POLÍTICAS PÚBLICAS DE SAÚDE PARA A POPULAÇAO LGBT NO BRASIL: IDENTIDADES SEXUAIS E NOVAS ZONAS DE EXCLUSÃO

A história das lutas por políticas públicas para a população LGBT teve início na década de 1980, com o advento da epidemia mundial de HIV/AIDS. Ao longo das décadas subsequentes as políticas públicas, em especial de saúde, foram tomando rumos que intencionavam pensar na integralidade dos sujeitos LGBT. Porém, o que se percebe é que a maior parte dessas políticas está embasada na construção de identidades sexuais, marcadas pelos binarismos homem/mulher, masculino/feminino, heterossexual/homossexual, sendo os primeiros termos ainda hegemônicos. A análise aqui proposta mostra como essas identidades acabam por criar novas segregações, promover a manutenção da heteronormatividade e a homofobia, em suas variantes. Através de críticas pós-identitárias, originadas da teoria queer, este artigo convida para uma desconstrução crítica da visão dos indivíduos como seres acabados em termos de sexualidade, gênero, práticas sexuais e desejos. Palavras chaves: políticas públicas; LGBT; identidades sexuais; saúde; teoria queer.

Lúcia, “uma Vida em Círculo” – Impasses de uma Rede de Cuidados para Crianças e Adolescentes

Este artigo trata do estudo de caso de uma adolescente atendida pela sade mental da cidade de Belo Horizonte/MG-Brasil. O objetivo analisar o percurso dessa jovem pela rede como exemplo dos muitos desafios que casos complexos representam para uma efetiva implantao da rede de ateno psicossocial. O caso foi escolhido como paradigmtico em termos de sua dificuldade de abordagem, uma vez que, em sua trajetria de tratamento, essa jovem percorre vrios dispositivos e servios, tanto da rede especializada de sade mental como da rede ampla de promoo, proteo e defesa de direitos de crianas e adolescentes, demandando sempre os servios mais complexos da assistncia, sem resolubilidade

Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods: In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis. Results: Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former. Conclusion: Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life

Rearrangement of Retinogeniculate Projection Patterns after Eye-Specific Segregation in Mice

It has been of interest whether and when the rearrangement of neuronal circuits can be induced after projection patterns are formed during development. Earlier studies using cats reported that the rearrangement of retinogeniculate projections could be induced even after eye-specific segregation has occurred, but detailed and quantitative characterization of this rearrangement has been lacking. Here we delineate the structural changes of retinogeniculate projections in the C57BL/6 mouse in response to monocular enucleation (ME) after eye-specific segregation. When ME was performed after eye-specific segregation, rearrangement of retinogeniculate axons in the dorsal lateral geniculate nucleus (dLGN) was observed within 5 days. Although this rearrangement was observed both along the dorsomedial-ventrolateral and outer-inner axes in the dLGN, it occurred more rapidly along the outer-inner axis. We also examined the critical period for this rearrangement and found that the rearrangement became almost absent by the beginning of the critical period for ocular dominance plasticity in the primary visual cortex. Taken together, our findings serve as a framework for the assessment of phenotypes of genetically altered mouse strains as well as provide insights into the mechanisms underlying the rearrangement of retinogeniculate projections

The isotopic fingerprint of Fe cycling in an equatorial soil-plant-water system : The Nsimi watershed, South Cameroon

Following an initial study of a tropical lateritic hillside system showing little iron isotope fractionation despite a strong accumulation within the soil profile, the present work investigates iron isotope signatures within the organic matter rich swamp system that represents 20% of the studied watershed surface (from Nsimi, South Cameroon). This study considers the soil-plant-water continuum in order to better understand the Fe elemental and isotopic transfer out of the ecosystem. Within the swamp system, the iron isotope compositions of gleysol samples (delta Fe-57(IRMM-14) similar to+ 0.6 parts per thousand) are significantly heavier than both the continental crust baseline and the reference lateritic soils from the hillslope (delta Fe-57(IRMM-14) = + 0.1 parts per thousand). This enrichment towards heavy isotopes is attributed to a preferential removal of light iron isotopes during soil forming processes. Pedogenic transformations (i.e., gleyzation, organic complexation of metal and leaching) are responsible for the reductimorphic features observed in ferralitic horizons (i.e., incomplete degradation of organic matter in surface and soil whitening favored by good draining conditions). The organic carbon-rich waters of the swamp system are prone to redox processes and strong metal chelation. The dissolved iron (i.e., fraction < 0.22 mu m) of the Mengong stream shows positive delta Fe-57 signatures, with a down-stream enrichment in heavy isotopes, from + 0.511 +/- 0.266 parts per thousand to + 1.076 +/- 0.240 parts per thousand. The binding of iron (Fe-III) with organic matter can explain the observed enrichment in heavy isotopes in the dissolved fraction. On the contrary, plant leaves are significantly enriched in light Fe (delta Fe-57 of -0.665 +/- 0.035 and -1.119 +/- 0.080 parts per thousand) relative to (i) the litter compartment (-0.166 +/- 0.078 to -0.262 +/- 0.013% for delta Fe-57) and (ii) the most superficial soils. Iron isotopic compositions in plants and litter vary as a function of both plant species and season. Hence, the differences in Fe isotopic compositions between the various studied compartments suggest that Fe isotopes can be used (i) to study elemental transfers during soil pedogenesis in tropical environment and (ii) to better appraise and constrain iron biogeochemical cycle between surface horizon of soils, surface waters and the vegetation