In chronic illnesses, such as prostate cancer, multiple health outcomes need to be considered. This project focused on two types of health outcomes: health-related quality of life (HRQoL) and cognitive function. The first aim was to investigate cognitive effects of pharmacological androgen-suppressing treatment. Numerous studies have shown cognitive performance to be associated with sex hormones. One of the main groups of drugs used for hormonal ablation in men with prostate cancer, the luteinising hormone releasing hormone (LHRH) agonists, has been associated with adverse cognitive effects in controlled studies in women and in case reports of female and male patients. However, there have been no published studies on the effect of LHRH agonists and other androgen-suppressing treatments on cognitive functioning in male patients. The second aim was to investigate the effect of treatments on HRQoL in men with prostate cancer. There are few randomised treatment studies of HRQoL in these patients. The third aim was to study additional predictors of HRQoL, examining stress and coping theory as a theoretical basis for understanding individual differences in HRQoL. The fourth aim was to examine patients' subjective experiences of prostate cancer. To investigate these questions, 82 men with non-localised prostate cancer were randomly assigned to receive leuprorelin (LHRH agonist), goserelin (LHRH agonist), cyproterone (steroidal antiandrogen), or close clinical monitoring. These patients and 20 community volunteers matched for age, marital status, and general health undertook medical, psychosocial, and cognitive assessments before treatment and after 6 and 12 months of treatment. The main question for statistical analysis was whether dependent variables would show Group x Time interactions in the predicted directions. Compared with baseline assessments, men administered androgen suppression monotherapy performed worse in 3/12 tests of attention, memory, and executive function. Twenty-six percent of men randomised to active treatment demonstrated clinically significant decline in one or more cognitive tests at 6 months compared with baseline performance. By contrast, no community volunteers or patients randomised to close monitoring showed decline in test performance. Men on hormonal treatments reported impaired sexual function on treatment compared with baseline assessments. Men assigned to close monitoring and cyproterone treatment reported increased emotional distress over time. Groups did not differ in change in existential satisfaction, subjective cognitive function, physical symptoms, or social and role functioning. For individuals, hormonal treatments were more frequently associated with decreased physical, sexual, social and role functioning, but were also associated with improved HRQoL for some individuals. In hierarchical regression analysis, HRQoL was lower for men who had more comorbid illnesses, a history of neurological dysfunction, higher threat appraisals, or higher use of emotion-focused coping strategies. Coping strategies also showed some longitudinal associations with HRQoL, even when earlier levels of HRQoL had been taken into account. Subjective reports demonstrated that many patients viewed prostate cancer as a relatively manageable problem. Several patients said that other health problems affected them more than prostate cancer, whereas no patient said that prostate cancer was worse than other problems. Comments about the seriousness of prostate cancer were equally divided between patients who reported it as very serious (14.3% of patients) and those who saw it as a relatively minor problem (14.3%). Other patient observations were grouped into categories of personal responses to prostate cancer, health, and health research; life circumstances that were not directly associated with health; attributions about medication; and function prior to the study. The results demonstrated that pharmacological androgen suppression therapy was associated with impaired memory, attention, and executive function in male patients. Hormonal treatments and close monitoring had differential effects on patients' HRQoL, particularly in terms of sexual function and emotional distress. HRQoL was also associated with appraisal and coping, to a greater extent than it was associated with medical variables, supporting the applicability of stress and coping theory for these patients. Observations from participants placed these findings in the context of participants' concerns, demonstrating that issues such as cognitive and sexual function were relevant for these patients. These findings suggest that cognitive function should be given increased attention as a health outcome, not only in "neurological" disorders but also in other "non-neurological" conditions such as prostate cancer. They also support continued efforts to understand both beneficial and adverse effects of treatments for chronic illness on HRQoL and individual factors that affect health outcomes.

This dissertation presents a new model of how children self-manage asthma with their parents. Traditional models of children's asthma self-management (CASM) rely on notions of adherence to medical regimens and consider parents to have primary responsibility for their children's health. However, children have primary control over the key CASM strategy: the self administered inhaler. This study investigated how children self-manage asthma, the tools they use and how they undertake shared responsibility for CASM with their parents. Employing sociological theories of children and childhood, a grounded theoretical, mixed method research design was employed to analyse data from multiple sources: primary qualitative data from interviews conducted with eight children (n = 8, age 7 -12 years) and their parents; interviews with two parents of infants; and secondary quantitative data from the 2001 NSW Child Health Survey (CHS01). Clear delineation was found between child and parent responsibilities. Responsibilities are responsive and adaptable according to the nature of the asthma event. There is consensus between children and parents as to what their responsibilities should be. Asthma is familiar, recognisable and usually easy to manage, particularly as children’s own actions are central to CASM. Thus, children considered asthma a predominantly 'ordinary' experience. 'Ordinary' tools include inhalers and non asthma-specific activities, such as resting. Parental responsibility focused on monitoring and reminding children of 'ordinary' CASM tasks. During frightening asthma events - such as night-time episodes and hospitalisation - children abdicated primary responsibility for CASM to their parents. 'Extraordinary' tools include nebulisers, oral medications and hospital. During 'extraordinary' asthma, the parental role is primary and includes responsibility for action and decision-making. While not considered 'ordinary', children nonetheless described frightening events in a way that accommodates asthma within schema for everyday life. Parents also described the '(extra) ordinariness' of asthma, but expressed greater anxiety for their children's future. This, plus the vigilance necessary for parents to monitor their child's condition, appeared to problematise asthma more for parents than for children. This was supported by results from parent-reported CHS01 analyses. This new model of CASM is discussed with respect to its implications for public health self management programs, guidelines and future research.

Psychology / (D. Litt et Phil.(Psychology ))

Submitted by Luis Guilherme Macena (guilhermelg2004@gmail.com) on 2012-11-22T16:12:19Z No. of bitstreams: 1 Joselia_Giordani_Hespanhol_Duarte.pdf: 1113728 bytes, checksum: 1ef6121c37e3547293ab750175dd0554 (MD5) / Made available in DSpace on 2012-11-22T16:12:19Z (GMT). No. of bitstreams: 1 Joselia_Giordani_Hespanhol_Duarte.pdf: 1113728 bytes, checksum: 1ef6121c37e3547293ab750175dd0554 (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, Brasil / Introdução: Apesar das mudanças no perfil da atenção pediátrica observadas nos últimos anos em decorrência dos avanços nos métodos diagnósticos e terapêuticos e da redução das internações por doenças infecto-contagiosas, a produção científica voltada para a avaliação do perfil e principais demandas das internações pediátricas ainda é escassa. Objetivo: Identificar as características e os procedimentos diagnósticos e terapêuticos das internações pediátricas em quatro hospitais do Ministério da Saúde (MS) no município do Rio de Janeiro. Método: Estudo observacional, de caráter descritivo. A pesquisa foi desenvolvida nos serviços de Pediatria de quatro hospitais do Ministério da Saúde que integram a Rede Hospitalar Federal no Rio de Janeiro. A amostra foi constituída de 170 internações ocorridas nas enfermarias de pediatria no período de janeiro a dezembro de 2008 de crianças desde o nascimento até 17 anos 11 meses e 29 dias. Resultados: As informações obtidas evidenciaram elevada freqüência de crianças portadoras de doenças crônicas (47.6%) no conjunto das internações estudadas. De forma semelhante, esses serviços também apresentaram elevado percentual de pacientes com histórico de reinternação (35.3%). A análise por unidade mostrou que apenas um serviço de pediatria, entre os quatro serviços estudados, apresentou menor proporção de crianças portadoras de doenças crônicas, média etária mais baixa e menor freqüência de reinternações. Nas outras três unidades hospitalares, em mais da metade do grupo estudado, as causas de internações encontradas, estavam ligadas às doenças crônicas. Para os procedimentos diagnósticos e terapêuticos, no total da amostra, foram encontrados percentuais mais altos para hemocultura (23.5%), suporte de O2 (17%), transfusão de sangue e hemoderivados (12.4%) e procedimentos cirúrgicos de alta complexidade (11%). Os resultados confirmam a necessidade de organização dos serviços pediátricos no sentido de estarem preparados com tecnologia adequada para o manejo, tratamento e acompanhamento do paciente portador de doença crônica. / Introduction: Changes in the profile of pediatric care have been observed in the past couple of years due to the technological advances in therapeutic and diagnostic methods and the reduction of hospitalization cases of infectious and contagious diseases. Yet, scientific research that evaluates the main needs of pediatric hospitalizations is rare. Goal: Identify the diagnostic and therapeutic procedures and the profile of pediatric hospitalization in four hospitals of the Health Ministry in the city of Rio de Janeiro. Method: Observational and descriptive study. The present research was developed at the pediatric services of four hospitals which are part of the Federal Hospitals Chain of the Health Ministry in Rio de Janeiro. The sample was comprised of 170 hospitalizations of children aged from birth to 17 years, 11 months, and 29 days. All hospitalizations occurred in the pediatric infirmaries of the aforementioned hospitals from January to December of 2008. Results: The collected data presented a high frequency of children with chronic diseases (47.6%). Likewise, the pediatric services also showed a high percentage of patients with a history of rehospitalization (35.3%). The analysis per hospital unit demonstrated that only one pediatric service, among the four unit services studied, presented a lower rate of children with chronic diseases, a lower average age rate, and a lower frequency of rehospitalizations. On the other three hospital units, more than half of the patients in each unit presented 30 reasons for hospitalization connected to chronic conditions. Upon analyzing diagnostic and therapeutic procedures, higher percentages for hemoculture (23.5%), oxygen therapy (17%), blood and hemoderivatives transfusion (12.4%), and high-complexity surgical procedures (11%) were found. The results confirm the necessity of better organization of the pediatric services in an effort to be prepared with the appropriate technology for the handling, treatment, and follow-up of patients with chronic conditions.

We evaluate if the social network structure, the percei ved support and the personal satisfaction acts on the caregiver's feeling of burden, coming from the caring of a child oran older parent with chronic invalidating illness. We used Mannheim's Instrument for Social Support (1986) and the Feeling of Burden Questionnaire (Zarit & Zarit, 1999) with 143 caregivers -50,3% mothers and 49,7% daughters. Taking into account the multivariate statistical tests, we can conclude that mothers have a larger relatives network than daughters, even though they don't significantly differ in the perception of social support. In mothers, the size of the relatives network, the everyday instrumental and the psychological crisis support diminishes the feeling of burden, as for the daughters the more intense crisis instrumental perceived support diminishes the same feeling. / Se evalúa si la estructura de la red social, el apoyo percibido y su nivel de satisfacción personal inciden en el sentimiento de sobrecarga del cuidador, derivado de la asistencia de un hijo o de un progenitor anciano con una enfermedad crónica invalidante. Con tal fin, fueron administrados a 143 cuidadoras -50,3% madres y 49,7% hijas- el Cuestionario sobre Apoyo Social de Mannheim (1986) y el Cuestionario sobre Sentimiento de Carga de Zarit y Zarit (1999). A partir de las pruebas multivariadas de significación estadística, se puede concluir que las madres presentan una red de parientes mayor que las hijas, aunque no se diferencian significativamente en la percepción del apoyo social. En ellas, el tamaño de la red de parientes, el apoyo instrumental cotidiano y psicológico en crisis aminora el sentimiento de sobrecarga, mientras que en las hijas lo disminuye la mayor intensidad de apoyo instrumental en crisis percibido por ellas.

Submitted by Franciele Moreira (francielemoreyra@gmail.com) on 2018-06-25T19:54:56Z No. of bitstreams: 2 Dissertação - Jackeline Gomes Borges - 2018.pdf: 2254374 bytes, checksum: d2da7b1eb61b4f77a59681f7cae7deea (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-06-27T11:42:05Z (GMT) No. of bitstreams: 2 Dissertação - Jackeline Gomes Borges - 2018.pdf: 2254374 bytes, checksum: d2da7b1eb61b4f77a59681f7cae7deea (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-06-27T11:42:05Z (GMT). No. of bitstreams: 2 Dissertação - Jackeline Gomes Borges - 2018.pdf: 2254374 bytes, checksum: d2da7b1eb61b4f77a59681f7cae7deea (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-05-29 / Introduction: Due to the growth of the elderly population in Brazil, the burden of chronic diseases and functional disability tend to increase, as well as the number of people who needlong-term care. Home care is a health care modality that complements the care provided in basic care and in hospital services, promoting humanization and quality of life, assisting in dehospitalization and optimizing health resources. It is important to know the profile of the elderly served by this modality to obtain information that will help in the execution of public policies for the improvement of the home care. Objective: To describe the clinical- epidemiological profile of elderly people with chronic diseases, assisted in a home care program, and factors associated with rehospitalization. Methodology: An observational, analytical and cross-sectional study carried out in the elderly accompanied by the home care service of a Rehabilitation Center of Goiás from March 2014 to January 2017. Data collection through electronic medical records study. Data analysis was performed by the statistical program Stata, version 14.0 with descriptive, bivariate and multiple analysis to verify the association between independent and dependent variables. Results: A total of 109 elderly people with mean follow-up time of 5.4 (± 3.7) months, 51.4% female, 46.8% married and 42.2% with no schooling. The mean age was 75.9 years (± 9.6), and those with> 80 years corresponded to 36.7%. Among the chronic diseases that led to functional disability, the most frequent sequelae was cerebrovascular accident, with 56.9%. Comorbidity was present in 87.2% of patients, 54.1% had some auxiliary device (tracheostomy, gastrostomy, oxygen, mechanical ventilation) and 48.6% presented some type of infection. Rehospitalization were more prevalent in patients with ancillary devices, comorbidities and infections. Of the elderly, 31.2% evolved to death in the follow-up period. The factors related to statistically significant rehospitalization were: neuro-muscular disease, chronic obstructive pulmonary disease and the presence of tracheostomy. Conclusion: There is a relevant percentage of elderly people over 80 years old. The main chronic disease was stroke. The prevalence of patients with comorbidities, ancillary devices and infectious intercurrences was high. As the statistically significant factors related to rehospitalization are associated with respiratory problems (neuro-muscular disease, chronic obstructive pulmonary disease and the presence of tracheostomy), it is proposed to increase the frequency of speech therapy, respiratory physiotherapy and dental care. / Introdução: Devido ao crescimento da população idosa no Brasil a carga de doenças crônicas e a incapacidade funcional tende a aumentar, assim como o número de pessoas que necessitam de cuidados de longa duração. A atenção domiciliar é modalidade de atenção à saúde que complementa os cuidados realizados na atenção básica e nos serviços hospitalares, promovendo a humanização e a qualidade de vida, auxiliando na desospitalização e otimizando os recursos de saúde. É importante conhecer o perfil dos idosos atendidos por esta modalidade para obter informações que auxiliarão na execução de políticas públicas para a melhoria dos cuidados domiciliares. Objetivo: Descrever o perfil clínico-epidemiológico de idosos com doenças crônicas, atendidos em um programa de atenção domiciliar, e fatores associados à reospitalização. Metodologia: Estudo observacional, analítico e transversal, realizado em idosos acompanhados pelo serviço de atenção domiciliar de um Centro de Reabilitação de Goiás no período de março de 2014 a janeiro de 2017. Coleta de dados por meio de estudo de prontuários eletrônicos. Análise de dados foi realizada pelo programa estatístico Stata, versão 14.0 com análise descritiva, bivariada e múltipla para verificar a associação entre as variáveis independentes e as dependentes. Resultados: Total de 109 idosos com tempo médio de seguimento de 5,4 (±3,7) meses, sendo 51,4 % do sexo feminino, 46,8% com estado civil casado e 42,2% com escolaridade ignorada. A média de idade foi 75,9 anos (± 9,6), e aqueles com > 80 anos corresponderam a 36,7%. Dentre as doenças crônicas que levaram à incapacidade funcional a mais frequente foi sequela de acidente vascular encefálico, com 56,9%. A comorbidade esteve presente em 87,2% dos pacientes, 54,1% apresentavam algum dispositivo auxiliar (traqueostomia, gastrostomia, oxigênio, ventilação mecânica) e 48,6% apresentaram algum tipo de infecção. As reospitalizações foram mais prevalentes nos pacientes portadores de dispositivos auxiliares, comorbidades e infecções. Dos idosos, 31,2% evoluíram para óbito no período de acompanhamento Os fatores relacionados à reospitalização estatisticamente significantes foram: doença neuro-muscular, doença pulmonar obstrutiva crônica e presença de traqueostomia. Conclusão: Há um percentual relevante de idosos com mais de 80 anos. A principal doença crônica foi acidente vascular encefálico. A prevalência de pacientes com comorbidades, dispositivos auxiliares e intercorrências infecciosas foi elevada. Como os fatores estatisticamente significantes relacionados à reospitalizações estão associados a problemas respiratórios (doença neuro-muscular, doença pulmonar obstrutiva crônica e presença de traqueostomia) propõe-se o aumento da frequência de atendimento fonoaudiólogo, de fisioterapia respiratória e atendimento odontológico

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-07T13:09:02Z No. of bitstreams: 1 Betânia Marta Domingues Quintanilha.pdf: 1304406 bytes, checksum: ae4a4a2c141d8a99d3f2ef3756701ddb (MD5) / Made available in DSpace on 2015-12-07T13:09:02Z (GMT). No. of bitstreams: 1 Betânia Marta Domingues Quintanilha.pdf: 1304406 bytes, checksum: ae4a4a2c141d8a99d3f2ef3756701ddb (MD5) Previous issue date: 2013 / Mestrado Profissional em Enfermagem Assistencial / A fibrose cística é uma doença crônica, progressiva e fatal. Há algum tempo era incomum os pacientes portadores dessa doença viverem além da infância, no entanto, os avanços no tratamento têm possibilitado um aumento na expectativa de vida dessas pessoas e com isso novos desafios no processo de cuidar. Este é um estudo descritivo exploratório com abordagem quali-quantitativa e tem por objetivo geral: Analisar o processo de resiliência do adolescente com seus fatores de risco e de proteção. A coleta de dados foi realizada no Instituto Nacional da mulher, da criança e do adolescente Fernandes Figueira com 12 adolescentes com idades entre 11 e 19 anos, entre os meses de fevereiro á abril de 2012, após aprovação do comitê de ética. Os procedimentos utilizados para a coleta das informações foi o questionário whoqol breve sobre qualidade de vida e uma entrevista semi-estruturada que foi gravada e posteriormente transcrita. A pontuação dos escores do questionário foi realizada utilizando-se o programa estatístico SAS 9.1.3 e a análise das entrevistas foi feita pela análise temática de conteúdo sendo adotado o referencial teórico de Boris Cyrulnik . Foi possível apreender pelas unidades de significado quatro categorias da analise que são Reaprender a viver uma outra vida- Metamorfosear, Entorno Afetivo Familiar, Escola e Amigos: a linha tênue entre risco e proteção e as Estratégias individuais de enfrentamento- Mecanismos de superação. Adentrar na subjetividade desses adolescentes e percebê-los em suas múltiplas dimensões propiciou compreender as adversidades por eles vividas, e a maneira pela qual eles procuraram extrair de cada situação da vida elementos que contribuam para o seu fortalecimento e os incitem a ir em frente. Para que os profissionais de enfermagem possam entender um pouco mais sobre a resiliência destes adolescentes com doença crônica, elaboramos um plano de curso de capacitação através do qual, poderemos especificar nossos cuidados, e nos momentos de tratamento sermos tutores de resiliência estimulando e promovendo os fatores de proteção e assim auxiliar esses adolescentes á dar um novo significado para sua vida / Cystic fibrosis is a chronic disease, progressive and fatal. Some time ago it was uncommon for patients with this disease live beyond infancy; however, advances in treatment have allowed an increase in the life expectancy of these people and with that new challenge in the care process. This research has the general objective: To analyze the resilience process of the teenagers risk and protective factors. This is a descriptive and exploratory search with qualitative and quantitative approach. A data collection was performed at the National Institute of woman, child and teenager Fernandes Figueira with 12 teenagers aged between 11 and 19 years, in the months February to April 2012, after the approval of the ethics committee. The procedures used for data collection was a semi-structured interview that was recorded and later transcribed, and a WHOQOL about quality of life. That was performed a thematic analysis of the content adopting the Boris Cyrulnik theoretical reference. It was possible to understand by the semantic units four categories of analysis that are Relearning to live another life - metamorphosing, Around Affective Family, School and Friends: the fine line between risk and protection and individual strategies to face - coping mechanisms. Being inside the subjectivity of these teenagers and see them in their multiple dimensions provides to understand their adversities, and the way in which of them sought to extract from every situation of life, elements that contribute to their strengthening and incite go ahead. By understanding a little more about the resilience of teenagers with chronic disease, we can specify our care, and in the times of treatment being guardians of resilience, stimulating and promoting protective factors and thus help these teens to take a new meaning to their lives

Cancer is the second leading cause of death in America. It’s been suggested that regular physical activity (PA) can improve health outcomes in cancer survivors. An estimate from BRFSS data (2009) suggested that 47% of all cancer survivors met recommended guidelines and that this estimate was not different from the population at large (48%). Several factors were examined from these BRFSS data to determine whether subgroups of survivors existed who might benefit from interventions aimed at improving their PA status. The purpose of this investigation was to obtain more recent estimates of adherence to established PA guidelines for cancer survivors. Data from 2015 NHIS were obtained from the CDC website. Of the survivors, 40% met PA guidelines. Additionally, 79% were 54 years or older, more likely to be female (60%), predominantly white (80%), with more than 2 comorbidities (41%), and with some form of functional limitation (66%). Compared to a study based on 2009 BRFSS data, an even smaller proportion of survivors met PA guidelines in this study. This might be due to differences in age distributions and no limitation of the analysis according to time since diagnosis. Targeted interventions to increase activity in cancer survivors continue to be warranted.

The purpose of this project was to design a chronic care plan using the chronic care management (CCM) framework to improve health services at lower healthcare costs. The practice-focused question explored whether the operationalization of the CCM model would impact progress toward the management of chronic illness for the target population of Medicare beneficiaries with 2 or more chronic illnesses in an urban acute care agency located in the western United States. The middle-range theory, logic rational plan model, Lewin’s change theory, and the CCM’s coordination care and collaborative care concepts were used to guide the project. Data were collected from nursing databases and government agencies. Nurses were significant to the CCM reform by supporting the elements for proactive care. Nurse practitioners can bill using the CCM codes, and clinical nurses can performed patient sensitive care. The social changes were patients with chronic illnesses realized a better quality of life at lower health costs.

My diploma thesis deals with issues of gender relations and the construction of identities of lived experiences of parents caring for a child (children) with a chronic illness. For my qualitative research, I have chosen the method of semi-structured interviews with both parents of the child (children). Subsequent analysis of the data in this empirical study examines the way in which care for a child with chronic illness affects, due to its demanding character, gender relations and whether it leads to more balanced gender relations or vice versa. I also deal with the process of identifying both parents in the day care of a child with chronic illness in the context of a combination of paid work and home care and children. In my work, I see how my communication partners are conceptualizing the chronic illness of the child as a differentness and the care of a child with a chronic illness as a burden. I focus on the emotional plane of parenthood and also analyze the processes of negotiation within different institutions (health and education organizations, state authorities). Key words: Chronic illness, child, parenthood, differentness, burden, care, gender relations