This Master's Thesis reports on the experiences of Type 2 Diabetes of Lesbian, Queer, and Women-Loving Women. The thesis examines the impact of sexual orientation on experiences with diabetes, and how this chronic disease affects the way a woman views herself, her health, and her body image. Each participant presented her narrative and world views in regards to her diabetes health care and management, stress and trauma, and management of relationships. Through narrative analysis, I have revealed differing mechanisms of coping and explanatory models; the many women of this study selectively chose to be more open about her sexual orientation than her diabetes status.

Made available in DSpace on 2016-04-29T13:18:08Z (GMT). No. of bitstreams: 1 Luciana Roberta Donola Cardoso.pdf: 1323389 bytes, checksum: 152237ce34951aabd58677f712755d06 (MD5) Previous issue date: 2008-05-14 / The Chronic Mild Stress (CMS) is an experimental animal model of depression induced by the exposure of rats to a set of moderate and uncontrollable aversive stimuli in a long and uninterrupted period of time. The purpose of this study was to investigate the relationship between performance in variable interval schedule of behavior and exposure to the protocol of stress (daily consumption of food and water, changes in body weight, frequency of answers issued in each bar and the frequency of reinforcements obtained when submitted to the same scheme competitor). The study design was composed of three experimental conditions: test consumption and preferably liquid; sessions operating on schedule competitor VI 10 (water) VI 10 (sucrose) and protocol of stress (CMS). Six male rats were used. One subject was used to control weight, not involved in any of the three experimental conditions. Five subjects were submitted to the protocol of stress and tests of consumption and preference of liquids throughout the experiment. Two subjects were submitted to the working sessions (VI competitor VI) before and after CMS and two subjects were submitted to the working sessions before, during and after the CMS. The results were: 1) all subjects showed loss of body weight during the exposure to stressors. 2) The four subjects submitted to the working sessions showed recovery of body weight after the suspension of the protocol. 3) All subjects showed an increase in daily consumption of water and feed during the CMS, despite the loss of weight in this period. 4) Liquid consumption and the percentage of sucrose intake was higher during the CMS for the four subjects submitted to the working sessions, featuring a reduction in the last week of exposure to the protocol of stress. 5) All subjects expressed a greater number of responses in the bar corresponding to sucrose before exposure to CMS. Meanwhile, during and after CMS, a preference for water became outstanding. 6) The subjects received almost all of the planned reinforcements of both magnitudes (sucrose solution or pure water) in the three periods of assessment. We conclude that: 1) the loss of weight during the CMS seems to be related to the combination of aversive stimuli compound by the Protocol of stress and deprivation of water and food intermittent making up this protocol 2) the increase in the total consumption of liquids during the CMS appear to be related to the submission to the working sessions in variable interval before submission to the Protocol 3) the exposure of the subject to a scheme of variable interval, before CMS, slows the decline in the consumption of liquid and increases consumption of fluids during the CMS / O Chronic Mild Stress (CMS) é um modelo animal experimental de depressão induzida por meio da exposição de ratos a um conjunto de estímulos aversivos moderados e incontroláveis, apresentados por um longo e ininterrupto período de tempo. O objetivo deste estudo foi investigar a possível relação entre o desempenho em esquema de intervalo variável e a exposição ao protocolo de estresse, quanto ao consumo diário de ração e água e as subseqüentes alterações no peso corporal; no consumo e na preferência de líquidos; na freqüência de respostas emitidas em cada barra e na freqüência de reforços obtidos nas mesmas quando submetidos ao esquema concorrente. O delineamento foi composto por três condições experimentais: teste de consumo e de preferência de líquidos; sessões operantes em esquema concorrente VI 10 (água) VI 10 (sacarose) e protocolo de estresse (CMS). Foram utilizados seis ratos machos, sendo que um sujeito foi utilizado para controle de peso, não submetido a nenhuma das três condições experimentais. Cinco sujeitos foram submetidos ao protocolo de estresse e aos testes de consumo e preferência de líquidos durante todo o experimento. Dois sujeitos foram submetidos às sessões operantes (concorrente VI VI) antes e depois do CMS e dois sujeitos foram submetidos às sessões operantes, antes, durante e depois do CMS. Os resultados obtidos foram: 1) todos os sujeitos apresentaram perda de peso corporal durante a exposição aos estressores. 2) Os quatro sujeitos submetidos às sessões operantes apresentaram recuperação do peso corporal após a suspensão do protocolo; 3) todos os sujeitos apresentaram aumento no consumo diário de água e ração durante o CMS, apesar da perda de peso neste período; 4) consumo total de líquidos e a porcentagem de sacarose ingerida foi maior durante o CMS para os quatro sujeitos submetidos as sessões operantes, apresentando uma redução na última semana de exposição ao protocolo de estresse; 5) todos os sujeitos emitiram um maior número de respostas na barra correspondente a sacarose antes da exposição ao CMS. Entretanto, durante e depois do CMS a preferência por água se tornou sobressalente; 6) os sujeitos obtiveram a quase totalidade de reforços programados de ambas as magnitudes (solução de sacarose ou água pura ) nos três períodos de avaliação. Conclui-se que: 1) a perda de peso corporal durante o CMS parece estar relacionada à combinação dos estímulos aversivos compostos pelo protocolo de estresse e à privação de água e ração intermitente que compõem este protocolo 2) o aumento no consumo total de líquidos durante o CMS parecem estar relacionados à submissão às sessões operantes em intervalo variável antes da submissão ao protocolo 3) a exposição dos sujeitos a um esquema de intervalo variável, antes do CMS, não só teria um efeito de retardar a diminuição no consumo de líquidos, como aumentar o consumo de líquidos durante o CMS

Alterações gastrointestinais em pacientes com doença renal crônica são queixas comuns, sendo a constipação considerada um dos sintomas mais prevalentes. O tratamento deste sintoma é limitado nesta população, devido às modificações dietéticas impostas pela perda da função renal e métodos dialíticos, especialmente na hemodiálise. Dados locais sobre a prevalência e fatores associados à constipação são pouco conhecidos em nosso meio. Neste estudo transversal, foram incluídos 57 participantes que realizam hemodiálise há pelo menos 3 meses no Hospital Moinhos de Vento em Porto Alegre, Brasil. Um questionário foi utilizado para avaliar dados sociodemográficos e clínicos potencialmente associados à constipação, a qual foi definida utilizando os critérios de ROMA III. Foi diagnosticada constipação em 28 pacientes nesta amostra (49,1%). Do total da amostra, 34 indivíduos (59,6%) relataram estar utilizando ou já terem utilizado laxantes em algum momento. Entre os constipados, 23 (82%) relataram esse uso. Outros 11 indivíduos usam laxativos cronicamente, ainda que não tenham sido classificados como constipados pelos critérios de ROMA III. Considerando a autopercepção, relataram “dificuldade para evacuar” 21/57 (36,8%). A concordância entre a autopercepção de “dificuldade para evacuar” e constipação pelos critérios de ROMA III ocorreu em 34 (59,6%) dos indivíduos. Entre os 28 pacientes constipados, 17 (77,3%) referem que sintomas gastrointestinais interferem no seu bem-estar, enquanto que entre os 29 pacientes não constipados, somente 5 (22,7%) referem esta interferência (p = 0,01) Quando investigado os fatores potencialmente associados à constipação,a inatividade física (Razão de prevalência 53,4; Teste exato de Fisher p = 0,052) e o sexo feminino (Razão de Prevalência 1,6; Pearson X2 p = 0,07) apresentaram tendênciaà associação significativa. No entanto, não foi encontrada associação significativa entre constipação e escolaridade, faixa etária, utilização de carbonato de cálcio, presença de 8 diabetes, estado nutricional e consumo de fibras atual. Conclusões: A constipação intestinal é um sintoma frequente em pacientes em hemodiálise no nosso meio. A utilização dos critérios de ROMA III para o diagnóstico de constipação permite diagnosticar um maior número de casos quando comparado apenas à autopercepção. A maior parte dos pacientes da amostra faz ou já fez uso crônico de laxantes, ainda que boa parte destes não se considere constipado, ou seja, classificados como constipados pelos critérios de ROMA III. Considerando-se a alta prevalência e interferência no bem-estar, a abordagem sobre a presença de constipação deve ser rotineira nessa população, a fim de alcançar-se um diagnóstico e manejo corretos. / Seventeen (77.3%) of the 28 constipated patients reported that their gastrointestinal symptoms interfered with their wellbeing, whereas just 5 (22.7%) of the 29 patients without constipation reported the same interference (p = 0.01). Investigation of factors potentially associated with constipation detected that inactivity (Prevalence ratio 53.4; Fisher’s exact test p = 0.052) and female sex (Prevalence ratio 1.6; PearsonX2 p = 0.07) exhibited tendencies towards a significant association. However, there were no significant associations between constipation and educational level, age group, use of calcium carbonate, presence of diabetes, nutritional status, or current fiber consumption. 10 Conclusions: Constipation is a common symptom among patients on hemodialysis in our country. Use of the ROMA III criteria diagnoses a higher number of cases of constipation than patients’ own perception alone. The majority of patients in the sample have used or were still using laxatives chronically, even though a considerable proportion of these patients were not considered constipated,they were not classified as constipated according to the ROMA III criteria. Considering its high prevalence and its impact on wellbeing, whether patients have constipation should be routinely investigated in this population, to enable correct diagnosis and management.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-07T21:51:55Z No. of bitstreams: 1 LenyGonçalves_dissert.pdf: 646345 bytes, checksum: a8b44e8fcdee7be587afc8044f534500 (MD5) / Made available in DSpace on 2018-11-07T21:51:55Z (GMT). No. of bitstreams: 1 LenyGonçalves_dissert.pdf: 646345 bytes, checksum: a8b44e8fcdee7be587afc8044f534500 (MD5) Previous issue date: 2017-08-31 / Chronic Kidney Disease (CKD) as well as its related treatments present significant impacts to the patients, family, and the entire health system as research has been showing. More specific intervention programs can be provided from a more effective knowledge of thisassisted population. Objectives: To identify and characterize the biopsychosocial and spiritual profile including sociodemographic and clinical data, anxiety and depression symptoms, quality of life, coping strategies and issues related to spirituality, religion and / or personal beliefs. Materials and Methods: Descriptive exploratory study with patients of both genders, agedover 18, with chronic renal failure – CRF, undergoing renal replacement therapy (hemodialysis, peritoneal dialysis and renal transplantation); attended at a school hospital in the interior of the State of São Paulo. After the patients´ agreement and their signingto the Informed Consent Term (ICT), they answered an individual interview with an Identification Card, Hospital Scale of Anxiety and Depression - HAD, WHOQOL-bref - quality of life, Scale of Modes of Coping Problems - EMEP and WHOQOL - spirituality, religiosity and personal beliefs - SRPB. Data were analyzed and grouped by frequency and percentage of answers, and discussed from the literature related to the area. Results: A total of 174 patients, predominantly between 41 and 70 years old (70.69%), 53.45% male, and 47.70% with incomplete primary education participated; as baseline disease, Systemic Arterial Hypertension (36.21%) and Diabetes Mellitus (25.29%) were found among others; major comorbidities Systemic Arterial Hypertension (47.70%) and Diabetes Mellitus (29.31%). Clinical symptoms of anxiety were presented in 70.11%, and 75.29% had depression. According to the quality of life, results were slightly above average, considering the analogue scale of the instrument. Regarding coping strategies, the highest averages were for Focus on Emotion, followed by Focus on the Problem and Social Support. Regarding issues related to spirituality, religion and / or personal beliefs, the best-rated facet was 'Faith', followed by 'Sense in the Life”. Conclusions: Sociodemographic data, quality of life, coping strategies, and religiosity / spirituality are according to the literature reports. However, clinical symptoms of anxiety and depression were significantly higher than those found in the general population and for chronic kidney patients. These findings have pointed out the need for specific intervention programs toward this sample evaluated, as well as further research in the area. / Pesquisas na área têm demonstrado que a Doença Renal Crônica (DRC) e seus respectivos tratamentos apresentam impactos significativos para os pacientes, familiares e para todo o sistema de saúde. Conhecer de forma mais efetiva esta população atendida pode favorecer programas específicos de intervenção. Objetivos: Identificar e caracterizar o perfil biopsicossocial e espiritual incluindo os dados sociodemográficos e clínicos, sintomas de ansiedade e depressão, qualidade de vida, estratégias de enfrentamento e questões ligadas à espiritualidade, religião e/ou crenças pessoais. Materiais e Método: Pesquisa descritiva e exploratória com pacientes, de ambos os sexos, acima de 18 anos, com diagnóstico de Insuficiência Renal Crônica – IRC, em terapia renal substitutiva (hemodiálise, diálise peritoneal e transplante renal); atendidos em um hospital de ensino do interior do Estado de São Paulo. Após concordarem com o estudo e assinarem o Termo de Consentimento Livre e Esclarecido - TCLE, os participantes responderam em forma de entrevista individual a uma Ficha de Identificação, Escala Hospitalar de Ansiedade e Depressão - HAD, WHOQOL-bref - qualidade de vida, Escala de Modos de Enfrentamento de Problemas - EMEP e WHOQOL - espiritualidade, religiosidade e crenças pessoais - SRPB. Os dados foram analisados e agrupados por frequência e porcentagem de respostas e discutidos a partir da literatura pertinente à área. Resultados: Participaram 174 pacientes, faixa etária predominante entre 41 a 70 anos (70,69%), 53,45%do sexo masculino, 47,70% com ensino fundamental incompleto. Como doença de base, Hipertensão Arterial Sistêmica (36,21%) e Diabetes Mellitus (25,29%), entre outras; comorbidades principais Hipertensão Arterial Sistêmica (47,70%) e Diabetes Mellitus (29,31%). Apresentaram sintomas clínicos de ansiedade 70,11%, e 75,29% de depressão. Para a qualidade de vida, resultados foram ligeiramente acima da média, considerando-se a escala analógica do instrumento. Referente às estratégias de enfrentamento, as maiores médias estiveram para Foco na Emoção, seguidas por Foco no Problema e Suporte Social. Com relação às questões ligadas à espiritualidade, religião e/ou crenças pessoais, a faceta melhor pontuada foi ‘Fé’, seguida por ‘Sentido na ‘Vida’. Conclusões: Dados sociodemográficos, qualidade de vida, estratégias de enfrentamento, e religiosidade / espiritualidade estão compatíveis com apontamentos da literatura. Entretanto, sintomas clínicos de ansiedade e de depressão foram significativamente maiores que os encontrados na população geral e para pacientes renais crônicos. Tais achados indicam necessidade de programas específicos de intervenção para a amostra avaliada, bem como, mais pesquisas na área.

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The management and treatment of chronic diseases, such as end-stage renal disease, is often unproductive because of patients' poor adherence to treatment. The chronic care model toolkit is an Agency for Healthcare Research and Quality supported framework, associated with improved outcomes in patients living with chronic disease. The purpose of this project was to develop and plan an educational program using the chronic care model toolkit for the interdisciplinary clinical staff of a renal hemodialysis center. The goal of this project was to adapt team building between patients and their clinicians through the use of the chronic care model in order to improve patients' adherence to treatment. The educational program materials were developed, including a plan for future implementation over 6 weeks in 2-hour twice-weekly sessions. Program planning accounted for the mixed roles and responsibilities of the interdisciplinary clinical team members, who will share their knowledge among the team and act as patient advisors. The pretest and posttest materials were developed from the toolkit Team Health Audit Questionnaire, which can be used to evaluate staff learning after the program is delivered. Existing clinical metrics are tracked through a Quality Assessment Performance Improvement measure, which will be used to evaluate potential long term influences of the program on patient adherence and outcomes. The project may contribute to social change in practice by enhancing teamwork that has the potential to improve clinical outcomes. Future research should include longitudinal studies on team building using the chronic care model toolkit to determine if its adaption enhances team effort and contributes to a collaborative workforce that improves clinical outcomes.

Thesis (M.A. (Clinical Psychology)) --University of Limpopo, 2014 / The aim of the study was to investigate help-seeking pathways that are followed by patients with chronic disease in one rural community in Limpopo Province. Specifically, the objectives of the study were: a). to investigate help-seeking pathways that were followed by patients with chronic diseases before and after they were diagnosed with their condition; b). to explore the treatment modalities that were used by the patients before they started receiving hospital treatment for their chronic conditions; and, c). to determine whether or not the patients received other forms of treatment in addition to their treatment for the chronic diseases. Through snowball sampling, 10 participants (female = 6; male = 4) drawn from Ga-Dikgale community (Limpopo Province) were selected and requested to participate in the present study. The ages of the participants ranged from 42 to 96 years. Data were collected using semi-structured interviews and analyzed using interpretative phenomenological analysis (IPA) The results of the study are presented under the following themes: a). participants‟ understanding of chronic disease; b). participants‟ view or understanding of factors that could have led to their chronic disease ; c). the help-seeking pathways that were followed by patients with chronic diseases before and after they were diagnosed with their condition; d). the treatment modalities that were used by the patients before they started receiving hospital treatment for their chronic conditions; and, e) whether or not the patients received other forms of treatment in addition to their treatment for the chronic diseases. The study found that different treatment agencies are consulted by patients with chronic diseases. These agencies include: spiritual leaders, traditional healers, to mention few. Based on the findings of the present study, it is concluded that help-seeking pathways are mainly determined by the perceived causes of the disease, which are culturally rooted.

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Chronic pelvic pain is a condition which receives less attention in men than in women. It is often difficult to diagnose and more difficult to treat. The new classification of prostatitis and its variants has introduced the term ‘chronic pelvic pain syndrome’ which underlines the difficulties in dealing with this disorder which may represent a variety of chronically painful conditions with a large functional component. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Chronic myeloproliferative disorders (CMPD) seem to be associated with an increased risk for pulmonary hypertension (PH). Case Report: A patient with history of chronic idiopathic myelofibrosis (CIMF) presented with progressive dyspnea (New York Heart Association class III). Until this time he had not received specific treatment for CIMF. Echocardiography and rightheart catheterization confirmed PH. Further diagnostic procedures excluded a specific cause of PH. Therefore, primary PH was assumed. 2 years later he presented again with progressive dyspnea due to a progress of PH. A few days later the patient died from acute posterior myocardial infarction. Pathologic examination of the lung showed an obstruction of the small vessels by conglomerates of megakaryocytes. Discussion: We conclude that PH developed secondarily due to CMPD. PH should be suspected in patients with CMPD and should influence the decision for treatment of CMPD. / Hintergrund: Chronische myeloproliferative Erkrankungen (CMPD) scheinen mit einem erhöhten Risiko für pulmonale Hypertonie (PH) assoziiert zu sein. Kasuistik: Ein Patient mit chronisch idiopathischer Myelofibrose (CIMF) wurde aufgrund einer progressiven Belastungsdyspnoe (New York Heart Association Stadium III) überwiesen. Bis zu diesem Zeitpunkt erhielt er keine spezifische Behandlung seiner CIMF. Echokardiographie und Rechtsherzkatheter ergaben das Vorliegen einer PH. Eine spezifische Ursache der PH konnte zunächst ausgeschlossen werden. Somit wurde das Vorliegen einer primären PH vermutet. 2 Jahre später wurde der Patient mit erneut verschlechterter Belastungsdyspnoe vorgestellt, wobei ein Progress der PH feststellbar war. Einige Tage später verstarb der Patient an einem Hinterwandinfarkt. Die Autopsie des Lungengewebes zeigte einen Verschluss der kleinen Lungengefäße durch Konglomerate von Megakaryozyten. Diskussion: Die Entwicklung der PH ist bei diesem Patienten als Folge der CMPD einzuschätzen. Das Vorliegen einer PH bei Patienten mit CMPD sollte die Entscheidung zu spezifischen therapeutischen Maßnahmen hinsichtlich der CMPD beeinflussen. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.