Thesis (M.S.)--University of Michigan, 1983.

Thesis (M.S.)--University of Michigan, 1983.

Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.S.)--University of Michigan, 1984.

Thesis (M.S.)--University of Michigan, 1984.

Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.S.)--University of Michigan, 1984.

Anledningen till att författarna gjorde denna studie var att bröstcancer är en av de vanligaste cancertyperna som drabbar kvinnor. Diagnosen innebär för de flesta kvinnor att hela eller delar av bröstet opereras bort. För många kvinnor representerar bröstet sexualitet och kvinnlighet. Syftet var att beskriva hur kvinnors sexualitet och sexuella relation förändras efter genomgången kirurgisk bröstcanceroperation och efterföljande behandling. Metoden var en kvalitativ litteraturstudie. Studien resulterade i tre huvudkategorier: (1) en förändrad kropp – en förändrad sexualitet, (2) en förändrad sexualitet – en förändrad sexuell relation, (3) emotionella förändringar i sexualiteten, samt tretton underkategorier. Resultatet visar att kvinnors sexualitet förändras både fysiskt och psykiskt. De flesta upplever en förändrad kroppsbild, minskad sexuell lust och njutning. Samlagen blir ofta smärtsamma vilket gör att många kvinnor drar sig undan sin partner. Många kvinnor upplever svårigheter i att prata om sin förändrade sexualitet med sin partner. Resultatet visar också att sjukvården ibland ger bristfällig information till kvinnor om eventuella biverkningar till följd av en bröstcanceroperation och efterföljande behandling. Då många bröstcancerdrabbade kvinnor upplever sexuella problem bör sjuksköterskor ge bättre information om eventuella biverkningar av behandlingen samt uppmärksamma dessa problem mer. Sjuksköterskor bör även möjliggöra till samtal med kvinnan om hennes funderingar kring sin förändrade sexualitet. / The reason why the authors conducted this study was that breast cancer is one of the most common types of cancer among women. For most women the diagnosis means that the entire or parts of the breast will have to be removed. For most women the breast represents sexuality and femininity. The aim was to describe how female sexuality and sexual relationship change after breast cancer surgery and subsequent treatment. The method was a qualitative litterature review. The study resulted in three main categories: (1) a changed body – a changed sexuality, (2) a changed sexuality – a changed sexual relationship, (3) emotional changes in sexuality, and thirteen subcategories. The result shows that female sexuality changes physically as well as psychically. Most women experience changes in body image, decreased sexual desire and pleasure. Intercourse becomes painful which makes many women withdraw from their partner. Many women experience difficulties in communicating about their changed sexuality with their partner. The result also shows that sometimes health care providers give poor information to women about plausible side effects due to breast cancer surgery and subsequent treatment. Because many women with breast cancer experience sexual problems nurses should give better information about plausible side effects from the treatment and highlight these problems. Nurses should also enable conversations with women regarding their thoughts concerning their changed sexuality.

<p>Anledningen till att författarna gjorde denna studie var att bröstcancer är en av de vanligaste cancertyperna som drabbar kvinnor. Diagnosen innebär för de flesta kvinnor att hela eller delar av bröstet opereras bort. För många kvinnor representerar bröstet sexualitet och kvinnlighet. Syftet var att beskriva hur kvinnors sexualitet och sexuella relation förändras efter genomgången kirurgisk bröstcanceroperation och efterföljande behandling. Metoden var en kvalitativ litteraturstudie. Studien resulterade i tre huvudkategorier: (1) en förändrad kropp – en förändrad sexualitet, (2) en förändrad sexualitet – en förändrad sexuell relation, (3) emotionella förändringar i sexualiteten, samt tretton underkategorier. Resultatet visar att kvinnors sexualitet förändras både fysiskt och psykiskt. De flesta upplever en förändrad kroppsbild, minskad sexuell lust och njutning. Samlagen blir ofta smärtsamma vilket gör att många kvinnor drar sig undan sin partner. Många kvinnor upplever svårigheter i att prata om sin förändrade sexualitet med sin partner. Resultatet visar också att sjukvården ibland ger bristfällig information till kvinnor om eventuella biverkningar till följd av en bröstcanceroperation och efterföljande behandling. Då många bröstcancerdrabbade kvinnor upplever sexuella problem bör sjuksköterskor ge bättre information om eventuella biverkningar av behandlingen samt uppmärksamma dessa problem mer. Sjuksköterskor bör även möjliggöra till samtal med kvinnan om hennes funderingar kring sin förändrade sexualitet.</p> / <p>The reason why the authors conducted this study was that breast cancer is one of the most common types of cancer among women. For most women the diagnosis means that the entire or parts of the breast will have to be removed. For most women the breast represents sexuality and femininity. The aim was to describe how female sexuality and sexual relationship change after breast cancer surgery and subsequent treatment. The method was a qualitative litterature review. The study resulted in three main categories: (1) a changed body – a changed sexuality, (2) a changed sexuality – a changed sexual relationship, (3) emotional changes in sexuality, and thirteen subcategories. The result shows that female sexuality changes physically as well as psychically. Most women experience changes in body image, decreased sexual desire and pleasure. Intercourse becomes painful which makes many women withdraw from their partner. Many women experience difficulties in communicating about their changed sexuality with their partner. The result also shows that sometimes health care providers give poor information to women about plausible side effects due to breast cancer surgery and subsequent treatment. Because many women with breast cancer experience sexual problems nurses should give better information about plausible side effects from the treatment and highlight these problems. Nurses should also enable conversations with women regarding their thoughts concerning their changed sexuality.</p>

O câncer do colo do útero (CCU) é passível de prevenção e tratamento, quando detectado precocemente e seguido do efetivo tratamento. Ainda assim, é o terceiro tipo mais comum entre as mulheres no mundo e mantém-se como a quarta causa de morte por câncer em mulheres no Brasil. Em países desenvolvidos observou-se diminuição importante da incidência e mortalidade por CCU nas últimas décadas, principalmente após a implantação de programas organizados de rastreamento. Estes programas pressupõem uma rede de atenção coordenada de serviços, capazes de oferecer desde o rastreamento populacional com foco e cobertura no grupo mais suscetível até a garantia de tratamento de qualidade quando necessário. A oferta de exames citológicos do colo do útero tem sido uma importante estratégia para o controle deste câncer na população feminina no Brasil. Entretanto supõe-se que um percentual significativo de mulheres, com exames alterados no rastreamento, que são encaminhadas para avaliação colposcópica para confirmação diagnóstica não chega a fazê-la, e o sistema de saúde também não é eficiente para controlar adequadamente esse evento. Nesta direção, estudo observacional, tipo coorte histórica, foi realizado com usuárias de um serviço de Atenção Primária à Saúde (APS) em Porto Alegre, RS, Brasil. O objetivo principal foi avaliar o programa de rastreamento desenvolvido neste serviço, principalmente em relação ao seguimento dos casos positivos identificados no rastreamento. Todas as mulheres que apresentavam lesões precursoras de câncer do colo do útero, no exame citológico (CP), entre 2001-2007, foram elegíveis para o estudo e acompanhadas até agosto de 2011. Avaliou-se a condição prévia de rastreamento, o diagnóstico/tratamento e o seguimento. Para a análise da qualidade do cuidado foram considerados o alcance dos atributos da APS (acesso, longitudinalidade e coordenação dos cuidados) e a efetividade do tratamento e do acompanhamento subsequente. A ausência de CP anterior estava associada à detecção de alteração de maior grau. A maioria das mulheres (94%) foi encaminhada para avaliação ginecológica, sendo que 97% delas compareceram a consulta. O tempo mediano entre as datas do CP alterado e a consulta no serviço de referência foi de 25 dias. Houve a confirmação do diagnóstico em 80% das mulheres que fizeram histologia. Após tratamento, 89% apresentaram CP normal, sendo que 66% têm seguimento subsequente realizado na APS. Estimamos que a vigilância em saúde com auxílio da busca ativa contribuiu para melhorar o acesso e a adesão aos cuidados. Este serviço trabalha para controle do CCU há mais de 20 anos, e as taxas de mortalidade por este câncer são menores do que as encontradas em Porto Alegre. O maior alcance da longitudinalidade e coordenação dos cuidados, características de um serviço orientado pela APS, pode ter relação com estes resultados. / Cervical cancer is preventable and treatable depending on its early detection followed by effective treatment. Even so, it is the third type of cancer more common among women in the world. In Brazil is the fourth cause of death due to cancer among women. In developed countries, an important decrease in incidence and mortality of cervical cancer has been observed in the last decades, mainly after the implementation of organized screening programs. Such programs are responsible for a network of services capable to offer population screening focusing on more susceptible groups, and including the warranty of high quality treatment when necessary. The offer of cytological exams of the uterine cervix has been an important strategy to control this cancer among Brazilian women. However, it is estimated that a significant proportion of women with abnormal screening exams who are referred to colposcopy to diagnostic confirmation do not perform such exam, and the health system is not efficient enough to control this event. In this perspective, a historical cohort study was performed, including women who attended a Primary Care Service in Porto Alegre city, southern Brazil. The main objective was to evaluate the screening program developed in this service, especially regarding the follow-up of positive cases identified during screening. All women who presented cervical cancer precursor lesions in the cytological exam between 2001 and 2007, were eligible for the study and they were followed-up until august 2011. The women condition prior to screening, diagnostic/treatment and follow-up was evaluated. To analyze the quality of care were considered the scope of the Primary Care attributes (access, longitudinality and coordination of care) and effectiveness of treatment and subsequent follow-up. The absence of a previous cytological exam was associated to the detection of a high grade abnormality. The majority of women (94%) were sent to gynecological evaluation and 97% attended the appointment. The median time between the date of the abnormal cytological exam and the appointment was 25 days. There was diagnostic confirmation through biopsy in 80% of the studied women. After treatment, 89% presented normal cytological exam, being 66% performed in the Primary Care Service. It’s estimated that a health surveillance with active search contributed to improve the access and adhesion to the follow-up. This service works to control the cervical cancer for more than 20 years, and the mortality rates of this cancer are lower than those reported for the whole city of Porto Alegre. The greatest extent of longitudinality and coordination of care, characteristics of a service-driven APS, may be related to these results.