Submitted by Luis Guilherme Macena (guilhermelg2004@gmail.com) on 2013-04-08T12:33:46Z No. of bitstreams: 1 Melissa_Dissertação.pdf: 389612 bytes, checksum: ab23a920bbb76b9e01c6b056791e7adb (MD5) / Made available in DSpace on 2013-04-08T12:33:46Z (GMT). No. of bitstreams: 1 Melissa_Dissertação.pdf: 389612 bytes, checksum: ab23a920bbb76b9e01c6b056791e7adb (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / Objetivo: avaliar a associação entre os níveis séricos de 25-hidroxivitamina D (25 OHD) e câncer de mama no climatério. Métodos: trata-se de um estudo do tipo casocontrole com mulheres de 45 a 70 anos atendidas nos ambulatórios de mastologia e ginecologia geral do hospital materno-infantil Instituto Fernandes Figueira, localizado no município do Rio de Janeiro. Foram selecionados 39 casos incidentes de câncer de mama e 60 controles. As participantes foram submetidas à entrevista para o preenchimento de um questionário estruturado e em seguida foi realizado a coleta de sangue para a dosagem de 25 OHD. Resultados: foi observada uma prevalência de 80,8% de hipovitaminose D (< 30ng/mL) entre as participantes do estudo. Em relação à estimativa de risco para carcinoma mamário, o grupo com níveis suficientes de 25 OHD não apresentou diferença com significância estatística do grupo com hipovitaminose D. Porém, na análise das estimativas de risco conforme o status menopausal, houve menor chance de exposição e desenvolvimento de câncer de mama nas mulheres pósmenopausadas com níveis suficientes de 25 OHD (OR* 0.53; IC 95%, 0.12-2.41) que as na pré-menopausa com níveis normais de vitamina D (OR* 0.97; IC 95%, 0.13-8.35) quando comparadas ao grupo com hipovitaminose D. Conclusão: Os resultados desse estudo sugerem que a hipovitaminose D entre mulheres pós-menopausadas seja um fator de risco para o câncer de mama durante o climatério. Todavia, ainda são necessários mais estudos que também confirmem essa associação. / Purpose: to evaluate the association between the plasma levels of 25-hydroxyvitamin D and the breast cancer in the climacteric. Methods: it is a kind of case-control study with women between 45 until 70 years old attended in clinics of mastology and ginecology of the maternal-infantile hospital Fernandes Figueira, localized in Rio de Janeiro city. Thirdy-nine incident cases of breast cancer and 60 controls were selected. The participants were submitted to an interview for filling out of a structured questionnaire and forthwith it was made the swab blood for the dosage of 25 OHD. Results: a prevalence of 80,8% of vitamin D deficiency was spotted among the participants of the study. In relation to the estimate of risk for breast cancer, the group with sufficient levels of 25 OHD did not present difference with significance statistic of the group with vitamin D deficiency. Nevertheless, during the analysis of the estimate of risk according to menopausal status, there were less chance of exposition and development of the breast cancer in postmenopaused women with sufficient levels of 25 OHD (OR* 0.53; IC 95%, 0.12-2.41) than the premenopaused women with normal levels of vitamin D (OR* 0.97; IC 95%, 0.13-8.35) when compared to the group with vitamin D deficiency. Conclusion: the results of this study suggests that the vitamin D deficiency among postmenopaused women is a factor of risk for the breast cancer during the climacteric. However, more studies are still necessary to confirm this association.

Made available in DSpace on 2014-07-22T13:16:46Z (GMT). No. of bitstreams: 2 Viviane_Mattos_iff_dou_2013.pdf: 2452540 bytes, checksum: f878315b979ccf6d606322b38567d1c8 (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2013 / Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil. / O câncer de mama tem sido motivo de constante e crescente preocupação, visto que, no mundo, é o segundo tipo de câncer mais frequente e o primeiro entre as mulheres. A síndrome metabólica é definida por vários distúrbios, dentre eles a resistência insulínica, a dislipidemia e a hipertensão arterial. Recentemente, estudos apontaram para uma associação entre essa síndrome e o aumento de risco para desenvolver câncer de mama. O objetivo geral deste estudo foi identificar a relação entre a síndrome metabólica e o câncer de mama e seus objetivos específicos foram pesquisar o papel da síndrome metabólica na gênese do câncer de mama, pesquisar o papel da história familiar, história reprodutiva, tabagismo, alcoolismo, exposições profissionais e outros fatores de risco do câncer de mama e identificar entre os diferentes marcadores de risco da síndrome metabólica aqueles associados ao risco de desenvolver câncer de mama, que podem ser alvo de políticas de prevenção primária. Para tal, foi realizado um estudo epidemiológico do tipo caso-controle de base hospitalar, com casos incidentes de câncer de mama, em mulheres atendidas nos ambulatórios de mastologia e ginecologia do Instituto Fernandes Figueira (IFF/FIOCRUZ), no Rio de Janeiro, no período de abril de 2011 a fevereiro de 2013. Participaram do estudo 218 pacientes, entre 45 e 69 anos, 68 casos e 150 controles. A diferença entre as proporções da distribuição de frequências das variáveis de interesse em casos e controles foi calculada utilizando o teste de qui-quadrado e teste exato de Fisher (two-sided). Odds Ratio (OR) com intervalo de confiança de 95% (IC 95%) foi a medida utilizada para avaliar a magnitude de associação. A Síndrome metabólica pode estar associada ao aumento do risco câncer de mama, porém não houve significância estatística, enquanto que a atividade física se apresentou como fator de proteção. Com relação aos componentes da síndrome metabólica, os níveis pressóricos e o aumento da glicemia se apresentaram como fatores de risco para o desenvolvimento de câncer. A resistência à insulina mostrou-se um fator de risco importante e a leptina um fator protetor. Vida saudável, juntamente com a oferta da prevenção secundária do câncer de mama, evitaria muitos adoecimentos e mortes decorrentes de diagnóstico tardio do câncer de mama. / Breast cancer has been the subject of constant and growing concern because is the most common cancer in women in the world and is the second most common type of cancer. The metabolic syndrome is characterized by abdominal obesity, high blood glucose levels, impaired glucose tolerance, dyslipidemia, and hypertension. Recently, several studies have examined the association of the metabolic syndrome with breast cancer. The aim of this study was to identify the relationship between metabolic syndrome and breast cancer, study the role of metabolic syndrome in the genesis of breast cancer, examine the role of family history, reproductive history, smoking, alcohol and other risk factors for breast cancer and to research association of the individual components of the metabolic syndrome with breast cancer, which may be the focus for primary prevention. A case-control study of postmenopausal women was conducted in women of gynecology and mastology sectors in Fernandes Figueira Institute (IFF / FIOCRUZ) from april 2011 to February 2013. The study included 218 patients between 45 and 69 years, 68 breast cancer cases and 150 controls. To compare case and control groups, according to frequency distribution was used chi-square test or Fisher's exact test (two-sided). Odds Ratio (OR) with a confidence interval of 95% (95% CI) was used to assess the magnitude of association. The metabolic syndrome may be associated with increased risk of breast cancer, but there was no statistical significance, while physical activity is presented as a protective factor. With respect to the individual components of the metabolic syndrome, increased blood pressure and high levels of blood glucose were presented as risk factors for the development of cancer. Insulin resistance proved to be an important risk factor and leptin a protective factor. Healthy living, along with the supply of secondary prevention of breast cancer, prevent many illnesses and deaths caused by late diagnosis of breast cancer.

Made available in DSpace on 2014-12-17T14:13:36Z (GMT). No. of bitstreams: 1 InavanLS.pdf: 1364854 bytes, checksum: ba90b85051f2ebfc654a59eda4cafaef (MD5) Previous issue date: 2008-07-28 / The metabolic syndrome (MetS) involves a group of risk factors and is associated with a significantly higher risk of developing cardiovascular diseases (CVD) and type 2 diabetes. Recent studies have shown the importance of preventing CVD through early diagnosis and treatment of patients with MetS. The objective of our study was to determine the prevalence of MetS by different diagnostic criteria in postmenopausal women and analyze the influence of socioeconomic factors on cardiovascular risk in this sample of the population. A cross-sectional study involving 127 postmenopausal women (45 to 64 years) from Natal and Mossor?, Brazil. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte. The experimental protocol consisted of applying structured interview, clinical examination and implementation of dosages blood. The diagnosis of MetS was based on NCEP-ATP III (National Cholesterol Education Program-Adult Treatment Panel III) and IDF (International Diabetes Federation) criteria. The research was accomplished with the participation of an interdisciplinary team in their several phases. The result of the sample studied had mean age of 53.9 ? 4.6 years and per capita income of 54.5 dollars. The prevalence of MetS, according to NCEP-ATP III and IDF criteria, was 52.8% and 61.4$, respectively. The agreement rate between NCEP-ATP III and IDF criteria was 81.9%, with a kappa value of 0.63 (CI 95%, 0.49-0.76), indicating good agreement between the two definitions. The most prevalent cardiovascular risk factor was HDL < 50 mg/dl, observed in 96.1% of the women analyzed, followed by increased waist circumference (&#8805; 80 cm) in 78.0%, elevated blood pressure in 51.2%, triglycerides &#8805; 150 mg/dl in 40.9% and glycemia &#8805; 100 mg/dl in 37.0% of the women. The occurrence of MetS was significantly associated with schooling and body mass index (BMI). High blood pressure was significantly associated with low family income, low schooling and weight gain. There was no significant association between the intensity of climacteric symptomatology and the occurrence of MetS. The conclusions of the research were that MetS and its individual components show a high prevalence in postmenopausal Brazilian women, and significant associations with weight gain and low socioeconomic indicators. The data point to the need for an interdisciplinary approach at the basic health care level, directed toward the early identification of risk factors and the promotion of cardiovascular health of climacteric women. / A s?ndrome metab?lica (SM) engloba um grupo de fatores de risco, estando associada com aumento significativo do risco para desenvolvimento de doen?as cardiovasculares (DCV) e diabetes tipo 2. Recentes pesquisas t?m demonstrado a import?ncia da identifica??o precoce e tratamento de pacientes com SM, visando ? preven??o das DCV. O objetivo do nosso trabalho foi determinar a preval?ncia de SM por diferentes crit?rios diagn?sticos em mulheres na p?s-menopausa e analisar a influ?ncia da intensidade dos fatores s?cio-econ?micos sobre o risco cardiovascular nessa amostra da popula??o. Foi realizado estudo transversal envolvendo 127 mulheres na p?s- menopausa (idade de 45 a 64 anos) residentes em Natal e Mossor?, Rio Grande do Norte. O estudo foi aprovado pelo Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte. O protocolo experimental constou da aplica??o de entrevista estruturada, exame cl?nico e realiza??o de dosagens sangu?neas. O diagn?stico de SM foi estabelecido com base nos crit?rios NCEP-ATP III (National Cholesterol Education Program - Adult Treatment Panel III) e da IDF (International Diabetes Federation). A pesquisa foi realizada com a participa??o de uma equipe interdisciplinar nas suas diversas fases. O resultado da amostra estudada apresentou m?dia de idade de 53,9 ? 4,6 anos e renda per capita m?dia de 54,5 d?lares. A preval?ncia de SM conforme os crit?rios NCEP-ATP III e IDF foi de 52,8% e 61,4%, respectivamente. A taxa de concord?ncia entre os crit?rios NCEP-ATP III e IDF foi de 81,9%, com valor de kappa de 0,63 (IC 95%, 0,49-0,76), indicando haver boa concord?ncia entre as duas defini??es. O fator de risco cardiovascular mais prevalente foi HDL<50 mg/dl, observado em 96,1% das mulheres analisadas, seguido por circunfer?ncia da cintura aumentada (&#8805;80 cm) em 78,0%, eleva??o da press?o arterial em 51,2%, triglicer?deos &#8805; 150 mg/dl em 40,9% e glicemia &#8805; 100 mg/dl em 37,0% das mulheres. A ocorr?ncia de SM foi significativamente associada com a escolaridade e ?ndice de massa corporal (IMC). Press?o arterial elevada foi significativamente associada com baixa renda familiar, baixa escolaridade e ganho de peso. N?o houve associa??o significativa entre a intensidade da sintomatologia climat?rica e ocorr?ncia de SM. As conclus?es da pesquisa foram que a SM e seus componentes individuais apresentam elevada preval?ncia em mulheres brasileiras na p?s-menopausa, havendo associa??es significativas com o ganho de peso e indicadores de baixo n?vel s?cio-econ?mico. Os dados apontam para a necessidade da abordagem interdisciplinar no n?vel da aten??o b?sica em sa?de, voltada para a identifica??o precoce de fatores de risco e promo??o da sa?de cardiovascular das mulheres no climat?rio.

Introdução: O tratamento hormonal para amenizar sintomas do climatério é bem conhecido, mas nem sempre pode ser indicado para grande parte das mulheres. Por estes motivos, tem-se testado várias opções de tratamento não hormonal, cujos resultados nem sempre são satisfatórios e conclusivos. Objetivo: Avaliar a eficácia da cinarizina no tratamento dos sintomas climatéricos. Casuística e método: Foram estudadas prospectivamente 62 mulheres climatéricas sintomáticas com predomínio de ondas de calor que preencheram os critérios de inclusão e exclusão com idade variando de 45 a 60 anos, as quais foram avaliadas pelo Índice Menopausal de Kupperman (IMK), e atendidas no Setor de Ginecologia Endócrina e Climatério do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram divididas aleatoriamente em dois grupos: S com 27 pacientes (25 mg de Cinarizina a cada 12 hs, v.o., por 6 meses) e M com 35 pacientes (1 comprimido de placebo a cada 12hs, v.o., por 6 meses). Resultados: No grupo S a média etária foi 53,9 anos; 51,9% brancas e 48,1% negras; e no grupo M a média etária foi de 54,7 anos; 51,4% brancas e 48,6% negras. Os níveis pressóricos e o índice de massa corpórea foram semelhantes, entre os grupos. A análise do IMK e suas variantes comparativamente nos grupos S e M nos tempos 0 e 1 foi p=0,235 e p=0,406, respectivamente. Conclusões: A cinarizina foi semelhante ao placebo no alívio dos sintomas do climatério avaliados pelo IMK. Houve melhora significante do sintoma vertigem nas pacientes que receberam cinarizina. / Introduction: The hormonal treatment for relief of climateric symptoms is well-known but most women can not be treated with homones. For this reason several treatments without hormones has been evaluated with no conclusive results yet. Objective: Evaluate the efficacy of cinnarizine in the treatment of climacteric symptoms. Casuistry and Method: Were prospectively studied 62 symptomatic climacteric women with prevalence of hot flashes who met the inclusion and exclusion criteria aged from 45 to 60 years, evaluated by Kupperman\'s Menopause Index (KMI) attended at the Sector of Endocrinology Gynecology and Climacteric from the Medical School of the Hospital das Clinicas of the University of São Paulo. The subjects were divided alleatory in two: 27 patients Group S (Cinnarizine 25mg every 12h) and Group M with 35 (1 Placebo each 12h). Results: In group S the mean age was 53.9 years; 51.9% white and 48.1% black; and in group M the mean age was 54.7 years; 51.4% white and 48.6% black. Blood pressure levels and body mass index were similar in both groups. The analysis of the KMI and their variables comparision betwen groups (S and M) at time 0 and 1 was p=0.235 and p=0.406 respectively. Conclusions: Cinnarizine was similar to placebo for recipe of climacteric symptoms evaluated by KMI. There was significant improvement of symptom vertigo in patients treated with cinnarizine.

Bakgrund: Livskvaliteten under klimakteriet och hur kvinnor skattar sin tillvaro påverkas av flera olika komponenter. Förutom sociala och miljömässiga förändringar, drabbas många kvinnor av olika grad av fysiska och psykiska symptom, som påverkar livskvaliteten negativt. För att förbättra måendet används numera både hormonella och icke-hormonella metoder. Antonovskys känsla av sammanhang (KASAM), innefattar begreppen: begriplighet, hanterbarhet och meningsfullhet, som har visat sig kunna underlätta för människors anpassning till svåra livssituationer. Motiv: Effekten av KASAM under klimakteriet är däremot ett mycket outforskat område, både nationellt och internationellt. Det saknas också forskning om starkare KASAM kan bli en skyddsfaktor för bättre hälsa och mående i denna målgrupp.   Syfte: Syftet med studien var att beskriva fysisk och psykisk hälsa samt livskvalitet bland kvinnor i klimakteriet, samt att undersöka om känsla av sammanhang var relaterad till graden av klimakteriesymptom och psykiskt välmående. Metod: Totalt 480 kvinnor i klimakteriet, rekryterades till en tvärsnittsstudie enligt kvantitativ ansats, via en webbenkät på Facebook. Förutom sociodemografiska faktorer inkluderades fyra validerade mätverktyg: Menopause Rating Scale (MRS), World Health Organization Quality of Life (WHOQOL)-BREF, Sense of Coherence (SOC)-13 och Hospital, Anxiety and Depression Scale (HADS). För att besvara syfte och frågeställningar utfördes två multivariata variansanalyser. Resultat: Huvudresultatet visade att det fanns en statistiskt signifikant skillnad i graden av fysiska och psykiska klimakteriesymptom relaterat till KASAM. Kvinnor med hög KASAM hade statistiskt signifikant lägre grad av vegetativa, psykologiska och urogenitala symptom, samt signifikant lägre grad av oro och nedstämdhet, jämfört med kvinnor med låg eller måttlig KASAM. Livskvaliteten relaterad till omgivningen var generellt god, medan fysiologiska, psykologiska och sociala domäner endast var måttliga. För övrigt var det drygt hälften (51 %) av kvinnorna, som använde någon form av hormonpreparat och 112 (23.3 %) idkade regelbunden fysisk aktivitet. Konklusion: Högre KASAM har samband med bättre mående hos kvinnor i klimakteriet, fastän det krävs ytterligare forskning i ämnet. / Background: The quality of life during the climacteric period and how women value their lives, is affected by several different components. In addition to social and environmental changes, many women suffer from varying degrees of physical and mental symptoms, which negatively affect the quality of life. Both hormonal and non-hormonal methods are nowadays used to improve well-being. Antonovsky's Sense of Coherence (SOC), consists of the concepts: comprehensibility, manageability and meaningfulness, which are proven to facilitate people´s adaption to harsh life situations.  Motive: The effect of SOC during menopausal transition is, however, a very unexplored field both nationally and internationally. There is also a lack of research whether stronger SOC can be a protective factor for better health or well-being in this target group.  Aim: The purpose of the study was to describe physical and mental health and quality of life among women during menopausal transition and to investigate whether Sense of Coherence is related to the degree of menopausal symptoms and mental wellbeing.  Methods: Totally 480 women in the climacteric period, were recruited to a cross-sectional study with a quantitative approach, through an internet survey on Facebook. In addition to socio-demographic factors, four validated assessment instruments were included: Menopause Rating Scale (MRS), The World Health Organization Quality of Life (WHOQOL)-BREF, Sense of Coherence (SOC)-13 and The Hospital Anxiety and Depression Scale (HADS). To answer the aim and the research questions, two Multivariate analyses of variances were conducted.  Results: The main results showed that there was a statistically significant difference in the degree of physical and mental climacteric symptoms related to KASAM. Women with high SOC had statistically significantly lower degree of vegetative, psychological and urogenital symptoms, as well as significantly lower degree of anxiety and depression, compared to women with low or moderate SOC. The quality of life related to the environment was generally good, while Physical, Psychological and Social Relationships domains were only moderate. In addition, slightly more than half (51 %) of the women, used some form of hormone replacement therapy and 112 (23.3 %) practiced regular physical activity.  Conclusion: Higher SOC among women in the climacteric period, is associated with better well-being, although further research is needed in this topic.

No description available.

本研究では，アクセプタンス&コミットメント・セラピーによる健康関連の生活の質の向上と更年期症状の重症度への効果を検討した。質問紙調査ならびに前後比較試験と一事例の実験デザインの3つの研究により検討した。その結果，ACTによる介入が健康関連の生活の質を向上させ，更年期症状の重症度を低減させる可能性が示された。本研究により更年期症状への介入の新たな選択肢を提示するとともに，ACTの適用範囲を広げることなった。 / 博士(心理学) / Doctor of Philosophy in Psychology / 同志社大学 / Doshisha University