Impacto das cirurgias para tratamento do câncer de mama na qualidade de vida e atividade profissional

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Publica.Esta dissertação teve como propósito avaliar o impacto das cirurgias para o tratamento do câncer de mama na qualidade de vida e atividade profissional das mulheres. Para tal foram realizados dois estudos transversais descritivos. Foram selecionadas para o estudo, 137 mulheres com diagnóstico de câncer de mama que realizaram sua primeira consulta no CEPON (Centro de Pesquisas Oncológicas /SC) no ano 2000, residentes na grande Florianópolis. O primeiro estudo teve como principal objetivo associar alguns aspectos relacionados à cirurgia para o tratamento do câncer de mama, tais como a técnica cirúrgica realizada, a reconstrução mamária, a existência de queixas pós operatórias, a fisioterapia pós-cirúrgica, o afastamento da atividade profissional com a qualidade de vida nestas mulheres. Para a avaliação da qualidade de vida foi utilizada uma versão traduzida para o português do Quality of Life Instrument - Breast Cancer Version, questionário proposto pelo National Medical Center and Beckman Research Institute (EUA). Não foram observadas diferenças estatisticamente significativas com relação ao tipo de cirurgia, a reconstrução mamária e a realização de fisioterapia pós-operatória quando associados a qualidade de vida, no entanto as mulheres que relataram mais queixas atuais apresentaram pior qualidade de vida, assim como as que se afastaram de suas atividades profissionais. O segundo estudo objetivou investigar qual o impacto das cirurgias para tratamento do câncer de mama na atividade profissional da mulher, buscando descrever o número de mulheres afastadas do trabalho, se o tipo de cirurgia (radical ou conservadora) influenciou no afastamento e as principais queixas que levaram a mulher a se afastar de sua profissão. Com relação ao afastamento profissional 59,72% das mulheres tiveram que se afastar de suas atividades profissionais devido à cirurgia. Os principais motivos que causaram o afastamento das mulheres de seus empregos foram: medo de se machucar, diminuição da força no braço, menor agilidade, indisposição para o trabalho, a percepção de que o braço "pesava" muito, perda ou diminuição do movimento no braço, dor e freqüência de exames clínicos. Não foram encontradas diferenças estatisticamente significativas quando relacionadas as variáveis tipo de cirurgia, fisioterapia pós-operatória com o afastamento profissional, no entanto a presença do linfedema encontrado em 58,1% das mulheres que se afastaram de suas atividades profissionais apresentou significância estatística marginal (p=0,0519)

Diagnóstico de limitação ao fluxo de ar das vias aéreas definida pela razão fixa VEF1/CVF comparada ao limite inferior da normalidade : estudo de base populacional

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2016A demonstração da obstrução crônica ao fluxo de ar é essencial para ao diagnóstico de doença pulmonar obstrutiva crônica (DPOC). Para a GOLD (Global Initiative for Chronic Obstructive Lung Disease) o diagnóstico de DPOC deve ser confirmado pela presença do valor fixo da razão do volume expiratório forçado em um segundo (VEF1) sobre a capacidade vital forçada (CVF) Abstract : The demonstration of chronic airflow obstruction is essential for the diagnosis of chronic obstructive pulmonary disease (COPD). The GOLD (Global Initiative for Chronic Obstructive Lung Disease) indicates that the diagnosis of COPD should be confirmed by the fixed value of the presence of reason forced expiratory volume forced in one second (FEV1) to forced vital capacity (FVC) <0.7 post bronchodilator. However, as this ratio decreases with increasing age, joint guidelines of the American Thoracic Society (ATS) and European Respiratory Society (ERS) proposed the use of the lower limit of normal (LLN) of FEV1 / FVC to define COPD. The use of fixed value of FEV1/FVC ratio (fixed ratio) as a criterion for the diagnosis of COPD can lead to overdiagnosis in the elderly and underdiagnosis in young people. Objective: Investigate the agreement between the functional diagnosis of COPD determined by the fixed ratio and by the LLN of the FEV1/FVC ratio in individuals aged = 40 years old in a populationbased study. Methods: This was a population-based study, representative of the residents of the city of Florianopolis =40 years, whose methodology was based on the PLATINO study. The assessment instruments used in the study comprised household interviews, anthropometric measurements and spirometry. The functional diagnosis of COPD was made by spirometry (FEV1/FVC <0.70 postbronchodilator). Continuous variables were summarized as mean and 95% confidence interval (CI) while categorical variables were expressed as percentages. The Kappa statistic was used to determine the agreement between the functional diagnosis of COPD by the fixed ratio and the LLN of the FEV1/FVC ratio. Differences between groups for categorical variables were examined using Chi-square test. Comparison of two means was performed by unpaired t test. Analyze of variance (ANOVA) with post-hoc analysis with Bonferroni significance test when appropriated was used to compare the means of three or more groups. All reported p values are based on two-sided tests and the significance level was 5% (p = 0.05). Results: 1059 spirometry were considered eligible. The prevalence of COPD determined by the fixed ratio was higher than that defined by the LLN (8.7% vs 5.6%). The global agreement between the two diagnoses was very good (Kappa = 0.76). The agreement between the two functional diagnosis, according to age group, showed that this was perfect for the age group 40-49 years (Kappa = 1), very good for the age groups 50-59 years and 60 to 69 years (Kappa = 0.86 and 0.78, respectively) and moderate for individuals aged = 70 years (Kappa = 0.56). Individuals with functional diagnosis of COPD determined by LLN were significantly younger and had more severe disease. Analysis of the distribution of smoking status among individuals with COPD determined by LLN showed that 80% of them were current smokers or ex-smokers and 1/4 of them also had a history of prior doctor diagnosis of asthma. Among nonsmokers, more than half reported a prior doctor diagnosis of asthma. Conclusion: The results show that although the agreement between the two criteria for the diagnosis of COPD was substantial, the prevalence of COPD determined by the fixed ratio was 1.5 times higher than that determined by LLN. These results suggest that it is possible that the criterion of fixed ratio, as suggested by GOLD, has overestimated the diagnosis of COPD

Low level Laser therapy in radiation-induced vaginal stenosis after cervical cancer treatment: Case Report/ Terapia a laser de baixa potência na estenose vaginal induzida por radiação após tratamento do câncer cervical: relato de caso

Background and objective: Low Level Laser Therapy (LLLT) has been widely studied to relieve pain and accelerate the wound healing process. Considering the occurrence of radiation-induced vaginal stenosis due to the treatment of cervical cancer, as well as the pain and tissue injury that ionizing radiation therapy causes, this study discusses the use of LLLT as a therapeutic resource to complement the recommended therapy of dilation of the vaginal canal. Methods: Case report of a woman with radiation-induced vaginal stenosis after brachytherapy cervical cancer treatment, complaining of pain and local bleeding. Results: LLLT favored vaginal dilation therapy, reducing vaginal pain and bleeding, reducing recovery time. Conclusions: LLLT can be a resource to be considered in the treatment of radiation-induced vaginal stenosis. Implications for Cancer Survivors: The use of this technique demonstrates improving the patient's quality of life after treatment, leads to a decrease in pain, improves adherence to physical therapy treatment, facilitates sexual intercourse and follow-up exams

Use of lymphatic taping to prevent the formation of ecchymosis in abdominoplasty and liposuction

Introduction: Ecchymosis is one of the most common complications in the postoperative period of plastic liposuction and abdominoplasty surgery. Its treatment and prevention are part of the routine of the dermatofunctional physiotherapist. The objective is to evaluate the occurrence of ecchymosis in patients undergoing abdominoplasty and/ or traditional liposuction of the abdomen and flanks and statistically correlate these occurrences with the treatment of lymphatic taping during the operation. Methods: Controlled clinical trial, composed of 20 female patients, aged between 20 and 60, divided into 10 in the control group (CG) and 10 in the experimental group (EG). All women had a surgical indication of abdominoplasty and/or liposuction of the abdomen and flanks. The CG was only evaluated preoperatively and on the 4th postoperative day, while the EG group was evaluated preoperatively, received transoperative treatment with application of lymphatic taping and was reevaluated on the 4th postoperative day. Results: The experimental group presented a better response in the resolution of ecchymosis (p=0.01) when compared to the control group. Conclusion: In this study, the use of lymphatic taping during the transoperative period of abdominoplasty and liposuction reduced or annulled the formation of ecchymosis in the postoperative period, contributing to the decrease in the number of physical therapy visits, the incidence of pain and thus accelerating the reestablishment of patients from abdominoplasty and/or liposuction surgeries

Práticas de autocuidado e os efeitos colaterais imediatos em mulheres com câncer ginecológico em braquiterapia

Objective: to reveal the immediate side effects and self-care practices adopted by women with gynecological cancer submitted to brachytherapy. Method: narrative research, conducted with 12 women, in southern Brazil, between December/2018 and January/2019, including semi-structured interviews submitted to content analysis. Results: three thematic categories emerged from the analysis: Care oriented and adopted by women in pelvic brachytherapy; Immediate side effects perceived by women in pelvic brachytherapy; Care not guided by health professionals. The care provided by the nurses most reported by the women was vaginal dilation, use of a shower and vaginal lubricant, tea consumption, cleaning, and storage of the vaginal dilator. The side effects most frequently mentioned in the interviews were urinary and intestinal changes in the skin and mucous membranes. Conclusion: nursing care in brachytherapy must prioritize care to prevent and control genitourinary and cutaneous changes, including self-care practices.Objetivo: revelar os efeitos colaterais imediatos e as práticas de autocuidado adotadas por mulheres com câncer ginecológico submetidas à braquiterapia. Método: pesquisa narrativa, realizada com 12 mulheres, no Sul do Brasil, entre dezembro/2018 e janeiro/2019, incluindo entrevista semiestruturada submetida à análise de conteúdo. Resultados: da análise emergiram três categorias temáticas: Cuidados orientados e adotados pelas mulheres em braquiterapia pélvica; Efeitos colaterais imediatos percebidos pelas mulheres em braquiterapia pélvica; Cuidados não orientados pelos profissionais da saúde. Os cuidados orientados pelas enfermeiras mais relatados pelas mulheres foram dilatação vaginal, uso de ducha e lubrificante vaginal, consumo de chá, higienização e guarda do dilatador vaginal. Os efeitos colaterais mais citados nas entrevistas foram alterações urinárias e intestinais na pele e mucosas. Conclusão: evidencia-se que a atenção de enfermagem em braquiterapia deve priorizar cuidados para prevenir e controlar as alterações geniturinárias e tegumentares, incluindo práticas de autocuidado

Nursing diagnoses of Icnp® in patients undergoing surgical treatment for penis cancer

Objective: formulating nursing diagnoses in patients undergoing surgical treatment for penis cancer using the ICNP®. Methods: an exploratory descriptive study performed at a University Hospital. Fourteen records of patients hospitalized between 2006 and 2010 were reviewed. The terms found on nursing records were listed on a spreadsheet using the Seven Axis model, then cross-mapped with those listed on ICNP® version 1.0. Results: nineteen nursing diagnoses were found, which were related to wound healing, nutrition, elimination, mobility, sleep, pain, anxiety, self-image, self-esteem, and sexuality. Some terms required approximation as they were synonyms or were not included in the referred version. Conclusion: the terms used by nurses for patients undergoing surgery for penis cancer allowed the formulation of diagnoses that revealed needs that were compromised in face of the mutilating character and the involvement of sexuality in this process

Significado do uso da prótese peniana de silicone no seguimento da braquiterapia pélvica

Objective: to describe the meaning of the use of silicone penile prosthesis for vaginal dilation in the follow-up of brachytherapy in women with gynecological cancer. Method: narrative research conducted at the Centro de Pesquisas Oncológicas, Brazil, with 34 women after pelvic brachytherapy, under follow-up at the physical therapy service. Data collection through semi-structured interviews, including sociodemographic and clinical data and the significance of the use of penile prosthesis in vaginal dilation, submitted to content analysis and discussed in the light of the study From 'sex toy' to intrusive imposition. Results: the meaning permeates the vaginal dilation exercise; difficulties related to vaginal conditions, disease, treatment, pain, sex, constraints, prejudices, failures in health education; motivations are related to the search for quality of life, support of partners and professionals. Conclusion: the approach of possible emotional, psychological, social and physical barriers should be planned and executed for prevention of vaginal stenosis and better reception.Objetivo: describir el significado del uso de una prótesis peneana de silicona para la dilatación vaginal posterior a la braquiterapia en mujeres con cáncer ginecológico. Método: investigación narrativa, realizada en el Centro de Pesquisas Oncológicas, Brasil, con 34 mujeres, después de braquiterapia pélvica, en seguimiento en el servicio de fisioterapia. Recopilación de datos a través de entrevistas semiestructuradas, incluyendo datos sociodemográficos y clínicos y el significado del uso de prótesis peneana en la dilatación vaginal, sometidos a análisis de contenido y discutidos a la luz del estudio From 'sex toy' to intrusive imposition. Resultados: el significado impregna el ejercicio de dilatación vaginal; dificultades relacionadas con condiciones vaginales, enfermedad, tratamiento, dolor, sexo, vergüenza, prejuicios, fallas en la educación para la salud; las motivaciones están relacionadas con la búsqueda de calidad de vida, apoyo de la pareja y profesionales. Conclusión: se debe planificar y ejecutar el abordaje de las posibles barreras emocionales, psicológicas, sociales y físicas para prevenir la estenosis vaginal y una mejor recepción.Objetivo: descrever o significado do uso da prótese peniana de silicone para dilatação vaginal no seguimento da braquiterapia em mulheres com câncer ginecológico. Método: pesquisa narrativa, realizada no Centro de Pesquisas Oncológicas, Brasil, com 34 mulheres, após braquiterapia pélvica, em seguimento no serviço de fisioterapia. Coleta de dados por entrevistas semiestruturadas, incluindo dados sociodemográficos, clínicos e o significado do uso da prótese peniana na dilatação vaginal, submetidas à análise de conteúdo e discutidas à luz do estudo From 'sex toy' to intrusive imposition. Resultados: o significado perpassa o exercício de dilatação vaginal; as dificuldades relacionadas às condições vaginais, doença, tratamento, dor, sexo, constrangimentos, preconceitos, falhas na educação em saúde; as motivações relacionam-se à busca por qualidade de vida, apoio dos companheiros e profissionais. Conclusão: a abordagem de possíveis barreiras emocionais, psicológicas, sociais e físicas deve ser planejada e executada para prevenção da estenose vaginal e melhor acolhimento

Is the frequency of crossfit practice correlated with stress urinary incontinence? a transversal study of prevalence/ A frequência da pratica de crossfit esta correlacionada com a incontinência urinaria de esforço? Um estudo transversal de prevalência

Objective: To verify the prevalence of SUI symptoms in practitioners of high intensity physical activities, such as CrossFit, and to analyze the correlation of the high frequency of this activity with urinary losses, in a CrossFit gym in Greater Florianópolis - SC. Methods: This is a cross-sectional study in which the sample was composed of women who had practiced the CrossFit modality for over a month and over 18 years of age. A questionnaire was applied to assess the data regarding personal characteristics, reproductive life, training frequency and Crossfit time, perceptions about urine loss and evaluation by the Pad-test. Results: The final sample was 34 women, the average age of the participants was 30.3 ± 6.43 years. Among them, 76.4% were nulliparous, 61.7% had been practicing the sport for at least 8 months, 14% reported perceiving urine loss on a daily basis and 88.2% had stress urinary incontinence characterized as mild to moderate. A correlation of greater urinary loss was found the greater the frequency of weekly training Conclusion: Most of the women participating presented urine loss on exertion, classified as mild to moderate. Demonstrating that high intensity activities, such as Crossfit, and their weekly frequency can directly influence stress urinary incontinence. There is a need for further research with a larger sample, greater homogeneity of training and individualization in the evaluation

Por dentro do Hospital Colônia Santana

Este artigo tem como objetivo realizar uma leitura etnográfica de prontuários de mulheres internadas no antigo Hospital Colônia Santana (HCS), de Santa Catarina, durante as décadas de 1940 e 1950. Os prontuários fazem parte do acervo do Centro de Documentação e Pesquisa do Instituto de Psiquiatria de Santa Catarina (CEDOPE/Ipq/SC), que abriga a documentação referente ao Hospital Colônia Santana e inclui, além dos prontuários, livros de registro dos internos, livros de ocorrência, relatórios institucionais, fotografias, cadernos, diários, desenhos e pinturas em telas dos internos e outros documentos da instituição. Este artigo traz uma abordagem inicial dessa documentação e busca focar nos modos como os prontuários, ao mesmo tempo que nos informam sobre as práticas médicas e rotinas terapêuticas do hospital, trazem pistas sobre os sujeitos internos, seus atos, condutas, agências e resistências. Nesta análise nos deteremos em alguns poucos prontuários, buscando neles rastros, pistas de algumas dentre centenas de mulheres que ingressaram na instituição durante essas décadas

Por dentro do Hospital Colônia Santana: uma leitura etnográfica de prontuários psiquiátricos de mulheres internas nas décadas de 1940 e 1950

Este artigo tem como objetivo realizar uma leitura etnográfica de prontuários de mulheres internadas no antigo Hospital Colônia Santana (HCS), de Santa Catarina, durante as décadas de 1940 e 1950. Os prontuários fazem parte do acervo do Centro de Documentação e Pesquisa do Instituto de Psiquiatria de Santa Catarina (CEDOPE/Ipq/SC), que abriga a documentação referente ao Hospital Colônia Santana e inclui, além dos prontuários, livros de registro dos internos, livros de ocorrência, relatórios institucionais, fotografias, cadernos, diários, desenhos e pinturas em telas dos internos e outros documentos da instituição. Este artigo traz uma abordagem inicial dessa documentação e busca focar nos modos como os prontuários, ao mesmo tempo que nos informam sobre as práticas médicas e rotinas terapêuticas do hospital, trazem pistas sobre os sujeitos internos, seus atos, condutas, agências e resistências. Nesta análise nos deteremos em alguns poucos prontuários, buscando neles rastros, pistas de algumas dentre centenas de mulheres que ingressaram na instituição durante essas décadas.This article aims to perform an ethnographic reading of medical records of women hospitalized at the former Colonia Santana Hospital (HCS), in Santa Catarina, during the 1940s and 1950s. The medical records are part of the collection of the Documentation and Research Center of the Psychiatry Institute of Santa Catarina (CEDOPE/Ipq/SC), which houses the documentation referring to the Hospital and includes, in addition to medical records, internees’ registration books, occurrence books, institutional reports, photographs, diaries, drawings and paintings on screens of inmates and other documents of the institution. This article brings an initial approach to this documentation and seeks to focus on the ways in which the medical records, while informing us about the medical practices and therapeutic routines of the hospital, bring clues about the women internees, their acts, conduct, agencies and resistance. In this analysis we will focus on a few medical records, looking for traces of them, clues from some of the hundreds of women who entered the institution during these decades