BackgroundThe relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services.MethodA systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population’s access to health services and original articles with full text available online.ResultsThe electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services.ConclusionsThe non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.

supplementation. Participants identified which supplement they believed they had 29 ingested ("caffeine", "placebo", "don't know") pre-and post-exercise. Subsequently, 30 participants were allocated to subgroups for analysis according to their identifications. 31Overall and subgroup analyses were performed using mixed-model and magnitude 32 based inference analyses. Caffeine improved performance vs. PLA and CON 33 (P≤0.001). Correct pre-and post-exercise identification of caffeine in CAF improved 34 exercise performance (+4.8 and +6.5%) vs. CON, with slightly greater relative 35 increases than the overall effect of caffeine (+4.1%). Performance was not different 36 between PLA and CON within subgroups (all P>0.05), although there was a tendency 37 towards improved performance when participants believed they had ingested caffeine 38 post-exercise (P=0.06; 87% likely beneficial). Participants who correctly identified 39 placebo in PLA showed possible harmful effects on performance compared to CON. 40 Supplement identification appeared to influence exercise outcome and may be a 41 source of bias in sports nutrition. 42

26Objective: To investigate the influence of habitual caffeine intake on aerobic exercise performance responses 27 to acute caffeine supplementation. Methods: A double-blind, crossover, counterbalanced study was performed. 28Forty male endurance-trained cyclists were allocated into tertiles according to their daily caffeine intake: low suggesting that high habitual caffeine intake does not negate the benefits of acute caffeine supplementation.

BackgroundBreast cancer affects millions of women worldwide, particularly in Brazil, where public healthcare system is an important model in health organization and the cost of chronic disease has affected the economy in the first decade of the twenty-first century. The aim was to evaluate the role of health policy in the burden of breast cancer in Brazil between 2004 and 2014.MethodsSecondary analysis was performed in 2017 with Brazilian Health Ministry official data, extracted from the Department of Informatics of the National Health System. Age-standardized mortality and the age-standardized incidence of hospital admission by breast cancer were calculated per 100,000 people. Public healthcare costs were converted to US dollars. Regression analysis was performed to estimate the trend of breast cancer rates and healthcare costs, and principal component analysis was performed to estimate a cost factor. Stata® 11.0 was utilized.ResultsBetween 2004 to 2014, the age-standardized rates of breast cancer mortality and the incidence of hospital admission and public healthcare costs increased. There was a positive correlation between breast cancer and healthcare public costs, mainly influenced by governmental strategies.ConclusionsGovernmental strategies are effective against the burden of breast cancer in Brazil.

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