Corpos em Disputa: Experiências de Travestis e Mulheres Trans no Acesso aos Banheiros Públicos / Disputing bodies: Experiences of Transvestites and Trans Women in Accessing Public Restrooms / Cuerpos en Disputa: Experiencias de Travestis y Mujeres Trans en el Acceso a Baños públicos

Trata-se de um estudo qualitativo e exploratório que objetiva refletir sobre experiências de travestis e mulheres trans na utilização de banheiros públicos. Utilizamo-nos dos pressupostos da pesquisa documental para a produção de dados. Para tal, consideramos o conteúdo, comentários e curtidas do vídeo intitulado "Uma mulher trans deve frequentar o banheiro feminino?", disponível na plataforma Facebook. Tomamos como lente orientadora de todo o processo interpretativo a análise do discurso. Evidenciamos alguns pontos centrais para debate: a estruturação de um sistema de classificação social que posiciona travestis e mulheres trans em categorias de periculosidade; a relação profícua estabelecida entre os sistemas de categorização e classificação social e as categorias de gênero e sexualidade enquanto organizadores da vida cotidiana e dos espaços sociais; a manutenção dos discursos que asseguram a lógica dicotômica binária e, consequentemente, a patologização das experiências de travestilidade e transexualidade; e a articulação política como estratégia que assegura, nos processos de espacialização, a superação de dinâmicas que naturalizam violências legitimadoras de interdições e segregações. Por fim, observamos como ponto de convergência de todas as análises realizadas as estratégias de manutenção da vida de travestis e mulheres trans, através da desestabilização de sistemas de opressão.

This is a qualitative and exploratory study that aims to reflect about the experiences of transvestites, transsexuals and transgender people when using public bathrooms. We used the assumptions of documental research as a way of data production. To this end, we considered the content, comments and likes of the video entitled "Uma mulher trans deve frequentar o banheiro feminino?", available on the Facebook platform. We took the discourse analysis as a guiding lens of the entire interpretive process. We pointed some central points for the debate: the structuring of a social classification system which places transvestites and trans women in dangerous categories; the fruitful relation established between the social categorization and classification systems and the gender and sexuality categories as organizers of the everyday life and the social spaces; the maintenance of discourses that ensure the binary dichotomous logic and, consequently, the pathologization of experiences of travestility and transsexuality; and the political articulation as a strategy which ensures, in spatialization processes, the overcoming of dynamics which naturalize violence that legitimizes interdictions and segregations. Finally, we observe as a point of convergence of all the analysis carried out the strategies for maintaining the life of transvestites and trans women people, through the destabilization of systems of oppression.

Este es un estudio cualitativo y exploratorio que tiene como objetivo reflexionar sobre las experiencias de travestis, transexuales y personas transgénero en el uso de baños públicos. Usamos los supuestos de la Investigación Documental para producir datos. Para ello, se consideró el contenido, comentarios y me gustas del video "Uma mulher trans deve frequentar o banheiro feminino?", de Facebook. El Análisis del Discurso fue una guía para el proceso interpretativo. Evidenciamos en el análisis que estas discusiones permean algunos debates centrales, tales como: El sistema de clasificación social, posicionando a travestis y mujeres trans en categorías peligrosas; Se establece una fructífera relación entre los sistemas de categorización y clasificación social vinculados a las cuestiones de género y sexualidad como organizadores de la vida cotidiana y de los espacios sociales; Mantenimiento de discursos que aseguren la lógica binaria y, en consecuencia, patologización de las experiencias de travestilidad y transexualidad; y la articulación política como estrategias que asegura los procesos de espacialidad, dinámicas de naturalización de las violencias que legitiman interdicciones y segregaciones. Se observó como punto de convergencia entre estos análisis realizados las estrategias de mantenimiento de la vida de travestis y mujeres trans, a través de la desestabilización de los sistemas de opresión.

Effectiveness of community and school-based sanitation interventions in improving latrine coverage: a systematic review and meta-analysis of randomized controlled interventions

INTRODUCTION@#Approximately 1000 children die each year due to preventable water and sanitation-related diarrheal diseases. Six in 10 people lacked access to safely managed sanitation facilities in 2015. Numerous community- and school-based approaches have been implemented to eradicate open defecation practices, promote latrine ownership, improve situation sanitation, and reduce waterborne disease.@*OBJECTIVE@#Given that current evidence for sanitation interventions seem promising, the aim of this study was to systematically summarize existing research on the effectiveness of community- and school-based randomized controlled sanitation intervention in improving (1) free open defecation (safe feces disposal), (2) latrine usage, (3) latrine coverage or access, and (4) improved latrine coverage or access.@*METHODS@#Eight electronic databases were searched: PubMed, Scopus, WHO Global Health Library (GHL), Virtual Health Library (VHL), POPLINE, Web of Science, Cochrane, and Google Scholar up to 26 April 2019. Original randomized clinical trials addressing community-based or school-based intervention that reported feces disposal and latrine coverage were deemed eligible. More than two researchers independently contributed to screening of papers, data extraction, and bias assessment. We conducted a meta-analysis by random-effects model. The risk of bias was assessed by the Cochrane risk of bias tool.@*RESULTS@#Eighteen papers that matched all criteria and 16 studies were included in the final meta-analysis. Compared to the control, the sanitation intervention significantly increased safe feces disposal (OR 2.19, 95% CI 1.51-3.19, p < 0.05, I@*CONCLUSION@#Our study showed strong evidence for both community- and school-based sanitation interventions as effective for the safe disposal of human excreta. The finding suggests major implications for health policy and design of future intervention in developing countries.

O binarismo de gênero nas placas de banheiros em espaços públicos / Binarismo de género en las placas de baño en espacios públicos / Gender binarism on bathroom boards in public spaces

Resumo Este artigo propõe reflexões críticas acerca do binarismo masculino/feminino presente na arquitetura e nas placas identificatórias dos banheiros presentes em espaços públicos. Partindo de um referencial pós-estruturalista das teorias de gênero e diversidade sexual, tomamos como corpo de análise as placas dos banheiros que, por meio de palavras, símbolos e imagens, separam esses espaços, tendo como critério exclusivo o sexo designado ao nascimento e não à identidade autodeclarada de gênero. Nesse contexto, a ambiguidade e a fluidez presentes em corpos trans atuam como significativos elementos de denúncia dos limites normativos da classificação dos banheiros, colocando em xeque territórios legitimados socialmente como masculinos e femininos. Assim, as placas são consideradas como analisadores institucionais, pois desvelam a disputa entre forças instituintes e forças instituídas, a qual mostra que, apesar das normativas legais brasileiras, a institucionalização do reconhecimento das diversas formas de ser homem e de ser mulher ainda é objeto de tensão.

Resumen Este artículo propone reflexiones críticas sobre el binarismo masculino/femenino presente en la arquitectura y sobre las placas de los baños presentes en los espacios públicos. Partiendo de un referencial postestructuralista de teorías de género y diversidad sexual, tomamos como cuerpo de análisis las placas de los baños que, a través de palabras, símbolos e imágenes, separan estos espacios, teniendo como criterio exclusivo el sexo designado al nacer y no la identidad de género auto declarada. En este contexto, la ambigüedad y la fluidez presentes en los cuerpos trans actúan como elementos significativos de denuncia de los límites normativos de la clasificación de los baños, poniendo en jaque territorios socialmente legitimados como masculinos y femeninos. Así, las placas son consideradas como analizadores institucionales, pues revelan la disputa entre fuerzas instituyentes y fuerzas instituidas, lo que muestra que, a pesar de las normas legales brasileñas, la institucionalización del reconocimiento de las diversas formas de ser hombre y de ser mujer sigue siendo objeto de tensión.

Abstract This article proposes critical reflections on the male/female binarism present in the architecture and in the identification boards of the bathrooms in public spaces. Based on a post-structuralist framework of the theories of gender and sexual diversity, we take as body of analysis the bathroom signs that, through words, symbols and images, separate these spaces having as exclusive criterion the designated sex at birth and not the self-declared gender identity. In this context, the ambiguity and fluidity present in trans bodies act as significant elements of denunciation of the normative limits of the classification of bathrooms, putting in question socially legitimized territories as male and female. Thus, the signs are considered as institutional analyzers, because they reveal the dispute of the instituting forces and the instituted forces, which shows that, despite the Brazilian legal norms, the institutionalization of the recognition of the various forms of being a man and being a woman is still object of tension.

Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Objective To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. Methods Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. Findings: A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. Conclusion :The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.

Objectif Déterminer si une intervention au niveau de l'eau, de l'assainissement et de l'hygiène pourrait avoir une influence sur les comportements en la matière, considérés comme importants dans la lutte contre le trachome. Méthodes Nous avons mené un essai randomisé par grappes dans les régions rurales d'Éthiopie entre le 9 novembre 2015 et le 5 mars 2019. Nous avons réparti aléatoirement 20 échantillons où l'intervention consistait à développer les infrastructures d'assainissement et d'approvisionnement en eau et à promouvoir l'hygiène, et 20 échantillons n'ayant fait l'objet d'aucune intervention. Tous les échantillons du groupe d'intervention ont suivi une formation sur l'hygiène à l'école primaire, disposaient d'un point d'eau communautaire, d'un poste de lavage par ménage, de savon à domicile, et recevaient des visites de la part de travailleurs chargés d'enseigner les bonnes pratiques en matière d'hygiène. Nous avons évalué le niveau d'observance des mesures en effectuant des enquêtes annuelles au sein des foyers. Résultats En l'espace de 3 ans, le nombre de postes de lavage, de savons et de latrines dans les ménages a davantage augmenté dans le groupe d'intervention que dans le groupe de contrôle: la différence de risque s'élevait à 47 points de pourcentage (intervalle de confiance de 95%, IC: 41­53) pour les postes de lavage, à 18 points de pourcentage (IC de 95%: 12­24) pour le savon et à 12 points de pourcentage (IC de 95%: 5­19) pour les latrines. La proportion de gens déclarant se laver le visage au savon était plus grande dans le groupe d'intervention (différence de risque de 21 points de pourcentage; IC de 95%: 15­27 pour les enfants de 0 à 5 ans), tout comme celle mentionnant l'usage de latrines (différence de risque de 9 points de pourcentage; IC de 95%: 2­15 pour les enfants de 6 à 9 ans). Pour de multiples indicateurs, il a fallu attendre minimum un an après l'instauration du programme pour que les variations observées entre les groupes d'intervention et de contrôle deviennent statistiquement significatives; ces variations se sont ensuite maintenues lors des visites ultérieures. Conclusion Intervenir à l'école et au sein de la communauté a permis d'améliorer l'accès à l'hygiène et les comportements en la matière. Néanmoins, cette évolution prend du temps et plusieurs années d'intervention sont nécessaires.

Screening for intestinal parasites in adults from three different regions of Colombia / Tamizaje de parásitos intestinales en adultos de tres regiones de Colombia

Intestinal parasitosis (IP) is a public health problem in developing countries affecting one fourth of the global population. IP are common studied in children, ne glecting the adults that are also at high risk and source of transmission. A screening study was performed with a convenience sample in three Colombian regions: Guachené (Cauca), Quibdó (Chocó), and Urabá (Antioquia). Feces samples from 284 volunteers (older than 18 years old) were tested by microscopy to identify para site ova and cysts. The IP frequency was 14.5%, and 52.1% were males. 63.2% of the parasitized patients exhibited diarrhea, and/or abdominal pain with significant association. 39.5% had single parasitic infection and 60.5% had multiple parasites: Blastocystis hominis (63.9%), Entamoeba hystolitica/dispar (39.4%), Endolimax nana (33.3%), Ascaris lumbricoides (22.2%), Giardia lamblia (19.4%), Entamoeba coli (13.9%), Trichuris trichiura (11.1%), hookworm species (11.1%), Strongyloides stercolaris (5.6%), and Iodamoeba butschlii (2.8%). A multivariate approach was used to determine predictor factors for IP: male gender, rainwater as drinking sour ce, and feces disposal different to toilet, latrine or septic tank were positively associated with infection. This study evidences that adult population, not only children from vulnerable areas of Colombia, must have to include as a risk for intestinal parasitism.

La parasitosis intestinal (PI) es un problema de salud pública en países en desarrollo que afecta un cuarto de la población mundial. Las PI son comúnmente estudia das en niños, olvidando que los adultos están también en riesgo y a su vez pueden ser fuentes de transmisión. Se realizó un estudio de tamizaje con una muestra escogida por conveniencia en tres regiones de Colombia: Guachené (Cauca), Quibdó (Chocó) y Urabá (Antioquia). Las muestras de materia fecal de 284 voluntarios mayores de 18 años, fueron estudiadas por microscopía para identificar parásitos, huevos y quistes. La frecuencia de las PI fue del 14.5%, 52.1% de los positivos fueron hombres. 63.2% de los individuos parasitados tenían asociación significativa con diarrea, y/o dolor abdominal. 39.5% tuvieron infección por un solo parásito y 60.5% fueron positivos para varios parásitos: Blastocystis hominis (63.9%), Entamoeba hystolitica/dispar (39.4%), Endolimax nana (33.3%), Ascaris lumbricoides (22.2%), Giardia lamblia (19.4%), Entamoeba coli (13.9%), Trichuris trichiura (11.1%), Strongyloides stercolaris (5.6%), y Iodamoeba butschlii (2.8%). Se realizó un aná lisis multivariado para determinar factores predictores para PI: el género masculino, el agua lluvia para consumo, y la disposición de excretas diferente a sanitario, letrina o pozo séptico, están asociados positivamente a la PI. Este estudio evidencia que la población adulta, no solo la infantil, residentes en áreas vulnerables de Colombia, deben incluirse como población de riesgo al parasitismo intestinal.

Discovery of Eurytrema Eggs in Sediment from a Colonial Period Latrine in Taiwan

In this study we take a closer look at the diseases that afflicted Japanese police officers who were stationed in a remote mountainous region of Taiwan from 1921 to 1944. Samples were taken from the latrine at the Huabanuo police outpost, and analyzed for the eggs of intestinal parasites, using microscopy and ELISA. The eggs of Eurytrema sp., (possibly E. pancreaticum), whipworm and roundworm were shown to be present. True infection with Eurytrema would indicate that the policemen ate uncooked grasshoppers and crickets infected with the parasite. However, false parasitism might also occur if the policemen ate the uncooked intestines of infected cattle, and the Eurytrema eggs passed through the human intestines. These findings provide an insight into the diet and health of the Japanese colonists in Taiwan nearly a century ago.

Intestinal Parasites in an Ottoman Period Latrine from Acre (Israel) Dating to the Early 1800s CE

The aim of this study is to determine the species of parasites that affected the inhabitants of the city of Acre on the coast of the eastern Mediterranean during the Ottoman Period. This is the first archaeological study of parasites in the Ottoman Empire. We analysed sediment from a latrine dating to the early 1800s for the presence of helminth eggs and protozoan parasites which caused dysentery. The samples were examined using light microscopy and enzyme-linked immunosorbent assay (ELISA) kits. We found evidence for roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), fish tapeworm (Dibothriocephalus sp.), Taenia tapeworm (Taenia sp.), lancet liver fluke (Dicrocoelium dendriticum), and the protozoa Giardia duodenalis and Entamoeba histolytica. The parasite taxa recovered demonstrate the breadth of species present in this coastal city. We consider the effect of Ottoman Period diet, culture, trade and sanitation upon risk of parasitism in this community living 200 years ago.

O ambiente domiciliar e seus riscos para quedas em idosos: uma revisão integrativa da literatura / The home environment and its risks for falls in the elderly: an integrative literature review / El entorno del hogar y sus riesgos para caídas en ancianos: una revisión bibliográfica integradora

O objetivo deste estudo foi identificar os fatores de risco associados à queda de idosos em ambiente domiciliar, por meio de uma revisão integrativa, realizada nas bases de dados LILACS, MEDLINE e BDENF, no período de 2007 a 2017. Entre os fatores de risco para a queda de idosos estão: idade, utilização de medicamentos, desempenhar determinadas atividades cotidianas de vida, dentre as mais notadas: ao levantar-se da cama, subir escadas, tomar banho, presença de tapetes sem antiderrapante com ausência de barra no banheiro, e acesso difícil ao interruptor de luz, o que acaba facilitando a queda aos idosos. Diante dos resultados desta pesquisa, existe a necessidade de mais pesquisas nesta temática para, então, ampliar-se o desenvolvimento de ações preventivas e de promoção à saúde em idosos.

The objective of this study was to identify the risk factors associated with the fall of the elderly in the home environment, through an integrative review, performed in the LILACS, MEDLINE and BDENF databases, from 2007 to 2017. Among the factors of risk for the fall of the elderly are: age, use of medicines, performing certain daily activities of life, among the most noteworthy: when getting out of bed, climbing stairs, taking a bath, the presence of non-slip mats with no bar in the bathroom, and difficult access to the light switch, which makes the fall easier for the elderly. Given the results of this research, there is a need for further research on this subject to expand the development of preventive actions and health promotion in the elderly.

El objetivo de este estudio fue identificar los factores de riesgo asociados con la caída de los ancianos en el entorno del hogar, a través de una revisión integradora, realizada en las bases de datos LILACS, MEDLINE y BDENF, de 2007 a 2017. Entre los factores de Los riesgos para la caída de los ancianos son: edad, uso de medicamentos, realizar ciertas actividades diarias de la vida, entre los más notables: al levantarse de la cama, subir escaleras, bañarse, la presencia de tapetes antideslizantes sin barra en el baño y difícil acceso al interruptor de la luz, lo que facilita la caída de los ancianos. Dados los resultados de esta investigación, es necesario realizar más investigaciones sobre este tema para ampliar el desarrollo de acciones preventivas y la promoción de la salud en los ancianos.

Community-based surveillance of Cryptosporidium in the indigenous community of Boliwong, Philippines: from April to December 2017 / 한국역학회지

OBJECTIVES: For the first time, Boliwong, an indigenous community in the Philippines, was surveyed for the prevalence of Cryptosporidium from April to December 2017.METHODS: Cryptosporidium oocysts were detected in samples from the river, creek, and water pumps via immunomagnetic separation techniques, and from human and animal concentrated faecal samples using the modified Ziehl-Neelsen technique.RESULTS: Seven of the 24 water samples (29.2%) were positive for Cryptosporidium, with the highest concentration (0.8 oocyst/L) detected in the creek. Of 35 fecal samples from different animal groups, 8 (21.6%) were positive for Cryptosporidium oocysts. The highest intensity of oocyst shedding was detected in dogs (χ2=8.00). Of the 137 human fecal samples, 39 (28.5%) were infected with Cryptosporidium. In this study, 3 risk factors were found to be associated with infection: (1) location (crude odds ratio [cOR], 16.39; 95% confidence interval [CI], 2.11 to 127.41; p=0.008), (2) drinking water from the natural spring (cOR, 0.29; 95% CI, 0.11 to 0.82; p<0.05), and (3) using an open pit as a sanitary toilet facility (cOR, 2.44; 95% CI, 1.14 to 5.20; p<0.05). When the cOR was adjusted, using an open pit as a sanitary toilet facility remained a significant risk factor of infection (adjusted OR, 0.41; 95% CI, 0.19 to 0.90; p<0.05).CONCLUSIONS: There is a potentially emerging Cryptosporidium zoonosis in Boliwong, Lagawe, Philippines. It is recommended that the toilet facilities and the water system in the community be rehabilitated to avoid any possible disease outbreak. Health education is also needed in the community to maintain proper hygiene and sanitation practices.