% refusal to have sexual intercourse; for 2.3%, unsatisfactory housework, and for 2.0% if she asks if her husband had another woman.The highest frequency of violence episodes occurred proportionally among divorced and married women. Women who did not live with their aggressor showed higher frequency of psychological violence than those who leave with them (p=0.01), however, these women also reported lower frequency of physical (p<0.001) and sexual (p=0.01) violence. Women whose partners were literate had lower proportions in the frequency of psychological (p=0.042) and physical (p=0.031) violence than those whose partners were illiterate. Higher education of the partner was proportionally related to lower frequency of psychological (p=0.021), physical (p=0.004) and sexual (p=0.040) violence. When women were literate, lower frequencies of episodes of physical (p=0.003) and sexual (p=0.023) violence were found. Higher education of the woman was related to lower frequency of episodes of psychological violence (p=0.005) . Based on results of this study we observed that level of formal the education of woman and her partner were protective factors to prevent the occurrence of violence, especially when both partners had a higher level of formal education.-19Intimate partner violence is the behavior that causes physical, sexual or psychological harm to a woman, which is caused by current or former intimate partners.,20The findings showed a higher frequency of psychological violence in separated and divorced women, indicating that stability in a relationship could favor a lower occurrence of this type of event. and given the research site that were a Basic Health Unit that is part of Brazilian Public Health System.All participants in this study indicated that they had suffered some type of IPV. A possible explanation for this occurrence could be a conversion of factors such as the sum of different participants who had experienced different types of violence, cultural issues of submission of the feminine to the masculine,,20,21 Although psychological violence does not leave physical marks, it has equal negative and harmful effects to women’s health.,22The highest prevalent type of violence was psychological, which confirmed the initial hypothesis of this study. This type of violence was followed by physical and sexual, which are similar results of those reported in the literature.,9,23Among the types of psychological violence, insult and intimidation are understood as the forms of violence that cause the most emotional damage and lower self-esteem, since they intend to control actions, behaviors, beliefs and decision-making. which tends to justify the finding on the recurrence of the episode of violence.The frequency of occurrence of physical violence (30%) in this study remained consistent with the rates reported by other countries, such as Japan (13%) and Peru (61%). The violent behavior of partners could be associated with the feeling of domination and control over the partner, and Mexico, but it is lower than in a study with Thai women. Sexual violence rarely occurs isolated, there is also risk factor for several health problems among women, with lasting repercussions in their lives.The identified sexual violence (12.3%) in our study is higher than in studies conducted in Nepal,6 have indicated the occurrence of sexual intercourse to try to maintain their own integrity. This situation could be explained by the discrepancy in the understanding of what is sexual violence to women and to men, since there is still the social idea that women should perform the sexual act only by the obligation of satisfying men’s desire.Among the most frequent types of sexual violence, forced sexual intercourse was identified. Other studies,24 have emphasized that alcohol should not be used by power authorities as an explanation for violent behavior, but as an aggravating factor of it. Furthermore, some studies,3,16 indicated that the habit of alcohol abuse can increase the risk of sexual violence up to four times, physical violence by ten times, and psychological violence by five times.When participants were asked on what they considered predisposing factors to the act of IPV, most of them indicated the abuse of alcohol by the partner. Other studies some of the participants considered possible explanations to justify the violence suffered, such as female infidelity and disobedience. Similar findings were found in a study by the WHO study carried out in urban areas of Brazil, Japan, Namibia, Serbia and Montenegro. The same pattern was also observed in Bangladesh, Ethiopia, Peru, Samoa, Egypt and Thailand.Concerning gender attitudes, it was possible to identify that, although there was no plausible reason that justifies an act of violence, For this reason, the hope of ending of the situation of violence gives way to conformism.,28The consideration of a possible justification to the violence suffered denotes attitudes of submission and conformism of the woman in relation to her partner, which confirmed the second hypothesis of this study, since continuous submission over the years, decreases self-esteem and the ability to think and react.Conformism tends to trivialize violence, which can be seen as something natural. This causes some women to assume passive postures, as if this were the most appropriate response to a possible change in the behavior of the partner.Attitudes of submission and subservience, such as those described here, may be associated with a rigid and traditional education based on subordination to the male gender. The declaration 6 of the Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women seeks to deconstruct, by stating that every woman has the right not to be discriminated against and to be valuable and educated, to ensure equality between genders.The present study has limitations, such as having been carried out at a single place and include a convenient sample. These facts may generate results with limitations in their generalizability. Furthermore, the division of the population into smaller groups, such as by type of violence, gender attitude, or family income resulted of small sub-samples that prevented to further explore the data using statistical analyses.Despite limitations, this study was able to present the experience of different types of violence reported by participants. In addition, we could identify occurrences and characteristics that allow better management of the studied population as an attempt to reduce the IPV suffered by them.Finally, our findings indicated the need to promote education for gender equality and higher self-esteem among women. These may help to inhibit the practice of IPV and help to establish interventions to control violence against everyone involved, not only to victims.This study described the physical, psychological and sexual violence committed by the intimate partner against women who received care assistance at the Brazilian Public Health System in a countryside city in northeastern of Brazil. The highest prevalence of violence was psychological, followed by physical and sexual violence. Level of formation education of women and their partners proved to be a protective factor against violence. Alcohol abuse was recognized as a predisposing factor for violent acts committed by the partner. The gender-related issue that raised attention was the identification of women who considered that there were explanations that justified the violence they have suffered, an issue that reflect gender culture experienced by the participants.  Dentre as formas de violência está a violência entre parceiros íntimos (VPI), com impacto sobre os direitos humanos, a qual é comumente praticada pelo homem contra sua parceira.,3A Organização Mundial da Saúde (OMS) considera a violência contra a mulher como um problema de saúde pública, com repercussão familiar e econômica.A Organização das Nações Unidas (ONU) define a violência contra a mulher como a prática de qualquer ato de violência de gênero que resulte em danos físicos, sexuais, psicológicos, ou em qualquer forma de sofrimento, incluindo ameaças, coerção, arbitrariedade e privação da liberdade. Estima-se que uma em cada três mulheres (30%) no mundo sofra alguma forma de violência.A VPI tende a levar as mulheres vítimas ao isolamento, diminuindo sua produtividade e seus vencimentos, bem como provocando danos à saúde mental e reprodutiva e agravo do bem-estar e da dignidade. Isso gera prejuízos para a sociedade, com repercussões negativas para a educação de novas gerações. Na ausência de dados que permitam uma intervenção sobre a situação de VPI, a mulher tende a gerenciar os traumas da violência sozinha, evitando expor sua relação e perpetuando o anonimato sobre tais casos.Nos países em desenvolvimento, os dados da violência sofrida pelas mulheres são escassos, ou por subnotificação, ou porque o comportamento violento do parceiro não é compreendido como tal pela vítima e nem pela sociedade. Justificam-se, assim, estudos contínuos para a identificação e o relato de violência. para mais facilmente estabelecer diferentes políticas públicas que visem erradicar e prevenir tal violência no mundo. Dentre tais políticas, estão a Convenção de Belém do Pará, promovida pela Comissão Interamericana de Direitos Humanos, a qual indica ações possíveis para punir e erradicar a violência contra a mulher, e a lei 11.340, promulgada pelo governo brasileiro e conhecida como Lei Maria da Penha, que intensifica o rigor nas punições contra agressões sofridas pelas mulheres, dando maior corpo às instituições brasileiras, para garantir a saúde e a preservação da vítima de violência.No intuito de melhorar a produção de dados sobre a violência, a Assembleia Geral da ONU promulgou um documento que caracteriza a violência contra a mulher,Dentre essas instituições brasileiras, está o Sistema Único de Saúde (SUS), que é importante no acolhimento e no tratamento das mulheres vítimas de VPI. A Atenção Primária, uma das frentes do SUS, faz o primeiro atendimento dessas vítimas, além de ser a responsável pelos tratamentos necessários para que elas se recuperem da violência sofrida.Verificar a prevalência dos tipos de violência sofridos por mulheres e identificar as atitudes de gênero em relação a eles.Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).Estudo descritivo, observacional sobre violência cometida pelo parceiro íntimo e atitudes de gênero. Utilizou-se o protocolo de divulgação científica  A coleta de dados ocorreu entre 12 de janeiro e 20 de dezembro de 2018 em um consultório específico designado pela Unidade Básica de Saúde, para garantir o sigilo e a discrição às participantes do estudo.O estudo foi desenvolvido pelo Centro Universitário FMABC em uma Unidade Básica de Saúde localizada na cidade de Cajazeiras (PB), Região Nordeste do Brasil. O Índice de Desenvolvimento Humano (IDH) da região era de 0,679.O tamanho amostral foi calculado por meio do programa G*Power 3.1.9.4, considerando os testes estatísticos utilizados e poder amostral de 90%, com p≤0,05. A amostra mínima indicada foi de 320 participantes. Optou-se por convidar 350 mulheres, considerando possíveis perdas amostrais. Das mulheres convidadas a participar, sete recusaram-se, indicando não possuir disponibilidade para falar sobre o assunto.Os critérios de inclusão das participantes foram ser mulher, com idade igual ou superior a 18 anos e o parceiro estar ausente no momento do convite/participação. Foram excluídas mulheres com incapacidade de participar e responder de forma autônoma à pesquisa.Todas as participantes foram voluntárias e estavam presentes na Unidade Básica de Saúde, para realizar algum atendimento médico, tendo sido convidadas a participar do estudo.World Health Organization Violence Against Women (WHO-VAW) validado para o Brasil,,13 que é um questionário específico para violência indicado pela OMS e permite um controle sobre a coleta de dados, diferenciando-os em 12 seções independentes que abordam diversos temas relacionados à VPI. As respostas são do tipo Likert, com dois ou três graus . Foram utilizadas as seções do questionário que diziam respeito às atitudes das mulheres com relação aos papéis de gênero; ao cotidiano da entrevistada e de seu parceiro íntimo; à caracterização das lesões sofridas e ao impacto e enfrentamento pela mulher da situação de violência.Para o acesso às variáveis que foram objeto de estudo (violência pelo parceiro íntimo e atitudes de gênero), foi utilizado o Para caracterização geral das participantes, utilizou-se um questionário sociodemográfico, com questões sobre estado civil , idade (medida em anos), se vivenciou episódios de violência (sim ou não), quantos episódios de violência , se convivia com o agressor (sim ou não) e qual tipo da violência sofrida .O estudo foi aprovado pelo Comitê de Ética em Pesquisa (CEP) do Centro Universitário FMABC . Contou-se com termo de consentimento verbal, no qual ficou assegurado sigilo sobre todas as informações coletadas. Em nenhum momento da pesquisa, as participantes foram identificadas, tendo sido atribuído um número de participação a cada uma. A assinatura do Termo de Consentimento foi dispensada pelo CEP, visando maior garantia de anonimato das participantes.Uma única pesquisadora realizou o contato com as participantes, sendo treinada para não expressar reações verbais e físicas pelas respostas das participantes, além de se restringir às questões padronizadas pelos instrumentos utilizados. Tais medidas visaram à redução de vieses de coleta. As respostas eram anotadas em uma caderneta de pesquisa de maneira codificadas e sem identificação da respondente.2 , sendo respeitada a premissa numérica do teste. Adotou-se o valor de significância de 5% em todos os testes estatísticos.Em seguida, todas as respostas foram transcritas para o programa (SPSS) por dois pesquisadores independentes. Verificaram-se possíveis erros de transcrição, os quais foram corrigidos. Os valores ausentes nos dados foram checados e mantidos, por se compreender que algumas participantes optaram por não responder a alguma determinada questão, por motivo pessoal. Para as análises nos casos de variáveis categóricas, optou-se pelo percentual válido. Para as variáveis contínuas, usaram-se a média e o desvio-padrão. Para a comparação entre variáveis categóricas, utilizou-se o teste χA amostra foi composta de 343 mulheres, com média de idade de 20,3  anos. Indicaram conviver com o agressor 77,5% das participantes. Sobre a quantidade de episódios de violência sofridos no último ano, 39,6% das participantes relataram terem passados por três ou mais episódios de violência psicológica, 42,0% de violência física e 31,8% de violência sexual .A Verificou-se que 52,9% das participantes sofreram violência psicológica, 30,5% física e 12,3% sexual . Com relação ao tipo de insulto, 42,2% referiram ter sofrido insultos verbais e 25,9% empurrão, além de 9,3% terem sido forçadas à prática sexual degradante .Foram indicados como possíveis desencadeadores da violência o abuso de álcool (67%) e o ciúme . Ainda que 36,5% das participantes tenham descrito não existir motivo plausível para um ato de violência, algumas consideraram haver possíveis justificativas para que uma mulher apanhasse do esposo. Para 19,4% a justificativa era a infidelidade; para 8,5%, a suspeita de infidelidade; para 3,2%, a desobediência do esposo; para 2,9%, a recusa em manter relação sexual; para 2,3%, o trabalho doméstico insatisfatório, e, para 2,0%, se ela “perguntar se marido possui outra mulher”.A maior frequência de episódios de violência ocorreu proporcionalmente com mulheres divorciadas e casadas. As mulheres que não conviviam com o agressor apresentaram maior frequência de violência psicológica do que as que conviviam , mas elas também relataram menor frequência das violências física  e sexual . As mulheres cujos parceiros sabiam ler e escrever apresentaram menores proporções na frequência das violências psicológica  e física  do que aquelas cujos parceiros não sabiam ler e escrever. Maior escolaridade do parceiro esteve proporcionalmente relacionada à menor frequência de violências psicológica , física  e sexual . Quando as mulheres sabiam ler e escrever, foram verificadas menores frequências de episódios de violência física  e sexual . Maior escolaridade da mulher se relacionou a menor frequência de episódios de violência psicológica  . Considerando tal premissa, os resultados do presente estudo indicaram que a escolaridade da mulher e a do parceiro foram fatores protetivos para evitar a ocorrência dos diferentes tipos de violência, principalmente quando o nível de escolaridade de ambos os parceiros é maior.-19A VPI é o comportamento que provoca dano físico, sexual ou psicológico a uma mulher, exercida por parceiros íntimos atuais ou anteriores.,20Os achados demonstraram maior frequência de violência psicológica em mulheres separadas e divorciadas, indicando que a estabilidade em um relacionamento poderia favorecer a menor ocorrência desse tipo de evento. e o local de pesquisa ser uma Unidade Básica de Saúde do SUS.A totalidade das participantes deste estudo indicou ter sofrido algum tipo de VPI. Uma explicação possível para tal ocorrência poderia ser uma conversão de fatores, como a soma de diferentes participantes que tiveram distintos tipos de violência vivenciada, questões culturais de submissão do feminino ao masculino,20,21 Ainda que a violência psicológica não deixe marcas físicas, ela é igualmente negativa e prejudicial para a saúde da mulher.,22A forma de violência com maior prevalência foi a psicológica, o que confirma a hipótese inicial do estudo, seguida da física e da sexual, resultados similares aos da literatura.,9,23Dentre os tipos de violência psicológica, o insulto e a intimidação são compreendidos como as formas de violência que mais causam prejuízo emocional e diminuição da autoestima, pois intencionam controlar as ações, os comportamentos, as crenças e as tomadas de decisões. o que tende a justificar o achado sobre a recorrência no episódio de violência.A frequência da ocorrência da violência física (30%), nesta pesquisa, permaneceu conforme os índices de outros países, que variam de 13%, no Japão, a 61%, no Peru. O comportamento violento dos parceiros poderia ser associado ao sentimento de dominação e de controle sobre a companheira, e no México, mas menor do que um estudo com mulheres tailandesas. A violência sexual raramente ocorre de forma isolada, sendo fator de risco para vários agravos à saúde da mulher, com repercussões duradouras em sua vida.A violência sexual identificada é maior do que em estudos realizados no Nepal,6 indicaram a ocorrência de relação sexual para tentar manter a própria integridade. Tal situação, poderia ser explicada pela discrepância na compreensão do que é violência sexual para a mulher e para o homem, pois ainda existe a ideia social de que a mulher deve realizar o ato sexual somente pela obrigação de satisfazer o desejo masculino.Dentre os tipos de violência sexual mais frequentes, foi identificada a relação sexual forçada. Outros estudos,24 que ressaltam que o álcool não deve ser usado pelas autoridades de poder como explicação para condutas violentas, mas como agravador delas. Ainda, alguns estudos,3,16 indicam que o hábito do abuso de álcool pode aumentar o risco em até quatro vezes da ocorrência de violência sexual, dez vezes para violência física e cinco vezes para a violência psicológica.Ao serem indagadas sobre o que as participantes consideravam fatores predisponentes ao ato de VPI, a maioria indicou o uso de álcool pelo parceiro, conforme outros estudos parcela das participantes considera possíveis explicações para a violência sofrida, como a infidelidade e a desobediência femininas. Algo semelhante foi encontrado no estudo da OMS realizado em áreas urbanas do Brasil, Japão, Namíbia e Sérvia e Montenegro, e também pode ser observado em Bangladesh, Etiópia, Peru, Samoa, Egito e Tailândia.Com relação às atitudes de gênero, foi possível identificar que, apesar de não haver motivo plausível que justifique um ato de violência, Assim, a esperança de término da situação de violência cede espaço ao conformismo.,28A consideração de uma possível justificativa para a violência sofrida denota atitudes de submissão e conformismo da mulher em relação ao parceiro, confirmando a segunda hipótese do estudo, visto que a submissão contínua, ao longo dos anos, diminui a autoestima e a capacidade de pensar e a de reagir.O conformismo tende a banalizar a violência, que passa a ser vista como algo natural. Isso faz com que algumas mulheres assumam posturas passivas, como se essa fosse a resposta mais adequada para uma possível mudança comportamental do parceiro.As atitudes de submissão e subserviência, como as aqui descritas, podem estar associadas a uma criação rígida, baseada na subordinação ao sexo masculino, o que a Convenção Interamericana para Prevenir, Punir e Erradicar a Violência Contra a Mulher, em seu Art. 6º, busca desconstruir, ao afirmar que toda mulher tem o direito de não ser discriminada e de ser valorizada e educada, de forma a garantir igualdade entre gêneros.O presente estudo tem limitações, como ter sido realizado em um único local e com amostra que se forma por conveniência. Esse fato pode gerar resultados com limitações em sua capacidade de generalização. Ainda, a divisão da população em grupos menores, como por tipo de violência, atitude de gênero ou renda familiar, originou pequenas subamostras, que impossibilitaram uma maior exploração dos dados pela análise estatística.Apesar das limitações, este trabalho foi capaz de apresentar a vivência de diferentes tipos de violência por suas participantes, identificando ocorrências e características que permitem um melhor manejo da população estudada, a fim de reduzir a VPI sofrida por elas.Finalmente, os achados indicam a necessidade de promover uma educação que vise à igualdade de gênero e à maior autoestima nas mulheres, inibindo a prática da VPI. Intervenções de controle da violência devem ser voltadas a todos os envolvidos, e não somente às vítimas.Esta pesquisa descreveu a violência física, psicológica e sexual cometida pelo parceiro íntimo contra mulheres atendidas no Sistema Único de Saúde em uma cidade do interior do nordeste brasileiro. A maior prevalência de violência encontrada foi a do tipo psicológica, seguida da física e da sexual. A escolaridade das mulheres e dos parceiros mostrou-se como fator protetivo para as diferentes formas de violência. O abuso de álcool foi reconhecido como fator predisponente de atos violentos praticados pelo parceiro. Com relação à atitude de gênero, o aspecto que mais chamou atenção foi a identificação de mulheres que consideram haver explicações que justificariam a violência sofrida, refletindo a cultura de gênero vivida pelas participantes.


There is an error in the affiliations for authors Miraine Dávila Felipe and Olivier Gascuel. Neither author should have a current address listed and both authors have two affiliations.Both authors are affiliated to #1: Unité Bioinformatique Evolutive, Département de Biologie Computationelle, Institut Pasteur, Paris, France.The correct second affiliation for Miraine Dávila Felipe is: Université de technologie de Compiègne, LMAC (Laboratory of Applied Mathematics of Compiègne), Compiègne, France.The correct second affiliation for Olivier Gascuel is: Institut de Systématique, Evolution, Biodiversité , Paris, France.