Problematizações (im)pertinentes : (sobre)vivências das travestis nos serviços de atenção básica em saúde no Brasil

Apresentamos neste artigo algumas discussões a respeito dos corpos nomeados travestis, e seus atravessamentos históricos e sociais, evidenciando as influências discursivas e essencialistas que os inventaram. Pontuaremos brevemente o processo de subjetivação, na qual tanto pode produzir culturas em massas, normalizando e padronizando identidades uniformizadas, como pode singularizá-las, possibilitando novas vivências, experimentações, desejos e prazeres. Em seguida discutiremos sobre o sistema sexo/gênero/sexualidade e a criação da sociedade cisheteronormativa, pontuando que esse sistema nada tem de natural, sendo estrategicamente implantado para manter o poder e sua hegemonia. Nesse sentido, propomos neste artigo, problematizar as violências psicológicas vivenciadas pelas travestis nas instituições públicas de saúde, instituições que em si, deveriam erradicar todo tipo de violência, mas que acabam contribuindo com sua intensificação.We present here some discussions about the appointed bodies transvestites, and its historical and social crossings, emphasizing the discursive and essentialist influences that invented them. Briefly We will briefly outline the process of subjectivation, in which both can produce crops in masses, normalizing and standardizing uniform identities, how can distinguishes them, enabling new experiences, trials, desires and pleasures. Then we will discuss about sex system/gender/sexuality and the creation of heteronormative society, pointing out that this system is not at all natural, being strategically deployed to keep the power and hegemony. In this sense, we propose in this article, discuss the psychological violence experienced by transvestites in public health institutions, institutions which in itself should eradicate all forms of violence, but end up contributing to its intensification

Cross-cultural adaptation and assessment of reproducibility of the Duke Activity Status Index for COPD patients in Brazil

OBJECTIVE: To cross-culturally adapt the Duke Activity Status Index (DASI) for use in Brazil and evaluate the reproducibility of the new (Brazilian Portuguese-language) version. METHODS: We selected stable patients with clinical and spirometric diagnosis of COPD. Initially, the DASI was translated into Brazilian Portuguese, and the cross-cultural adaptation was performed by an expert committee. Subsequently, 12 patients completed the questionnaire, so that their questions and difficulties could be identified and adjustments could be made. An independent translator back-translated the final version into English, which was then submitted to and approved by the original author. The final Brazilian Portuguese-language version of the DASI was applied to 50 patients at three distinct times. For the assessment of interobserver reproducibility, it was applied twice within a 30-min interval by two different interviewers. For the assessment of intraobserver reproducibility, it was applied again 15 days later by one of the interviewers. RESULTS: The mean age of the patients was 62.3 ± 10.0 years, the mean FEV1 was 45.2 ± 14.7% of the predicted value, and the mean body mass index was 26.8 ± 5.8 kg/m². The intraclass correlation coefficients for intraobserver and interobserver reproducibility were 0.95 and 0.90, respectively. The correlations between the DASI and the Saint George's Respiratory Questionnaire (SGRQ) domains were all negative and statistically significant. The DASI correlated best with the SGRQ activity domain (r = -0.70), the total SGRQ score (r = -0.66), and the six-minute walk distance (r = 0.55). CONCLUSIONS: The Brazilian Portuguese-language version of the DASI is reproducible, fast, and simple, correlating well with the SGRQ.OBJETIVO: Adaptar culturalmente e avaliar a reprodutibilidade do Duke Activity Status Index (DASI) para o português do Brasil. MÉTODOS: Foram selecionados pacientes estáveis com diagnóstico clínico e espirométrico de DPOC. Inicialmente, o DASI foi traduzido para o português, e a adaptação cultural foi realizada por uma comissão de especialistas. Em seguida, o questionário foi aplicado em 12 pacientes para saber suas dúvidas e dificuldades, sendo realizadas as devidas adaptações. Um tradutor independente fez a tradução retrógrada, que foi submetida e aprovada pelo autor original. A versão final do DASI foi aplicada em 50 pacientes em dois momentos, com intervalo de 30 minutos (reprodutibilidade interobservador) e, num terceiro momento, após 15 dias (reprodutibilidade intraobservador). RESULTADOS: A média de idade dos pacientes foi de 62,3 ± 10,0 anos, a média do VEF1 foi de 45,2 ± 14,7% do valor previsto, e a do índice de massa corpórea foi de 26,8 ± 5,8 kg/m². Os coeficientes de correlação intraclasse intraobservador e interobservador foram de 0,95 e 0,90, respectivamente. As correlações do DASI com todos os domínios do Saint George's Respiratory Questionnaire (SGRQ) foram negativas e estatisticamente significantes. As melhores correlações ocorreram com o domínio atividade (r = -0,70) e a pontuação total do SGRQ (r = -0,66), assim como com a distância percorrida no teste de caminhada de seis minutos (r = 0,55). CONCLUSÕES: A versão em língua portuguesa do Brasil do DASI é reprodutível, de rápida e fácil aplicação e apresentou uma boa correlação com o SGRQ.Secretaria Estadual de Saúde Secretaria Municipal de SaúdeUniversidade Federal de Sergipe Hospital Universitário Serviço de PneumologiaUniversidade Federal de São Paulo (UNIFESP) Centro de Reabilitação PulmonarAssociação de Assistência à Criança DeficienteUniversidade Estadual de Ciências da Saúde de Alagoas Núcleo de Propedêutica e TerapêuticaStanford University School of MedicineUNIFESP, Centro de Reabilitação PulmonarSciEL

Geospatial analysis of water uses and potential conflicts in the microregion of Ceres, Goiás, Brazil

Conflicts related to water have been expanding around the world, especially in areas which experience rapid changes in land use and occupation. The Ceres microregion (Goiás) has passed by an accelerated process of sugar cane agroindustrialization in recent years and water scarcity problems has been percieved. This work contributes to understand potential environmental conflicts related to water resources in Ceres microregion by the evaluation of the ways, intensity and spatial distribution of water consumption in differents basins of the microregion. It was analyzed secondary data from water demands, sugar and alcohol production, irrigation and others from geostatistic tools. The results suggest that sugar cane crops have a strong impact over water consumption, although this activity is not related to the water deficit in most of the basins, what suggests it is not responsible for situations of water scarcity or conflicts associated to shortages

Criterios de implementación ISO 14001:2015. Caso de estudio sector servicios públicos domiciliarios.

Una organización que implementa un sistema de gestión ambiental como valor agregado a sus productos y/o servicios no solo tiene la ventaja de competir en un mercado cada vez más globalizado, sino que también aporta a la protección del medio ambiente y el uso sostenible de los recursos naturales. Este documento presenta el resultado de la aplicación de un caso de estudio para el análisis de una empresa de servicios públicos domiciliarios de acueducto, alcantarillado y aseo ubicada en el municipio de Cumaribo, departamento del Vichada, en aplicación de la norma ISO 14001:2015. Se realizó un diagnóstico de la situación ambiental de la empresa aplicando criterios de la norma internacional, identificando procesos productivos, contexto general de la organización, aspectos e impactos ambientales y requisitos legales que sirvieron de base para generar una aproximación a la forma de cómo se aplica un sistema de gestión ambiental. Como resultado se esboza el alcance de un sistema de gestión ambiental a partir del análisis de cuestiones internas y externas, necesidades y expectativas de las partes interesadas y se determinan aspectos estratégicos como misión, visión y política enfocada al desempeño ambiental de la empresa. Sea este documento la base para que futuros profesionales estudien el comportamiento ambiental en la prestación de los servicios públicos domiciliarios y lo aborden desde la óptica de la norma ISO 14001:2015 para proponer esquemas de prestación eficientes y ambientalmente sostenibles.An organization that implements an environmental management system as added value to its products and services not only has the advantage of competing in an increasingly globalized market, but also contributes to the protection of the environment and the sustainable use of natural resources. This document presents the result of the application of a case study for the analysis of a public services enterprise for aqueduct, sewerage and cleaning located in the municipality of Cumaribo, department of Vichada, in application of the ISO 14001: 2015 standard. A diagnosis of the environmental situation of the company was carried out applying criteria of the international standard, identifying production processes, the general context of the organization, environmental aspects and impacts, and legal requirements that served as the basis for generating an approach to how it is applied. an environmental management system. As a result, the scope of an environmental management system is outlined from the analysis of internal and external issues, needs and expectations of the interested parties and strategic aspects such as mission, vision and policy focused on the environmental performance of the company are determined. This document be the basis for future professionals to study environmental behavior in the provision of public services and approach it from the perspective of the ISO 14001: 2015 standard to propose efficient and environmentally sustainable delivery schemes

Insulin and angiotensin II signaling pathways cross-talk: implications with the association between diabetes mellitus, arterial hypertension and cardiovascular disease

Insulin (Ins) and angiotensin II (AII) play pivotal roles in the control of two vital and closely related systems: the metabolic and the circulatory, respectively. A failure in the proper action of each of these hormones results, to a variable degree, in the development of two highly prevalent and commonly overlapping diseases - diabetes mellitus (DM) and hypertension (AH). In recent years, a series of studies has revealed a tight connection between the signal transduction pathways that mediate Ins and AII actions in target tissues. This molecular cross-talk occurs at multiple levels and plays an important role in phenomena that range from the action of anti-hypertensive drugs to cardiac hypertrophy and energy acquisition by the heart. At the extracellular level, the angiotensin-converting enzyme controls AII synthesis but also interferes with Ins signaling through the proper regulation of AII and the accumulation of bradykinin. At an early intracellular level, AII, acting through JAK-2/IRS-1/PI3-kinase, JNK and ERK, may induce the serine phosphorylation and inhibition of key elements of the Ins-signaling pathway. Finally, by inducing the expression of the regulatory protein SOCS-3, AII may impose a late control on the Ins signal. This review will focus on the main advances obtained in this field and will discuss the implications of this molecular cross-talk in the common clinical association between DM and AH.Insulina (Ins) e Angiotensina II (AII) são fundamentais no controle de dois sistemas vitais e inter-relacionados: o metabólico e o cardiocirculatório, respectivamente. A disfunção de qualquer um desses hormônios pode levar ao desenvolvimento de duas doenças de alta prevalência, muitas vezes concomitantes e, talvez, com fisiopatologia integrada - diabetes mellitus (DM) e hipertensão arterial (HA). Vários estudos mostram que os sistemas de sinalização intracelular de Ins e AII estão conectados e influenciam um ao outro. Esta comunicação molecular ocorre em diferentes etapas da sinalização celular e é importante para vários fenômenos fisiológicos, desde o desenvolvimento de hipertrofia cardíaca e aquisição de energia pelo coração, até a ação de drogas anti-hipertensivas. No nível extracelular, a enzima de conversão de angiotensina regula a síntese de AII e o acúmulo de bradicinina, e ambos desempenham papel regulador sobre a sinalização de Ins. No nível intracelular, a interação dos sinais de Ins e AII ocorre em dois momentos distintos. Inicialmente, em etapas mais precoces da sinalização celular, a AII, atuando através da cascata JAK-2/IRS-1/PI3-quinase, JNK e ERK, provoca a fosforilação em serina e a conseqüente inibição de elementos-chave da via de sinalização da Ins. Finalmente, a AII induz a expressão da proteína regulatória SOCS-3, que impõe um controle mais tardio sobre o sinal de Ins. Esta revisão discute os avanços mais recentes neste campo e a importância dessa interação molecular na fisiopatologia e na associação clínica de DM e HA.19520

Physicians’ preference towards the non-evidence based hydroxychloroquine treatment for COVID-19: the pandemic effect

OBJECTIVE: To evaluate whether there is a "pandemic effect" promoting irrational medical reasoning. METHODS: Cross-sectional study. Setting state medical councils were asked to send all registered physicians two sequential email invitations to complete a Google Form questionnaire. Between April 15 and May 3, 2020, 370 doctors answered our questionnaire with questions about the prescription of hydroxychloroquine for COVID-19 and vitamin C for sepsis. The questionnaire had a five-point Likert scale (greater number, greater support) on the degree of propensity to prescribe the medication and a binary question (yes or no) to express the doctor's final decision to prescribe. These two questions, in the same order, were asked for scenarios of mild, moderate and severe cases. RESULTS: The propensity to prescribe hydroxychloroquine for COVID-19 increased with the severity of the clinical presentation: for mild cases, 37% (95% CI 32%-42%) of the physicians chose "yes", increasing to 68% (95% CI 63%-72%) and 89% (95% CI 85%-92%) for moderate or severe cases, respectively (Cochran's Q test: P<0.001). The medians and interquartile ranges of the Likert scales for hydroxychloroquine were 2 (1-4), 4 (2-4), 4 (4-5) in mild, moderate and severe cases of COVID-19 (Friedman test: P<0.001). CONCLUSIONS: The propensity of the Brazilian physician to prescribe hydroxychloroquine for COVID-19 is high and, according to the severity of the disease, ranged from 37 to 89%. On the contrary, the propensity to prescribe vitamin C for sepsis, a non-pandemic situation, was lower and not associated with clinical severity. Our data suggest a "pandemic effect" promoting irrationality in medical reasoning