<p>Syftet med denna studie var att kartlägga alternativa behandlingsmetoder för behandling av tidiga klimakteriebesvär, kring menopaus. Studien genomfördes som en litteraturstudie med beskrivande design, där tjugo vetenskapliga artiklar granskades. Resultatet visar fem alternativa behandlingsmetoder: akupunktur, yoga, fysisk aktivitet, naturläkemedel och fytoöstrogener. Både akupunktur och yoga gav en signifikant förbättring vad det gäller värmevallningar, nattliga svettningar, sömnkvalitet och livskvalitet. Med ökad fysisk aktivitet upplevde kvinnorna färre fysiska och psykiska besvär kopplade till klimakteriet och förbättring av allmänna välbefinnandet, ingen skillnad sågs vad det gäller vasomotorbesvär. När naturläkemedel och fytoöstrogener jämförts med placebo, ses möjligen en minskning av värmevallningar och nattliga svettningar, samt ökning av livskvaliteten med dessa olika preparat men samma förbättring ses i dessa studier även med placebopreparat. Ingen av de alternativa behandlingsmetoderna hade effekt på vaginalslemhinnan och förbättrade därmed inte de urogenitala besvären. Slutsats av denna litteraturgenomgång av alternativa behandlingsmetoder är att vissa behandlingsmetoder innebär en förbättring vad det gäller tidiga klimakteriebesvär och livskvalitet, men att flera behandlingsmetoder inte är mer effektfulla än placebo. Ytterligare forskning, med fler stora randomiserade kontrollerade studier är nödvändig för att se effekten av och utvärdera de för närvarande tillängliga alternativa behandlingsmetoderna. Ännu ett forskningsområde är att studera kvinnornas upplevelser av alternativa behandlingsmetoder.</p> / <p>The aim of this study was to describe complementary therapies for treating early climacteric complaints, around menopause. The study was conducted as a literature review with a descriptive design, where the author examined twenty scientific articles. The result shows five complementary therapies, acupuncture, yoga, physical activity, herbal medicines and phytoestrogens. Both acupuncture and yoga significantly reduced hot flushes and night sweats, they also improved subjective sleep quality and quality of life. Increased physical activity made women report fewer physical and psychological symptoms attributed to menopause and improved general well-being, but it had no effect on vasomotor symptoms. When herbal medicines and phytoestrogens have been compared with placebo, they all showed a similar small relief of hot flushes and night sweats and improvement in quality of life. None of the complementary therapies showed effect on vaginal tracts and did not improve urogenital symptoms. The conclusion from this literature review is that some complementary therapies show improvement in the early menopausal symptoms and quality of life, but some treatments are not more powerful than placebo. Further research, with larger randomized controlled studies are necessary, both to see the effect of the currently accessible alternative treatments, but also to examine how women perceive the impact.</p>

Syftet med denna studie var att kartlägga alternativa behandlingsmetoder för behandling av tidiga klimakteriebesvär, kring menopaus. Studien genomfördes som en litteraturstudie med beskrivande design, där tjugo vetenskapliga artiklar granskades. Resultatet visar fem alternativa behandlingsmetoder: akupunktur, yoga, fysisk aktivitet, naturläkemedel och fytoöstrogener. Både akupunktur och yoga gav en signifikant förbättring vad det gäller värmevallningar, nattliga svettningar, sömnkvalitet och livskvalitet. Med ökad fysisk aktivitet upplevde kvinnorna färre fysiska och psykiska besvär kopplade till klimakteriet och förbättring av allmänna välbefinnandet, ingen skillnad sågs vad det gäller vasomotorbesvär. När naturläkemedel och fytoöstrogener jämförts med placebo, ses möjligen en minskning av värmevallningar och nattliga svettningar, samt ökning av livskvaliteten med dessa olika preparat men samma förbättring ses i dessa studier även med placebopreparat. Ingen av de alternativa behandlingsmetoderna hade effekt på vaginalslemhinnan och förbättrade därmed inte de urogenitala besvären. Slutsats av denna litteraturgenomgång av alternativa behandlingsmetoder är att vissa behandlingsmetoder innebär en förbättring vad det gäller tidiga klimakteriebesvär och livskvalitet, men att flera behandlingsmetoder inte är mer effektfulla än placebo. Ytterligare forskning, med fler stora randomiserade kontrollerade studier är nödvändig för att se effekten av och utvärdera de för närvarande tillängliga alternativa behandlingsmetoderna. Ännu ett forskningsområde är att studera kvinnornas upplevelser av alternativa behandlingsmetoder. / The aim of this study was to describe complementary therapies for treating early climacteric complaints, around menopause. The study was conducted as a literature review with a descriptive design, where the author examined twenty scientific articles. The result shows five complementary therapies, acupuncture, yoga, physical activity, herbal medicines and phytoestrogens. Both acupuncture and yoga significantly reduced hot flushes and night sweats, they also improved subjective sleep quality and quality of life. Increased physical activity made women report fewer physical and psychological symptoms attributed to menopause and improved general well-being, but it had no effect on vasomotor symptoms. When herbal medicines and phytoestrogens have been compared with placebo, they all showed a similar small relief of hot flushes and night sweats and improvement in quality of life. None of the complementary therapies showed effect on vaginal tracts and did not improve urogenital symptoms. The conclusion from this literature review is that some complementary therapies show improvement in the early menopausal symptoms and quality of life, but some treatments are not more powerful than placebo. Further research, with larger randomized controlled studies are necessary, both to see the effect of the currently accessible alternative treatments, but also to examine how women perceive the impact.

Introduction: Hormone therapy (HT) has been considered as a safe treatment for menopausal symptoms. Use of HT increased dramatically in the 1980s and 1990s. Results from large randomized clinical trials (RCT) could, around the turn of the century, however not find evidence for long-term benefits with HT. These results attracted great attention from media and the scientific community leading to changed treatment guidelines and decreased use of HT. Aim: The overall aim of this thesis was to explore Swedish women’s conceptions, knowledge, management, and attitudes regarding the menopausal transition and HT. Material and methods: To explore and describe women’s conceptions of the menopausal transition women seeking medical advice due to climacteric symptoms were interviewed (n=20) and their statements were analyzed with a qualitative method (paper I). In 1999 (n=1760) and 2003 (n=1733) attitudes to (paper II) and knowledge of (paper III) the menopausal transition and HT among 53- and 54 year old women were investigated with a cross-sectional design using postal questionnaires. We also analyzed if attitudes differed before and after new scientific findings were published on risks and benefits of HT and if knowledge differed between educational levels. Since many women try to abandon use of HT a RCT was performed to study the effect of two different methods to discontinue HT, on recurrence of hot flushes, resumption of HT and on health related quality of life (HRQoL). Women (n=87) with vasomotor symptoms before initiating HT participated. Results: We found that the majority of the middle aged women in our study viewed the menopausal transition as a natural process the nature of which is affected by both hormonal changes and by ageing. Each woman seems to experience a set of psychological and physical symptoms that are in some sense unique to her experience. Women’s answers to the questions about HT demonstrate that attitudes towards HT held by women going through menopause have changed rather dramatically between 1999 and 2003. These changes probably reflect the influence on the women of media reports based on research that identified risks associated with HT that had not been identified before 1998. Women’s knowledge of the effects of HT seems to be unsatisfactory from a clinical perspective. No differences in hot flush frequency and resumption of HT were found between the women randomized to two different modes of discontinuation of HT. Almost 50 % of the women restarted HT within one year after discontinuation. Deteriorated wellbeing and severity of hot flushes were important predicting factors for resumption of HT. Conclusion: It is important to be aware of the individual woman’s conceptions and attitudes about and knowledge of the menopausal transition and HT to be able to individualize the counselling situation. Women who initiate HT due to hot flushes may experience recurrence of vasomotor symptoms and deteriorated HRQoL after discontinuation. A great proportion of them may resume HT. At present knowledge of possible advantages for the taper-down method when discontinuing HT is still lacking.

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No description available.

Situado no contexto da qualidade em saúde, este estudo versa sobre a decisão clínica e autonomia do paciente. Parte-se da premissa que, demais da competência técnica profissional e utilização de tecnologia adequada, o respeito aos direitos dos pacientes é atributo essencial à boa qualidade do atendimento médico. Tomando como exemplo a abordagem terapêutica do climatério, foi feita análise qualitativa do processo de decisão clínica, com base nas informações obtidas através de entrevistas semi-estruturadas com médico ginecologistas e com pacientes em fase de climatério. O propósito foi buscar apreender os valores dos médicos e dos pacientes e tentar compreender a lógica de seus comportamentos e atitudes, no que se refere especificamente aos papéis desempenhados por eles nesse processo. Com base nos resultados da análise, discute-se a complexidade da aplicação do princípio da autonomia na prática clínica e apresenta-se uma reflexão sobre a acreditação, como estratégia possível de contribuição a esse processo e à melhoria da qualidade do atendimento médico, por sua grande identificação como os aspectos relativos aos direitos dos pacientes, aos processos de educação permanente e à melhoria contínua da qualidade. / This research is set in the context of quality in health care. The object of the study was the patients role in clinical decision-making, considering that assuring good quality of clinical care requires respect to patients rights, as much as good technology. In order to study the decision process, we chose hormonal replacement therapy in the climacteric through qualitative analysis, based on non-structured interviews with gynecologists and postmenopausal women. The main purpose was the understanding of the values, attitudes and the reasoning employed by physicians and patients. The complexity of application of the bioethical principal of autonomy in daily clinical practice is discussed. The contribution of accreditation to these processes is examined, stressing the relevance of the functions related to patients rights, continuous education and continuous quality improvement.

Situado no contexto da qualidade em saúde, este estudo versa sobre a decisão clínica e autonomia do paciente. Parte-se da premissa que, demais da competência técnica profissional e utilização de tecnologia adequada, o respeito aos direitos dos pacientes é atributo essencial à boa qualidade do atendimento médico. Tomando como exemplo a abordagem terapêutica do climatério, foi feita análise qualitativa do processo de decisão clínica, com base nas informações obtidas através de entrevistas semi-estruturadas com médico ginecologistas e com pacientes em fase de climatério. O propósito foi buscar apreender os valores dos médicos e dos pacientes e tentar compreender a lógica de seus comportamentos e atitudes, no que se refere especificamente aos papéis desempenhados por eles nesse processo. Com base nos resultados da análise, discute-se a complexidade da aplicação do princípio da autonomia na prática clínica e apresenta-se uma reflexão sobre a acreditação, como estratégia possível de contribuição a esse processo e à melhoria da qualidade do atendimento médico, por sua grande identificação como os aspectos relativos aos direitos dos pacientes, aos processos de educação permanente e à melhoria contínua da qualidade. / This research is set in the context of quality in health care. The object of the study was the patients role in clinical decision-making, considering that assuring good quality of clinical care requires respect to patients rights, as much as good technology. In order to study the decision process, we chose hormonal replacement therapy in the climacteric through qualitative analysis, based on non-structured interviews with gynecologists and postmenopausal women. The main purpose was the understanding of the values, attitudes and the reasoning employed by physicians and patients. The complexity of application of the bioethical principal of autonomy in daily clinical practice is discussed. The contribution of accreditation to these processes is examined, stressing the relevance of the functions related to patients rights, continuous education and continuous quality improvement.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: With the female aging process, the climacteric is a key stage in the women s lives, in which there is a decrease in sex hormones, a change of distribution in body fat and changes in lipid profile involving the increase of coronary risk in women. Objective: To evaluate the coronary risk in women in the climacteric period using the Conicity Index. Methods: A cross-sectional study, not probabilistic, linked to the research "Female Aging Study" from the Regional University of the Northwest of Rio Grande do Sul State - UNIJUI approved by the Research Ethics Committee of UNIJUI under opinion No. 864,988 / 2014 and CAAE 37096614.0 .0000.5350. The study consists of women between 35-65 years of age enrolled in the Family Health Strategy in the urban area of the city of Ijuí, RS (Brazil). Data collection was conducted from 2014 to 2016 and the variables of interest were sociodemographic and health conditions; assessment of nutritional status; clinical evaluation with measurement of blood pressure; and biochemical evaluation; coronary risk was assessed using the C-Index. The women were divided into two groups considering the phase of the climacteric, G1: premenopausal women and G2: postmenopausal women. Results: Comprising 102 women, mean age 51.5 ± 7.9 years old, 40.2% of these (41) belonging to G1 and 59.8% (61) to G2. It was observed a statistical difference between G1 and G2 in relation to waist circumference, body fat%, LDL-cholesterol, total cholesterol, fasting glucose, systolic blood pressure and Conicity Index. In addition, the G2 has higher averages in most variables compared to G1. The average taper Index in both groups showed a high coronary risk in women in the study. By analyzing the variables G1 considering coronary risk low and high is observed statistically significant differences for: body weight, waist circumference, body mass index, triglycerides, diastolic blood pressure and Conicity Index; in G2 for waist circumference, body mass index, body fat percentage, glucose and Conicity Index. In the analysis of coronary risk between G1 and G2 it was found p≤0,05 value for coronary risk, low waist circumference, percentage of body fat and taper index; already with high coronary risk was observed between the percentage of body fat, LDL-cholesterol, total cholesterol, fasting glucose and Conicity Index. Conclusion: Women in G2 showed the highest coronary risk when compared to the women in G1, although these ones already show high coronary risk. In addition, women showed changes in anthropometric, lipid and glycemic profile with the arrival of the climacteric period, being the taper index a good predictor of coronary risk. This way, it is necessary the expansion of targeted assistance for women in climacteric period with a view to support therapeutic decision making in primary health care. / Introdução: Com o processo de envelhecimento feminino o climatério é uma etapa marcante na vida das mulheres, no qual ocorre a diminuição dos hormônios sexuais, modificação da distribuição da gordura corporal e alterações no perfil lipídico que implicam no aumento de risco coronariano em mulheres. Objetivo: Avaliar o risco coronariano em mulheres no período do climatério utilizando o Índice de Conicidade. Métodos: Estudo transversal analítico, não probabilístico, vinculado à pesquisa Envelhecimento Feminino da Universidade Regional do Noroeste do Estado do Rio Grande do Sul - UNIJUI, aprovado pelo Comitê de Ética e Pesquisa da UNIJUI sob o parecer nº 864.988/2014 e CAAE 37096614.0.0000.5350. Estudo composto por mulheres de 35 a 65 anos de idade cadastradas na Estratégia Saúde da Família da área urbana do município de Ijuí, RS (Brasil). A coleta de dados foi realizada no período de 2014 à 2016 e as variáveis de interesse foram dados sociodemográficos e condições de saúde; avaliação do estado nutricional; avaliação clínica com a aferição da pressão arterial; e avaliação bioquímica; o risco coronariano foi avaliado através do Índice de Conicidade. As mulheres foram divididas em dois grupos considerando a fase do climatério, G1: mulheres pré-menopausa e G2: mulheres pós-menopausa. Resultados Composto por 102 mulheres com idade média de 51,5±7,9 anos; destas 40,2% (41) pertencentes ao G1 e 59,8% (61) ao G2. Observa-se diferença estatística entre G1 e G2 em relação a circunferência da cintura, % gordura corporal, LDL-Colesterol, colesterol total, glicose em jejum, pressão arterial sistólica e índice de conicidade. Além disso, o G2 apresenta médias maiores em grande parte das variáveis analisadas quando comparadas ao G1. A média do Índice de conicidade em ambos os grupos apresenta risco coronariano elevado nas mulheres do estudo. Ao analisar as variáveis do grupo G1 considerando risco coronariano baixo e risco coronariano elevado constata-se diferença estatística significativa para: peso corporal, circunferência da cintura, índice de massa corporal, triglicerídeos, pressão arterial diastólica e Índice de conicidade; já no G2 para a circunferência da cintura, índice de massa corporal, percentual de gordura corporal, glicose e Índice de conicidade. Na análise do risco coronariano entre os grupos G1 e G2 constatou-se valor de p≤0,05 para risco coronariano baixo a circunferência da cintura, o percentual de gordura corporal e Índice de conicidade; já com risco coronariano elevado observaram-se entre o percentual de gordura corporal, LDL-Colesterol, colesterol total, glicose em jejum e Índice de conicidade. Conclusão: As mulheres no G2 apresentam maior risco coronariano quando comparadas as do G1, embora estas, já apresentarem risco coronariano elevado. Além disso, as mulheres apresentaram alterações no perfil antropométrico, lipídico e glicêmico com a chegada do climatério, o que representa que o Índice de conicidade é um bom preditor de risco coronariano. Desta forma, faz-se necessário a ampliação da assistência direcionada nas mulheres no período do climatério na perspectiva de apoiar a tomada de decisão terapêutica na atenção primária de saúde.

Made available in DSpace on 2014-12-17T14:13:34Z (GMT). No. of bitstreams: 1 LilianLLFG.pdf: 222211 bytes, checksum: 31854458a20f46e1a1694741d4211f31 (MD5) Previous issue date: 2007-08-30 / The present study had as objective translates, to do equivalence and validation of the Utian Quality of Life (UQOL) for the Brazilian population through methods internationally accepted, in which the original questionnaire was translated for the Portuguese by three teachers and the consensual version was translated back for English by two American teachers (back translation). A multidisciplinary committee evaluated all versions and the final version in Portuguese was applied to climacteric women for the process of adaptation. Validation of the instrument was performed by measuring the reliability and validity properties. Construct validity was examined through the comparison between UQOL and the general measuring scale of quality of life Short Form-36 (SF-36). The final version of translation process was easily recognized by the target population, that didn't tell understanding problems. The results obtained for the reliability intra and interobserver showed significant agreement in all of the subjects. The construct validity was obtained through correlations statistically significant among the domains occupational, health and emotional of UQOL with the SF-36 domains. For the exploratory factorial analysis, it was verified that three factors explain 60% of the total variance of the data, the present study allowed concluding that UQOL was appropriately translated and adapted for applicability in Brazil, presenting high reliability and validity. In that way, the executed project provided the involvement of different areas as gynecology, psychology and physiotherapy (interdisciplinary). Thus, this instrument can be included and used in Brazilian studies to assessment the quality of life during the climacteric years / O presente estudo teve como objetivo traduzir, realizar a equival?ncia e validar o question?rio Utian Quality of Life (UQOL) para popula??o brasileira atrav?s de m?todos internacionalmente aceitos, no qual o question?rio original foi traduzido para o portugu?s por tr?s professores, sendo a vers?o consensual posteriormente versada para o ingl?s por dois outros professores de nacionalidade americana (backtranslation). A multidisciplinaridade deu-se in?cio com a etapa da tradu??o em que um comit? multidisciplinar avaliou todas as vers?es, originando-se a vers?o final em portugu?s, aplicada a mulheres climat?ricas para o processo de adapta??o. A valida??o do instrumento foi realizada atrav?s das propriedades de medida de reprodutibilidade e validade. Para an?lise da validade de construto, foi aplicado simultaneamente ao UQOL o question?rio gen?rico de qualidade de vida Short Form-36 (SF-36). A vers?o final do processo de tradu??o foi reconhecida plenamente pela popula??o-alvo, n?o havendo problemas de compreens?o. Os resultados obtidos para a reprodutibilidade intra e interobservador demonstraram concord?ncia significativa em todos os itens do question?rio. A validade de construto foi obtida atrav?s de correla??es estatisticamente significativas entre os dom?nios ocupa??o, sa?de e emocional do UQOL com os dom?nios do SF-36. Pela an?lise fatorial explorat?ria, verificou-se que tr?s fatores explicam 60% da vari?ncia total dos dados, concluindo se que o question?rio UQOL foi traduzido e adaptado para aplicabilidade no Brasil, apresentando alta reprodutibilidade e validade. Dessa forma, o projeto executado proporcionou o envolvimento de ?reas distintas como ginecologia, psicologia e fisioterapia (interdisciplinaridade). Com a conclus?o da valida??o desta ferramenta, ser? poss?vel contemplar aspectos cl?nicos ligados a qualidade de vida e ? sa?de, podendo ser inclu?do e utilizado em estudos brasileiros que visem avaliar a qualidade de vida durante a peri e p?s-menopausa

Made available in DSpace on 2014-12-17T14:35:55Z (GMT). No. of bitstreams: 1 MariaFO.pdf: 1181297 bytes, checksum: ffe7adb1b5fd180890bcf80e3aa954fd (MD5) Previous issue date: 2002-04-26 / Climacteric is the name of the period of the human life that it is going from the 40 years old, approximately, until the 65 years old. Though, for besides a biological phase of the woman's life, the climacteric is an object of the social world that is rendered to different apprehensions and readings on the symbolic plan. In this study, it was looked for to know the social representations, that health' professionals acting in the programs of the climacteric and the users of those same services, build in respect of that purpose. Besides, it tried to be seen that the social hegemonic representation that guides the actions and the agents' attitudes in the practices of attendance and education for the woman's health in the climacteric in the extent of the investigated institutions. The data were collected through interviews, questionnaire, focal discussion group and direct observation. The observation field was constituted by the three institutions that develop the attendance and education for the woman's health in the climacteric phase, in the city of Natal. A gender perspective was also been adopted, sought to evidence as the cognitive structures that assure the masculine power reproduction, pronounce to the social representations to build a sense to the investigated purpose. It was verified that the social representations of the climacteric are built mainly around the semantic fields old age and disease. For the health professionals, the meaning of the simbol old age carries the marks of the indentified system of the middle class employed, but also, of the feminine habitus that guides them to have an ethical and aesthetic apprehension of their own body. The climacteric, in that way, is seen as a difficult phase , a painful event that scares . For the women attended by those professionals, the sign old age means feeling emphasis from the biological climacteric aspects, in other words, the sensations and signs that forbid the body to accomplish certain linked basic life functions. Along the whole course of this thesis, it was verified that the climacteric is a complex phenomenon that needs to be faced as such. While cultural phenomenon, it is urgent to look for means to help to combat the centrality of the professional representations that face the climacteric as old age and disease, particularly in the field of health / Climat?rio ? uma palavra que serve para nomear o per?odo da vida humana que vai dos 40 anos, aproximadamente, at? os 65 anos de idade. Todavia, para al?m de uma fase biol?gica da vida da mulher, o climat?rio ? um objeto do mundo social que se presta a diferentes apreens?es e leituras no plano simb?lico. Neste estudo, buscou-se conhecer as representa??es sociais que profissionais da sa?de atuando nos programas do climat?rio e as usu?rias desses mesmos servi?os constroem a respeito desse objeto. Al?m disso, procurou-se ver como a representa??o social hegem?nica orienta as a??es e atitudes dos agentes nas pr?ticas de assist?ncia e educa??o para a sa?de da mulher no climat?rio, no ?mbito das institui??es investigadas. Os dados foram coletados atrav?s de entrevistas, question?rio, grupo focal de discuss?o e da observa??o direta. O campo de observa??o foi constitu?do pelas tr?s institui??es que, na cidade do Natal, desenvolvem a assist?ncia e educa??o para a sa?de da mulher no climat?rio. Adotando-se, tamb?m, uma perspectiva de g?nero, procurou-se evidenciar como as estruturas cognitivas que asseguram a reprodu??o do poder masculino articulam-se ?s representa??es sociais para construir uma atribui??o de sentido ao objeto investigado. Constatou-se que as representa??es sociais do climat?rio s?o constru?das, principalmente, em torno dos campos sem?nticos velhice e doen?a. Para as profissionais de sa?de, a ressignifica??o do signo velhice carrega as marcas do sistema identit?rio da classe m?dia assalariada, mas tamb?m, do habitus feminino que lhes orienta a ter uma apreens?o ?tica e est?tica do pr?prio corpo. O climat?rio, dessa forma, ? visto como uma fase dif?cil , um evento doloroso que amedronta . Para as mulheres assistidas por essas profissionais o signo velhice ? ressignificado dando-se ?nfase aos aspectos biol?gicos do climat?rio, ou seja, as sensa??es e sinais que impedem o corpo de realizar determinadas fun??es b?sicas ligadas ao viver/sobreviver. Ao longo de todo o percurso da tese, constatou-se que o climat?rio ? um fen?meno complexo que precisa ser encarado como tal. Enquanto fen?meno cultural urge, particularmente no campo da sa?de, buscar meios que ajudem a combater a centralidade das representa??es profissionais que encaram o climat?rio como velhice e como doen?a