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INTRODUCTION: Twelve modifiable risk factors (RFs) account for 40% of dementia cases worldwide. However, limited data exist on such factors in middle- and low-income countries. We aimed to estimate the population-attributable fractions (PAFs) for the 12 RFs in Argentina, assessing changes over a decade and exploring socioeconomic and sex influences. METHODS: We conducted cross-sectional analyses of the 12 RFs from Argentinian surveys conducted in 2009, 2015, and 2018, including 96,321 people. We calculated PAFs and stratified estimates based on sex and income. RESULTS: We estimated an overall PAF of 59.6% (95% CI = 58.9-60.3%). The largest PAFs were hypertension = 9.3% (8.7-9.9%), physical inactivity = 7.4% (6.8-8.2%), and obesity = 7.4% (6.8-7.9%). Men were more impacted by excessive alcohol, while women by isolation and smoking. Lower income linked to higher PAFs in education, hypertension, and obesity. DISCUSSION: Argentina has a higher PAF for dementia than the world population, with distinct RF distribution. PAF varied by sex and economic status, advocating tailored prevention strategies.

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ABSTRACT Objective: to identify courses available online by national civil defense bodies in Brazil and Mexico to assist in the additional training of healthcare professionals for disasters. Method: an exploratory descriptive study, based on a qualitative approach, using technological prospecting methodology, carried out on the official Civil Defense websites in Brazil and Mexico. Results: ten courses offered by the Government of Mexico's National Center for Disaster Prevention were found, nine of which were short-term and one offered as vocational training. All of these courses were synchronous. In Brazil, 36 courses were located, all in asynchronous formats, with durations varying between 20 and 50 hours. Although the courses presented programmatic content that included activities inherent to healthcare professionals, none of them made specific mention of professionals in this area as the target audience. Conclusion: the prospective study reinforces that Information and Communication Technologies for distance education present themselves as an alternative present in both countries in terms of additional training for disasters, although not yet specifically aimed at healthcare professionals. The need to include this area of interdisciplinary and multi-professional content reflects gaps in sector integration.

RESUMEN Objetivo: identificar cursos disponibles en línea por los organismos nacionales de defensa civil en Brasil y México para ayudar en la capacitación adicional de profesionales de la salud para desastres. Método: estudio descriptivo exploratorio, de enfoque cualitativo, utilizando metodología de prospección tecnológica, realizado en los sitios web oficiales de la Defensa Civil de Brasil y México. Resultados: se encontraron 10 cursos ofrecidos por el Centro Nacional para la Prevención de Desastres del Gobierno de México, nueve de los cuales fueron de corta duración y uno se ofreció como formación vocacional. Todos estos cursos fueron sincrónicos. En Brasil se ubicaron 36 cursos, todos en formato asincrónico, con duraciones que variaron entre 20 y 50 horas. Aunque los cursos presentaron contenidos programáticos que incluyeron actividades inherentes a los profesionales de la salud, ninguno de ellos hizo mención específica a los profesionales de esa área como público objetivo. Conclusión: el estudio prospectivo refuerza que las Tecnologías de la Información y las Comunicaciones para la educación a distancia se presentan como una alternativa presente en ambos países en términos de capacitación adicional para desastres, aunque aún no dirigida específicamente a los profesionales de la salud. La necesidad de incluir esta área de contenidos interdisciplinarios y multiprofesionales refleja brechas en la integración del sector.

RESUMO Objetivo: identificar cursos disponíveis on-line pelos órgãos de defesa civil nacional do Brasil e do México visando auxiliar na formação complementar de profissionais de saúde para desastres. Método: estudo descritivo exploratório, a partir de uma abordagem qualitativa, utilizando a metodologia de prospecção tecnológica, realizada nos sites oficiais de Defesa Civil do Brasil e do México. Resultados: foram encontrados 10 cursos oferecidos pelo Centro Nacional de Prevenção de Desastres do Governo do México, sendo nove de curta duração e um oferecido como curso técnico. Todos esses cursos na modalidade síncrona. No Brasil, localizaram-se 36 cursos, todos em formatos assíncronos, com duração variável entre 20 e 50 horas. Embora os cursos apresentassem conteúdo programático que incluía atividades inerentes aos profissionais de saúde, nenhum deles fazia menção específica aos profissionais desta área como público-alvo. Conclusão: o estudo prospectivo reforça que as Tecnologias da Informação e da Comunicação para educação a distância se apresentam como uma alternativa presente em ambos os países quanto à formação complementar para desastres, porém, ainda não direcionados especificamente aos profissionais da saúde. A necessidade de inclusão desta área de conteúdos interdisciplinares e multiprofissionais reflete lacunas de integração de setores.

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For several decades, calamitous debris flows have inflicted profound negative impact on Peruvian rainforest society, encompassing both economic losses and human casualties. To address this concern, this study proposes a methodological tool to assess vulnerability while focusing on intercultural nuances. The contextual analysis of the incident reports identifies La Merced (Junín, Perú) as a severely affected locality, thereby justifying its selection for a detailed case study on the Pampa del Carmen sector. The study conducted a thorough systematic review of parameters such as diglossia, poverty, and origin that are crucial for vulnerability assessment. Moreover, these parameters aided in developing a structured digital survey. The integration of survey data into the analytic hierarchy process revealed high levels of vulnerability in the sector, emphasizing the imminent need for targeted interventions. The intercultural approach is significant as it facilitates future risk mitigation strategies based on effective integration and genuine acknowledgment of social dynamics and individual freedoms within the region for devising impactful risk management policies and plans.

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BACKGROUND: In the Brazilian health system, community health facilities consist of multidisciplinary teams that focus on family health, whereas health centers treat mainly illnesses of registered patients. In the present study we compared socio-economic factors and performance of mammography screening (MS) and clinical breast exam (CBE),  respectively, among women who used both types of public health service centers. METHODS: The present study included 180 women aged ≥40 years, who used different health service centers within the same municipal district. Of all 180 women, 110 (41.1%) and 70 (38.9%) used a health center and a community health facility. Logistic regression analysis was performed to calculate odds ratios (ORs) and confidence intervals (CIs) of variables. RESULTS: Regression modeling indicated that women who used the community health facility, performed annual MS 9.52 (OR= 0.105; 95%CI: 0.03- 0.36) times more often (p <0.001). In this model retirement and gynecological service use ≤ each second year, increased annual MS performance 8.16 (95%CI: 1.55- 54.32) and 7.78 (95%CI: 2.54- 23.79) times (p <0.001; p <0.001). Among 113 (62.8%) women who reported strong fear of MS, the chance of its performance was 35.71 (OR= 0.028; 95%CI: 0.02- 0.32) times decreased (p= 0.05). In a second model use of gynecological service ≤ each second year, increased chance of annual CBE performance 7.92 (95%CI: 3.25- 19.29) times (p <0.001). Women who used the community health facility performed annual and bi-annual CBE 2.90 (OR= 0.345; 95%CI: 0.14- 0.86) and 2.97 (OR= 0.337; 95%CI: 0.12- 0.92) times more often, compared to women who used the health center (p =0.030). CONCLUSIONS: Performance of MS and CBE varied both considerable among women who used different types of health service centers. Gynecological service use, fear and socioeconomic variables, additionally influenced regular performance of MS and CBE.

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Male HIV serodiscordant couples have diverse relationship agreements regarding sex outside the relationship. We examined the relationship agreements as described by 343 male HIV-negative partners in HIV serodiscordant relationships in Australia, Brazil and Thailand participating in a multi-year cohort study. At baseline, 125 (34.1%) HIV-negative partners reported no agreement, 115 (33.5%) had a monogamous agreement, and 103 (37.9%) had an open agreement allowing sex outside the relationship. Relationship agreements were largely stable over time, with 76% of HIV-negative men reporting the same agreement across follow up, while changes were predominantly towards having an open agreement. Behaviour largely matched relationship agreements, and the predictors of breaking an agreement by having condomless anal intercourse (CLAI) with an outside partner were CLAI within the relationship (OR = 3.17, 95%CI: 1.64-6.14, p < 0.001) and PrEP use in the last three months (OR = 3.42, 95%CI: 1.48-7.92, p = 0.004). When considering HIV transmission risk for HIV-negative men in serodiscordant relationships, greater focus needs to be placed on sex that is occurring outside the relationship and the agreements that facilitate this.

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OBJECTIVE: This study aimed to examine the efficacy of an integrated program (PIA-2) to reduce the risk for problems related to eating, weight and body image in female adolescents from Argentina. METHOD: A quasi-experimental study was conducted by comparing an experimental group versus a control group. The final sample included 509 girls aged 13-18 (M = 15.39 and SD = 1.30) from nine schools located in three geographical regions. They provided data at three assessment time points: baseline, post-intervention and a 3-month follow-up. Dependent variables included skipping breakfast, physical activity, eating disorder risk and thin-ideal internalization. The program was carried out in three 90-minute sessions within usual school hours, at 1-week intervals. RESULTS: Participants who received the intervention decreased more than the control group in skipping breakfast month by month. However, a significant effect of the intervention was not found on physical activity, eating disorder risk, and thin-ideal internalization. DISCUSSION: The presence of mixed findings shows the need to adjust the intervention to enhance the results. The importance of working jointly with other Latin American countries is emphasized, in order to promote the growth of the field of prevention, regarding cultural particularities shared by our societies. PUBLIC SIGNIFICANCE: Integrated programs aimed at reducing risk factors for the entire spectrum of problems related to eating, weight and body image could lead to beneficial and more efficient effects. However, their development is still incipient in Latin America. PIA-2 Program, designed for female adolescents, produced positive results in one of the four variables studied, decreasing the weekly frequency of skipping breakfast among adolescents. This is pioneering research in Argentina and the region since very few studies on integrated prevention have been published in Latin America. It is crucial to continue with efforts aimed at developing programs that are suited to the specific needs of the population of Latin American countries. In this aspect, our study is undoubtedly an important contribution.

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Coastal flood risk is expected to increase as a result of climate change effects, such as sea level rise, and socioeconomic growth. To support policymakers in making adaptation decisions, accurate flood risk assessments that account for the influence of complex adaptation processes on the developments of risks are essential. In this study, we integrate the dynamic adaptive behavior of homeowners within a flood risk modeling framework. Focusing on building-level adaptation and flood insurance, the agent-based model (DYNAMO) is benchmarked with empirical data for New York City, USA. The model simulates the National Flood Insurance Program (NFIP) and frequently proposed reforms to evaluate their effectiveness. The model is applied to a case study of Jamaica Bay, NY. Our results indicate that risk-based premiums can improve insurance penetration rates and the affordability of insurance compared to the baseline NFIP market structure. While a premium discount for disaster risk reduction incentivizes more homeowners to invest in dry-floodproofing measures, it does not significantly improve affordability. A low interest rate loan for financing risk-mitigation investments improves the uptake and affordability of dry-floodproofing measures. The benchmark and sensitivity analyses demonstrate how the behavioral component of our model matches empirical data and provides insights into the underlying theories and choices that autonomous agents make.

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This article analyzes the social and health challenges linked to sex work and the interventions carried out within this arena, taking into consideration the ways in which prostitution is socially marginalized. Basing our analysis on the experiences and understandings of sex workers practicing in the city of Oporto (Portugal), we attempt to understand the main forms of vulnerability faced by this group, along with the ways in which they experience the relationship with State services and social and health interventions that target them. Qualitative field research was conducted involving a case study of an intervention project. Data collection was carried out from March to June 2019, and included documentary research, participant observation, and semi-structured interviews with project staff and six sex workers. Among the results of our study, we found that sex workers are subject to severe constraints, limiting their use of informal support networks and their access to State social protection and healthcare services. Moreover, although the intervention project based on harm reduction intended to support these women and was indeed valued, it had a strong epidemiological prevention bias favoring an individualistic and assistentialist approach, while failing to address other social vulnerabilities identified by the women themselves.

Teniendo en cuenta las marginaciones que recaen sobre la prostitución, analizamos los retos sociales y sanitarios que subyacen al ejercicio del trabajo sexual y la intervención realizada en este ámbito. Partimos de las experiencias y entendimientos de trabajadoras sexuales que ejercen su actividad en la ciudad de Oporto (Portugal), en un intento de comprender cuáles son las principales vulnerabilidades a las que se enfrentan y cómo viven la relación con los servicios del Estado y con la intervención sociosanitaria dirigida a ellas. La investigación de campo siguió un enfoque cualitativo basado en un estudio de caso de un proyecto de intervención. La recolección de datos se llevó a cabo, entre los meses de marzo y junio de 2019, mediante investigación documental, ejercicios de observación participante y entrevistas semiestructuradas al personal técnico y a seis trabajadoras sexuales. Como resultado de esta investigación, se ha constatado que las trabajadoras del sexo están sometidas a graves restricciones que limitan su recurso a las redes de apoyo informales y su acceso a los dispositivos de protección del Estado en términos de apoyo social y atención sanitaria. Es más, el proyecto de intervención de reducción de riesgos que apoya a estas mujeres, aunque valorado, asume un fuerte sesgo de prevención epidemiológica y favorece un enfoque individualista y asistencialista, dejando al descubierto otras vulnerabilidades sociales identificadas por ellas mismas.

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As Peru is subject to large seismic movements owing to its geographic condition, determining seismic risk levels is a priority task for designing appropriate management plans. These actions become especially relevant when analyzing Pisco, a Peruvian city which has been heavily affected by various seismic events through the years. Hence, this project aims at estimating the associated seismic risk level and its previous requirements, such as hazard and vulnerability. To this end, a hybrid approach of machine learning (i.e., Random Forest) and hierarchical analysis (i.e., the Saaty matrix) was used. Risk levels were calculated through a double-entry table that establishes the relation between hazard and vulnerability levels. Results suggest that the city of Pisco exhibits both medium (lower city areas) and high (higher city areas) hazard levels in similar proportion. In addition, the coast area is considered a very-high hazard zone. Regarding vulnerability, the central area of the city exhibits a medium vulnerability level, whereas the periphery denotes high and very-high vulnerability levels. The interrelation of these components results in overall high-risk levels, with very-high levels in some central areas of the city. Finally, the results from this research study are expected to be useful for the authorities in charge of fostering specific activities in each sector and, simultaneously, as a motivator for future studies within this field.

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RESUMEN Objetivo Proponer una herramienta para identificar sectores de población que requieren mayor atención por parte de autoridades locales o gubernamentales en situaciones de crisis biológica, considerando los factores que influyen en la adherencia a las normas de minimización de riesgos. Metodología Se implementó un algoritmo de ordenamiento, tomando como referencia las restricciones de julio del 2021 en Ecuador. El contexto del estudio se resume en siete sectores urbanos de la ciudad de Guayaquil, con una población caracterizada por un nivel de educación promedio por debajo de la educación secundaria superior (70%) y más del 50% entre 20-34 años, con alguna ocupación en el medio de una economía popular debilitada. Siete factores de riesgo fueron identificados después de un análisis estructural de la hipótesis de adherencia (x2/gl=3,6; CFI≥0,91; TLI≥0,90; RMSEA≤0,05), basado en una muestra aleatoria de n=515 adultos viviendo en las áreas afectadas. Resultados El seguimiento de las normas está influenciado por la percepción del clima de seguridad, el riesgo percibido y el entendimiento del riesgo. El umbral de ordenamiento (h) permite establecer relaciones unidireccionales entre variables. Conclusiones Los resultados muestran que Vergeles, Norte y Fertisa representan los sectores con mayor prioridad de atención en materia de salud pública {A4,A5,A6}>{A2}>{A3}>{A1}>{A7}. Se requiere identificar más factores para garantizar una diferenciación óptima.

ABSTRACT Objective To propose a tool to identify local communities that require public health work priority, taking into account factors that influence adherence to risk minimization guidelines, especially in lock-down environments and unconventional workplaces. Methodology An ordering algorithm, based on the theory of uncertainty, was applied to classify population zones exhibiting high levels of infection and non-compliance with regulations in Guayaquil, during the last 'weekend' lockdown episode in July 2021. Seven urban sectors showed the highest number of infections (more than 70% of the local population): Vergeles (A1), Samanes (A2), Socio Vivienda (A3), Guasmo Norte (A4), Fertisa (A5), Alborada (A6), Urdesa (A7). Seven risk factors were identified after a path analysis of compliance hypothesis (x2/gl=3,6; CFI≥0,91; TLI≥0,90, RMSEA≤0,05), based on a random sample of n=515 adults living in the affected areas. Results Adherence to norms is influenced by the safety climate, perceived risk and risk understanding. The ordering threshold (h) leaded unidirectional relationships between variables. Conclusions: Adding more factors are believed to increases the differentiation path. The results showed that Vergeles, Norte and Fertisa were the areas with the highest priority for public health care {A4,A5,A6}>{A2}>{A3}>{A1}>{A7}.

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Resumo: O artigo analisa os impactos socioterritoriais provocados por desastres com barragens à luz da Vigilância Socioassistencial. Adotou-se o método qualitativo, por meio de análise documental e técnica, de cidades impactadas por desastres com barragens de mineradoras em Minas Gerais (Brasil). Concluiu-se que as condições objetivas de respostas no campo da Assistência Social estão aquém dos preceitos internacionais de Gestão Integral de Riscos e de Desastres (GIRD), destacando foco para o aprimoramento específico para uma gestão planejada e compartilhada de Redução de Riscos de Desastres (RRD).

Abstract: The article analyzes the socio-territorial impacts caused by disasters with dams in the light of Social Assistance Surveillance. We adopted the qualitative method based on documental and technical analysis of cities impacted by disasters with mining dams in Minas Gerais/BR. We concluded that the objective conditions of answers in the field of Social Assistance fall short of the international precepts of Disaster Risk Management (DRM), highlighting a focus for specific improvement for a planned and shared management of Disaster Risk Reduction (DRR).

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The multi-hazard vulnerability of Small Island Developing States in the Caribbean has underpinned the repeated saga of destructive natural and anthropogenic events that have disrupted land, livelihoods, the economy, and society over the past several decades. Preparedness and response have been the focus of national governments and regional entities and the repeated battering calls into question the concept of recovery and 'building back better'. This paper examines the concept of recovery and 'building back better' in the context of the Caribbean, paying particular attention to the experience of the selected countries of Antigua and Barbuda, the Bahamas, Dominica, Guyana, Jamaica, and Saint Vincent and the Grenadines. These nations have recently been impacted by different disasters, ranging from storms to earthquakes to volcanic eruptions. This paper also explores the similarities among the recommendations concerning recovery needs, presenting key insights into suggested approaches for an inclusive people-centred recovery process that 'builds back better'.

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Child-centred disaster risk reduction aims to reduce child vulnerability and increase resilience to disasters. The 2015 Comprehensive School Safety Framework (CSSF) sought to decrease hazard risks to education. Between 2015 and 2017, Dominica was struck by Tropical Storm Erika and Hurricane Maria, which significantly affected the education system at the local and national scales. Since Maria, a couple of national initiatives (Safer Schools and Smart Schools) have been introduced to increase resilience and meet the CSSF's objectives. This paper assesses progress made through a qualitative analysis of interviews with 29 school leaders, government officials, and disaster risk reduction stakeholders. Implementation of the climate resilience programme in 2018 resulted in nationwide teacher training and production of school disaster plans. Limited successes have improved social resilience, but short-term implementation due to COVID-19 and a lack of a teacher knowledge base have presented challenges to the scheme's long-term sustainability and the implementation of the CSSF's goals.

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Given the lack of an effective treatment for COVID-19, it is essential to explore the psychological variables involved in the development and maintenance of preventive behaviors during the current epidemic. In this study, we analyze the predictive value of perceived stress (measured with the Perceived Stress Scale) and coping styles (measured with the Extreme Risks Coping Scale) for adhering to infection prevention behavior in a sample of 1132 Mexican adults aged between 18 and 84. A logistic regression analysis showed that Active Coping and Cognition-Focused Coping, in addition to age and being a student, proved to be predictors of adhering to SARS COV2 preventive behaviors (R2 = 0.282). The findings from this study can be used to design strategies to promote potentially effective epidemic mitigation behaviors.

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ABSTRACT: Between 2015 and 2019, Brazil recorded the two most serious disasters involving mining dams of the 21st century. The purpose of this article is to offer an understanding of these disasters as systemic risks. They involve from global and national processes related to social determinants that materialize in a complex system of dams distributed throughout the country with their intrinsic risks. When they occur, result in a set of impacts with potential damage and immediate effects combined with secondary and tertiary impacts that can trigger chain reactions, which promote risk factors of heterogeneous and complex occurrence. Approaching these events from the point of view of systemic risk allows for a broader understanding of both the singularity of each of these disasters and their multiple exposure, risk and disease processes, as well as the structural characteristics in which social, political processes and dynamics and economic factors reproduce in multiple territories a common pattern of disasters and their effects. We conclude that the promotion of population health and sustainable territories should guide the organization of production processes and not the opposite, with the externalization of human, environmental and social costs of mining and its disasters.

RESUMO: Entre 2015 e 2019, o Brasil registrou os dois mais graves desastres envolvendo barragens de mineração do século XXI. O objetivo deste artigo é oferecer a compreensão desses desastres como riscos sistêmicos, que envolvem desde processos globais e nacionais relacionados aos determinantes sociais que se concretizam em um complexo sistema de barragens distribuídas pelo País com seus riscos intrínsecos. Quando ocorrem, resultam em um conjunto de impactos com potencial de danos e efeitos imediatos combinados com impactos secundários e terciários que podem desencadear reações em cadeia, promovendo fatores de riscos de ocorrência heterogênea e complexa. Abordar esses eventos com base no conceito de risco sistêmico permite uma compreensão mais ampla tanto da singularidade de cada um desses desastres e seus múltiplos processos de exposição, riscos e doenças, como também das características estruturais com que os processos e dinâmicas sociais, políticas e econômicas reproduzem, em múltiplos territórios, um padrão comum de desastres e seus efeitos. Concluímos que a promoção da saúde da população e de territórios sustentáveis deve orientar a organização dos processos produtivos e não o contrário, com a externalização dos custos humanos, ambientais e sociais da mineração e seus desastres.

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Resumen La Tomografía Computarizada de Haz Cónico (CBCT) representa una promisoria herramienta para la clínica odontológica. En Endodoncia, CBCT ofrece tridimensionalidad y resolución imagenológica, potenciando el diagnóstico de diferentes condiciones patológicas. Sin embargo, su limitación por sobreexposición a radiación, ha llevado a directrices que recomiendan cautela para su indicación. Se presenta un caso infrecuente de un molar mandibular con una sola raíz y canal, y las circunstancias de uso de CBCT. Mujer de 48 años es derivada para endodoncia del primer molar mandibular izquierdo permanente. El examen radiográfico preoperatorio demostró el hallazgo inusual de un canal centrado en una única raíz. Con la información apropiada y el consentimiento de la paciente, la indicación de CBCT favoreció su diagnóstico y tratamiento. CBCT no debería ser utilizada rutinariamente para estos fines, pero podría justificarse en casos "fronterizos". Se discuten su indicación e implementación clínica, siguiendo actuales recomendaciones y directrices.

Resumo A tomografia computadorizada de feixe cônico (TCFC) representa uma ferramenta promissora para a clínica odontológica. Na Endodontia, a CBCT oferece tridimensionalidade e resolução de imagem, potencializando o diagnóstico de diferentes condições patológicas. No entanto, sua limitação devido à superexposição à radiação levou a diretrizes que recomendam cautela em sua indicação. Um caso raro de um molar inferior com uma única raiz e canal é apresentado e as circunstâncias do uso da TCFC. Uma mulher de 48 anos é encaminhada para tratamento de canal para o primeiro molar inferior esquerdo permanente. O exame radiográfico pré-operatório demonstrou o achado incomum de um canal centrado em uma única raiz. Com as devidas informações e o consentimento do paciente, a indicação da TCFC favoreceu seu diagnóstico e tratamento. A CBCT não deve ser usada rotineiramente para esses fins, mas pode ser justificada em casos "fronteiriços". Sua indicação e implementação clínica são discutidas, seguindo as recomendações e diretrizes atuais.

Abstract Cone-beam computed tomography (CBCT) is a promising tool in dental practice. CBCT provides three-dimensional images and imaging resolution to be used in endodontics. This enhances the diagnosis of various pathologies. However, guidelines have recommended limiting its use due to overexposure to radiation. This article presents the rare case of a mandibular molar with a single root and canal that benefited from taking a CBCT. A 48-year-old woman is referred for endodontic treatment of the permanent left mandibular first molar. The preoperative radiographic examination showed an unusual canal centered along a single root. Taking a CBCT with the relevant information and the patient's consent improved her diagnosis and treatment. CBCTs should not be used routinely for these purposes but could be justified in "borderline" cases. This paper discusses its indication and clinical implementation following current recommendations and guidelines.

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RESUMEN Teniendo en cuenta las marginaciones que recaen sobre la prostitución, analizamos los retos sociales y sanitarios que subyacen al ejercicio del trabajo sexual y la intervención realizada en este ámbito. Partimos de las experiencias y entendimientos de trabajadoras sexuales que ejercen su actividad en la ciudad de Oporto (Portugal), en un intento de comprender cuáles son las principales vulnerabilidades a las que se enfrentan y cómo viven la relación con los servicios del Estado y con la intervención sociosanitaria dirigida a ellas. La investigación de campo siguió un enfoque cualitativo basado en un estudio de caso de un proyecto de intervención. La recolección de datos se llevó a cabo, entre los meses de marzo y junio de 2019, mediante investigación documental, ejercicios de observación participante y entrevistas semiestructuradas al personal técnico y a seis trabajadoras sexuales. Como resultado de esta investigación, se ha constatado que las trabajadoras del sexo están sometidas a graves restricciones que limitan su recurso a las redes de apoyo informales y su acceso a los dispositivos de protección del Estado en términos de apoyo social y atención sanitaria. Es más, el proyecto de intervención de reducción de riesgos que apoya a estas mujeres, aunque valorado, asume un fuerte sesgo de prevención epidemiológica y favorece un enfoque individualista y asistencialista, dejando al descubierto otras vulnerabilidades sociales identificadas por ellas mismas.

ABSTRACT This article analyzes the social and health challenges linked to sex work and the interventions carried out within this arena, taking into consideration the ways in which prostitution is socially marginalized. Basing our analysis on the experiences and understandings of sex workers practicing in the city of Oporto (Portugal), we attempt to understand the main forms of vulnerability faced by this group, along with the ways in which they experience the relationship with State services and social and health interventions that target them. Qualitative field research was conducted involving a case study of an intervention project. Data collection was carried out from March to June 2019, and included documentary research, participant observation, and semi-structured interviews with project staff and six sex workers. Among the results of our study, we found that sex workers are subject to severe constraints, limiting their use of informal support networks and their access to State social protection and healthcare services. Moreover, although the intervention project based on harm reduction intended to support these women and was indeed valued, it had a strong epidemiological prevention bias favoring an individualistic and assistentialist approach, while failing to address other social vulnerabilities identified by the women themselves.

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BACKGROUND: Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients' individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to better discrimination of patients in need of invasive diagnostic procedures and optimized allocation of health care resources. OBJECTIVE: The goal of the research was to systematically review available literature on the performance of current prostate cancer risk calculators in healthy populations by comparing the relative impact of individual items on different cohorts and on the models' overall performance. METHODS: We performed a systematic review of available prostate cancer risk calculators targeted at healthy populations. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese, or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, analyzed calculators, population for which it was calibrated, included risk factors, and the model's overall accuracy. RESULTS: We included a total of 18 calculators from 53 different manuscripts. The most commonly analyzed ones were the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study on Prostate Cancer (ERSPC) risk calculators developed from North American and European cohorts, respectively. Both calculators provided high diagnostic ability of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations that reached a diagnostic ability as high as 0.938. The most commonly included risk factors in the calculators were age, prostate specific antigen levels, and digital rectal examination findings. Additional calculators included race and detailed personal and family history. CONCLUSIONS: Both the PCPR and ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic ability. Furthermore, designing calculators from scratch considering each population's sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which has been calibrated for its intended population and can be easily reproduced and implemented. TRIAL REGISTRATION: PROSPERO CRD42021242110; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242110.

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Abstract The SHAHRP program was effective reducing drinking and alcohol - harms in Australia, but cross-cultural adaptation is required before replication. This study aimed at assessing the feasibility of SHAHRP in Brazil focused on implementation and acceptability. A mixed-methodsdesign was used: quantitative for implementing the program and evaluation and qualitative for acceptability. The quantitative design was a pilot of a randomized controlled trial. Private schools were randomly divided into four intervention (n=160) and four control (n=188) schools. Student's mean age was 12.7 years. The fidelity of implementation and likely outcome measures were assessed. Qualitative data on acceptability were provided by students and teachers. The percentage of implementation varied from 62.5% to 87.5%. Behaviours such as alcohol-harms requires a larger cohort and longer follow-up to be adequately evaluated. The risk reduction approach and activities had good acceptability from students and teachers. Quantitative and qualitative outcomes on knowledge and decision-making indicated possible improvement in SHAHRP schools. The program is feasible and well accepted in a Brazilian setting, opening the way for a more comprehensive evaluation and dissemination.

Resumo O programa SHAHRP foi eficaz na Austrália, mas precisa de adaptação transcultural para replicação em outro país. Este estudo teve como objetivo avaliar a viabilidade do SHAHRP no Brasil com base na sua implementação e aceitação. Utilizou-se métodos mistos: quantitativo para a implementação do programa e da avaliação e qualitativo para aceitação. O desenho quantitativo foi o piloto de um estudo clínico randomizado. Participaram escolas particulares: quatro intervenções (n = 160) e quatro controles (n = 188). Os alunos tinham 12,7 anos em média. A fidelidade da implementação e possíveis medidas de resultados foram avaliadas. Os dados qualitativos sobre aceitação foram relatados por alunos e professores. A fidelidade de implementação variou de 62,5% a 87,5%. Comportamentos como danos causados ​​pelo uso de álcool precisam de uma amostra maior e de mais tempo para avaliação. A abordagem de redução de riscos e as atividades do programa foram bem aceitas por alunos e professores. Os resultados quantitativos e qualitativos sobre conhecimento e tomada de decisão indicaram possível melhora nas escolas-intervenção. O programa é viável e bem aceito no cenário brasileiro, abrindo caminho para avaliação e disseminação mais abrangentes.

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The use of undetectable viral load (VL) to negotiate condomless anal intercourse (CLAI) in HIV serodiscordant male relationships has become more common as more data regarding the effectiveness of antiretroviral treatments for the prevention of HIV transmission has been described. We examined viral load agreements (VLAs) for condomless sex in the presence of an undetectable VL in 343 HIV serodiscordant male couples in Australia, Brazil and Thailand. Factors associated with having a VLA included having agreements for the HIV-positive partner to report his VL result (p < 0.001), agreeing that VL affects agreements about sexual practice (p < 0.001), the HIV-negative partner's perception of his partner's undetectable VL (p < 0.001), the couple's belief in the efficacy of undetectable VL in preventing HIV transmission (p < 0.001), and the couple engaging in CLAI with each other (p < 0.001). Over time, these agreements became more common although 49.3% of couples in the sample never had a viral load agreement. As these agreements become more common, further education is required to support male couples in using them safely.

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