[Mortality and disability-adjusted life years in motorcyclists in Latin America and the Caribbean during the first decade of action for road safetyMortalidad y años de vida ajustados por discapacidad de los motociclistas en América Latina y el Caribe en la primera década de seguridad vial]. / Mortalidade e anos de vida ajustados por incapacidade de motociclistas na América Latina e Caribe na primeira década de segurança viária.

Objective: To identify the temporal trend in mortality and years of life lost to death or disability (DALY) due to motorcycle accidents in males from Latin America and the Caribbean from 2010 to 2019, using estimates produced by the Global Burden of Disease (GBD) study. Method: In this ecological study, the time series was analyzed using a piecewise linear regression model (joinpoint) to estimate and test the annual percent change and the average annual percent change with a 95% confidence interval. Results: The super-region defined by GBD 2019 as Latin America and the Caribbean ranked first globally in mortality and DALY for male motorcyclists aged 15-49 in 2019. Rates increased significantly from 2010 to 2013, with a significant reduction in both after this period. During the analyzed decade, the Tropical Latin America sub-region (Brazil and Paraguay) had the highest mortality and DALY rates in the population of interest; nevertheless, this was the only sub-region achieving a significant reduction in these rates. The Caribbean sub-region (Bermuda, Dominica, Suriname, Guyana, Belize, Bahamas, Puerto Rico, Saint Lucia, Dominican Republic, Haiti, Saint Kitts and Nevis, U.S. Virgin Islands, Grenada, Trinidad and Tobago, Barbados, Saint Vincent and the Grenadines, Antigua and Barbuda, Cuba e Jamaica) showed a significant increase in both rates over the same period, while Andean Latin America (Ecuador, Bolivia and Peru) and Central Latin America (Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Honduras, and Venezuela) remained stable. Conclusions: The data underscore the importance of developing surveillance actions aimed at preventing motorcycle accidents, since the observed declining rates are still insufficient to address the morbidity and mortality associated with road accidents as a public health problem.

Objetivo: Determinar la tendencia temporal de la mortalidad y los años de vida perdidos por muerte o ajustados por discapacidad (AVAD) de hombres por accidentes de motocicleta en América Latina y el Caribe en el período 2010-2019, a partir de las estimaciones del estudio de la carga mundial de enfermedades (CME). Métodos: En este estudio ecológico se analizaron las series temporales mediante el modelo de regresión lineal segmentada (joinpoint), con cálculo y comprobación del cambio porcentual anual y del cambio porcentual anual promedio, con un intervalo de confianza del 95%. Resultados: La región de América Latina y el Caribe definida por el estudio de la CME ocupó el primer lugar a nivel mundial en mortalidad y AVAD de motociclistas varones de 15 a 49 años en el 2019. Las tasas tuvieron un notable aumento del 2010 al 2013, y ambas registraron una reducción importante después de ese período. En la década analizada, la subregión de América Latina Tropical (Brasil y Paraguay) presentó las mayores tasas de mortalidad y de AVAD en la población de estudio, pero fue la única con una reducción importante de las mismas. La subregión del Caribe (Antigua y Barbuda, Bahamas, Barbados, Belice, Bermudas, Cuba, Dominica, Granada, Guyana, Haití, Islas Vírgenes de Estados Unidos, Jamaica, Puerto Rico, República Dominicana, Saint Kits y Nevis, San Vicente y las Granadinas, Santa Lucía, Suriname, y Trinidad y Tabago) mostró un aumento importante de ambas tasas, mientras que América Latina Andina (Bolivia, Ecuador y Perú) y América Latina Central (Colombia, Costa Rica, El Salvador, Guatemala, Honduras, México, Nicaragua, Panamá y Venezuela) se mantuvieron estables. Conclusiones: Los datos refuerzan la importancia de las actividades de vigilancia destinadas a prevenir los accidentes de motocicleta, puesto que la reducción observada de las tasas aún es insuficiente para abordar la morbimortalidad por accidentes de tráfico como problema de salud pública.

[Hypertension in female prisoners in Brazil: far beyond the biological aspects]. / Hipertensão em mulheres presas no Brasil: muito além do biológico.

The scope was to estimate the prevalence of arterial hypertension (AHT) and associated risk factors among female prisoners. Data from the National Health Survey of the Female Prison Population and Prison Guards were used, investigating sociodemographic variables, prison characteristics, health behaviors and conditions. Information was collected through a self-administered questionnaire, and the magnitude of the association was estimated by the odds ratio and 95% confidence interval. Of the 1,327 prisoner participants, 24.4% were hypertensive, the majority were 31 years of age or older (54.6%), and 51.5% self-reported mixed race. After adjustment for associated risk factors in the bivariate analysis, a direct relationship between age and AHT was observed, in which age equal to/over 41 years was independently associated with a 7-fold greater chance of having AHT, compared to those under 25 years of age. Those who self-reported mixed race, had high cholesterol, were obese and were also independently associated with a higher prevalence of AHT. The greater the number of people with whom the inmate shares a cell was associated with a higher prevalence of AHT, but without a dose-response relationship. The conclusion drawn is that age, race, obesity, physical inactivity and stress are risk factors for AHT in female prisoners.

Objetivou-se estimar a prevalência de hipertensão arterial (HA) e os fatores de risco associados em mulheres presas. Utilizou-se dados do Inquérito Nacional de Saúde na População Penitenciária Feminina e em Servidoras Prisionais, investigando-se características sociodemográficas, fatores das prisões, comportamentos e condições de saúde. As informações foram coletadas por meio de questionário autoaplicado, sendo a magnitude da associação estimada por odds ratio e intervalo de confiança de 95%. Das 1.327 participantes, 24,4% eram hipertensas, a maioria tinha 31 anos ou mais (54,6%), 51,5% autorreferiram etnia/cor parda. Após mutual ajustamento pelos fatores de risco associados na análise bivariada, observou-se relação direta e com gradiente entre idade e HA, em que idade igual/maior a 41 anos foi associada independentemente com uma chance sete vezes maior de ter HA, se comparado a quem tem menos de 25 anos. Aquelas que autorreferiram etnia/cor negra apresentaram colesterol alto e estavam obesas, também foram associadas de forma independente com maior prevalência de HA. O maior número de pessoas com que a presa divide cela esteve associado à maior prevalência de há, sem uma relação dose-resposta. Conclui-se que idade, etnia/cor, obesidade, inatividade física e estresse são fatores de risco para HA em mulheres presas.

My Exposure to Violence: translation and cultural adaptation to the BR Portuguese.

OBJECTIVE: To translate and adapt the My Exposure to Violence instrument for measuring exposure to community violence into Brazilian Portuguese. METHODS: Psychometric study of translation and cross-cultural adaptation in seven stages: (I) initial translations, (II) synthesis of translations, (III) back-translations, (IV) cross-cultural pre-adaptation, (V) evaluation by committee of judges, (VI) pre-test, and (VII) submission to the original author. In step V eight judges evaluated the instrument's equivalence of content, and the content validity index was calculated for each item (CVI-I) and for the average of the instrument (CVI-M), considering a CVI-I ≥ 0.78 as excellent and a CVI-M ≥ 0.80 as acceptable and ≥ 0.90 as excellent. The pre-test was conducted with 39 adolescents enrolled in an educational institution in Fortaleza, state of Ceará. The understandability of the items was evaluated. RESULTS: In step I, two translations were produced with few differences between them. These were resolved in step II, by generating the synthesis version (T12). In step III, the back-translated items reflected the same content as the items in the original version. In step IV, T12 was revised by the authors, who made specific linguistic changes in order to facilitate understanding. In step V, one item (22) presented CVI < 0.78. Due to the relevance of the suggestions, 19 of the 23 items (82.60%) were modified. The CVI-M of the instrument was 0.92. In stage VI, the mean age of the participants was 17.48 years (SD = 1.27). The pre-final version had 21 out of 23 items (91.30%) fully understood by more than 90% of the participants. No changes were made to the final version. CONCLUSIONS: My Exposure to Violence was cross-culturally adapted into Brazilian Portuguese, and was well understood by the target population. Other psychometric properties, such as reliability and validity, should be evaluated in further studies to strengthen the evidence of the translated and adapted version.

Leprosy among female prisoners in Brazil.

To estimate the prevalence of leprosy among Brazilian female prisoners and identify factors associated with the disease. Cross-sectional study conducted between 2014 and 2015 in 15 Brazilian female prisons. The data of 1,327 women were collected using Audio Computer-Assisted Self-Interviewing and dermatological and neurological examination to identify suspicious lesions of leprosy. The average age was 33.4 years. Suspicion of leprosy was identified in 5.1% of women in prison, and lifetime self-reported prevalence was 7.5%. The variables that were associated with lifetime self-reported leprosy were: women in prison once being twice as likely to have leprosy; white women were 1.4 time more likely to have leprosy than non-white women; women who knew someone with leprosy was 1.9 time more likely to have leprosy; and women who shared a cell with 11 or more women were 2.5 times more likely to have leprosy than women who shared a cell with two or fewer people. The leprosy prevalence among female prisoners in Brazil were greater than that found in a Brazilian woman of the general population and show the extremely high vulnerability of this population generated through pre-incarceration poverty, as well as potential transmission in prison.

Complementary and Integrative Medicine in academic health education.

OBJECTIVE: To analyze academic education in Complementary and Integrative Medicine (CIM) according to university students from the health area. METHODS: Cross-sectional study with 1399 students from six public and private Brazilian universities, with online and in-person collection of socioeconomic, demographic, educational and academic data, carried out in 2019. The bivariate analysis was applied for the outcome "presence of CIM in academic health education", using the SPSS Statistic program, version 23.0™. RESULTS: The prevalence of the presence of CIM in academic health education was 52.3%, being 31.1% in the compulsory and 8% in the non-compulsory curricular education, 2.0% in scientific research and 4.7% in university extension activities. There was an association of the outcome with knowledge of the national CIM policy (OR = 5.258; p = 0.000), of which knowledge can be indicated and used in one's professional area (OR = 4.836; p = 0.000), interest and/or use of CIM by the teachers/tutors of the course (OR = 3.955; p = 0.000), stimulus by the university to carry out scientific research (OR = 3.277; p = 0.000) and university extension projects with CIM (OR = 3.686; p = 0.000). CONCLUSION: Academic education using CIM in health area courses is not very prevalent in teaching, research and university extension in Brazil, but when present in the curricular and non-curricular educational processes, it shows a significant association with knowledge, skills and their use by university students. The creation of a National Educational Planning in CIM is a vital imperative.

Physical violence inside female prisons in Brazil: prevalence and related factors.

The present study aims to identify the prevalence of physical violence against female prisoners in Brazil, as well as related factors. This is a cross-sectional national survey conducted in 15 female prisons in five regions of Brazil selected in multiple stages. The following types of analysis were performed: univariate analysis; stratified analysis relating the outcome (suffer physical violence inside prison) to predictor variables, using the Pearson chi-square test; calculation of the Odds Ratio (O.R.); and multiple logistic regression. The Hosmer-Lemeshow test was used for analysis of goodness of fit and adequacy of the model. The prevalence of physical violence inside female prisons was 37.4%. There was a correlation between physical violence victimization in prison and the following variables: physical victimization prior to arrest (p = 0.013), solitary confinement (p = 0.000), mental suffering (p = 0.003), current or previous abusive intake of alcohol (p = 0.011), current or previous injection of cocaine (p = 0.002) and not performing prison labor (p = 0.003). Physical violence has become inherent in the Brazilian female prison system. Continued studies are needed to monitor the situation and to develop  interventions to prevent physical violence inside the facilities.

Prevalence of hypertension and associated factors in female prison correctional officers in a national sample in Brazil.

OBJECTIVES: To estimate hypertension prevalence and associated factors among female correctional officers (FCO) in female Brazilian prisons. METHODS: Cross-sectional, analytical study conducted in 15 female prisons in all five Brazilian regions between January 2014 and December 2015. The study population consisted of correctional officers with at least 6 months in the position. The sampling included 40% of FCO present in the prison during data collection, yielding 295 FCOs. Data were collected via Audio Computer-Assisted Self-Interview. A physical examination of participants was conducted including blood pressure, weight, and waist and hip circumference. The Odds Ratio and confidence intervals for independent factors were estimated. RESULTS: Hypertension prevalence in correctional officers was 37.9%, (95% CI 32.1-44.0). Hypertension was associated with obesity (95% CI = 1.884-9.947), cardiovascular disease (95% CI = 3.348-16.724), and participation in the specific training course for the relevant position (95% CI = 1.413-9.564). CONCLUSIONS: While findings, except for the last factor, are not novel, this is the first such study conducted in Brazil. Hypertension prevalence among this pool of all female correctional officers is higher than in the average population, and FCOs associate this with the prison environment. Current training does not appear to address this problem. Especially since prison populations are growing in Brazil, this problem needs to be addressed for the health of the FCOs and the prisoners in their care.

The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics.

INTRODUCTION: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. METHODS: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. RESULTS: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). CONCLUSION: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.

Incentives and barriers to HIV testing among female sex workers in Ceará.

OBJECTIVE: Estimating HIV prevalence and describing the incentives and barriers for HIV testing among female sex workers. METHODS: This cross-sectional study recruited 402 women aged 18 years or older, residing in Fortaleza, state of Ceará, Brazil, who reported having had sexual intercourse in exchange for money in last four months. The sample was recruited using Respondent Driven Sampling, between August and November 2010. RESULTS: The 84.1% of the sample tested and the estimated prevalence of HIV infection was 3.8%. The sample was young (25 to 39 years ), single (80.0%), with one to three children (83.6%), had eight or more years of schooling (65.7%), and belonged to social classes D/E (53.1%). The majority worked in fixed locations (bars, motels, hotels, sauna - 88.9%), and prostitution was their only source of income (54.1%). About 25% of the sample did not know where to test in the public health sector and 51.8% either never tested or hadn't tested for over a year or more. The main reported barriers to testing were the perceptions that there was no risk of becoming infected (24.1%), and, alternatively, fear of discrimination if the test was positive (20.5%). Incentives for testing were the greater availability of testing sites (57.0%) and health facilities with alternative schedules (44.2%). CONCLUSIONS: Prevalence for HIV was similar to that found in other Brazilian cities in different regions of the country, although higher than the general female population. Non-traditional venues not associated with the health system and availability of testing in health units during non-commercial hours are factors that encourage testing. Not considering oneself to be at risk, fear of being discriminated against and not knowing testing locations are barriers.

Hipertensão em mulheres presas no Brasil: muito além do biológico / Hypertension in female prisoners in Brazil: far beyond the biological aspects

Resumo Objetivou-se estimar a prevalência de hipertensão arterial (HA) e os fatores de risco associados em mulheres presas. Utilizou-se dados do Inquérito Nacional de Saúde na População Penitenciária Feminina e em Servidoras Prisionais, investigando-se características sociodemográficas, fatores das prisões, comportamentos e condições de saúde. As informações foram coletadas por meio de questionário autoaplicado, sendo a magnitude da associação estimada por odds ratio e intervalo de confiança de 95%. Das 1.327 participantes, 24,4% eram hipertensas, a maioria tinha 31 anos ou mais (54,6%), 51,5% autorreferiram etnia/cor parda. Após mutual ajustamento pelos fatores de risco associados na análise bivariada, observou-se relação direta e com gradiente entre idade e HA, em que idade igual/maior a 41 anos foi associada independentemente com uma chance sete vezes maior de ter HA, se comparado a quem tem menos de 25 anos. Aquelas que autorreferiram etnia/cor negra apresentaram colesterol alto e estavam obesas, também foram associadas de forma independente com maior prevalência de HA. O maior número de pessoas com que a presa divide cela esteve associado à maior prevalência de há, sem uma relação dose-resposta. Conclui-se que idade, etnia/cor, obesidade, inatividade física e estresse são fatores de risco para HA em mulheres presas.

Abstract The scope was to estimate the prevalence of arterial hypertension (AHT) and associated risk factors among female prisoners. Data from the National Health Survey of the Female Prison Population and Prison Guards were used, investigating sociodemographic variables, prison characteristics, health behaviors and conditions. Information was collected through a self-administered questionnaire, and the magnitude of the association was estimated by the odds ratio and 95% confidence interval. Of the 1,327 prisoner participants, 24.4% were hypertensive, the majority were 31 years of age or older (54.6%), and 51.5% self-reported mixed race. After adjustment for associated risk factors in the bivariate analysis, a direct relationship between age and AHT was observed, in which age equal to/over 41 years was independently associated with a 7-fold greater chance of having AHT, compared to those under 25 years of age. Those who self-reported mixed race, had high cholesterol, were obese and were also independently associated with a higher prevalence of AHT. The greater the number of people with whom the inmate shares a cell was associated with a higher prevalence of AHT, but without a dose-response relationship. The conclusion drawn is that age, race, obesity, physical inactivity and stress are risk factors for AHT in female prisoners.

Mortalidade e anos de vida ajustados por incapacidade de motociclistas na América Latina e Caribe na primeira década de segurança viária / Mortality and disability-adjusted life years in motorcyclists in Latin America and the Caribbean during the first decade of action for road safety / Mortalidad y años de vida ajustados por discapacidad de los motociclistas en América Latina y el Caribe en la primera década de seguridad vial

RESUMO Objetivo. Identificar a tendência temporal da mortalidade e dos anos de vida perdidos por morte ou incapacidade (DALY) de homens por acidente motociclístico na América Latina e Caribe no período de 2010 a 2019, utilizando estimativas do estudo Global Burden of Disease (GBD). Métodos. Este estudo ecológico analisou a série temporal pelo modelo de regressão linear segmentada (joinpoint), estimando-se e testando-se a variação percentual anual e a variação percentual anual média, com intervalo de confiança de 95%. Resultados. A grande região da América Latina e Caribe definida pelo GBD ocupou o primeiro lugar global em mortalidade e DALY de motociclistas homens de 15 a 49 anos em 2019. As taxas aumentaram significativamente de 2010 a 2013, havendo redução significativa de ambas após esse período. Durante a década analisada, a sub-região da América Latina Tropical (Brasil e Paraguai) apresentou as maiores taxas de mortalidade e DALY na população em estudo, porém foi a única com redução significativa das mesmas; a sub-região do Caribe (Bermudas, Dominica, Suriname, Guiana, Belize, Bahamas, Porto Rico, Santa Lúcia, República Dominicana, Haiti, São Cristóvão e Névis, Ilhas Virgens/EUA, Granada, Trinidad e Tobago, Barbados, São Vicente e Granadinas, Antígua e Barbuda, Cuba e Jamaica) apresentou aumento significativo de ambas as taxas, enquanto América Latina Andina (Equador, Bolívia e Peru) e América Latina Central (Colômbia, Costa Rica, El Salvador, Guatemala, México, Nicarágua, Panamá, Honduras e Venezuela) permaneceram estáveis. Conclusões. Os dados reforçam a importância das ações de vigilância destinadas à prevenção de acidentes motociclísticos, uma vez que os resultados de queda nas taxas ainda são insuficientes frente à morbimortalidade no trânsito como problema de saúde pública.

ABSTRACT Objective. To identify the temporal trend in mortality and years of life lost to death or disability (DALY) due to motorcycle accidents in males from Latin America and the Caribbean from 2010 to 2019, using estimates produced by the Global Burden of Disease (GBD) study. Method. In this ecological study, the time series was analyzed using a piecewise linear regression model (joinpoint) to estimate and test the annual percent change and the average annual percent change with a 95% confidence interval. Results. The super-region defined by GBD 2019 as Latin America and the Caribbean ranked first globally in mortality and DALY for male motorcyclists aged 15-49 in 2019. Rates increased significantly from 2010 to 2013, with a significant reduction in both after this period. During the analyzed decade, the Tropical Latin America sub-region (Brazil and Paraguay) had the highest mortality and DALY rates in the population of interest; nevertheless, this was the only sub-region achieving a significant reduction in these rates. The Caribbean sub-region (Bermuda, Dominica, Suriname, Guyana, Belize, Bahamas, Puerto Rico, Saint Lucia, Dominican Republic, Haiti, Saint Kitts and Nevis, U.S. Virgin Islands, Grenada, Trinidad and Tobago, Barbados, Saint Vincent and the Grenadines, Antigua and Barbuda, Cuba e Jamaica) showed a significant increase in both rates over the same period, while Andean Latin America (Ecuador, Bolivia and Peru) and Central Latin America (Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Honduras, and Venezuela) remained stable. Conclusions. The data underscore the importance of developing surveillance actions aimed at preventing motorcycle accidents, since the observed declining rates are still insufficient to address the morbidity and mortality associated with road accidents as a public health problem.

RESUMEN Objetivo. Determinar la tendencia temporal de la mortalidad y los años de vida perdidos por muerte o ajustados por discapacidad (AVAD) de hombres por accidentes de motocicleta en América Latina y el Caribe en el período 2010-2019, a partir de las estimaciones del estudio de la carga mundial de enfermedades (CME). Métodos. En este estudio ecológico se analizaron las series temporales mediante el modelo de regresión lineal segmentada (joinpoint), con cálculo y comprobación del cambio porcentual anual y del cambio porcentual anual promedio, con un intervalo de confianza del 95%. Resultados. La región de América Latina y el Caribe definida por el estudio de la CME ocupó el primer lugar a nivel mundial en mortalidad y AVAD de motociclistas varones de 15 a 49 años en el 2019. Las tasas tuvieron un notable aumento del 2010 al 2013, y ambas registraron una reducción importante después de ese período. En la década analizada, la subregión de América Latina Tropical (Brasil y Paraguay) presentó las mayores tasas de mortalidad y de AVAD en la población de estudio, pero fue la única con una reducción importante de las mismas. La subregión del Caribe (Antigua y Barbuda, Bahamas, Barbados, Belice, Bermudas, Cuba, Dominica, Granada, Guyana, Haití, Islas Vírgenes de Estados Unidos, Jamaica, Puerto Rico, República Dominicana, Saint Kits y Nevis, San Vicente y las Granadinas, Santa Lucía, Suriname, y Trinidad y Tabago) mostró un aumento importante de ambas tasas, mientras que América Latina Andina (Bolivia, Ecuador y Perú) y América Latina Central (Colombia, Costa Rica, El Salvador, Guatemala, Honduras, México, Nicaragua, Panamá y Venezuela) se mantuvieron estables. Conclusiones. Los datos refuerzan la importancia de las actividades de vigilancia destinadas a prevenir los accidentes de motocicleta, puesto que la reducción observada de las tasas aún es insuficiente para abordar la morbimortalidad por accidentes de tráfico como problema de salud pública.

Análise ergonômica do trabalho de policiais civis da polícia especializada do Ceará: um estudo de caso / Ergonomic analysis of the work of civilian policemen of the specialized police of Ceará: a case study / Análisis ergonómico del trabajo de los policías civiles de la policía especializada de Ceará: un estudio de caso

Introdução: a dinâmica laboral, os fatores ambientais e a individualidade de enfrentamento nos postos de trabalho podem influenciar o surgimento de alterações físicas e psicológicas nos indivíduos. Objetivo: identificar os riscos ergonômicos de policiais de uma Unidade Especializada da Polícia Civil do Estado do Ceará. Métodos: trata de um estudo de caso no qual foi realizada uma Análise Ergonômica do Trabalho, de forma qualitativa e multidisciplinar, de três policiais civis, considerando quatro posições diferentes: posição ortostática com seu equipamento de proteção individual e de exercício laboral; posição de prontidão de tiro; posição de descanso, alerta em operação e fora da operação; e posição ortostática em operação. A análise foi realizada por meio de cinco etapas: análise da demanda; análise da tarefa; análise da atividade; diagnóstico; e recomendações, sendo avaliados o peso dos equipamentos, sobrecargas musculares e articulares e compensações posturais oriundas do exercício das atividades laborais. Resultados: foi detectada elevada carga de peso dos equipamentos, levando a desvios posturais. Os policiais também apresentaram condutas posturais viciosas na execução das atividades. Conclusão: alterações e vícios posturais precisam ser solucionadas visando o cuidado com a saúde dos policiais, de modo a evitar afastamentos para tratamento de saúde. Recomendações foram propostas.

Introduction: the labor dynamics, the environmental factors and the individuality of confrontation at workstations may influence the emergence of physical and psychological alterations in individuals. Objective: to identify the ergonomic risks of policemen of a Specialized Unit of the Civil Police of the State of Ceará. Methods: this is a case study in which a qualitative and multidisciplinary Ergonomic Analysis of Work was carried out on three civilian policemen, considering four different positions: orthostatic position with their individual protection equipment and work exercise; shooting readiness position; resting position, alert in operation and out of operation; and orthostatic position in operation. The analysis was conducted through five stages: demand analysis; task analysis; activity analysis; diagnosis; and recommendations, evaluating the weight of the equipment, muscle and joint overloads and postural compensations arising from the exercise of labor activities. Results: a high weight load of the equipment was detected, leading to postural deviations. The policemen also presented vicious postural behaviors in the execution of their activities. Conclusion: postural alterations and addictions need to be solved in order to take care of the policemen's health, so as to avoid absence for health treatment. Recommendations were proposed.

Introducción: la dinámica laboral, los factores ambientales y la individualidad del enfrentamiento en los puestos de trabajo pueden influir en la aparición de alteraciones físicas y psicológicas en los individuos. Objetivo: identificar los riesgos ergonómicos de los policías de una Unidad Especializada de la Policía Civil del Estado de Ceará. Método: se trata de un estudio de caso en el que se realizó un Análisis Ergonómico del Trabajo cualitativo y multidisciplinar a tres policías civiles, considerando cuatro posiciones diferentes: posición ortostática con su equipo de protección individual y ejercicio de trabajo; posición de preparación para el tiro; posición de descanso, alerta en operación y fuera de operación; y posición ortostática en operación. El análisis se realizó a través de cinco etapas: análisis de la demanda; análisis de la tarea; análisis de la actividad; diagnóstico; y recomendaciones, evaluando el peso del equipo, las sobrecargas musculares y articulares y las compensaciones posturales derivadas del ejercicio de las actividades laborales. Resultados: se detectó una elevada carga de peso del equipo, lo que provocó desviaciones posturales. Los policías también presentaron comportamientos posturales viciosos en la ejecución de sus actividades. Conclusión: las alteraciones posturales y las adicciones necesitan ser solucionadas para cuidar de la salud de los policías, de forma a evitar ausencias para tratamiento sanitario. Se propusieron recomendaciones.

Mortalidade e anos de vida ajustados por incapacidade de motociclistas na América Latina e Caribe na primeira década de segurança viária

[RESUMO]. Objetivo. Identificar a tendência temporal da mortalidade e dos anos de vida perdidos por morte ou incapaci- dade (DALY) de homens por acidente motociclístico na América Latina e Caribe no período de 2010 a 2019, utilizando estimativas do estudo Global Burden of Disease (GBD). Métodos. Este estudo ecológico analisou a série temporal pelo modelo de regressão linear segmentada (joinpoint), estimando-se e testando-se a variação percentual anual e a variação percentual anual média, com intervalo de confiança de 95%. Resultados. A grande região da América Latina e Caribe definida pelo GBD ocupou o primeiro lugar global em mortalidade e DALY de motociclistas homens de 15 a 49 anos em 2019. As taxas aumentaram significa- tivamente de 2010 a 2013, havendo redução significativa de ambas após esse período. Durante a década analisada, a sub-região da América Latina Tropical (Brasil e Paraguai) apresentou as maiores taxas de mortali- dade e DALY na população em estudo, porém foi a única com redução significativa das mesmas; a sub-região do Caribe (Bermudas, Dominica, Suriname, Guiana, Belize, Bahamas, Porto Rico, Santa Lúcia, República Dominicana, Haiti, São Cristóvão e Névis, Ilhas Virgens/EUA, Granada, Trinidad e Tobago, Barbados, São Vicente e Granadinas, Antígua e Barbuda, Cuba e Jamaica) apresentou aumento significativo de ambas as taxas, enquanto América Latina Andina (Equador, Bolívia e Peru) e América Latina Central (Colômbia, Costa Rica, El Salvador, Guatemala, México, Nicarágua, Panamá, Honduras e Venezuela) permaneceram estáveis. Conclusões. Os dados reforçam a importância das ações de vigilância destinadas à prevenção de acidentes motociclísticos, uma vez que os resultados de queda nas taxas ainda são insuficientes frente à morbimortali- dade no trânsito como problema de saúde pública.

[ABSTRACT]. Objective. To identify the temporal trend in mortality and years of life lost to death or disability (DALY) due to motorcycle accidents in males from Latin America and the Caribbean from 2010 to 2019, using estimates produced by the Global Burden of Disease (GBD) study. Method. In this ecological study, the time series was analyzed using a piecewise linear regression model (joinpoint) to estimate and test the annual percent change and the average annual percent change with a 95% confidence interval. Results. The super-region defined by GBD 2019 as Latin America and the Caribbean ranked first globally in mortality and DALY for male motorcyclists aged 15-49 in 2019. Rates increased significantly from 2010 to 2013, with a significant reduction in both after this period. During the analyzed decade, the Tropical Latin America sub-region (Brazil and Paraguay) had the highest mortality and DALY rates in the population of interest; never- theless, this was the only sub-region achieving a significant reduction in these rates. The Caribbean sub-region (Bermuda, Dominica, Suriname, Guyana, Belize, Bahamas, Puerto Rico, Saint Lucia, Dominican Republic, Haiti, Saint Kitts and Nevis, U.S. Virgin Islands, Grenada, Trinidad and Tobago, Barbados, Saint Vincent and the Grenadines, Antigua and Barbuda, Cuba e Jamaica) showed a significant increase in both rates over the same period, while Andean Latin America (Ecuador, Bolivia and Peru) and Central Latin America (Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Honduras, and Venezuela) remained stable. Conclusions. The data underscore the importance of developing surveillance actions aimed at preventing motorcycle accidents, since the observed declining rates are still insufficient to address the morbidity and mortality associated with road accidents as a public health problem.

[RESUMEN]. Objetivo. Determinar la tendencia temporal de la mortalidad y los años de vida perdidos por muerte o ajusta- dos por discapacidad (AVAD) de hombres por accidentes de motocicleta en América Latina y el Caribe en el período 2010-2019, a partir de las estimaciones del estudio de la carga mundial de enfermedades (CME). Métodos. En este estudio ecológico se analizaron las series temporales mediante el modelo de regresión lineal segmentada (joinpoint), con cálculo y comprobación del cambio porcentual anual y del cambio porcentual anual promedio, con un intervalo de confianza del 95%. Resultados. La región de América Latina y el Caribe definida por el estudio de la CME ocupó el primer lugar a nivel mundial en mortalidad y AVAD de motociclistas varones de 15 a 49 años en el 2019. Las tasas tuvieron un notable aumento del 2010 al 2013, y ambas registraron una reducción importante después de ese período. En la década analizada, la subregión de América Latina Tropical (Brasil y Paraguay) presentó las mayores tasas de mortalidad y de AVAD en la población de estudio, pero fue la única con una reducción impor- tante de las mismas. La subregión del Caribe (Antigua y Barbuda, Bahamas, Barbados, Belice, Bermudas, Cuba, Dominica, Granada, Guyana, Haití, Islas Vírgenes de Estados Unidos, Jamaica, Puerto Rico, República Dominicana, Saint Kits y Nevis, San Vicente y las Granadinas, Santa Lucía, Suriname, y Trinidad y Tabago) mostró un aumento importante de ambas tasas, mientras que América Latina Andina (Bolivia, Ecuador y Perú) y América Latina Central (Colombia, Costa Rica, El Salvador, Guatemala, Honduras, México, Nicaragua, Panamá y Venezuela) se mantuvieron estables. Conclusiones. Los datos refuerzan la importancia de las actividades de vigilancia destinadas a prevenir los accidentes de motocicleta, puesto que la reducción observada de las tasas aún es insuficiente para abordar la morbimortalidad por accidentes de tráfico como problema de salud pública.

HIV prevalence among men who have sex with men in Brazil: results of the 2nd national survey using respondent-driven sampling.

This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS).Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy.A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities.A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7-20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4-21.7) were seropositive.HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0-14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.

My Exposure to Violence: translation and cultural adaptation to the BR Portuguese / My Exposure to Violence: tradução e adaptação transcultural para o português brasileiro

ABSTRACT OBJECTIVE To translate and adapt the My Exposure to Violence instrument for measuring exposure to community violence into Brazilian Portuguese. METHODS Psychometric study of translation and cross-cultural adaptation in seven stages: (I) initial translations, (II) synthesis of translations, (III) back-translations, (IV) cross-cultural pre-adaptation, (V) evaluation by committee of judges, (VI) pre-test, and (VII) submission to the original author. In step V eight judges evaluated the instrument's equivalence of content, and the content validity index was calculated for each item (CVI-I) and for the average of the instrument (CVI-M), considering a CVI-I ≥ 0.78 as excellent and a CVI-M ≥ 0.80 as acceptable and ≥ 0.90 as excellent. The pre-test was conducted with 39 adolescents enrolled in an educational institution in Fortaleza, state of Ceará. The understandability of the items was evaluated. RESULTS In step I, two translations were produced with few differences between them. These were resolved in step II, by generating the synthesis version (T12). In step III, the back-translated items reflected the same content as the items in the original version. In step IV, T12 was revised by the authors, who made specific linguistic changes in order to facilitate understanding. In step V, one item (22) presented CVI < 0.78. Due to the relevance of the suggestions, 19 of the 23 items (82.60%) were modified. The CVI-M of the instrument was 0.92. In stage VI, the mean age of the participants was 17.48 years (SD = 1.27). The pre-final version had 21 out of 23 items (91.30%) fully understood by more than 90% of the participants. No changes were made to the final version. CONCLUSIONS My Exposure to Violence was cross-culturally adapted into Brazilian Portuguese, and was well understood by the target population. Other psychometric properties, such as reliability and validity, should be evaluated in further studies to strengthen the evidence of the translated and adapted version.

RESUMO OBJETIVO Traduzir e adaptar para português brasileiro o instrumento de aferição de exposição à violência comunitária, My Exposure to Violence. MÉTODOS Estudo psicométrico de tradução e adaptação transcultural em sete etapas: (I) traduções iniciais, (II) síntese das traduções, (III) retrotraduções, (IV) pré-adaptação transcultural, (V) avaliação por comitê de juízes, (VI) pré-teste e (VII) submissão ao autor original. Na etapa V oito juízes avaliaram a equivalência de conteúdo do instrumento, sendo calculado o índice de validade de conteúdo para cada item (IVC-I) e para a média do instrumento (IVC-M), considerando-se um IVC-I ≥ 0,78 como excelente e um IVC-M ≥ 0,80 como aceitável e ≥ 0,90 como excelente. O pré-teste foi realizado com 39 adolescentes matriculados em uma instituição de ensino em Fortaleza, no Ceará, sendo avaliada a compreensibilidade dos itens. RESULTADOS Na etapa I, duas traduções foram produzidas, com poucas diferenças entre si. Estas foram dirimidas na etapa II, gerando a versão síntese (T12). Na etapa III, os itens retrotraduzidos refletiram o mesmo conteúdo dos itens da versão original. Na etapa IV, ocorreu a revisão de T12 pelos autores, que realizaram modificações linguísticas específicas, de modo a facilitar o entendimento. Na etapa V, um item (22) apresentou IVC < 0,78. Devido a pertinência das sugestões, 19 dos 23 itens (82,60%) sofreram modificações. O IVC-M do instrumento foi 0,92. Na etapa VI, a média de idade dos participantes foi de 17,48 anos (DP = 1,27). A versão pré-final teve 21 dos 23 itens (91,30%) totalmente compreendidos por mais de 90% dos participantes. Não foram realizadas alterações na versão final. CONCLUSÕES O My Exposure to Violence foi adaptado transculturalmente para o português brasileiro, tendo sido bem compreendido pela população alvo. Outras propriedades psicométricas, como confiabilidade e validade, devem ser avaliadas em estudos posteriores para fortalecer as evidências da versão traduzida e adaptada.

Mortalidade por violência contra mulheres antes e durante a pandemia de Covid-19. Ceará, 2014 a 2020 / Mortality from violence against women before and during the Covid-19 pandemic. Ceará, 2014 to 2020

RESUMO Compreendendo a importância do monitoramento da violência contra mulheres, este estudo teve como objetivo analisar o comportamento da curva de crimes violentos, letais e intencionais contra mulheres, no estado do Ceará, nos últimos anos e discutir acerca dos aspectos que envolvem a curva epidemiológica dos crimes letais contra a mulher, principalmente com o início da pandemia de Covid-19. Trata-se de uma pesquisa ecológica, utilizando os dados secundários disponíveis na plataforma da Secretaria de Segurança Pública e Defesa Social do estado do Ceará entre os anos de 2014 a 2020. A coleta foi realizada no mês de janeiro de 2021, os dados foram analisados com auxílio do programa Excel. Constatou-se que a violência contra a mulher no estado do Ceará encontra-se em ascensão e que anos com eventos sanitários atípicos, como a pandemia da Covid-19, tendem a impactar negativamente a vida em sociedade e mais diretamente a vida das mulheres. Torna-se essencial que as autoridades, as instituições, organizações sociais, comunidade acadêmica, profissionais de todos os setores e serviços públicos e privados estejam sensibilizados e empenhados em cobrar a efetivação das políticas de enfrentamento alinhadas a rede de serviços, principalmente no momento de maior vulnerabilidade da pandemia.

ABSTRACT Understanding the importance of monitoring in confront violence against women, this study aimed to analyze the behavior of the curve of violent, lethal and intentional crimes against women in the state of Ceará in recent years and discuss aspects that involve the epidemiological curve of lethal crimes against women, especially with the beginning of the Covid-19 pandemic. This is an ecological survey, using the secondary data available on the platform of the Secretariat of Public Security and Social Defense of the state of Ceará between the years 2014 to 2020. The collection was carried out in January 2021, the data were purchased with the aid of the Excel program. It was found that violence against women in the state of Ceará is on the rise and that years with atypical health events, such as the Covid-19 pandemic, tend to have a negative impact on life in society and more directly on women lives. It is essential that authorities, institutions, social associations, the academic community, professionals from all sectors in public and private services are sensitized and committed to demanding the implementation of confrontation policies aligned with the service network, especially at the moment of greatest vulnerability of the pandemic.

Leprosy among female prisoners in Brazil / Hanseníase entre mulheres privadas de liberdade no Brasil

Abstract To estimate the prevalence of leprosy among Brazilian female prisoners and identify factors associated with the disease. Cross-sectional study conducted between 2014 and 2015 in 15 Brazilian female prisons. The data of 1,327 women were collected using Audio Computer-Assisted Self-Interviewing and dermatological and neurological examination to identify suspicious lesions of leprosy. The average age was 33.4 years. Suspicion of leprosy was identified in 5.1% of women in prison, and lifetime self-reported prevalence was 7.5%. The variables that were associated with lifetime self-reported leprosy were: women in prison once being twice as likely to have leprosy; white women were 1.4 time more likely to have leprosy than non-white women; women who knew someone with leprosy was 1.9 time more likely to have leprosy; and women who shared a cell with 11 or more women were 2.5 times more likely to have leprosy than women who shared a cell with two or fewer people. The leprosy prevalence among female prisoners in Brazil were greater than that found in a Brazilian woman of the general population and show the extremely high vulnerability of this population generated through pre-incarceration poverty, as well as potential transmission in prison.

Resumo Objetivou-se estimar a prevalência de hanseníase entre presidiárias brasileiras e identificar fatores associados à doença. Estudo transversal realizado entre 2014 e 2015 em 15 presídios femininos brasileiros. Os dados de 1.327 mulheres foram coletados por meio de autoentrevista assistida por computador e exame dermatológico e neurológico para identificar lesões suspeitas de hanseníase. A idade média foi de 33,4 anos. A suspeita de hanseníase foi identificada em 5,1% das mulheres na prisão, e a prevalência autorreferida ao longo da vida foi de 7,5%. As variáveis que se associaram à hanseníase autorrelatada ao longo da vida foram: mulheres presas uma vez com duas vezes mais chance de ter hanseníase; mulheres brancas tinham 1,4 vez mais chance de ter hanseníase do que mulheres não brancas; mulheres que conheciam alguém com hanseníase tinham 1,9 vez mais chance de ter hanseníase; e mulheres que compartilhavam uma cela com 11 ou mais mulheres tinham 2,5 vezes mais chance de ter hanseníase do que mulheres que compartilhavam uma cela com duas ou menos pessoas. A prevalencia de hanseníase entre presidiárias no Brasil foi maior do que a encontrada entre mulheres da população geral e evidencia a vulnerabilidade dessa população gerada pela pobreza pré-reclusão, bem como o potencial de transmissão na prisão.

[Prevalence and violence-associated factors in the work environment of female prison guards in Brazil]. / Prevalência e fatores associados à violência no ambiente de trabalho em agentes de segurança penitenciária do sexo feminino no Brasil.

This article aims to estimate the prevalence and violence-associated factors in the work environment of female correctional officers in Brazil. A cross-sectional, analytical study was conducted in 15 female correctional facilities in Brazil's five regions. Pearson's chi-square test was performed. The Odds Ratio and Confidence Intervals were estimated for factors that showed a significant association or were confounding factors. The prevalence of having experienced at least one violent occurrence during professional duty as an officer was 28.4%. An interesting factor is fact that agents themselves are identified as the main suspects of robbery (74.6%), moral violence (68.1%) and sexual harassment (66.8%) against their co-workers. Working in more than one correctional facility increased the chance of suffering from violence (OR = 3.23; CI = 1.51 - 6.9). The main associated factors are: working in temporary detention centers, age of admission to the prison system and low social support among co-workers. Violence in the Brazilian prison environment is of great magnitude and considered a complex phenomenon with multiple causes. To combat this, it is necessary to adopt intersectoral actions, capable of intervening both in the prison environment and in society.

Hazardous alcohol use among transwomen in a Brazilian city.

There is a lack of information about alcohol use by transgender women. We estimated the prevalence of dangerous alcohol use in the last 12 months by transgender women, who are known as travestis in Brazil, and we identified the associated risk factors. Three hundred travestis were recruited using Respondent Driving Sampling (RDS). We applied the Alcohol Use Disorders Identification Test (AUDIT). We controlled the sample by applying a weight to each interviewee. Three quarters (74.2%) of travestis were regular drinkers, half (48.7%) scored over eight in the AUDIT and 14.8% scored over 20. The risk factors for alcohol use were: aged over 24, low income and unprotected sex. The dangerous use of alcohol is prevalent among travestis. Given that this group has a greater risk of HIV infection and transmission, and that the dangerous use of alcohol was associated with unsafe sex, specific intervention strategies are required.

Health characteristics of female victims of domestic violence housed in a state care shelter. / Características de saúde de mulheres em situação de violência doméstica abrigadas em uma unidade de proteção estadual.

The promotion of care for female victims of violence implies action that is not limited to combatting the problem, but also to the dimension of care provided to the victims. This study seeks to understand the sociodemographic and health characteristics of female victims of violence who are/have been under the protective custody of the state, before and after the Maria da Penha Law (MPL), and the healthcare offered to them. It is a cross-sectional, exploratory-descriptive documentary study, with a qualitative/quantitative approach, conducted in the second semester of 2013 in a special unit for the protection of female victims of violence in the State of Ceará. The sample was composed of 197 medical records of women attended between 2001 and 2012. Few changes occurred in the health profile of female victims of domestic violence sheltered by the State after the enactment of the MPL. Significant changes occurred in the pattern of care provided, such as increased investigation, promotion, and registration of health-related activities. The identification of the aftereffects of aggression per se is still scarce. A suggested addition would be the inclusion of a health professional in the staff at the shelters to meet this demand.