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Associação entre o nível de escolaridade e a idade da menopausa: uma revisão sistemática / Association between educational level and age menopause: a systematic reviewFelipe Simões Canavez 27 June 2007 (has links)
O século XX foi marcado por significativa transformação social, que se refletiu em rápido aumento da expectativa de vida da população mundial. Nesse contexto, é cada vez mais significativa a parcela de mulheres que atingem a menopausa. Doenças cardiovasculares, que representam a principal causa de morte entre os adultos, e a osteoporose, apresentam uma
relação nítida com a antecipação da menopausa, isto é, aquela que ocorre abaixo da média esperada para uma população. As pesquisas na área, antes praticamente relacionadas ao
tratamento dos efeitos causados pelo climatério, se voltam cada vez mais para entender como os hábitos ou estilos de vida podem influenciar a fisiologia ovariana e, conseqüentemente,
alterar o momento da menopausa. A relação com alguns destes hábitos, como o fumo, já apresenta forte embasamento na literatura. Entretanto, a correlação com o nível socioeconômico, seja pelas dificuldades de se medir adequadamente esse constructo, ou talvez pela quantidade insuficiente de trabalhos de qualidade, não se apresenta de forma tão evidente. O nível de escolaridade, considerado um dos melhores indicadores do nível socioeconômico, tanto pela maior facilidade de obtenção da informação, como pelo já demonstrado grau de associação com diversos desfechos em saúde, foi avaliado nesta revisão
sistemática como fator de exposição para a antecipação da idade da menopausa. Este trabalho se alinha com a crescente tendência de se entender como os determinantes sociais podem
influenciar nos desfechos em saúde, e de se buscar estratégias eficazes em prol da diminuição das desigualdades em saúde. A estratégia de busca eletrônica foi desenvolvida de forma
específica para as diferentes bases (MEDLINE [PubMed] e LILACS) e através de consulta a referências cruzadas. Somente foram incluídos estudos observacionais pela natureza da
questão, já que não seria possível, neste caso, a realização de estudos experimentais. Após a identificação inicial de 776 artigos, 40 deles foram selecionados para apreciação do texto
completo. No final, esta revisão sistemática englobou 30 artigos, relatando resultados de 32 estudos. Como resultado, verificou-se que estudos que não demonstram associação
significativa do nível de educação com a idade da menopausa formaram a maioria da amostra. A forma como nível de escolaridade foi medida e a metodologia para comparação entre os estratos se mostraram largamente heterogêneas. Não se encontraram evidências inequívocas sobre a existência de associação entre o nível de escolaridade e a idade da menopausa através desta revisão. / The 20th century was marked by significant social changes that reflected on a fast increase of life expectancy of the worldwide population. In this context, the portion of women that attain menopause is increasingly more significant. Cardiovascular diseases, that represent the main cause of death among adults, and osteoporosis, present a clear relation with the anticipation of menopause, that is, that one that occurs below the expected average to a certain population. Initially, studies in this area were practically restricted to treatment of effects
caused by the climateric period. Currently, they are more and more concerned to understand how habits or life styles can influence the ovarian physiology and, consequently, how they
can alter the age at menopause. Association with some of these habits, such as smoking tobacco, already presents a strong foundation in the literature. However, the correlation with
socioeconomic level, maybe due to difficulties concerning how to measure this concept properly or to the insufficient amount of qualified papers, is not so clearly presented. Educational level, considered as one of the best socioeconomic indicators, both due to the greater facility to obtain information and already the demonstrated degree of association with
several outcomes in health, was evaluated in this systematic review as an exposure factor to the anticipation of the age at menopause. This work is lined up an increasing tendency to
understand how social determinants can influence health outcomes and how effective strategies could be built to decrease health inequalities. The strategy of electronic search was developed in a specific way to different basis considered (Medline [PubMed] and Lilacs) and complemented with cross-reference search. Only observational studies were included by the nature of the question, since it would not be possible, in this case, to perform experimental studies. After initial identification of 776 articles, in which 40 out of them were selected for evaluation of the complete text. In the end, our systematic review included 30 articles, giving an account of 32 studies. As a result of the review, it was noticed that studies not showing a significant association between educational level and the age at menopause formed the most part of the sample. The way by which the educational level was measured as well as the methods used for comparing strata, were largely heterogeneous, This review did not find strong evidences about the existence of an association between educational level and age at menopause.
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Os entre-lugares do sujeito e da escritura em Arnaldo AntunesFernandes Júnior, Antônio [UNESP] 02 April 2007 (has links) (PDF)
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fernandesjunior_a_dr_arafcl.pdf: 936826 bytes, checksum: 1b6377d5cdebd4a6f7f645a9d0ad7624 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Este trabalho destina-se ao estudo dos procedimentos de escritura e autoria na produção poética de Arnaldo Antunes, cuja poesia, configura-se como um espaço de confluência de diferentes linguagens (visual, sonora, verbal) e formas de veiculação (livro, vídeo, CD, corpo), elementos desencadeadores de sua linguagem poético-musical. Na obra desse poeta, a prática de escritura não se limita somente a citações de outros textos (externos), mas também de movimentos internos à própria obra, por meio de citações, deslocamentos e apropriações que o poeta efetua para a composição de outro texto. Da fusão entre o verbal, o visual e o sonoro, bem como das desconstruções da palavra e do verso realizadas, merece destaque os movimentos intertextuais efetuados dentro de sua própria obra. A alternância de suporte (livro, vídeo ou encarte de CD) permite obter diferentes efeitos de sentido de um mesmo poema, pois, além da diferença do suporte, existem as modificações realizadas na materialidade do texto. Nesse deslocamento interno, há alterações da disposição gráfica dos poemas, permitindo ao texto re-significar ao mudar de contexto (suporte). Para a estruturação deste trabalho, dividimo-lo em quatro etapas: análise dos textos de Antunes com base na noção de devir-criança, concebida por Gilles Deleuze; apresentação teórica do conceito de suporte, a partir de Roger Chartier, e sua aplicabilidade para a leitura dos poemas e canções do referido autor; discussão do conceito de subjetividade, desenvolvido por Michel Foucault, com o objetivo de perceber as metamorfoses do sujeito na poesia de Antunes; por último, tratamos das questões de autoria e escritura, que, de alguma maneira envolvem os tópicos anteriores, como tentativa de empreender um outro gesto de leitura da/na poética de Antunes. Portanto, neste estudo... / Ce travail a comme but l'étude des procédés d'écriture et de la qualité d'auteur dans la production poétique d'Arnaldo Antunes, dont la poésie se montre comme un espace de confluence de différents langages (visuel, sonore, verbal) et les formes véhiculées (livre, vidéo, CD, corps), des éléments déclancheurs de son langage poétique-musical. Dans lþoeuvre de ce poète, la pratique d'écriture ne se limite pas seulement aux citations d'autres textes (externes), mais aussi aux mouvements internes à l'oeuvre elle même, par le biais des citations, des déplacements et des appropriations, que le poète réalise pour la composition dþautre texte. De la fusion du verbal, du visuel et du sonore, aussi que des (dé)constructions du mot et du vers réalisées, on souligne les mouvements intertextuels faits à l'intérieur de son oeuvre. L'alternance de support (livre, vidéo ou des textes qui accompagnent le CD) permet d'obtenir de différents effets du sens d'un même poème, puisqu'au délà de la différence du support, ils existent des modifications réalisées dans la disposition graphique des poèmes en permettant aux texte de signifier à nouveau le moment où il change de contexte (support). Pour structurer ce travail on lþa divisé dans quatre étapes: analyse des textes d'Antunes basée sur la notion de devenir-enfant, conçue par Gilles Deleuze; preséntation théorique du concept du support, à partir de Roger Chartier, et sa capacité dþapplication pour la lecture des poèmes et des chansons de lþauteur en étude; discussion du concept de subjectivité, développé par Michel Foucault, pour percevoir les métamorphoses du sujet dans la poésie d'Antune; et dernièrement, on a abordé des questions de la qualité d'auteur et de l'écriture, qui, dans une certaine mesure, enveloppent les topiques antérieures, comme tentaive d'entreprendre un autre geste... (Complete abstract, click electronic access below)
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Understanding adolescent and young people's sexual health and development in a public health context : research studies and interventionsDowning, Jennifer January 2014 (has links)
Sexual health risk-taking behaviour is typically initiated during adolescence and continues throughout teenage years and early adulthood at higher levels than at other life stages. For some groups (e.g. deprived and vulnerable populations) the risks can be greater still. Risk behaviours in early youth are related to increased rates of risk-taking and the adoption of multiple risk behaviours in early adulthood. Prevention interventions implemented early on are shown to be most effective at preventing or reducing the poor health outcomes associated with risk-behaviours. Policies and prevention interventions are informed by current data showing patterns of risk behaviour, identification of emerging behaviour, factors associated with these behaviours and evidence of intervention prevention effectiveness. This submission presents a linking commentary which summarises and critiques a series of peer reviewed publications, supported by additional publications, all of which were carried out during my employment at Liverpool John Moores University. Studies have identified key factors affecting sexual development and associated behaviour; associations between sexual and other behaviours, such as alcohol behaviours; and the relationship between social and well-being factors and sexual behaviours in adolescents and young people. Studies also evaluate public health initiatives and review public health evidence of intervention effectiveness. These studies have contributed to understanding sexual development and its impact on behaviours during the life course; have highlighted the health service and education needs of young people; and have identified effective interventions and intervention components to inform national guidance, public health policy and intervention development.
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Adopting DevOps in Agile: Challenges and SolutionsWang, Cheng, Liu, Changling January 2018 (has links)
Background. DevOps is a hot topic in recent years. It emphasizes the combination of development and operation. Agile is one of the most popular development methods, but Agile mainly focused on software development part, there is no more involvement in deployment and operations. In this case, many companies consider adopting DevOps in Agile to attempt to improve the situation. Objectives. The combination of two different technologies is bound to produce some challenges, whether it is for practitioners or researchers, it is very important to find these challenges and mitigate them, so this article aims to investigate the challenges of adopting DevOps in Agile, then through the systematic literature review and survey questionnaire to determine the corresponding mitigation strategy. Then, in order to detail understand the process of adopting DevOps in Agile, we use interview to research the real process of adopting DevOps in agile. Methods. According to our research question, we used the systematic literature review(SLR), survey questionnaire and interview as our research methodology. Through literature review, we collected data of adopting DevOps in Agile, and summary the challenges and its relevant mitigation strategies. Then survey questionnaire helped us linking the content of literature to the industry, and compare their difference. Through the interview, we explored the actual process of adopting DevOps in Agile in industry, and correspond the challenges to the actual process. Results. Our study summarized the software development process of adopting DevOps based on Agile and revealed 23 challenges and corresponding mitigation strategies. The report also compares the commonalities and gaps between the results from the literature and the findings of real-life adopting of DevOps challenges and mitigation strategies. Conclusions. In this article, we introduced the challenges and corresponding mitigation strategies for adopting DevOps based on agile and summarize the corresponding software development process. The obvious challenges and mitigation strategies were divided into four categories: 1) People 2) Project 3) Process 4) Organization, after which we conducted further discussions based on the actual conditions and compared the results of systematic literature review and the results of questionnaire to detail explore their difference.
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Associação entre o nível de escolaridade e a idade da menopausa: uma revisão sistemática / Association between educational level and age menopause: a systematic reviewFelipe Simões Canavez 27 June 2007 (has links)
O século XX foi marcado por significativa transformação social, que se refletiu em rápido aumento da expectativa de vida da população mundial. Nesse contexto, é cada vez mais significativa a parcela de mulheres que atingem a menopausa. Doenças cardiovasculares, que representam a principal causa de morte entre os adultos, e a osteoporose, apresentam uma
relação nítida com a antecipação da menopausa, isto é, aquela que ocorre abaixo da média esperada para uma população. As pesquisas na área, antes praticamente relacionadas ao
tratamento dos efeitos causados pelo climatério, se voltam cada vez mais para entender como os hábitos ou estilos de vida podem influenciar a fisiologia ovariana e, conseqüentemente,
alterar o momento da menopausa. A relação com alguns destes hábitos, como o fumo, já apresenta forte embasamento na literatura. Entretanto, a correlação com o nível socioeconômico, seja pelas dificuldades de se medir adequadamente esse constructo, ou talvez pela quantidade insuficiente de trabalhos de qualidade, não se apresenta de forma tão evidente. O nível de escolaridade, considerado um dos melhores indicadores do nível socioeconômico, tanto pela maior facilidade de obtenção da informação, como pelo já demonstrado grau de associação com diversos desfechos em saúde, foi avaliado nesta revisão
sistemática como fator de exposição para a antecipação da idade da menopausa. Este trabalho se alinha com a crescente tendência de se entender como os determinantes sociais podem
influenciar nos desfechos em saúde, e de se buscar estratégias eficazes em prol da diminuição das desigualdades em saúde. A estratégia de busca eletrônica foi desenvolvida de forma
específica para as diferentes bases (MEDLINE [PubMed] e LILACS) e através de consulta a referências cruzadas. Somente foram incluídos estudos observacionais pela natureza da
questão, já que não seria possível, neste caso, a realização de estudos experimentais. Após a identificação inicial de 776 artigos, 40 deles foram selecionados para apreciação do texto
completo. No final, esta revisão sistemática englobou 30 artigos, relatando resultados de 32 estudos. Como resultado, verificou-se que estudos que não demonstram associação
significativa do nível de educação com a idade da menopausa formaram a maioria da amostra. A forma como nível de escolaridade foi medida e a metodologia para comparação entre os estratos se mostraram largamente heterogêneas. Não se encontraram evidências inequívocas sobre a existência de associação entre o nível de escolaridade e a idade da menopausa através desta revisão. / The 20th century was marked by significant social changes that reflected on a fast increase of life expectancy of the worldwide population. In this context, the portion of women that attain menopause is increasingly more significant. Cardiovascular diseases, that represent the main cause of death among adults, and osteoporosis, present a clear relation with the anticipation of menopause, that is, that one that occurs below the expected average to a certain population. Initially, studies in this area were practically restricted to treatment of effects
caused by the climateric period. Currently, they are more and more concerned to understand how habits or life styles can influence the ovarian physiology and, consequently, how they
can alter the age at menopause. Association with some of these habits, such as smoking tobacco, already presents a strong foundation in the literature. However, the correlation with
socioeconomic level, maybe due to difficulties concerning how to measure this concept properly or to the insufficient amount of qualified papers, is not so clearly presented. Educational level, considered as one of the best socioeconomic indicators, both due to the greater facility to obtain information and already the demonstrated degree of association with
several outcomes in health, was evaluated in this systematic review as an exposure factor to the anticipation of the age at menopause. This work is lined up an increasing tendency to
understand how social determinants can influence health outcomes and how effective strategies could be built to decrease health inequalities. The strategy of electronic search was developed in a specific way to different basis considered (Medline [PubMed] and Lilacs) and complemented with cross-reference search. Only observational studies were included by the nature of the question, since it would not be possible, in this case, to perform experimental studies. After initial identification of 776 articles, in which 40 out of them were selected for evaluation of the complete text. In the end, our systematic review included 30 articles, giving an account of 32 studies. As a result of the review, it was noticed that studies not showing a significant association between educational level and the age at menopause formed the most part of the sample. The way by which the educational level was measured as well as the methods used for comparing strata, were largely heterogeneous, This review did not find strong evidences about the existence of an association between educational level and age at menopause.
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O impacto das revisões de literatura na ciência odontológica e na clínica periodontal : o exemplo de uma revisão sistemática de estatinas como adjuvante à terapia periodontalMuniz, Francisco Wilker Mustafa Gomes January 2017 (has links)
As revisões sistemáticas são consideradas os desenhos experimentais capazes de guiar os cuidados em saúde. Contudo, as revisões narrativas ainda são largamente publicadas até o presente momento. No âmbito do tratamento das doenças periodontais, diversos estudos têm reportado que o uso adjuvante de estatinas à terapia periodontal mecânica pode acarretar melhorias nos parâmetros clínicos periodontais, como adicionais reduções de profundidade de sondagem e ganhos de inserção clínica. O objetivo deste trabalho é contextualizar a informação advinda de uma revisão sistemática realizada sobre um tema clínico significativo e compreender qual o seu papel como suporte da atenção ao paciente periodontal, a partir da compreensão obtida no estudo bibliométrico de revisões de literatura. No estudo bibliométrico, uma amostra representativa das revisões de literatura, publicadas na base Scopus, foi selecionada. Tipo de revisão, número de citações, ano de publicação, temática do estudo e outras variáveis foram coletadas. Nesse estudo, observou-se que o número de revisões sistemática tem aumentado significativamente ao longo dos anos quando comparados com o número de revisões narrativas. Apesar disso, o número ajustado de citações das revisões sistemáticas não difere significativamente das recebidas nas revisões narrativas. Já na revisão sistemática de uso adjuvante de estatinas, uma estratégia de busca nas bases Pubmed, Scopus e Embase foi realizada para identificar todos os ensaios clínicos que tenham utilizado estatinas como adjuvantes ao tratamento periodontal mecânico em comparação à terapia periodontal mecânica isolada ou associada a placebo. Quinze estudos foram selecionados. Observou-se que, na maioria dos estudos, o uso adjuvante de estatina apresentou adicionais reduções de profundidade de sondagem e ganhos de inserção clínica quando comparado com seus respectivos grupos controles. Contudo, a alta heterogeneidade desse resultado e o grande número de estudos ser executado por um mesmo grupo de pesquisa são fatores limitadores dessa revisão sistemática. Dessa maneira, pode-se concluir que o número de revisões sistemáticas vem aumentando a longo do tempo, porém o seu número de citações parece não acompanhar as mesmas tendências. Além disso, o uso adjuvante de estatina na terapia periodontal ainda não deve ser recomendado até a execução de outros estudos com melhor qualidade. / Systematic review is considered the experimental design capable of guiding the health care. However, narrative reviews are broadly published nowadays. Regarding periodontal diseases treatment, several studies reported that the adjuvant use of statins to mechanical periodontal treatment may promote additional improvements in clinical periodontal parameters, such as additional reduction in probing depth and clinical attachment gain. This study aimed to contextualize the information obtained in a systematic review about a significant clinical thematic and comprehend is its role in the periodontal care, through information gathered in a bibliometric study of literature review studies in Dentistry. In the bibliometric study, a representative sample of literature reviews studies, published in Scopus database, was selected. Type of review, number of citations, year of publication, study thematic, and other variables were collected. It was showed that the number of systematic reviews increased throughout the years in comparison to narrative reviews. Additionally, the Dentistry clinical fields presented the highest number of published systematic reviews. Despite of that, the mean adjusted number of citations granted for systematic reviews did not differ from the narrative ones. Regarding the performed systematic review, a search strategy was conducted on Pubmed, Scopus, and Embase databases to identify all clinical trials that used statins as adjuvant to mechanical periodontal treatment in comparison to mechanical periodontal treatment alone or in association with placebo. Fifteen studies were included. It was showed that most of the included studies presented additional reduction in probing depth and clinical attachment gain in comparison to their control groups. However, the high heterogeneity among the studies and the high number of studies conducted by the same research group are limitations of the present systematic review. It was concluded that the number of systematic review are increasing dramatically throughout the years, but this trend is not followed by the number of citations granted to this type of study. Furthermore, the adjuvant use of statin in the mechanical periodontal therapy may not be recommended until further well-designed studies have been published.
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Developers' performance analysis based on code review data : How to perform comparisons of different groups of developersBarysau, Mikalai January 2016 (has links)
Nowadays more and more IT companies switch to the distributed development model. This trend has a number of advantages and disadvantages, which are studied by researchers through different aspects of the modern code development. One of such aspects is code review, which is used by many companies and produces a big amount of data. A number of studies describe different data mining and data analysis approaches, which are based on a link between code review data and performance. According to these studies analysis of the code review data can give a good insight to the development performance and help software companies to detect a number of performance issues and improve the quality of their code. The main goal of this Thesis was to collect reported knowledge about the code review data analysis and implement a solution, which will help to perform such analysis in a real industrial setting. During the performance of the research the author used multiple research techniques, such as Snowballing literature review, Case study and Semi-structured interviews. The results of the research contain a list of code review data metrics, extracted from the literature and a software tool for collecting and visualizing data. The performed literature review showed that among the literature sources, related to the code review, relatively small amount of sources are related to the topic of the Thesis, which exposes a field for a future research. Application of the found metrics showed that most of the found metrics are possible to use in the context of the studied environment. Presentation of the results and interviews with company's representatives showed that the graphic plots are useful for observing trends and correlations in development of company's development sites and help the company to improve its performance and decision making process.
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Prevalence of Mental Diseases in Austria. Systematic Review of the Published EvidenceLaszewska, Agata, Österle, August, Wancata, Johannes, Simon, Judit January 2018 (has links) (PDF)
Background: Addressing the growing burden of mental
diseases is a public health priority. Nevertheless,
many countries lack reliable estimates of the proportion
of the population affected, which are crucial for
health and social policy planning. This study aimed to
collect existing evidence on the prevalence of mental
diseases in Austria.
Methods: A systematic review was conducted using
MeSH, EMTREE and free-text terms in seven bibliographic
databases. In addition, the references of included
papers and relevant Austria-specific websites
were searched. Articles published after 1996 pertaining
to the Austrian adult population and presenting
prevalence data for mental diseases were included in
the analysis.
Results: A total of 2612 records were identified in the
database search, 19 of which were included in the
analysis, 13 were community-based studies and 6 examined institutionalized populations. Sample sizes
ranged from 200 to 15,474. The evidence was centered
around depression (n= 6, 32%), eating disorders
(n= 4, 21%) and alcohol dependence (n= 3, 16%).
While most studies (n= 10, 53%) used questionnaires
and scales to identify mental diseases, seven studies
used structured clinical interviews, and two studies
examined use of psychotropic drugs. Due to the diversity
of methodologies, no statistical pooling of prevalence
estimates was possible.
Conclusion: Information on the prevalence of mental
diseases in Austria is limited and comparability between
studies is restricted. A variety of diagnostic instruments,
targeted populations and investigated diseases
contribute to discrepancies in the prevalence
rates. A systematic, large-scale study on the prevalence
of mental diseases in Austria is needed for comprehensive
and robust epidemiological evidence.
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Bröstcancerpatienters behov av kommunikation om sjukdomen och dess behandling i vårdenJakobsson, Felicia, Johansson, Magnus January 2018 (has links)
Bakgrund: Hos kvinnor är den vanligaste formen av cancer bröstcancer. Att drabbas av bröstcancer är för många kvinnor ett trauma och innebär en stor förändring. Att kommunicera information till bröstcancerpatienter är en viktig del i omvårdnaden då det ger kvinnan en känsla av kontroll över sitt liv. Syfte: Att sammanställa kunskap om kvinnliga bröstcancerpatienters behov av kommunikation i vårdsammanhang om sjukdom och behandling från diagnos till slutförd behandling. Metod: En litteraturöversikt med deskriptiv design användes som metod. PubMed, CINAHL, PsycINFO och Google Scholar var databaser som användes vid sökningen. 11 kvalitativa artiklar valdes ut efter kvalitetsgranskningen. Resultat: Kommunikation var en viktig del i vården för bröstcancerpatienterna och kommunikation kunde uttryckas på många olika sätt. Kvinnorna hade olika behov av kommunicerad information och att bli sedd som en unik individ var betydelsefullt. Att få vara med och bestämma över sin behandling var också viktigt för dem. Otillräckligt med tid, svåra medicinska termer, otillräcklig behandlingsinformation och avsaknad av existentiell kommunikation uppfattades av kvinnorna som negativt. Att få information anpassat till fas i sjukdomen var viktigt för bröstcancerpatienterna samt att den icke-verbala kommunikationen kompletterade den verbala kommunikationen. Slutsats: Trots att det fanns många positiva upplevelser kring kommunikation med vårdpersonal förekom även många negativa aspekter vilket tyder på att kommunikation i vården fortfarande behöver förbättras och utvecklas. En nyckel till god kommunikation visade sig vara att anpassa den efter individen och inte enbart till sjukdomen. Då bröstcancerpatienternas behov av kommunikation var stort kan vårdpersonal med hjälp av god kommunikation hjälpa kvinnorna att hantera svårigheter som uppkommer i samband med sjukdomen och minska eventuellt lidande. / Background: The most common type of cancer among women is breast cancer. To be diagnosed with breast cancer is traumatic to many women and causes a major change in life. Communicating information to breast cancer patients is an important part of healthcare, as it gives the woman a sense of control over her life. Purpose: To compile knowledge of female breast cancer patients' need for communication in the healthcare context of disease and treatment from diagnosis to completed treatment. Methods: A literature review with a descriptive design was used as a method. PubMed, CINAHL, PsycINFO and Google Scholar were databases used in the search. 11 qualitative articles were selected after the quality review. Results: Communication was an important part of healthcare for breast cancer patients and communication could be expressed in many different ways. The women had different needs for communicated information and being seen as a unique individual was important. Being involved and deciding on their treatment was also important to them. Insufficient time, difficult medical terms, inadequate treatment information and lack of existential communication were perceived by the women as negative. Getting information adapted to the phase of the disease was important for breast cancer patients. Non-verbal communication supplementing verbal communication was also important. Conclusions: Although there were numerous positive experiences concerning communication between healthcare personnel and patients there were many negatives as well. This indicates that healthcare still needs to improve in communication. A key to good communication was to base it around the individual and not the disease. With good communication, healthcare personnel can help these women cope with the difficulties that the disease bring and lessen eventual suffering.
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Revisão sistemática de literatura sobre o uso terapêutico do ozônio em feridas / Systematic Literature Review about the therapeutic use of the ozone in woundsJuliana Trench Ciampone de Oliveira 28 November 2007 (has links)
Dentre os tratamentos possíveis para feridas, um deles, ainda pouco discutido e divulgado, é o uso terapêutico do ozônio. A finalidade desta revisão foi verificar se há benefícios neste uso em feridas. Os objetivos foram: buscar evidências científicas sobre estes benefícios por meio da revisão sistemática da literatura científica; realizar levantamento bibliográfico de estudos primários sobre a temática; analisar a qualidade metodológica destes estudos e discutir sobre as evidências de seus resultados. A metodologia utilizada foi a revisão sistemática da literatura científica, de acordo com o preconizado pelo Centro Cochrane do Brasil. Foram selecionadas oito bases de dados eletrônicas que disponibilizam publicações de pesquisas na área da saúde (CINAHAL, COCHRANE, EMBASE, LILACS, MEDLINE, OVID, PubMed, USP/Sibi/DEDALUS). Além destas bases, um estudo foi encontrado em um livro alemão específico sobre a temática. A busca foi feita de acordo com os Descritores em Ciências da Saúde baseado no MESH (Medical Subject Headings of U.S. National Library of Medicine). Foram encontrados 1637 estudos, sendo 55 pré-selecionados, e apenas 23 incluídos para a revisão. Dentre os principais resultados destacam-se: 52,2% dos estudos incluídos foram ensaios clínicos não controlados, 21,7% ensaios clínicos randomizados controlados abertos, 17,4% ensaios clínicos não randomizados controlados e 8,7% relatos de casos. A maioria dos estudos considerou como desfecho a cicatrização total da ferida ou a estimulação do processo de cicatrização, seguidos da melhora do aspecto da ferida, diminuição da dor/sintomas, melhora dos exames laboratoriais e, um deles relatou diminuição de odor da ferida. Foi analisado o quanto cada estudo controlou ou não variáveis intrínsecas e extrínsecas e quem foram os sujeitos de pesquisa em cada um deles. Analisou-se, ainda, se houve estratificação de variáveis entre os grupos controle e experimental nos estudos controlados e aplicou-se a Escala adaptada de Jadad para verificar a validade interna dos estudos randomizados, cujas pontuações obtidas foram inferiores ao mínimo estabelecido para um estudo de alta qualidade. Como conclusão, ao considerar apenas como estudos de qualidade aqueles randomizados, é possível reconhecer evidência forte do benefício do uso do ozônio, o que confirma a hipótese desta revisão. Mas, a partir da análise de sua validade interna, controle de variáveis interferentes e quantidade e tipo de população, os estudos apresentam problemas de condução e não é possível esse mesmo reconhecimento. Não é desprezível, porém, o fato de que todos os estudos obtiveram resultados favoráveis com o uso de ozônio, o que enseja a recomendação de viabilidade de realização de mais estudos, do tipo ensaios clínicos controlados e bem conduzidos, com estratificação de variáveis intrínsecas e extrínsecas e, principalmente, que utilizem como única intervenção o próprio ozônio, sem associar qualquer tipo de método que interfira no processo de cicatrização. Finalmente, considerando todos os aspectos discutidos e a realidade brasileira, o ozônio, poderia ser uma importante opção de tratamento para feridas e trazer diversos benefícios aos seus portadores, caso isso fosse provado por estudos bem delineados e de qualidade / Among the possible treatments for wounds there is one that is still very little discussed and divulged: the therapeutic use of the ozone. The purpose of this review is to verify if there are benefits of that use. These were the following goals: to search for scientific evidence of those benefits through systematic scientific literature review; to the bibliographic research of basic studies related to this theme; to analyze the methodological quality of those studies and to discuss the evidence of their results. The methodology used was the systematic scientific literature review, according to what is stated by the Cochrane Center of Brazil. Eight electronic data bases that contain publications of researches in the health area were selected (CINAHAL, COCHRANE, EMBASE, LILACS, MEDLINE, OVID, PubMed, USP/Sibi/DEDALUS). Apart from those data bases, one study was found in a Germany book specific on that theme. The research was done according to the Health Science Key-words based on the MESH (Medical Subject Headings of U.S. National Library of Medicine). 1637 studies were found, 55 were pre-selected and only 23 were included in the review. The main results were the following: 52,2% of the included studies were non-controlled clinical trials, 21,7% were open-label randomized controlled clinical trials, 17,4% were non-randomized controlled clinical trials and 8,7% were case reports. Most part of the studies considered the complete wound healing or the healing process stimulation as outcomes, followed by improvement of the wound aspects, reduction in the pain/symptoms, improvement on the laboratory exams and one of them reported the wound smell reduction. This review analyzed how many intrinsic and extrinsic variables were controlled and who the subjects were in each study. Besides that, it was analyzed if there were variables stratification among the control and the experimental groups in the controlled trials and the adapted Jadad Scale was applied to verify the internal validity of the randomized trials, whose obtained scores were less than the minimum standardized for a high quality study. To sum up, when only randomized trials are considered as of quality, it is possible to recognize strong evidence of benefit in the use of the ozone, which confirms the hypothesis of this review. But, when analyzing the internal validity, the controlled variables and the number and the kind of subjects, the studies presented execution problems and it is not possible to recognize the same thing. It is needless to say that all studies have obtained favorable results in the use of the ozone, which triggers the need to carry out more related studies, as well as to conduct controlled clinical trials, with intrinsic and extrinsic variables stratification and, mainly, that the ozone without associating any method that can interfere in the wound healing is used as unique intervention. Finally, considering all discussed aspects and the Brazilian reality, the ozone could be an important option of wound treatment and it could bring many benefits to its carriers if this was proofed by well conducted quality studies
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