Active workstations: A literature review on workplace sitting.

The purpose of this paper is to further understand current literature on prolonged sitting, sitting posture and active sitting solutions. This paper is divided into three sections: The first section (Part I) is a comprehensive overview of the literature on how a static prolonged seated posture can affect: spinal health, trunk posture, contact pressure/discomfort development and vascular issues. The second section (Part II) reviews and qualitatively compares the four working postures recognized in ANSI/HFES 100-2007: reclined sitting, upright sitting, declined sitting and standing. The final section (Part III) is a summary of research on active chairs that revolves around the two types of movement patterns: 1- sustaining continual movement over a range of postures, occasionally reaching neutral lordosis, and 2- maintaining high frequency and duration of daily light contractile activity in the legs (or lower limbs).

Differential effects of sex on upper body kinematics and kinetics during fatiguing, Asymmetric lifting.

This study quantified sex-specific biomechanical adaptations to fatigue in asymmetric lifting. Twenty-one females and fifteen males performed a prolonged asymmetric lifting protocol while upper body, trunk and pelvis kinematics were collected. Features of movement identified with principal component analysis, and peak joint angular velocities and moments were calculated. Sex-specific kinematic adaptations to fatigue included females adopting a 'stoop-like' lifting strategy to a greater extent than males. Additionally, females exhibited higher vertical elbow positions during load rotation, moved their body toward the destination for load deposit, and did not reduce peak right shoulder flexion velocities, in contrast to male participants. Females also had greater low back and shoulder peak normalized joint moments. When fatigued, females adopted an asymmetric lifting strategy that minimized metabolic demand as supported by smaller decreases in maximum voluntary contractions. However, females' fatigue-related adaptations increased biomechanical exposures associated with injury risk.

The biomechanical benefits of active sitting.

This cross-sectional study examined the biomechanical effects of two active chairs (AC1: had the feature to pedal and slide forward on the seat pan; AC2: a multiaxial motion seat pan) compared to a traditional office chair and standing workstation. Twenty-four healthy participants worked at each of the workstations for 60-min. The following equipment was used: Motion Capture, Electromyography, Ratings of Perceived Discomfort Questionnaire, and Exit Survey. The active protocol had positive effects on the body, including increased neuromuscular activity in the gastrocnemius, increased overall movement, and a more open trunk-thigh angle. Greater discomfort in the buttocks due to the lack of seat pan contour was reported for the AC1 which identified a need for a design modification. While standing, participants' shoulders were less flexed than when sitting in any of the three seats, however, greater discomfort was reported in the lower legs after 1 h of computer work. Practitioner summary: A comparison of four different workstations was conducted to further understand the use of active workstations. Active sitting was found to have positive effects on the body, such as allowing sitters to increase movement while sitting without the high activation of muscular activity. Standing can also provide a positive break from sitting.

Does active sitting provide more physiological changes than traditional sitting and standing workstations?

This cross-sectional study examined the physiological effects of two active chairs (AC1: had the feature to pedal and slide forward; AC2: was a multiaxial chair) compared to a traditional office chair and standing workstation. Twenty-four healthy participants computed at each of the workstations for 60 min. The active protocol was to alternate between a pedalling/side-to-side motion and sliding forward/front-to-back motion to the sound of a metronome operating at 40 bpm. The participants' physiological effects were recorded using near-infrared spectroscopy (NIRS); electrodermal activity (EDA) and a heart rate (HR) monitor for each collection period. Statistical analysis was conducted using a repeated measures analysis of variance for within-task and between-workstation comparisons. A Tukey's post hoc analysis was calculated for significant findings. Both active chairs significantly increased oxygenated blood in the gastrocnemius and participants' heart rate and EDA (stress) levels were affected slightly by task and time. However, participants felt more "productive" sitting in the control chair than in either of the active chairs.

A biomechanical analysis of active vs static office chair designs.

The objective of this study was to provide a biomechanical comparison of two different types of active chairs (AC1 & AC2) versus a static chair (NAC). Thirty healthy participants were recruited: fifteen healthy females and fifteen healthy males. Participants worked at a computer workstation (1-h per chair). Equipment included: Pressure pads, Electromyography, Near-Infrared Spectroscopy, and Questionnaires (rate of perceived discomfort, seating discomfort questionnaire and exit survey). A significant increase in anterior-posterior postural sway was found on the seat pan with the use of the AC1. An increase in neuromuscular activity of the external obliques and an increase change in total oxygen index (%TOI) values in the gastrocnemius were also found using the AC1, however the difference was not much higher than the NAC and AC2. Lower discomfort scores in the gluteal area were found with the use of active chair AC1 compared to the NAC. Preliminary findings suggest that having an office chair with a split seat pan design shows potential to yield biomechanical and physiological benefits for the sitter, however further research is needed to better understand the ergonomic benefits of active sitting.

A parametric investigation on seat/occupant contact forces and their relationship with initially perceived discomfort using a configurable seat.

The present work investigates the contact forces between sitters and seat as well as their correlations with perceived discomfort. Twelve different economy class aeroplane seat configurations were simulated using a multi-adjustable experimental seat by varying seat pan and backrest angles, as well as seat pan compressed surface. Eighteen males and 18 females, selected by their body mass index and stature, tested these configurations for two sitting postures. Perceived discomfort was significantly affected by seat parameters and posture and correlated both with normal force distribution on the seat-pan surface and with normal forces at the lumbar and head supports. Lower discomfort ratings were obtained for more evenly distributed normal forces on the seat pan. Shear force at the seat pan surface was at its lowest when sitters were allowed to self-select their seat-pan angle, supporting that a shear force should be reduced but not zeroed to improve seating comfort. Practitioner Summary: The effects of seat-pan and backrest angle, anthropometric dimensions and sitting posture on contact forces and perceived discomfort were investigated using a multi-adjustable experimental seat. In addition to preferred seat profile parameters, the present work provides quantitative guidelines on contact force requirement for improving seating comfort.

Ergonomic evaluation of a new truck seat design: a field study.

A postural evaluation of commercial licensed truck drivers was conducted to determine the ergonomic benefits of a truck seat prototype in comparison with an industry standard seat. Twenty commercially licensed truck drivers were recruited to perform a 90-min driving task. Postures were assessed using accelerometers and a backrest and seat pan pressure mapping system. Subjective discomfort measurements were monitored using two questionnaires: ratings of perceived discomfort (RPD) and the automotive seating discomfort questionnaire (ASDQ). Participants reported significantly higher discomfort scores when sitting in the industry standard seat. Participants sat with more lumbar lordosis and assumed a more extended thoracic posture when seated in the prototype. Pairing the gluteal backrest panel with the adjustable seat pan also helped reduce the average sitting pressure on both the seat pan and the backrest. The prototype provided several postural benefits for commercially certified truck drivers, as it did for a young and healthy population.

A pre/post evaluation of fatigue, stress and vigilance amongst commercially licensed truck drivers performing a prolonged driving task.

Purpose. The main purpose of this research study was to evaluate changes in fatigue, stress and vigilance amongst commercially licensed truck drivers involved in a prolonged driving task. The secondary purpose was to determine whether a new ergonomic seat could help reduce both physical and cognitive fatigue during a prolonged driving task. Two different truck seats were evaluated: an industrial standard seat and a new truck seat prototype. Methods. Twenty male truck drivers were recruited to attend two testing sessions, on two separate days, with each session randomized for seat design. During each session, participants performed two 10-min simulated driving tasks. Between simulated sessions, participants drove a long-haul truck for 90 min. Fatigue and stress were quantified using a series of questionnaires whereas vigilance was measured using a standardized computer test. Results. Seat interactions had a significant effect on fatigue patterns. Conclusion. The new ergonomic seat design holds potential in improving road safety and vehicle accidents due to fatigue-related accidents.

Effects of seat parameters and sitters' anthropometric dimensions on seat profile and optimal compressed seat pan surface.

Designing one seat for multi-sitters and multi-activities is challenging especially in a very restrained aircraft economy class cabin. In this paper, the effects of seat parameters and sitters' anthropometric dimensions on seat profile and optimal compressed seat pan surface were studied using a newly built multi-adjustable experimental seat. The 'optimal' seat pan contact surface was obtained by controlling the height of 52 cylinders so that the normal contact force was distributed to all cylinders as evenly as possible. With 13 other motorized adjustments controllable by a computer, individual seat profile in the symmetry plane such as seat height, seat pan length, seat pan angle, lumbar protrusion and headrest position were also studied. Data were collected from 36 men and women of varying body size testing 40 seat configurations. Parametric models were obtained for predicting seat profile and optimal compressed seat pan seat surface in function of seat pan and back rest angles for two sitting postures. It is expected that the proposed parametric models provide necessary reference values in seat development for a better fit of a target population of sitters with large varying body size.

Biomechanical investigation of prolonged driving in an ergonomically designed truck seat prototype.

A postural evaluation during a prolonged driving task was conducted to determine the ergonomic validity of a new freely adjustable truck seat prototype. Twenty participants were recruited to perform two 2-h simulated driving sessions. Postures were assessed using motion capture, accelerometers and pressure pads. Subjective discomfort was also monitored in 15-min increments using ratings of perceived discomfort (RPD) and the Automotive Seating Discomfort Questionnaire. Participants had a more neutral spine posture during the first hour of the drive and reported lower RPDs while sitting in the prototype. Pairing the gluteal backrest panel with the adjustable seat pan helped reduce the average sitting pressure. The industry-standard truck seat may lead to the development of poor whole body posture, and the proposed ergonomic redesign of a new truck seat helped improve sitting posture and reduce perceived discomfort. Practitioner Summary: A new freely adjustable truck seat prototype was compared to an Industry standard seat to assess hypothesised improvements to sitting posture and discomfort for long haul driving. It was found that the adjustable panels in the prototype helped promote spine posture, reduce sitting pressure and improved discomfort ratings.

Quantifying the postural demands of patrol officers: a field study.

Police officers are at high risk for developing musculoskeletal injuries. This study aimed to determine differences in physical demands of patrol officers during day shifts and night shifts. Sixteen participants were recruited (10 males, 6 females) for in-vehicle observation over one full day shift and one full night shift. Dynamic pressure distribution when seated in the vehicle was assessed and compared between the first and last parts of each shift. Activity characterization and postural analyses were conducted from video that was recorded continuously for the duration of each shift to determine time spent in each task and corresponding postures. Postural analysis and cumulative joint loads were used to identify higher-risk tasks. Several activities caused the officers to adopt non-neutral postures of the neck, shoulders and back. Future work needs to focus on modifying the interior of the vehicle, as well as decreasing exposure time to activities resulting in non-neutral postures.

An ergonomic evaluation of city police officers: an analysis of perceived discomfort within patrol duties.

The purpose of this study was to assess the perceived discomfort of patrol officers related to equipment and vehicle design and whether there were discomfort differences between day and night shifts. A total of 16 participants were recruited (10 males, 6 females) from a local police force to participate for one full day shift and one full night shift. A series of questionnaires were administered to acquire information regarding comfort with specific car features and occupational gear, body part discomfort and health and lifestyle. The discomfort questionnaires were administered three times during each shift to monitor discomfort progression within a shift. Although there were no significant discomfort differences reported between the day and night shifts, perceived discomfort was identified for specific equipment, vehicle design and vehicle configuration, within each 12-h shift.

DOES RECTUS FEMORIS TRANSFER INCREASE KNEE FLEXION DURING STANCE PHASE IN CEREBRAL PALSY?

OBJECTIVE: To evaluate whether distal rectus femoris transfer (DRFT) is related to postoperative increase of knee flexion during the stance phase in cerebral palsy (CP). METHODS: The inclusion criteria were Gross Motor Function Classification System (GMFCS) levels I-III, kinematic criteria for stiff-knee gait at baseline, and individuals who underwent orthopaedic surgery and had gait analyses performed before and after intervention. The patients included were divided into the following two groups: NO-DRFT (133 patients), which included patients who underwent orthopaedic surgery without DRFT, and DRFT (83 patients), which included patients who underwent orthopaedic surgery that included DRFT. The primary outcome was to evaluate in each group if minimum knee flexion in stance phase (FMJFA) changed after treatment. RESULTS: The mean FMJFA increased from 13.19° to 16.74° (p=0.003) and from 10.60° to 14.80° (p=0.001) in Groups NO-DRFT and DRFT, respectively. The post-operative FMJFA was similar between groups NO-DRFT and DRFT (p=0.534). The increase of FMJFA during the second exam (from 13.01° to 22.51°) was higher among the GMFCS III patients in the DRFT group (p<0.001). CONCLUSION: In this study, DRFT did not generate additional increase of knee flexion during stance phase when compared to the control group. Level of Evidence III, Retrospective Comparative Study.

DOES RECTUS FEMORIS TRANSFER INCREASE KNEE FLEXION DURING STANCE PHASE IN CEREBRAL PALSY?

ABSTRACT Objective: To evaluate whether distal rectus femoris transfer (DRFT) is related to postoperative increase of knee flexion during the stance phase in cerebral palsy (CP). Methods: The inclusion criteria were Gross Motor Function Classification System (GMFCS) levels I-III, kinematic criteria for stiff-knee gait at baseline, and individuals who underwent orthopaedic surgery and had gait analyses performed before and after intervention. The patients included were divided into the following two groups: NO-DRFT (133 patients), which included patients who underwent orthopaedic surgery without DRFT, and DRFT (83 patients), which included patients who underwent orthopaedic surgery that included DRFT. The primary outcome was to evaluate in each group if minimum knee flexion in stance phase (FMJFA) changed after treatment. Results: The mean FMJFA increased from 13.19° to 16.74° (p=0.003) and from 10.60° to 14.80° (p=0.001) in Groups NO-DRFT and DRFT, respectively. The post-operative FMJFA was similar between groups NO-DRFT and DRFT (p=0.534). The increase of FMJFA during the second exam (from 13.01° to 22.51°) was higher among the GMFCS III patients in the DRFT group (p<0.001). Conclusion: In this study, DRFT did not generate additional increase of knee flexion during stance phase when compared to the control group. Level of Evidence III, Retrospective Comparative Study.

Percepções sobre as mudanças nas atividades cotidianas e nos papéis ocupacionais de mulheres no climatério / Perceptions on daily activities changes and occupational roles of women in climacteric stage

O climatério é definido como o processo natural do ciclo de vida feminino, inerente à transição da fase reprodutiva para a fase não reprodutiva, e tem o seu marco principal com a menopausa. Durante esse período, a mulher perpassa por várias mudanças fisiológicas, emocionais, sociais e econômicas, que podem impactar negativamente nas atividades exercidas. Com o objetivo de analisar as percepções e os significados atribuídos pelas mulheres atendidas no Ambulatório de Climatério do HC-UFPR sobre o impacto nas atividades cotidianas e nos papéis ocupacionais, realizou-se uma pesquisa exploratória e qualitativa através de um questionário estruturado com dados socioeconômicos, contendo também um check-list autoaplicável e uma entrevista semiestruturada, com aferição dos dados através de técnicas de análise de conteúdo. Observou-se que o preconceito social e o desconhecimento pela mulher sobre as mudanças ocorridas nessa fase se constituem em barreiras para realização de diversas atividades, afetando os cuidados necessários com a saúde e, consequentemente, prejudicando a sua qualidade de vida. Em contrapartida, nesse período, muitas mulheres apresentam maior habilidade de adaptação, descobrindo novas atividades, realizando planos adiados e desempenhando novos papéis ocupacionais. Constata-se a importância da compreensão sobre as mudanças, as percepções e os significados do climatério pela própria mulher e pelos profissionais, para a formulação de uma assistência integral e na qual se valorize a sua individualidade.

Does the GMFCS level influence the improvement in knee range of motion after rectus femoris transfer in cerebral palsy?

The aim of this study was to evaluate the influence of the Gross Motor Function Classification System (GMFCS) on the outcomes of rectus femoris transfer (RFT) for patients with cerebral palsy and stiff knee gait. We performed a retrospective review of patients seen at our gait laboratory from 1996 to 2013. Inclusion criteria were (i) spastic diplegic cerebral palsy, (ii) GMFCS levels I-III, (iii) reduced peak knee flexion in swing (PKFSw<55°), and (iv) patients who underwent orthopedic surgery with preoperative and postoperative gait analysis. Patients were divided into two groups according to whether they received a concurrent RFT or not at the time of surgery: non-RFT group (185 knees) and RFT group (123 knees). The primary outcome was the overall knee range of motion (KROM) derived from gait kinematics. The secondary outcomes were the PKFSw and the time of peak knee flexion in swing (tPKFSw). We observed a statistically significant improvement in KROM only for patients in the RFT group (P<0.001). However, PKFSw and tPKFSw improved in both groups after surgery (P<0.001 for all analyses). In the RFT group, the improvement in KROM was observed only for patients classified as GMFCS levels I and II. In the non-RFT group, no improvement in KROM was observed in any GMFCS level. In this study, patients at GMFCS levels I and II were more likely to benefit from the RFT procedure.

Most frequent gait patterns in diplegic spastic cerebral palsy.

OBJECTIVE: To identify gait patterns in a large group of children with diplegic cerebral palsy and to characterize each group according to age, Gross Motor Function Classification System (GMFCS) level, Gait Deviation Index (GDI) and previous surgical procedures. METHODS: ONE THOUSAND EIGHT HUNDRED AND FIVE PATIENTS WERE DIVIDED IN SEVEN GROUPS REGARDING OBSERVED GAIT PATTERNS: jump knee, crouch knee, recurvatum knee, stiff knee, asymmetric, mixed and non-classified. RESULTS: The asymmetric group was the most prevalent (48.8%). The jump knee (9.6 years old) and recurvatum (9.4 years old) groups had mean age lower than the other groups. The lowest GDI (43.58) was found in the crouch group. There were more children classified within GMFCS level III in the crouch and mixed groups. Previous surgical procedures on the triceps surae were more frequent in stiff knee and mixed groups. The jump knee group received less and the stiff-knee group more surgical procedures at hamstrings than others. CONCLUSIONS: The asymmetrical cases were the most frequent within a group of diplegic patients. Individuals with crouch gait pattern were characterized by the lowest GDI and the highest prevalence of GMFCS III, while patients with stiff knee exhibited a higher percentage of previous hamstring lengthening in comparison to the other groups. Level of Evidence III, Retrospective Comparative Study.

Padrões de marcha mais frequentes na paralisia cerebral tipo diparesia espástica / Most frequent gait patterns in diplegic spastic cerebral palsy

Identificar padrões de marcha em um grande grupo de crian-ças com paralisia cerebral (PC) tipo diplegia espástica e caracterizarcada grupo de acordo com a idade, nível do Gross Motor FunctionClassification System (GMFCS) e Gait Deviation Index (GDI) e cirurgiasprévias. Métodos: Foram divididos em sete grupos 1805 pacientescom base nos padrões de marcha observados: joelho saltitante, agachamento,recurvatum, joelho rígido, assimétrico, misto, e não classificável.Resultados: O grupo assimétrico foi o mais prevalente (48,8%).Os grupos joelho saltitante (9,6 anos) e recurvatum (9,4 anos) exibiramidade média menor que os demais grupos. O GDI mais baixo (43,58)foi observado no grupo agachamento. Notaram-se mais pacientesclassificados como nível III do GMFCS nos grupos agachamento emisto. Cirurgias prévias no tríceps sural foram mais frequentes nosgrupos joelho rígido e misto. O grupo joelho saltitante recebeu menornúmero de procedimentos cirúrgicos prévios nos isquiotibais, enquantoque o grupo com joelho rígido recebeu maior número, quandocomparado aos demais. Conclusões: Os casos assimétricos forammais frequentes, mesmo em grupo de pacientes diplégicos. Pacientescom padrão em agachamento foram caracterizados pelo GDI maisbaixo e prevalência do nível III no GMFCS, enquanto que o grupojoelho rígido exibiu uma porcentagem maior de alongamento préviodos isquiotibiais em comparação com os demais grupos. Nível deEvidência III, Estudo Retrospectivo Comparativo...

To identify gait patterns in a large group of childrenwith diplegic cerebral palsy and to characterize each groupaccording to age, Gross Motor Function Classification System(GMFCS) level, Gait Deviation Index (GDI) and previous surgicalprocedures. Methods: One thousand eight hundred and fivepatients were divided in seven groups regarding observed gaitpatterns: jump knee, crouch knee, recurvatum knee, stiff knee,asymmetric, mixed and non-classified. Results: The asymmetricgroup was the most prevalent (48.8%). The jump knee (9.6 yearsold) and recurvatum (9.4 years) groups had mean age lowerthan the other groups. The lowest GDI (43.58) was found in thecrouch group. There were more children classified within GMFCSlevel III in the crouch and mixed groups. Previous surgical procedureson the triceps surae were more frequent in stiff kneeand mixed groups. The jump knee group received less and thestiff-knee group more surgical procedures at hamstrings thanothers. Conclusions: The asymmetrical cases were the most frequentwithin a group of diplegic patients. Individuals with crouchgait pattern were characterized by the lowest GDI and the highestprevalence of GMFCS III, while patients with stiff knee exhibited ahigher percentage of previous hamstring lengthening in comparisonto the other groups. Level of Evidence III, RetrospectiveComparative Study...

Saúde e população LGBT: demandas e especificidades em questão / Health and LGBT community: needs and specificities under discussion / Salud y población LGBT: demandas y especificidades en cuestión

A população LGBT - lésbicas, gays, bissexuais e transgêneros - é vulnerável quanto ao atendimento de seus direitos humanos, incluindo o acesso aos serviços públicos de saúde. A partir da eminente necessidade de formação dos agentes da saúde no tema LGBT, assim como da elaboração de ações voltadas para as demandas específicas dessa população, é nossa intenção contribuir para a reflexão sobre alguns dos fatores que podem interferir de maneira substancial no processo de saúde da população LGBT. Aprofundamo-nos sobre algumas das questões próprias a cada segmento, sublinhando a importância da atenção dos profissionais da saúde frente às reações em cadeia que implicam o processo de vulnerabilidade e que conduzem ao adoecimento dessa população.(AU)

The LGBT community - lesbians, gays, bisexuals and transgenders - is vulnerable to achieve the fulfillment of their human rights including the access to public health. Assuming the imminent need for the formation of health workers in LGBT theme, as well as for the development of actions to respond to the specific demands of this population, it is our intention to contribute to the reflection on some of the factors that may interfere substantially in the LGBT process of health. We discuss some of the specific issues to each segment, highlighting the importance of attention of health professionals about the chain reactions that involve the process of vulnerability and that lead to illness in this population.(AU)

La población LGBT - lésbicas, gays, bisexuales y transexuales - es vulnerable en relación al atendimiento de sus derechos humanos, incluyendo el acceso a los servicios públicos de salud. A partir de la eminente necesidad de formación de los agentes de la salud en el tema LGBT, así como de la elaboración de acciones destinadas para las demandas específicas de esa población, es nuestra intención contribuir para la reflexión sobre algunos de los factores que pueden interferir de manera substancial en el proceso de salud de la población LGBT. Profundizamos sobre algunas de las cuestiones propias a cada segmento, subrayando la importancia de la atención de los profesionales de la salud frente a las reacciones en cadena que implican el proceso de vulnerabilidad y que conducen a que esa población enferme.(AU)

Saúde e população LGBT: demandas e especificidades em questão / Health and LGBT community: needs and specificities under discussion / Salud y población LGBT: demandas y especificidades en cuestión

A população LGBT - lésbicas, gays, bissexuais e transgêneros - é vulnerável quanto ao atendimento de seus direitos humanos, incluindo o acesso aos serviços públicos de saúde. A partir da eminente necessidade de formação dos agentes da saúde no tema LGBT, assim como da elaboração de ações voltadas para as demandas específicas dessa população, é nossa intenção contribuir para a reflexão sobre alguns dos fatores que podem interferir de maneira substancial no processo de saúde da população LGBT. Aprofundamo-nos sobre algumas das questões próprias a cada segmento, sublinhando a importância da atenção dos profissionais da saúde frente às reações em cadeia que implicam o processo de vulnerabilidade e que conduzem ao adoecimento dessa população...

The LGBT community - lesbians, gays, bisexuals and transgenders - is vulnerable to achieve the fulfillment of their human rights including the access to public health. Assuming the imminent need for the formation of health workers in LGBT theme, as well as for the development of actions to respond to the specific demands of this population, it is our intention to contribute to the reflection on some of the factors that may interfere substantially in the LGBT process of health. We discuss some of the specific issues to each segment, highlighting the importance of attention of health professionals about the chain reactions that involve the process of vulnerability and that lead to illness in this population...

La población LGBT - lésbicas, gays, bisexuales y transexuales - es vulnerable en relación al atendimiento de sus derechos humanos, incluyendo el acceso a los servicios públicos de salud. A partir de la eminente necesidad de formación de los agentes de la salud en el tema LGBT, así como de la elaboración de acciones destinadas para las demandas específicas de esa población, es nuestra intención contribuir para la reflexión sobre algunos de los factores que pueden interferir de manera substancial en el proceso de salud de la población LGBT. Profundizamos sobre algunas de las cuestiones propias a cada segmento, subrayando la importancia de la atención de los profesionales de la salud frente a las reacciones en cadena que implican el proceso de vulnerabilidad y que conducen a que esa población enferme...