Bakgrund Kvinnan får ofta någon typ av sexuell dysfunktion av gynekologisk cancer och dess behandling. En gynekologisk cancersjukdom innebär både fysiskt- och psykiskt lidande. Stöd har visat positiv effekt för cancerpatienter. Den omvårdnadsteori som valdes för examensarbetet var Joyce Travelbees omvårdnadsteori. Syfte Att undersöka hur kvinnliga patienter med en gynekologisk cancerdiagnos upplever stöd från vårdpersonal relaterat till sex- och samlevnad. Metod Detta är en litteraturstudie där artiklar granskades från databasen PubMed. Sjutton originalartiklar valdes men två av dessa exkluderades då de ej svarade på inklusionskriterierna. Dessa 15 artiklar kvalitetsgranskades med hjälp av granskningsmallar. Resultatet analyserades med en innehållsanalys. Resultat Kvinnor önskar mer stöd relaterat till sex- och samlevnad. De önskar även att partnern involveras i vården. Kvinnorna upplever otillräckligt stöd relaterat till sex- och samlevnad gånger kvinnan fått stöd har detta varit otillräckligt. De önskar både få muntlig och skriftlig information/rådgivning. Slutsats Att drabbas av gynekologisk cancer påverkar hela kvinnan. Kvinnor upplever att de får för lite stöd relaterad till sex- och samlevnad och önskar mer stöd från vården i dessa frågor. Detta examensarbete skall bidra till att vårdpersonal uppmärksammar dessa kvinnor. / Background Women often get some type of sexual dysfunction of gynecological cancer and its treatment. A gynecological cancer disease involves both physical- and mental suffering. Support has demonstrated efficacy for cancer patients. The nursing theory that was selected to this bachelor’s thesis was Joyce Travelbee. Aim To examine how female patients with a gynecological cancer diagnosis feel support from health professionals related to sex- and relationships Method This is a literature review in which articles were searched from the database PubMed. Seventeen original articles were selected, but two of these were excluded because they did not respond at the inclusion criteria. These 15 articles of quality were assessed using audit templates. The results were analyzed using a content analysis.   Results Women want more support related to sex- and relationships. The women also want their partner to become more involved in care. The women experiencing insufficient support related to sex- and relationships times the woman received support, this has been inadequate. They want both verbal and written information/advice.  Conclusion To suffer from gynecological cancer affects the whole woman. Women feel that they receive little support related to sex- and relationships and want more support from the care in these issues. This bachelor’s thesis will contribute to the health professionals pay attention to these women.

Bakgrund: År 2017 drabbades 2850 kvinnor av gynekologisk cancer. Det finns flertalet behandlingsstrategier där den vanligaste är kirurgi. Efter behandlingen kan många kvinnor befinna sig i ett lidande där den sexuella hälsan påverkas. Syfte: Att undersöka kvinnans upplevelse av sexuell hälsa efter behandling av gynekologisk cancer. Metod: Studien har genomförts som en litteraturöversikt baserad på kvalitativa artiklar där materialet grundades på kvinnors upplevelse av sexuell hälsa efter behandling av gynekologisk cancer. Artiklarna hittades på databaserna CINAHL och MEDLINE. Resultat: Resultatet visar på olikheter gällande kvinnors upplevelser av den sexuella hälsan efter behandling av gynekologisk cancer. De vanligaste förekommande förändringarna till följd av behandlingen var torra slemhinnor och förminskad vagina som ledde till smärta vid samlag och bidrog till minskad sexlust. Självkänslan påverkades hos många kvinnor och konsekvenserna av behandlingen inverkade på deras relationer. Deltagarna upplevde otillräcklig information om behandlingens effekter på den sexuella hälsan från vården. Konklusion: Behandlingen resulterade i förändringar på den sexuella hälsan som drabbade kvinnan både psykiskt och fysiskt. Många kvinnor önskade mer information och ett större stöd från sjukvården under sjukdomsförloppet. Sjuksköterskan har ett ansvar att bryta tystnaden och möta patientens känslor kring den förändrade sexualiteten. En ökad kunskap krävs för att förebygga ohälsa hos dessa patienter. / Background: 2850 women suffered from gynecological cancer year 2017. There are several treatment options and the most common one is surgery. After treatment many women suffer from issues regarding their sexual health. Aim: To explore women’s experiences of sexual health after treatment of gynecological cancer. Method: The study was made as a literature review based on qualitative articles where the women expressed their experience of sexual health after treatment of gynecological cancer. The articles were found on the two databases CINAHL and MEDLINE. Result: The result shows that the women had different experiences of how gynecological cancer and the treatment affected their sexual health. The most common effects of the treatment was dry mucous membrane and shortened vagina that made intercourse painful which decreased their libido. For many of the women their self esteem was affected and the majority expressed that the consequences of the treatment had an impact on their relationship. The women of the study experienced a lack of information about the treatments effects on their sexual health from health care providers. Conclusion: The treatment resulted in a change in the womens’ sexual health that affected them both physically and mentally. The women would have appreciated more information and a greater support from healthcare providers during the time of the disease. Nurses have a responsibility to break the silence and meet the patients’ needs when it comes to the change in sexuality. More knowledge is necessary to prevent illness when it comes to these patients.

A proposta deste estudo foi investigar os conhecimentos, atitudes e práticas dos médicos ginecologistas e obstetras em relação à saúde bucal e ao tratamento odontológico de pacientes gestantes. Foram entrevistados, através de questionários padronizados, 204 médicos ginecologistas e obstetras associados à Sociedade de Obstetrícia e Ginecologia do Estado de São Paulo (SOGESP) e que atuam no Município de São Paulo. Os resultados mostraram que 94,12% dos entrevistados possuem informações sobre os fatores etiológicos da cárie dental e 82,36% possuem informações sobre os fatores etiológicos das alterações gengivais e periodontais que ocorrem no período gestacional. Dos que possuem informações sobre os fatores etiológicos da cárie dental e/ou das alterações gengivais e periodontais que acontecem na gravidez, 96,97% repassam essas informações às pacientes gestantes. Em relação ao nível de informações sobre saúde bucal, 32,35% consideram satisfatório o próprio nível de conhecimentos sobre saúde bucal, enquanto 47,06% julgam relativamente satisfatório e 20,59% acreditam ser insatisfatórios seus conhecimentos sobre esse tema. 94,12% dos entrevistados acreditam que cabe tanto ao cirurgião dentista quanto ao médico orientar as pacientes grávidas em relação à prevenção em saúde bucal na gestação, mas 5,88% acreditam que a orientação às gestantes, no que diz respeito à saúde bucal, cabe apenas ao cirurgião dentista. 97,06% dos pesquisados consideram segura a realização de um tratamento odontológico durante a gravidez, 85,29% consideram segura a realização do exame radiográfico odontológico nesse período e 97,06% recomendam às gestantes procurar atendimento odontológico durante o pré-natal. O segundo trimestre da gravidez é considerado o período mais indicado para o atendimento odontológico programado de pacientes gestantes por 64,71% dos entrevistados. O relacionamento cirurgião dentista-médico, no que diz respeito aos cuidados com a saúde da paciente gestante é satisfatório para 23,53% dos pesquisados, relativamente satisfatório para 35,29% e não satisfatório para 41,18%. Somente 5,88% dos ginecologistas e obstetras realizam um exame bucal das gestantes durante as consultas do pré-natal, mas 100,00% consideram importante a integridade da saúde bucal das pacientes grávidas em relação ao desenvolvimento normal da gestação e orientam-nas sobre a importância da saúde bucal durante o pré-natal. / The propose of the present study was to investigate the gynecologists and obstretrics phisicians’ knowledge and behavior about the oral health and dental treatment in the pregnant patients. Standardized questionaries was used to interview 204 gynecologists and obstetrics physicians associates to the Sociedade Brasileira de Ginecologia e Obstetrícia do Estado de São Paulo (SOGESP) and they act in the São Paulo city. The results showed that 94,12% possess information about etiology of the gengival and periodontal deseases that occur during the pregnancy. Among these professionals, 96,97% repass these information to the pregnant patients. 32,35% consider satisfactory the own knowledge about oral health while 47,06% judge relatively satisfactory and 20,59% believe to be unsatisfactory the own knowledge about the subject. 94,12% believe that dentists and physicians to guide the pregnant patients in oral health in the pregnancy, but 5,88% believe that the the dentists are responsible for this task. 97,06% consider insurance the accomplishment of dental treatment during the pregnancy. 85,29% consider insurance the accomplishment of the radiographic dental examination in this period and 97,06% recommend to the pregnant patients to look dental treatment during the prenatal. The second trimester of pregnancy is considered the most indicated period to realize a planned dental treatment in pregnant patients by 64,71%. The relationship dentist / physician in whom it says respect to the cares with oral health of the pregnant patients is satisfactory for 23,53% of the searched ones, relatively satisfactory for 35,29% and unsatisfactory for 41,18%. 5,88% only carry through oral examination of the pregnant patients during the prenatal, but 100,00% consider important the integrity of oral health during the pregnancy in relation of the normal development of the pregnancy and guide the pregnant patients on the importance of the oral health during the prenatal.

Uma das modalidades de tratamento para mulheres acometidas pelo câncer ginecológico é a radioterapia interna, também conhecida como braquiterapia. Caracteriza-se pela colocação de materiais radioativos junto ao tumor. No caso daquele tipo de câncer, para se efetuar a irradiação, é necessário introduzir um aplicador dentro da vagina. Este tratamento pode ser bastante desconfortável para a mulher, tanto no momento da aplicação, quanto após a mesma. Neste sentido, estudos sobre o tema apontam não apenas para efeitos colaterais físicos, mas também para conseqüências psicológicas na qualidade de vida de pacientes tratadas por braquiterapia. Entretanto, tais estudos são ainda incipientes, tendo maior concentração na área de Enfermagem. É quase inexistente uma produção de caráter psicológico que aprofunde o conhecimento a respeito de questões emocionais em mulheres submetidas a esse procedimento invasivo. Sendo assim, esta pesquisa qualitativa objetivou compreender aspectos psicológicos em mulheres com câncer ginecológico submetidas a essa modalidade radioterápica. Para tanto, foram realizadas sete entrevistas abertas com mulheres em tratamento junto ao Serviço de Radioterapia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo. As entrevistas foram áudio-gravadas, transcritas na íntegra e submetidas à análise de acordo com o método clínico-qualitativo, utilizando-se a psicanálise como marco teórico para a interpretação dos dados. Foi elaborado um diário de campo como instrumento auxiliar de pesquisa. Após realização das leituras flutuantes e análise do material, observou-se que a braquiterapia é sentida pelas mulheres como uma agressão, gerando intensa angústia, desespero e raiva. A manipulação na região vaginal, com entradas e saídas de objetos (aplicador, sonda, etc.), desencadeia vivências e efeitos físicos desagradáveis, como dor, ardência urinária, sensação de queimação. Em uma perspectiva psicanalítica, o tratamento é vivido como um objeto hostil e persecutório que é introduzido na intimidade sexual, afetando a mulher em sua feminilidade. A posição física em que as mulheres permanecem para receber a irradiação acarretou sensação de submissão, vergonha e exposição de sua intimidade. Ainda com relação a este tratamento, foram feitas associações e comparações com a experiência anterior de gravidez/parto, possivelmente pela existência de conflitos e questões inconscientes relacionadas ao nascimento, mas também à morte concretizada pela doença grave. As mulheres atribuíram significados ao surgimento do câncer ginecológico relacionados à vivência de depressão, à sexualidade e à gravidez/parto, sendo que se evidenciou uma culpa inconsciente pela doença. Para enfrentarem as vicissitudes do tratamento, as mulheres tiveram que se basear mais no princípio de realidade - buscar a remissão da doença através do tratamento e da confiança na equipe - do que no princípio de prazer (ou evitação do desprazer), mas com considerável sofrimento psíquico. Neste sentido, considera-se relevante pensar numa assistência psicológica às pacientes, com o intuito de minimizar possíveis efeitos psicológicos adversos associados à braquiterapia. / One of the treatment modes for women affected by gynecological cancer is internal radiotherapy, also known as brachytherapy. It is characterized by the placement of radioactive material near the tumor. For that type of cancer, the irradiation requires the introduction of an applicator inside the vagina. This treatment can be quite uncomfortable for the women, both during and after the application. In this sense, research on the theme appoints not only physical collateral effects, but also psychological consequences for the quality of life of patients treated with brachytherapy. However, these studies are still incipient, with a greater concentration in the Nursing area. Production of psychological nature, which deepens knowledge about emotional issues in women submitted to this invasive procedure, almost does not exist. Thus, this qualitative research aimed to understand psychological aspects in women with psychological cancer submitted to this radiotherapeutic modality. Therefore, seven open interviews were held with women under treatment at the Radiotherapy Service of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. The interviews were tape-recorded, fully transcribed and submitted to analysis according to the clinical-qualitative method, using psychoanalysis as a theoretical framework for data interpretation. A field diary was elaborated as an auxiliary research instrument. After floating reading and analysis of the material, it was observed that the women feel brachytherapy as an aggression, generating intense anguish, despair and rage. Manipulation in the vaginal region, with insertions and withdrawals of objects (applicator, probe, etc.), causes unpleasant experiences and effects, such as pain, urinary burning and a burning feeling. In a psychoanalytical perspective, treatment is experienced as a hostile and persecutory object, which is introduced in the sexual intimacy, affecting the woman in her femininity. The physical position in which women remain to receive the irradiation caused a feeling of submission, shame and exposure of their intimacy. Moreover, with respect to this treatment, associations and comparisons were made with previous experiences of pregnancy/delivery, possibly due to the existence of conflicts and unconscious questions related to birth, but also to death made real by the severe disease. The women attributed meanings to the appearance of gynecological cancer, related to the experience of depression, sexuality and pregnancy/delivery, evidencing an unconscious feeling of guilt about the disease. In order to face the vicissitudes of treatment, the women had to base themselves more on the reality principle - seeking the remission of the disease through treatment and confidence in the team - than on the principle of pleasure (or avoidance of displeasure), but accompanied by considerable mental suffering. In this sense, it is considered relevant to think of psychological care delivery to these patients, with a view to minimizing possible adverse psychological effects associated with brachytherapy.

In today’s world, there is a strong competition between companies. In this competition environment, it is accepted that one of the most important elements is quality for companies to be differentiated. The company which can produce high quality products or high quality services can survive in this competition. Nevertheless, the situations of being high quality or low quality depends on the tolerance limits which are determined by customers and it can be changed from person to person. In today’s world, even though, when quality concept is considered, the first thing that comes to the minds is “the quality of products”, the fact of quality is not important for only manufacturing companies but also service companies. To be able to comprehend that if the products or the services which are provided by the company satisfy the customers’ needs, the quality should be measured. Nevertheless, when the process of measuring the quality is carried out by experiments, observations and tangible data in the manufacturing companies, there is no tangible data in the service companies to measure the quality. That’s why there are many different models and qualitative approaches that are developed to be able to measure the quality in service companies. In the scope of this thesis, a model has been developed to measure the current quality and evaluate the perceived quality of a healthcare company. Developed model is consisted of two main parts which are functional quality and technical quality. Besides, for determining the perceived quality, socio-demographic attributes are also considered. To be able to implement the functional quality part of the model, a survey has been created about the clinic and it has been sent to the patients. And the data about the perceived quality has been gathered from the patients. To be able to implement the technical quality part of the model, interviews with the staff of the clinic have been made and the studies to improve the perceived quality of the clinic, permissions and certificates are identified. Developed model has been tested in the case company and it has been found acceptable. The model ensures to measure the current service quality of the clinic and unveils the areas which cause the low quality in the clinic. Thus, the spots that need to be improved are identified.

Background: Breast and Gynecological cancers are a major public health problem. Smoking is associated with several chronic diseases including cancer. Other lifestyles of public health predispose many people to dyslipidemia, hypertension and obesity; risk factors for metabolic syndrome, and are associated with cancer. Objectives: The purpose of this study is to find if those who smoke, and have the metabolic syndrome, are more likely to have breast or gynecological cancers, and to find the distribution by education, having health insurance, race/ethnicity and socio-economic status. Methods: A case-control study of females aged 20 years and above who participated in the United States National Health and Nutrition Examination Survey (NHANES) 2001-2010. Results: Females who have smoked more than hundred cigarettes in life and still smoke; a) have a 42 percent less chance of having a breast cancer diagnosis (OR 0.58; 95% CI 0.36 – 0.93, p-value 0.025), and b) are 2.67 times as likely to report a cervical cancer diagnosis as females who have smoked less than hundred cigarettes in life (OR 2.67; 95% CI 1.72 – 4.13, p-value Conclusion: Smoking and metabolic syndrome are very important indicators of reproductive health and needs further study. Smoking cessation interventions should be an integral part of cervical cancer prevention programs especially targeted at younger females and females who live below the federal poverty level.

Syfte: Att undersöka patienters upplevelser av ett besök på en studentmottagning för gynekologi och preventivmedelsrådgivning. Metod: Deskriptiv tvärsnittsstudie i form av en enkätundersökning med frågor rörande bemötande, tillgänglighet och förslag till förbättring. Enkäten hade både öppna och slutna svarsalternativ och delades ut av barmorskan eller gynekologen efter avslutat besök under en period av två veckor, 150 enkäter delades ut. Huvudresultat: 138 personer deltog i denna studie varav 95% var kvinnor, svarsfrekvensen var 92%. Den vanligaste orsaken till att Studentgyn besöktes var preventivmedelsrådgivning. Patienterna var överlag nöjda med det bemötande som givits av personalen på Studentgyn. Vidare upplevde samtliga ett förtroende för vårdgivaren och ansåg att denne var väl förberedd inför besöket. En majoritet av besökarna erbjöds en besökstid inom en vecka, de förbättringsförslag som lämnades handlade dock till stor del om möjligheten att komma i kontakt med Studentgyn för att boka en tid. Patienterna önskade längre telefontider samt tidsbokning via internet. Avslutningsvis uppgav samtliga att de kunde rekommendera Studentgyn till vänner och bekanta. Slutsats: Denna undersökning har kommit fram till att patienterna överlag varit väldigt nöjda med Studentgyn. Dock framkom ett missnöje avseende möjligheten att komma i kontakt med Studentgyn för tidsbokning och många av deltagarna lämnade förbättringsförslag rörande detta.

Bakgrund: Gynekologisk cancer är ett utbrett spektrum av cancersjukdomar bland kvinnor och behandlingarna har betydelse för upplevelsen av den sexuella hälsan. Den sexuella hälsan är viktig för människans totala upplevelse av hälsa. Om den sexuella hälsan upplevs otillfredsställande kan ett lidande uppstå. Syfte: Syftet är att beskriva kvinnors upplevelse av sexuell hälsa vid gynekologisk cancer. Metod: En litteraturöversikt över tolv kvalitativa artiklar har genomförts. Resultat: Resultatet visade upplevda barriärer för sexuell hälsa vid gynekologisk cancer. Barriärerna presenteras i tre huvudkategorier: Den sexuella kroppen, Sexuella hinder och Sexuella relationer. Slutsats: Kvinnor med gynekologisk cancer upplever huvudsakligen flera barriärer för sexuell hälsa. Upplevelsen av dessa sexuella barriärer kan leda till en otillfredsställande sexuell hälsa vilket vidare kan orsaka ett lidande. Genom kunskap om upplevelsen av sexuell hälsa vid gynekologisk cancer kan sjukvården erbjuda vård som omfattar flera aspekter av sjukdomen och därmed minska risken för lidande. Klinisk betydelse: Denna litteraturstudie kan bidra med kunskap om kvinnors upplevda sexuella hälsa vid gynekologisk cancer. Sjukvården har en viktig roll att uppfylla med hänsyn till kvinnors upplevelse av bristande information. Utbildning och diskussion kring sexuell hälsa på sjuksköterskeutbildningen skapar förutsättningar för att samtal om sexuella hälsa ska bli ett självklart inslag i vården. / Background: Gynecological cancer is an expanded spectrum of cancer diseases among women and the treatments have importance for the experience of sexual health. Sexual health is important for the total experience of health. If the sexual health is perceived unsatisfactory, a suffering can arise. Aim: The aim is to describe women’s experience of sexual health within gynecological cancer. Method: A literature review of twelve qualitative articles was performed. Results: The analysis resulted in experienced barriers for sexual health within gynecological cancer. The barriers are presented in three main categories: The sexual body, Sexual obstacles and Sexual relations. Conclusion: Women with gynecological cancer mainly experience several barriers for sexual health. The barriers can lead to an unsatisfied sexual health which can cause a suffering. By knowledge about the experience of sexual health within gynecological cancer, the health care can provide care including several aspects of the disease and thereby decrease the risk for suffering. Clinical significance: This study can contribute knowledge about women’s perceived sexual health within gynecological cancer. Health care providers have an important role to fulfill regarding women’s experience of lack of information. Education and discussion about sexual health in the nursing education creates conditions for conversations about sexual health to become an obvious part of the health care. / <p>Röda Korsets sjuksköterskeförening stipendium juni 2015</p>

Background: Breast and Gynecological cancers are a major public health problem. Smoking is associated with several chronic diseases including cancer. Other lifestyles of public health predispose many people to dyslipidemia, hypertension and obesity; risk factors for metabolic syndrome, and are associated with cancer. Objectives: The purpose of this study is to find if those who smoke, and have the metabolic syndrome, are more likely to have breast or gynecological cancers, and to find the distribution by education, having health insurance, race/ethnicity and socio-economic status. Methods: A case-control study of females aged 20 years and above who participated in the United States National Health and Nutrition Examination Survey (NHANES) 2001-2010. Results: Females who have smoked more than hundred cigarettes in life and still smoke; a) have a 42 percent less chance of having a breast cancer diagnosis (OR 0.58; 95% CI 0.36 – 0.93, p-value 0.025), and b) are 2.67 times as likely to report a cervical cancer diagnosis as females who have smoked less than hundred cigarettes in life (OR 2.67; 95% CI 1.72 – 4.13, p-value Conclusion: Smoking and metabolic syndrome are very important indicators of reproductive health and needs further study. Smoking cessation interventions should be an integral part of cervical cancer prevention programs especially targeted at younger females and females who live below the federal poverty level.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.