VIVENDO ENTRE A SEGURANÇA E O RISCO: IMPLICAÇÕES À SAÚDE DO POLICIAL MILITAR

This is a descriptive and exploratory study conducted in the first half of 2012 with 12 military police officers from a Military Police Brigade in a capital of southern Brazil, which aimed to investigate occupational hazards from the point of view of workers. Data was collected through interviews and analyzed by means of thematic analysis. The study complied with Resolution 466/12 of the National Health Council. Physical violence, disease transmission by contact with blood, and accidents were the main risks identified. Most of the participants reported wearing personal protective equipment to protect their health. The subjects perceive that their job interferes negatively with their personal life, and greater satisfaction with the activity involves the community’s acknowledgement for the services provided. Co-management of everyday problems and ongoing health education can be protagonism alternatives that may contribute to prevention of diseases and promotion of military police officers’ health.


INTRODUCTION
The job of civil police officers within the public security context is generally seen from a technical point of view only, disregarding the police officer himself/herself (1) , who is constantly exposed to physical and mental violence. In addition, prescriptions, punishments and rewards, organizational characteristics of this job which is founded on hierarchy and discipline, "directly affect performance, the relationships established between police officers, and, more broadly, the principles that should guide their conduct, even when outside their work environment" (2:365) , all of which can be configured as stress factors for involving mild to severe disciplinary sanctions.
According to a study conducted in Rio de Janeiro, police corporations are known for the heavy workload and suffering imposed on their employees, resulting in physical and mental exhaustion (3) . International studies show that policing activities are associated with sleep disorders, leading to dangerous vehicle driving, feelings of uncontrolled anger, administrative errors, security violation attributed to fatigue and absenteeism (4) ; moreover, chronic exposure to human tragedy may put police officers at risk, especially for mental health disorders such as stress, as well as a potential risk for alcohol or drug abuse (5) .
In this context, it is worth reflecting on data pointed in a study which evaluated the quality of life of civil police officers. For difficulties of comparison with other studies on the theme involving police officers, due to lack of research, a comparison with other distinct groups was made, in age, socio-economic and cultural terms, and observed that the police officers presented better quality of life with regard to physical and psychological domains than the groups of elderly and depressed patients studied. However, these security agents showed conditions worse than those of elderly individuals from lowincome communities and depressed patients concerning social relationships and environment, which reflects the difficulties they have in interpersonal relationships (1) .
Deficiencies in the training process can be found as well, considering that training programs do not qualify public security professionals to interact according to the expectations of a democratic society in which the police officer must be proactive, basing his/her performance on problem solving; besides, training programs lack theoretical frameworks, which causes graduates to feel insecure to act efficiently in police service (6) .
In light of this, it is believed that the Military Police Officer [Policial Militar] (PM) belongs to a vulnerable professional category when it comes to risks to his/her physical and mental integrity (2) , with the latter being associated with work organization. Societies have historically labeled said professionals as heroes or villains, which generates discomfort in these subjects; however, there are initiatives intended to change this cultural perspective, to transform the concept of an organization with an image of aggressiveness and repression into one that makes itself available for serving the community, having a more preventive and educational character (8) .
This study is relevant for showing the power of investigations focusing on the perspective of those who do the job, considering their importance as protagonists of their activity. The worker is empowered as he/she participates in the risk identification process and in the comanagement of the transformation of this routine, because in the day-to-day work risks materialize in their bodies, either through work accidents or occupational diseases (7) . This raises the following question: to what occupational hazards are Military Police Officers exposed, according to their own perception?
This research is also justified for intending to build knowledge capable of promoting the occupational health of workers from these organizations. It is understood that enriching the theoretical and practical framework from a critical and reflective perspective of work environments, their structure and organization adds value to the field of knowledge involving Occupational Health Nursing and/or Worker's Health.
The aim of this study was to investigate exposure to occupational hazards in the activity of Military police officers from their own viewpoint.

METHODOLOGY
This is an exploratory and descriptive study of qualitative approach. Data  Soldiers were chosen for hierarchically working under subordination and being in charge of guaranteeing compliance with and completion of the job prescribed. It is believed that the military work organization based on discipline, hierarchy and subordination contains dissatisfactions about working methods and conditions. Information was voice recorded and then transcribed and analyzed according to the thematic analysis methodology (9) , respecting the level of language of the interviewes. The material was pre-analyzed, analyzed and treated through comparison with the available literature. Semantic categorization was employed (9) . The analysis of the material resulted in the following categories: Faces and Interfaces of the Military Police Officers' (dis)satisfaction with the job; Occupational hazards and diseases caused by the Military Police's activity; Aggravation prevention and health promotion.
The research participants were asked to sign an Informed Consent Form. They were identified with the letter E followed by Arabic numerals. The study complied with all precepts of Resolution 466/12, which regulates research involving human beings, and was approved by the Ethics Committee of the Regional Integrated University of Upper Uruguai and Missions [Universidade Regional Integrada do Alto Uruguai e das Missões] under Protocol No. 134-4/PPH / 11. The Captain of the institution was requested permission for the study.

CHARACTERIZATION OF SUBJECTS
The study included 12 Military Police Officers aged between 22 and 25 years old, from a universe of 30. All were invited, but some declined to participate for undisclosed reasons. Among the interviewees, 75% had been working for 2 years and 5 months, which corresponds to the time passed since the last Basic Course for Military Police Training.

FACES AND INTERFACES OF THE POLICE OFFICERS' (DIS)SATISFACTION WITH THE JOB
More than half of the subjects reported job dissatisfaction, whose reasons encompass social and organizational gaps involving the activity, such as large increase in crime, justice flaws, some misunderstanding by the community as to deficiencies in meeting demands, lack of equipment, professional devaluation and work overload, and even disregard off duty lists.
[…] when you think it is your day off, they tell you to come to work; you do not have a fixed roster […] (E2) Lack of resources such as uniforms, vehicles in inadequate conditions, poor training courses and high exposure to risks whether during working hours or breaks, coupled with low wages and 'tight' rosters with few days off, were mentioned in a study conducted in Rio de Janeiro as dissatisfaction factors for these professionals (10) . Among the occupational characteristics shown in an epidemiological study, excessive workload was pointed. About four out of ten workers reported not having even a weekly day off (11) .
The relationships with the supervisory board, for most of the subjects, were also considered unsatisfactory. They associated the hierarchy imposed by the nature of the job as an obstacle.
Not so good, because most of the times we do not have much affinity, we are not very close to the command; it is more like a matter of hierarchy and discipline. (E4) The soldiers work under permanent disciplinary supervision and always have their job inspected. A good relationship with their superiors becomes very important to ensure institutional recognition, and, when it comes to contributions to the job, the type of recognition that seems to be more meaningful for captains, hierarchically superior to soldiers, is that coming from peers and subordinates, "which does not go through formal evaluation processes, but is rather expressed in the daily work routine" (2:369) .
However, despite misunderstanding in some situations, the relationship with the community was cited by the subjects as satisfactory.
It is generally good, but there is also some truculence, because some people do not understand some delay in occurrences; sometimes we happen to have no car available, so things get delayed, due to lack of cops too, that is why it takes too long; so people often do not understand Negative public opinion is part of the burden of police work, and the negative concept expressed about police officers by the many social strata is ingrained in culture. Such a concept legitimizes and naturalizes the violence that they suffer much more than any other worker.
In this study, all subjects referred to the recognition for a well-done job, manifested by positive feedback from the community and achieved by solidarity and security work shown and performed in the daily routine, as the greatest satisfaction of the activity. Satisfaction for being able to help others, to work with people, for the community's gratitude for the assistance provided, were also feelings extracted from reports of military professionals in a study conducted in Rio Grande do Sul (12) . Recognized job together with autonomy and subjectivity are essential so that risks and stress generated at work can be subverted and transformed into pleasure (2) . Despite the exposure to risks and the stress generated, it is possible to see dedication in and affection for the job performed.
A study pointed that young military police officers with less time in the corporation and who develop ostensive activities enjoy this type of job and speak of their activities with enthusiasm; if given the opportunity to choose their profession again, more than 70% would choose it again. For some of them, even stress is perceived as something positive and a source of excitement for them to carry out their job (3) .

OCCUPATIONAL HAZARDS AND DISEASES CAUSED BY THE MILITARY POLICE OFFICERS' JOB
All subjects perceived the risks of their activity and mentioned physical violence and/or exposure to loss of physical integrity, transmission of diseases by contact with blood and fluids, and accidents as being the main types of exposures, which configure psychosocial, biological and accident-related risks.
[...] The risk of being shot and the risk of catching a disease, because we often come in contact with blood; psychological risks, sometimes risk of hitting a police car because we are at a speed higher than that allowed in chases [. According to the Pan American Health Organization (13) , occupational hazards are classified as: physical, caused by agents such as noise, extreme temperatures (hot and cold), among others; chemical, caused by contact with chemicals; biological, associated with microorganisms; ergonomic and psychosocial, resulting from poor posture, equipment and working organization; and mechanical and accident-related, linked to lack of protection for the worker.
According to a study (1) , among 4,518 dead and wounded police officers, 56.1% were victimized on days off, against 43.9% on duty. The occurrence of accidents and violence on days off deserves attention as well because a high percentage of police officers have a second job in the private security field, maintaining, in this way, the exposure to risks while working inside or outside the corporation.
Thus, due to their occupation, these workers often engage in conflict situations during their breaks from public service. A good portion of the subjects emphasized the imminence of risks posed by social violence and firearms as the main artifact capable of causing them harm.
It is important, in this discussion, to stress that such working circumstances may cause stress in the worker, which is a psychosocial risk. The permanent availability demanded by the responsibilities of supervisory positions, particularly those related to the policing of subareas that are under their command, in addition to heavy workload and assignments, are factors that make this profession a consuming one (2) .
Oh! the stress factor is immeasurable, there are many situations that make you go from zero to a hundred in a matter of seconds, because now you are in the middle of a fight between husband and wife, and then you are being shot [. ..]. (E4) I consider as stress factors certain risk situations that end up causing us stress, like when we get into confrontation with bandits, shooting, this kind of thing; pressure, many times, from our superior, physical stress due to excessive working hours [...]. (E1) Dangerous work environment, situations of risk during conflicts with criminals, oppression from superiors, distance from family, poor resources and/or working conditions favor the worker's emotional exhaustion and, if not resolved, turn into psychological distress and diseases such as stress. The family routine may be affected by these difficulties, and all this configuration may lead these professionals to take irrational actions when making decisions under pressure; additionally, physical and emotional stress may cause episodes of memory lapses and lack of concentration (14) , increasing the risk of work-related accidents. In this research, over a third of the participants reported having suffered accidents while working.
Other reasons were cited, including unsafe working conditions that facilitated the risk of accidents, such as the vests they wear, which do not protect them against gunshots for being worn out, besides vehicles in poor conditions, lack of more specific security equipment to protect other body parts. Most of the subjects claimed having already fallen ill due to their job, which was attributed to excessive working hours and accidents during chases and confrontations. Excessive workload was associated with the recurrent occurrence of colds and the flu, probably due to a weakened immune system as a result of stress.
It is easy to get the flu because we are always subject to having to face, no matter when, whether it is cold or hot, a confrontation that is happening at that time...at whatever time. (E11) Many accidents have happened during chases. I myself have already been away because of a car accident while working. (E9) It was not the intention of the study to assess the prevalence of accidents; the results were extracted from the analysis of the participants' reports. The exhaustive working hours, along with the stress generated in the execution of the activities, can cause physical and emotional fatigue, contributing to the larger number of accidents or other health problems. Musculoskeletal diseases, neurosurgical interventions, cardiovascular diseases and general practice demands were mentioned by a group of police officers as the most frequent reasons for sick leaves (3) , a situation that results in deficit for the organization and burden on those who remain working.
In a study conducted in Rio de Janeiro aiming to describe risk factors related to Systemic Hypertension reported by military professionals from the health field, stress was the most prevalent risk factor, resulting from the professionals' lifestyle, followed by sedentariness and bad eating habits (15) . In our study, stress was also mentioned, and the subjects seek coping means by disconnecting from work in their spare time and after shifts, seeking leisure and improvement. Oh! I read, walk, run ... It is not so easy to unwind because some days you face a lot of adrenaline, too much stress, but you have to practice something to get some rest, otherwise you are done. (E9)

AGGRAVATION PREVENTION AND HEALTH PROMOTION
As for aggravation prevention, a subject referred to immunization as the means he uses to prevent diseases by contact with blood, and some reported care actions involving attention and dexterity as means for preventing aggravations, though they fear the risk of diseases and work accidents. However, the majority reported using Personal Protective Equipment (PPE) for aggravation prevention and health protection, mentioning ballistic vests, guns, pistols, sticks and eventually surgical gloves, which are made available by the institution. According to Regulatory Norm No. 6, the company is required to provide employees with PPE appropriate to the risks, and the employees are required to use them (16) .
We have to use personal protective equipment like gloves in cases of people injured, vests in case of shooting with people, to take good care of our gun so we do not accidentally shoot a partner or ourselves [...]. (E7) With regard to knowledge of educational activities aimed at preventing accidents, 50% is unaware of such practices. For the other 50%, there is controversy about these actions and their periodicity. It is of great relevance to note that health education actions, carried out periodically, can contribute to reducing occupational hazards. Discussing and understanding unsafe conditions and actions, stimulating attention, favors the development of a secure work.
Education is a key strategy for aggravation prevention and health promotion. It is noteworthy that, among the subjects studied, when asked the question "are you prepared to provide first aid", 75% said no. Most of the speeches refer to the precariousness of the 'training' in the basic course as the main cause, which is a worrisome piece of data, considering exposure not only to damages caused by physical violence and injuries but also exposure to biological agents as a result of contact with blood and fluids. Despite the poor basic course, the group can benefit from ongoing education, a fundamental strategy for changes in the job and a place for critical, reflective, purposeful, committed and technically-competent performance. Thus, there is a need to decentralize and disseminate the teaching ability in the sector. Dialogic education, in which interaction between different subjects is a space for teaching and learning (17) , may be necessary.
A police officer's training must prepare him/her to interact with the environment in which he/she was recruited. For this reason, it is imperative to adapt the training to the attributions, situations and actions inherent to police service, such as "crimes in progress, domestic fights, lost children, car accidents, suspect people, alleged break-ins, public disturbances and unnatural deaths" (6:5) , social conflicts that lead to trauma and require knowledge relating to the preservation of life.
Thus, it is worth reflecting on the importance of a quality education provided by Basic Courses for Military Police Training because said activity is directly related to people in situations of fragility and violence. Interdisciplinarity can contribute to the pursuit of excellence in training, considering that the integration of various pieces of knowledge and practices can promote new relations between fields of knowledge, leading to the interaction and closer relations between professionals and favoring the advancement of knowledge.
In addition, at the encounter with various pieces of knowledge, including those that nurses have, there are more alternatives for the construction of strategies aimed at solving individual and collective problems; besides, interdisciplinary work favors the appreciation of relationships between people (18) .
Because of their training, nurses can engage in ongoing health education actions targeting these workers in order to promote the creation and maintenance of healthier and safer environments for these professionals. Pedagogical actions towards preventing aggravation and promoting the police officer's health can be incorporated into the routine of these workers by occupational health nurses.
Given this data, it is possible to comprehend that nursing needs to invest in research able to expand knowledge in this field and improve this activity, to come up with new possibilities of care actions in all social settings, including work in its most diverse activities. Although growing but still incipient, it is necessary to advance in the epistemological strengthening of a nursing practice that contemplates the process of living in the world, its new meanings and interpretations so as to legitimize its place in contemporary times, allowing it to contribute to comprehensiveness in care.

FINAL CONSIDERATIONS
Based on the results, it can be inferred that the activity of military police officers is permeated by countless occupational hazards that may bring aggravations to the workers' health. Physical violence, disease transmission by contact with blood and accidents were identified as the main risks of the activity. In addition, it was possible to notice some emotional exhaustion among the workers, caused by the nature of the military job, by dangerous circumstances and working conditions, which result in diseases. Poor working conditions were highlighted by all subjects studied, softened by the search for leisure.
Further studies should be developed with the objective of discussing ways to prevent aggravations within this category, in order to provide the activity with better health and safety, and a study on the nature of a female police officer's job can reveal important information about phenomena involving prejudice and masculinization imposed on some activities.