Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2008. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2012-11-22T15:59:23Z No. of bitstreams: 1 marianunes.pdf: 1444943 bytes, checksum: 24b2f3c045976d5718e02a3b092dd26e (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2012-11-28T20:56:24Z (GMT) No. of bitstreams: 1 marianunes.pdf: 1444943 bytes, checksum: 24b2f3c045976d5718e02a3b092dd26e (MD5) / Made available in DSpace on 2012-11-28T20:56:24Z (GMT). No. of bitstreams: 1 marianunes.pdf: 1444943 bytes, checksum: 24b2f3c045976d5718e02a3b092dd26e (MD5) Previous issue date: 2008 / O presente estudo teve como objetivo compreender as representações sociais que as mulheres possuem acerca da histerectomia, antes e após o procedimento cirúrgico. Caracteriza-se por uma pesquisa qualitativa, descritiva, tendo como base teórico-metodológica a Teoria das Representações Sociais. Foram sujeitos deste estudo, treze mulheres em processo de histerectomia, residentes em Rio Grande e em São José do Norte - RS. A coleta de dados efetuou-se em dois momentos, utilizando-se entrevistas semi-estruturadas, gravadas e transcritas. Os dados do préoperatório foram colhidos no ambulatório de ginecologia do H.U e do pós-operatório, na área acadêmica e no domicílio das informantes. Utilizou-se a análise de conteúdo na modalidade temática para o tratamento dos dados. A pesquisa foi aprovada pelo comitê de ética da Universidade do Rio Grande - FURG. Apreendeu-se por meio deste estudo que as representações sociais das mulheres variaram em função da presença ou ausência de filhos(as), do motivo da primeira consulta e da patologia de base, evidenciando os diferentes olhares frente ao impacto da retirada do útero. No pré-operatório, as mulheres sem filhos(as) manifestaram sentimentos de insatisfação, lamentando a impossibilidade de cumprirem seu papel social por meio da maternidade e assim realizarem seu sonho. A maioria das participantes, com filhos(as), demonstrou satisfação e alívio, pela solução dos problemas advindos do quadro clínico. As questões relacionadas à sexualidade mostraram-se carregadas de preocupação e insegurança com os aspectos relativos à vida sexual e afetiva. Os mitos, crendices e tabus referentes à histerectomia, não guardaram relação com a maternidade, gerando incertezas quanto às conseqüências da histerectomia. Em relação aos seus companheiros, a maioria concordou com a realização do procedimento, no entanto, referiram-se apenas ao corpo biológico e ao desempenho sexual. No pós-operatório imediato, as mulheres que não possuíam filhos(as), objetivaram queixa de dor intensa e persistente, caracterizada em alguns casos como dor psíquica. Por outro lado, as participantes mães objetivaram tal queixa, a partir da patologia de base, manifestando dor, frente a um câncer, e ausência de dor na miomatose uterina. No pós-operatório mediato distinguiram-se repercussões negativas, ancoradas na impossibilidade de tornarem-se mães, na incapacidade de manterem o casamento, nas incertezas de sentir prazer e serem aceitas socialmente. E repercussões positivas, referentes a solução de problemas e alívio de sintomas, medidas preventivas, cuidado de si, resgate da auto-estima, desmistificação, vida conjugal e afetiva, incluindo aspectos emocionais e sociais. Nesse sentido, percebeu-se que o comportamento da mulher frente à histerectomia, manifestado pelo êxito e satisfação, foi reconstituído a partir de suas vivências. Tal comportamento não se ancorou nos tabus e preconceitos e sim no bem-estar readquirido após terem vivenciado o processo cirúrgico. No entanto, a representação expressou o significado e valor que cada mulher atribui ao seu útero, inspirado no seu contexto de vida e nas suas relações sociais. Dessa forma, entende-se que a problematização das questões imbricadas na prática da histerectomia contribui para que a mulher tenha uma representação menos traumática frente à indicação de retirada do útero. Evidencia-se a enfermagem como coadjuvante na prática do cuidado em saúde a clientes em processo de histerectomia. / Este estudio tuvo como objetivo comprender las representaciones sociales que tienen las mujeres acerca de la histerectomía, antes y después del procedimiento cirugico. Se caracteriza por una investigación cualitativa, descriptiva, teniendo como base teórico-metodológica la Teoría de las Representaciones Sociales. Fueran sujetos de este estudio, trece mujeres en el proceso de histerectomía, residentes en Rio Grande y São José do Norte - RS. La colecta de datos fue realizada en dos etapas, mediante entrevistas semiestructuradas, grabadas y transcritas. Los datos del pre-operatorio fueron recogidos en el ambulatorio de ginecología del HU y del post-operatorio en los medios académicos y en los hogares de los informantes. Fue utilizado el análisis de contenido en la modalidad temático para el tratamiento de los datos para el tratamiento de los datos. La investigación fue aprobada por el comité de ética de la Fundacão Universidade de Rio Grande. Aprehendiese através de este estudio que las representaciones sociales de las mujeres varían en función la presencia o ausencia de los hijos(as), del motivo de la primera consulta y de las patologías de base, evidenciando las diferentes visiones frente al impacto de la retirada del útero. En el pre-operatorio, las mujeres sin hijos (as) expresaron sentimientos de insatisfacción, lamentando la imposibilidad de cumplir con su papel social por medio de la maternidad y, por tanto, alcanzar su sueño. La mayoría de las participantes, con hijos (as), mostró satisfacción y alivio, para la solución de los problemas derivados de la situación clínica. Las cuestiones relacionadas con la sexualidad apareció cargado de incertidumbre y preocupación por los aspectos relacionados con la vida sexual y la vida afectiva. Los mitos, creencias y tabúes en relación con la histerectomía, no mantiene relación con la maternidad, generando incertidumbre sobre las consecuencias de la histerectomía. Para sus compañeros, la mayoría concordó con la realización del procedimiento, sin embargo, refiéranse apenas al cuerpo biológico y el desempeño sexual. En el post-operatorio inmediato, las mujeres que no tienen hijos (as), tuvieran quejas de dolor intenso y persistente, caracterizado en algunos casos, como el dolor psíquico. Además, las participantes madres tuvieran tal queja partiendo de la patología de base, expresando dolor, frente a un cáncer, y ausencia del dolor en la miomatosis uterina. En el postoperatorio mediato demostraran repercusiones negativas, basada en la imposibilidad de convertirse en madres, el fracaso para mantener el matrimonio, la incertidumbre de sentir placer y ser aceptadas socialmente. Y efectos positivos, para la solución de problemas es el alivio de los síntomas, las medidas de prevención, el cuidado de sí mismos, el rescate de la autoestima, la desmitificación, el matrimonio y la vida afectiva, incluyendo aspectos emocionales y sociales. En ese sentido, percibiese que el comportamiento de la mujer frente a la histerectomía, es expresada por el éxito y satisfacción, fue reconstituida a partir de sus experiencias. Ese comportamiento no se fijó en los tabúes y los prejuicios, pero en el bienestar readquirido después de tener experimentado el procedimiento quirúrgico. Sin embargo, la representación expresó el significado y valor que cada mujer da a su útero, inspirada en su contexto de vida y sus relaciones sociales. De este modo, se entiende que la problematización de las cuestiones interrelacionadas en la práctica de una histerectomía, contribuye a que la mujer tenga una representación menos traumática, frente a la indicación de la extracción del útero. Evidenciase la enfermería, como la coadyuvante en la práctica de la atención de la salud a los clientes en el proceso de histerectomía. / The goal of the study is to understand the social representations that women have before and after the hysterectomy. It is a descriptive and a qualitative research, which bases on the Social Representations Theory. Thirteen women who are in the hysterectomy process were the people of this study and they live in Rio Grande and in São José do Norte – RS. The data were collected by semi-structured interviews that were recorded and typed. The preoperative center data were collected at the gynecology ambulatory from the HU and the data from the postoperative center were collected at the academic area and at the informer’s homes. We used the content analysis into thematic modalities to analyze the data. The ethics committee from Fundação Universidade do Rio Grande approved the research. The study allows knowing that the social representations of women change according to three reasons: the children presence or absence, the reason why women first go to the doctor and base pathology, noticing the different views toward the hysterectomy impact. In preoperative, women who do not have children show dissatisfaction and they felt sorry because they cannot be mothers and then, they do not play their social role as mothers. Most of women who have children showed satisfaction and relief by solving clinical problems. They were very concerned and insecure in despite of questions about sexuality, and they were insecure about their sexual and affective life aspects. Myths, beliefs and taboos did not relate to motherhood, creating doubts about the hysterectomy consequences. Most of women agreed with the procedure when they thought about their partners, however, they referred just to the biological body and the sexual acting. In immediately postoperative center, women who do not have children, complained about an intensive and a permanent pain named as a psycho pain. On the other hand, this complainant was due to the base pathology, women manifest pain toward cancer and they manifest no pain toward the uterine miomatose. Negative repercussions were differed in the promptly postoperative. That is because women cannot have children, they also are not able to keep on married, and they are not sure about feeling pleasure and about being socially accepted. Positive repercussions referred to solve problems, symptoms relief, prevention ways, self-care, self-esteem rescue, and demystification, affective and conjugal life including social and emotional aspects. Under this sense, we realized that women’s behavior in front of hysterectomy is showed by the success and by the satisfaction, and it was reconstructed through their experiences. Such behavior was not linked to taboos and bias but it was linked to the reacquired welfare after women had experienced the surgery process. However, the representation expressed the meaning and the value that each woman gave to her uterus inspired by her life context and by her social relationships. Thus, it is possible to understand that the questions about the hysterectomy practice problematization contribute for the woman to have a less traumatic representation toward the advice of to take the uterus off. Nursery is helpful in the health care practice to clients in the hysterectomy process.

Orientador: Jesse de Paula Neves Jorge / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T03:51:59Z (GMT). No. of bitstreams: 1 Prota_FranciscoEduardo_D.pdf: 271190 bytes, checksum: 7a4b25298004f37adb6a487471a8a999 (MD5) Previous issue date: 2006 / Resumo: Introdução: A histerectomia por via vaginal se constitui no procedimento de melhor desempenho para retirada do útero, segundo vários fatores avaliados, quando comparada àquela por via abdominal ou mesmo a laparoscópica. Apesar destas vantagens, em nosso meio a maioria dos serviços a praticam em pacientes portadoras de distopias, sendo poucos os que indicam em pacientes sem prolapso uterino. Objetivo: Avaliar os parâmetros pré, intra e pós-operatórios de mulheres submetidas à histerectomia vaginal na ausência de prolapso uterino. Sujeitos e métodos: Foi realizado estudo retrospectivo através da revisão de prontuários de 190 mulheres submetidas à histerectomia vaginal na ausência de prolapso uterino operadas no Hospital e Maternidade Celso Pierro da PUC-Campinas e no Hospital Penido Burnier no período de março de 2000 a setembro de 2005. Foram avaliados parâmetros pré-operatórios como idade, índice de massa corpórea, número de gestações, vias de parto, indicação da cirurgia, volume uterino pela ultrassonografia, antecedentes clínicos e antecedentes de cirurgias pélvicas. Quanto aos procedimentos intra-operatórios foram avaliados o tipo de anestesia, tempo operatório, quantidade de sangramento, técnica empregada na retirada da peça cirúrgica, cirurgias associadas e complicações. Os parâmetros pós-operatórios avaliados foram o tempo de permanência hospitalar, peso do útero e complicações. A análise estatística dos dados foi realizada através de medidas de freqüência, médias e desvio padrão. Para o desenvolvimento destes procedimentos estatísticos foi utilizado o pacote SAS Versão 8.2. Resultados: A média etária de mulheres avaliadas nessa casuística foi de 44,6 anos, com índice IMC médio de 26,4kg/m2; 91% delas com uma ou mais gestações e 72,7% referindo antecedente de pelo menos um parto via abdominal. A indicação cirúrgica mais freqüente foi a miomatose uterina em 45,3% dos casos, seguida por diagnóstico de sangramento uterino anormal em 43,7%. A anestesia mais utilizada foi o bloqueio espinhal e a quantidade do sangramento maior ou igual a 300ml ocorreu em 11,6% dos casos. A duração da cirurgia em 58,9% dos casos não excedeu 75 minutos. Houve distribuição semelhante quanto ao uso ou não de técnicas de redução do volume uterino. As freqüências de complicações intra e pós-operatórias foram baixas 3,6% e 15,8% respectivamente. O tempo de hospitalização foi inferior a 48 horas em 87,4% dos casos sendo o tempo médio de hospitalização de 31,5 horas. Conclusões: A taxa de complicação, o tempo de cirurgia, a quantidade de sangramento e o tempo de internação foram baixos, mostrando que a histerectomia por via vaginal na ausência de prolapso é um procedimento cirúrgico seguro e vantajoso para muitas mulheres / Abstract: Introduction: Vaginal hysterectomy represents the best performance procedure to the removal of the uterus, based on many evaluated factors, when compared to abdominal hysterectomy or even laparoscopic hysterectomy. Despite many well known advantages of vaginal hysterectomy, most surgeons among us only indicate it to women with prolapsed uterus, being very few those who indicate it to women with non prolapsed uterus. Objective: Evaluate pre, intra and post operative parameters from women eligible to vaginal hysterectomy with non prolapsed uterus Patients and Methods: This is retrospective study in which 190 medical records of women who underwent vaginal hysterectomy with non prolapsed uterus at Hospital e Maternidade Celso Pierro da PUC-Campinas and at the Hospital Penido Burnier during the period from march 2000 to september 2005 were reviewed. Women¿s age, body mass index, parity, frequency of vaginal delivery, indication of hysterectomy, uterine volume through ultrasound, clinical history and previous pelvic surgeries were analyzed. In respect to the intra operatory procedures, types of anesthesia, surgical time, blood loss, technique used to remove the uterus, associated surgeries and complications were analyzed. The postoperative parameters analyzed were hospitalization period, histologic analysis of the removed organ, uterus weight and complications. Statistical analysis were done with frequency, means and standard deviation, using SAS version 8.2. Results: The mean age of women evaluated in this study was 44,6 years, with a mean body mass index of 26,4kg/m2; 91% of them with one or more gestation and 72.7% referred at least one cesarean section. The most frequent surgical indication was fibroid uterus 45.3% of the cases, followed by the diagnosis of dysfunctional uterine bleeding in 43.7%. The most frequent anesthesia was spinal and the amount of blood loss equal or greater than 300ml occurred in 11.6% of the cases. Operation time did not exceed 75 minutes in 58.9% of the cases. The distribution of techniques to reduce the uterine volume were similar. The frequency of intra and postoperative complications were low, 3.6% and 15.8%, respectively. The hospitalization time was less than 48 hours in 87.4% of the cases, and the mean hospital stay was 31.5 hours. Conclusions Complication rate, mean operation time, the amount of blood loss and the hospitalization period were low, which show that vaginal hysterectomy in non prolapsed uterus is a safe and advantageous procedure to many women / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

Objetivo: O propósito desse estudo foi avaliar os impactos isolados e associados da terapia hormonal (estradiol valerate 1 mg orally/day) e do exercício físico (exercício aeróbico moderado, 3h/semana) na qualidade de vida (QV), qualidade de vida relacionada à saúde (QVRS), e sintomas climatéricos entre mulheres histerectomizadas na pós-menopausa. Métodos:Foi um estudo longitudinal, duplocego, placebo-controlado realizado com 44 mulheres histerectomizadas na pósmenopausa. Os 4 grupos estudados de acordo com a terapia e os exercícios foram: exercício físico e terapia hormonal (TFTH, n=9); sedentárias e terapia hormonal (SEDTH, n=14); exercício físico e placebo (TFPLA; n=11) e sedentárias e placebo (SEDPLA, n= 10). A QVRS foi avaliada pela versão brasileira do SF-36, a QV pelo WHOQOL-BREF e os sintomas pelo IMK, no início e no sexto mês de estudo. Resultados: Houve um decréscimo nos sintomas em todos os grupos, mas apenas os grupos que realizaram EF obtiveram aumentos na QV e na QVRS. A ANOVA demonstrou diferenças significativas nos componentes, capacidade funcional (P=0.001) e dor (P=0.012) do SF-36, e nos domínios, físico (P=0,013), psicológico (P<0,001) e relações sociais (P=0,028) após seis meses de estudo entre os grupos que realizaram exercícios em comparação aos sedentários independente da TH. Não foram demonstrados efeitos da TH, nem da associação entre exercícios e TH sobre os escores da QV e da QVRS. Conclusão: Exercícios físicos podem reduzir os sintomas da menopausa, melhorar a QV e a QVRS, independente da TH / Objective: The purpose of this study was to evaluate the isolated and associated effects of estrogen therapy (estradiol valerate 1 mg orally/day) and physical exercises (moderate aerobic exercise, 3h/weekly) on quality of life (QOL), health related quality of life (HRQOL) and menopausal symptoms among women who had undergone hysterectomy. Design: It was a six-months, randomized, double-blind, placebocontrolled clinical trial with 44 postmenopausal women who had undergone hysterectomy. The interventions were: physical exercise and hormone therapy (PEHT, n=9); sedentary and hormone therapy (SEDHT, n=14); physical exercise and placebo (PEPLA; n=11), sedentary and placebo (SEDPLA, n= 10). HRQOL was assessed by a Brazilian standard version of SF-36, QOL by WHOQOL-BREF and symptoms by Kupperman Scale, at baseline and after 6 months. Results: There was a decrease of symptoms in all groups, but only groups which performed physical exercises showed increases in QOL and in HRQOL. ANOVA showed that changes in physical functioning (P=0.001), bodily pain (P=0.012), physical domain (P=0,013), psychological domain (P<0,001), and social relationship (P=0,028) scores over the six months period differed significantly between exercisers and sedentaries, regardless of hormone therapy. There were no effects of hormone therapy, and no significant association between physical exercise and hormone therapy in HRQOL. Conclusions: Physical exercises can reduce menopausal symptoms and enhance QOL and HRQOL, independently of taking or not hormone therapy

M.A. / Many women who live with body disfigurement as a consequence of illness, continue to suffer from body perceptual disturbances many years following their recovery. Problematic however, is the tendency of disease-specific studies investigating body perceptual disturbances to focus on illness associated body changes. Consequently, this silences the experiences of many women who live with body disfigurement in the absence of illness and more specifically, in instances where body disfigurement is the result of having suffered a common ailment (Francis, 2002; Newell, 2000). Impeding the concerns raised are inferences of earlier studies such as that by Patterson and Craig (1963) who reason that, by virtue of the body's integrity being dependent upon external appearances, hysterectomy, as something internal to the body, fails to feature as a psychological difficulty experienced in women who have this. Recent studies by Newell (2000) and Francis (2002) identify a need for research on body disfigurement following a common ailment and in the absence of illness. In an attempt to address some of the concerns raised, and in keeping with body disfigurement resulting from a common ailment (e.g. cancer, dysmenorrhoea and uterine fibroids, etc), this study compares levels of depression and self-concept in women who have undergone either mastectomy, hysterectomy or vulvectomy. Additionally, this study challenged the inferences by Patterson and Craig (1963) in that the onset of psychopathology in these women is here thought to develop irrespective of the levels of disfigurement visibility (whether disfigurement is internal to the body as in hysterectomy or external to the body as in mastectomy and vulvectomy). In terms of the three areas of participation, of the hysterectomy group (n = 16), of the mastectomy group (n = 8), and of the vulvectomy group (n = 4). Additionally, only participants who had not undergone reconstructive surgery were selected. To investigate for self-concept and body perceptual disturbances, data was collected using the Beck Depression Inventory II, the Self-Description Questionnaire III, the Six Factor Self-Concept Scale and also from open-ended questions posited in a Biographical Questionnaire. The Mann-Whitney, Kruskal-Wallis and Wilcoxon Signed Ranks tests were utilised as nonparametric statistics of choice in the data analyses. The results showed seven areas of significant group differences as this pertains to: levels of depression, physical appearance, spiritual/religious values, general esteem, opposite sex peer relations, parent relations and power. Most striking was the participant responses made in respect to the Importance versus Accuracy subsection of the SDQ-III. Of the 12 statements contained under this section, all were considered to be more important to the participants than the statement was thought accurate of them. Significant differences on this subsection were observed in terms of: parent relations, spiritual/religious values, emotional stability and physical appearance. Although investigating depression and self-concept in women with body disfigurement in South Africa proved to be a complex and difficult research undertaking, the results of this study clearly strengthen its implementation value and demonstrate the need for future research in this area. This pilot study enabled for invaluable insight to be gleaned in terms of the thoughts, feelings and struggles of these women. Similarly the study provided for a method of pre-testing and fine-tuning prior to Phase Two. Additionally, the results of this study contribute to the sparse volume of literature on body disfigurement in the absence of illness. This complex, yet emotionally charged and dynamic terrain is fraught with a magnitude of possibilities for future research and of which can take an infinite number of directions. Altered body appearance and function can invariably result in highly complex psychological and psychosocial disturbances. Francis (2002) echoes what this study commits to when she says: "… when the process of knowing is fractured in a sudden catastrophe, when knowing of the external surfaces of the familiar body is interrupted, the sense of being at home in ones body becomes problematic" (p. 108). As such, this study embraces the possibility that many women in South Africa, who live with body disfigurement in the absence of illness, continue to suffer disturbances in body perception years later and that this is so despite being illness free and irrespective of visibility levels. The study's demonstration of this in real-life intervention serves to highlight this. Similarly, in that 92.3% of participants felt the need to join group therapy or formulate support groups for disfigured individuals as a means by which to voice and better come to terms with past and current traumatic experiences encountered as a result of living with altered body appearance and function, the need for future research in body disfigurement in the absence of illness, is strengthened. It is hoped that, albeit in some small way, this study adds volume to the silenced experience of these women. Similarly, this study hopes to provide a foundation from which many silenced experiences can be voiced.

Bakgrund: Hysterektomi är en vanlig gynekologisk operation som kan utföras på tre olika sätt; abdominellt, vaginalt eller laparoskopiskt. En kvinna med en benign sjukdom med behov av en hysterektomi lider av många symtom som kan sänka kvinnans livskvalitet och sexuella funktion. Kvinnor kan preoperativt ha en ängslan och oro kring hur operationen kommer att påverka kvinnans livskvalitet och sexuella hälsa.   Syfte: Att undersöka hur kvinnor skattar sin livskvalitet och sexuella funktion efter en genomgången elektiv hysterektomi med benign orsak.   Metod: Litteraturstudie där 13 kvantitativa originalartiklar granskades. Resultaten av dessa sammanställdes och analyserades med en innehållsanalys.   Resultat: Den största delen av artiklarna rapporterade att kvinnornas livskvalitet och sexuella funktion förbättrades efter hysterektomin. Kvinnornas sociala funktion, fysiska funktion, psykiska funktion och deras smärtproblematik förbättrades. Den sexuella funktionen förbättrades hos majoriteten av kvinnorna med ökad sexuell frekvens och fler sexuellt aktiva men oförändrad sexuell lust. Kvinnorna skattade sin Female Sexual Function Index (FSFI) högre, däremot visade två studier på försämrad FSFI och därmed försämrad sexuell funktion. Trots den förbättrade FSFI-poängen skattar kvinnorna fortfarande lägre än normalpopulationen.   Slutsats: Majoriteten av de kvinnor som genomgått en hysterektomi på grund av benigna orsaker skattar sin livskvalitet bättre postoperativt genom att kvinnorna får en förbättrad social funktion, fysisk funktion och psykisk hälsa. Den sexuella funktionen skattas högre trots att kvinnorna fortfarande skattar lägre än vad normalpopulationen gör. Fler kvinnor blir sexuellt aktiva och får högre sexuell frekvens men den sexuella lusten upplevs oförändrad. / Background: Hysterectomy is a relatively common gynecological surgery that can be performed in three different ways: abdominally, vaginally or laparoscopically. It has been suggested that women with benign cause for a hysterectomy suffers from many symptoms that can lower a woman's overall quality of life and sexual function. Many women experience anxiety prior to the operation concerning the outcomes of the surgery.   Aim: The purpose is to investigate how women estimate their quality of life and sexual function after an elective hysterectomy with a benign cause.   Method: A literature review where 13 quantitative original articles were examined. The result was compiled and analyzed using a content analysis method.   Results: Most of the articles reported that women's quality of life and sexual function improved after the hysterectomy. The women's social function, physical function, mental function and their pain problems had improved. This included that the women’s sexual frequency and sexual activity improved but their sexual desire was unchanged. In a contrary note some women estimated their FSFI higher, whilst in two other studies it was shown that some had FSFI which also concluded an impaired sexual function. Although women estimated their FSFI higher postoperatively their scores still show lower FSFI score than the normal population.   Conclusion: Most women who go through with a hysterectomy because of benign diseases evaluate their quality of life to be higher postoperatively by improving their social function, physical function and mental health. Their sexual function is estimated to be higher than it was preoperatively, even though women still show lower FSFI score than the normal population.

Abstract Estrogen replacement therapy (ERT) has been associated with favorable effects on risk factors for atherosclerosis. In observational studies ERT was also suggested to reduce the risk of cardiovascular disease in postmenopausal women, but the cardioprotective role of estrogen has been challenged after negative results in randomized trials. However, the mechanisms of estrogen action in atherosclerosis development are only partially known. In order to investigate the regulation of plasma low-density lipoprotein (LDL) cholesterol in postmenopausal women and the effects of ERT on cholesterol and glucose metabolism and blood pressure, 79 hysterectomized, non-diabetic postmenopausal women were randomized in a double-blind, double-dummy study to receive either peroral estradiol valerate (2 mg/day) or transdermal 17β-estradiol gel (1 mg estradiol/day) for six months. At baseline the level of LDL cholesterol was related to body mass index, the fractional catabolic rate (FCR) and the production of LDL apolipoprotein B (apo B), but not to cholesterol absorption efficiency. Both peroral and transdermal ERT decreased plasma total and LDL cholesterol, while high-density lipoprotein cholesterol and triglycerides increased only in the peroral group. The LDL-lowering response was related to changes in estrogen levels, which presumably enhance LDL receptor activity shown as an increase in FCR for LDL apo B. In contrast, the determined genetic factors, apo E phenotype, EcoRI and XbaI polymorphisms of the apo B gene and polymorphism of 7α-hydroxylase gene, were not significant in regulation of LDL cholesterol, neither did they modify the response of ERT in these postmenopausal women. Similar outcomes were observed with both peroral and transdermal ERT as regards glucose metabolism and blood pressure. The overall effect of ERT on glucose tolerance was found to be neutral. Blood pressure decreased among non-hypertensive subjects on both estrogens, which could be related, at least in part, to the alterations in vasoactive peptides. The data of the present study suggest an overall favorable effect of both peroral and transdermal estrogen on common cardiovascular risk factors. However, the clinical significance of these findings in the prevention of cardiovascular diseases needs to be proven in long-term, randomized trials.

Orientador: Stelio Pacca Loureiro Luna / Resumo: Introdução: A analgesia preemptiva é superior à pós-operatória para reduzir a dor e o consumo de analgésicos no pós-operatório. A acupuntura tem a mesma eficácia analgésica pós-operatória que os AINEs e os opioides em cães, no entanto, em animais indóceis não é possível realizá-la no pré-operatório e seu uso no pós-operatório imediato seria facilitado pelo efeito sedativo residual dos anestésicos. Objetivo: Investigar a eficiência analgésica da acupuntura, antes ou após à ovariossalpingohisterectomia, em comparação ao uso preemptivo do meloxicam em cadelas. Metodologia: Utilizaram-se 36 cadelas (32 ± 2 meses e 10 ± 1 kg), divididas aleatoriamente em três grupos GA - acupuntura preemptiva, GPA - acupuntura pós-operatória e GM - meloxicam preemptivo (0,2 mg/kg intravenoso). Os cães foram tranquilizados com acepromazina (0,05 mg/kg, IM), induziu-se a anestesia com propofol (5,33±0,30 mg/kg, IV) e manteve-se com isoflurano/O2. Nos cães dos grupos GA e GPA realizou-se acupuntura bilateral, nos acupontos Intestino grosso 4, Baço-pâncreas 6 e Estômago 36, durante 20 minutos, após medicação pré anestésica ou imediatamente após a cirurgia, respectivamente. Um avaliador encoberto quanto ao tratamento e previamente treinado avaliou a dor pela escala curta de Glasgow (CMPS-SF) e o escore de sedação pela escala de Wagner (ESGW), nos momentos, basal e até 24 horas após a cirurgia. Cães com pontuação ≥ 6 pela escala de Glasgow receberam resgate analgésico com 0,5 mg/kg de morfina, intramusc... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Acupuncture has the same efficacy to control postoperative pain as NSAID and opioids, however, in non-compliant animals it is difficult to perform it preoperatively and its use in the immediate postoperative period would be facilitated by the residual effect of anesthetics. Objective: To compare the analgesic efficacy of acupuncture, before or after ovariosalpingohisterectomy, in comparison to the preemptive use of meloxicam. Material and methods: Thirty six bitches were randomly divided into three 3 groups: GA (preemptive acupuncture), GPA (postoperative acupuncture) and GM (preemptive meloxicam 0.2 mg/kg IV). Dgs were tranquilized with acepromazine (0.05 mg/kg IM), anesthesia was induced with propofol (5,33±0,30 mg/kg, IV) and maintained with isoflurane/O2. Bilateral acupuncture was performed in dogs of the GA and GPA, in LI4, Sp6 and S36 acupoints for 20 minutes, before or immediately after surgery respectively. A blind and previously trained evaluator assessed pain using the short-form Glasgow Composite Measure Pain Scale (CMPS-SF) and sedation before and until 24 hours post-operatively. Dogs with a score ≥6 according to Glasgow scale received analgesia with morphine 0.5 mg/kg IM. Data were analyzed by Kruskall – Wallis, followed by Dunn´s test or two-way ANOVA, followed by Tukey´s test. Results: There was no difference between groups in pain over time (GA 2.43±0.69, GPA 2.19±1.08, GM 2.5±1.37) and sedation scores (GA 3.23±2.16, GPA 3.13±2.80 GM 2.95±2.32), ... (Complete abstract click electronic access below) / Mestre

Hysterektomi är det vanligaste gynekologiska ingreppet som utförs på kvinnor världen över. Att operera bort det reproduktiva organet kan ha en stor påverkan på välbefinnandet hos kvinnor som genomgår ingreppet i fertil ålder. Syftet med litteraturstudien var att belysa kvinnors erfarenheter av att genomgå en hysterektomi i fertil ålder. En allmän litteraturstudie baserad på åtta kvalitativa artiklar genomfördes. Resultatet redovisas genom fem teman: Bristande information och kunskap, Att fatta beslutet, Nytt perspektiv på sexualitet och kvinnlighet, Förlust av fertilitet samt Stöd från partner efter ingreppet. I resultatet framkom kvinnors okunskap kring hysterektomi samt upplevelsen av vårdens bristfälliga informationsöverföring. Inför beslutet var det många av kvinnorna som led av så svåra symtom innan operationen att hysterektomi var en självklar utväg för en bättre livskvalitet. Upplevelsen av sexualitet och kvinnlighet var en subjektiv och individuell påföljd av operationen där kvinnor påverkades antingen negativt eller positivt. Förlusten av livmodern påverkade kvinnorna på olika sätt beroende på inställning till reproduktion. Partnerns stöd visade sig vara betydelsefullt för både kvinnans psykologiska välbefinnande och postoperativ återhämtning. Litteraturstudien bidrar till en ökad förståelse om de hysterektomerade kvinnornas erfarenheter i fertil ålder. För att optimera omvårdnaden av dessa patienter krävs förbättringar kring informationsöverföring samt uppföljning av kvinnans välbefinnande. / Hysterectomy is the most common gynecological surgery performed on women worldwide. Removing the reproductive organ while in a fertile age, can have a great influence on women’s wellbeing. The aim of this study was to illustrate women’s experiences of undergoing a hysterectomy while in a fertile age. A general literature study was conducted based on eight qualitative articles. The result is presented by five themes: Lack of information and knowledge, Decision-making, Sexuality and femininity in a new perspective, Loss of fertility and Support from partner after surgery. The result showed women’s ignorance about hysterectomy and the experience of inadequate information transfer within health care. Many women suffered from severe symptoms which made hysterectomy an obvious choice for a better quality of life. The experience of sexuality and femininity had a subjective and individual outcome after the surgery where all women were affected either negatively or positively. The experience of losing the uterus varied among the women, depending on attitude towards reproduction. This literature study contributes to an increased comprehension of the hysterectomized women’s experiences while in a fertile age. Information transfer and follow-ups regarding women’s well-being is in need to be improved to optimize the care of these patients.

Bakgrund: Hysterektomi innebär att kvinnans livmoder opereras bort och är en av de vanligaste gynekologiska operationerna. Indikationer för ingreppet är vanligtvis benigna blödningsrubbningar, myom, endometrios, framfall och maligna gynekologiska tillstånd. Dessa tillstånd orsakar ett stort lidande för kvinnorna och sjuksköterskan behöver beakta både fysiska och psykiska aspekter inom omvårdnad för att kunna öka kvinnornas välbefinnande och livskvalitet. Syfte: Att beskriva kvinnors upplevelser av att genomgå en hysterektomi. Metod: Kvalitativ litteraturöversikt utifrån tio vetenskapliga artiklar. Databaserna som användes var CINAHL, Medline och Pubmed. En tematisk analys gjordes i fyra steg. Resultat: Fem teman framkom i resultatet; begränsad av en förändrad kropp, behov av stöd, en välfungerande vård, omvårdnad utan personcentrering samt påverkad livskvalitet efter operationen. Konklusion: Kvinnor upplevde innan sin hysterektomi en förlust av sin egen kropp då den inte längre fungerade som tidigare. Detta ledde till en förlust av deras identitet och påverkade deras vardagliga liv. Kvinnorna var i stort behov av att få begriplig information och stöd av både vårdpersonal och sin omgivning. Den specialiserade vården sågs som välfungerande men kvinnorna saknade personcentrering i vården. / Background: A hysterectomy means that the woman’s uterus is surgically removed and is one of the most common gynecological surgeries. Indications for the procedure are usually benign bleeding disorders, fibroids, endometriosis, prolapse and malignant gynecological conditions. These conditions cause a great suffering for the women and the nurse need to consider both physical and psychological aspects in nursing to be able to increase the women's well-being and quality of life. Aim: To describe women's experiences of undergoing a hysterectomy. Method: Qualitative literature review based on ten scientific articles. The databases used were CINAHL, Medline and Pubmed. A thematic analysis was done in four steps. Findings: Five themes emerged in the results; limited by a changed body, need for support, a well-functioning care, care without person-centeredness and an affected quality of life after the operation. Conclusion: Before their hysterectomy, women experienced a loss of their own body as it no longer functioned as before. This led to a loss of their identity and affected their everyday lives. The women needed comprehensible information and support from both healthcare professionals and their surroundings. Specialized care was seen as well-functioning, but the women lacked person-centered care.

Bakgrund: Hysterektomi är en vanlig gynekologisk operation där livmodern avlägsnas till följd av olika gynekologiska besvär. Var tionde kvinna genomgår operationen i Sverige. Vid hysterektomi påverkas kvinnan både fysiskt och psykologiskt och sjuksköterskan bör ge god vård med ett helhetsperspektiv på människan. Syfte: Syftet med studien var att belysa kvinnors psykologiska upplevelse av hysterektomi. Metod: Studien var en allmän litteraturstudie med en induktiv ansats. Totalt nio refereegranskade artiklar bearbetades från databaserna PsycInfo, CINAHL och PubMed, varav fyra var kvalitativa och fem kvantitativa artiklar. Resultat: Studiens resultat delades in i fem huvudkategorier utifrån studiens syfte: Depression och ångest, Förändrad fertilitet och självbild, Relationer, Behov av stöd och Lättnad. Konklusion: Flera av kvinnorna mådde psykiskt dåligt efter borttagning av livmodern samtidigt som somliga kvinnor mådde betydligt bättre, upplevelserna varierade bland kvinnorna. Kunskapen bidrar till att både blivande sjuksköterskor och sjuksköterskor förstår hur en kvinna kan påverkas psykologiskt efter en hysterektomi och betydelsen av en helhetssyn i vården av kvinnan. Det behövs en ökad kunskap om hur kvinnor mår psykologiskt efter en hysterektomi. / Background: Hysterectomy is a common gynecological procedure involving the removal of the uterus due to various gynecological issues. Every tenth woman undergoes the surgery in Sweden. Psychological health is influenced by risk factors and affect women’s daily lives and the nurse should provide good care with a holistic perspective on the individual. Purpose: The purpose of this study was to elucidate women’s psychological experiences of hysterectomy. Method: The study was a general literature review with an inductive approach. A total of nine peer-reviewed articles were processed from the databases PsycInfo, CINAHL and PubMed, including four qualitative and five quantitative articles. Result: The study’s findings were categorized into five main categories based on the study’s purpose: Depression and Anxiety, Altered Fertility and Self-Image, Relationships, Need for support and Relief. Conclusion: Several of the women felt mentally unwell after the removal of the uterus, while some women felt significantly better; experiences varied among the women. This knowledge helps both future nurses and current nurses understand how a woman can be psychologically affected after a hysterectomy and the importance of a holistic approach in women's care. There is a need for increased understanding of women's psychological well-being after a hysterectomy.