Made available in DSpace on 2015-07-22T20:50:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-28 / Objetivo: Avaliação da efetividade da dança como tratamento da dor e melhora da qualidade de vida em pacientes com fibromialgia. Métodos: Oitenta pacientes femininas com fibromialgia (FM), de 18 a 65 anos de idade foram randomizadas para o grupo dança (n=40) ou grupo controle (n=40). As pacientes do grupo de dança realizaram por 16 semanas aulas de dança do ventre duas vezes por semana e as pacientes do grupo controle ficaram na lista de espera. Foram utilizados escala analógica de dor (EVA), teste de caminhada de 6 minutos, Fibromyalgia Impact Questionnaire (FIQ), Medical Outcome Survey Short Form 36 (SF-36), Inventário de Beck, Inventário de Ansiedade traço-estado (IDATE), Questionário Body Dysorphic Disorder Examination (BDDE), as avaliações foi realizada no baseline, após16 semanas e 32 semanas. Na análise estatística foram inclusos todos os pacientes. Resultados: O grupo de dança apresentou resultados estatisticamente melhores para EVA de dor (p<0,001), teste de caminhada (p<0,001), FIQ (p=0,003), no SF-36 nos domínios dor (p<0,001), aspectos emocionais (p<0,003), saúde mental (p<0,021) e BDDE (p<0,009). Conclusão: A dança do ventre pode ser utilizada no tratamento para fibromialgia, por reduzir a dor, melhorar a capacidade funcional, qualidade de vida e imagem corporal destas pacientes. / Objective: The aim of the present study was to assess the effectiveness of belly dance as a treatment for pain and improving the quality of life of patients with fibromyalgia. Methods: Eighty female patients with fibromyalgia between 18 to 65 years were randomly allocated to a dance group (n=40) and control group (n=40). Patients in the dance group underwent 16 weeks of belly dance twice a week, while the patients in the control group remained on a waiting list. Patients were evaluated with regard to pain (VAS), function (6MWT), quality of life (FIQ and SF-36), depression (Beck Inventory), anxiety (STAI) and self-image (BDDE) questionnaire. Evaluations were carried out at baseline, 16 weeks and 32 weeks. Results: The dance group achieved significant improvements when compared to the control group in VAS for pain (p<0.001), six-minute walk test (p<0.001), FIQ (p=0.003), BDDE (p<0.009) as well as the pain (p<0.001), emotional aspects (p<0.003) and mental health (p<0.021) domains of the SF-36. Conclusion: Belly dance can be used in the treatment of fibromyalgia to reduce pain and improve function capacity, quality of life and self-image. / TEDE / BV UNIFESP: Teses e dissertações

Bakgrund: I Sverige är bröstcancer den vanligaste cancerformen hos kvinnor. Att drabbas av bröstcancer medför ofta stora psykiska och fysiska påfrestningar och besvären kvarstår i många fall efter avslutad behandling. I dagsläget finns det endast begränsade rehabiliteringsalternativ för de som drabbats. Tidigare forskning har visat att fysisk aktivitet ger positiva effekter hos personer som drabbats av bröstcancer. Yoga är en träningsform som kombinerar fysisk aktivitet med meditativa tekniker och kan anpassas till deltagarens förutsättningar oavsett hälsotillstånd.  En ökad kunskap om yogans effekter kan ge sjuksköterskor en förståelse för hur yoga kan användas inom rehabilitering för att hjälpa den som drabbats av bröstcancer under återhämtningsprocessen. Syfte: Syftet med litteraturstudien var att beskriva effekten av yoga vid bröstcancer, där den metodologiska aspekten belyser vilka fysiska och psykiska effekter yoga har på personer som drabbats av bröstcancer. Metod: En beskrivande litteraturstudie där tolv randomiserade kontrollerade studier granskats och sammanställts för att svara på syftet.   Huvudresultat: Resultatet visade på fler förbättringar inom psykiska symtom än vid fysiska symtom. I resultatet framkom att yoga har en direkt effekt på fatigue och livskvalitet med en kvarstående effekt efter avslutad behandling jämfört med kontrollgrupper. Även resultatet för menopausala symtom visade på en tydlig minskning efter yogainterventionen. Däremot visade resultatet för sömnkvalitet endast på förbättringar om yoga utövades minst två gånger i veckan. Slutsats: Även om utfallet av litteraturstudien gav ett blandat resultat speglar huvudresultatet yogans positiva effekter på psykiska symtom hos personer som drabbats av bröstcancer. En ökad kunskap om yogans effekter kan ge sjuksköterskor en bättre förståelse för hur yoga kan användas inom rehabilitering med syfte att ge en förbättrad livskvalitet för den specifika patientgruppen. / Background: In Sweden, breast cancer is the most common form of cancer in women. Being affected by breast cancer often causes great mental and physical stress and the problems persist in many cases after treatment is completed. Currently, there are only limited rehabilitation options for those affected. Previous research has shown that physical activity produces positive effects in people suffering from breast cancer. Yoga is a form of exercise that combines physical activity with meditative techniques and can be adapted to the conditions of the participant regardless of state of health. An increased knowledge of the effects of yoga can give nurses an understanding of how yoga can be used in rehabilitation to help those affected by breast cancer during the recovery process.   Aim: The aim of this literary review was to describe the effects of yoga in breast cancer, where the methodological aspect highlights the physical and psychological effects yoga has on people affected by breast cancer. Method: A descriptive literary review where twelve randomised controlled studies have been reviewed and complied to answer the purpose. Main result: The results showed more improvements in psychological symptoms than in physical symptoms. The result showed that yoga has a direct effect on fatigue and quality of life with a lasting effect after completion of treatment compared to control groups. The results for menopausal symptoms also showed a clear decrease after the yoga intervention. In contrast, sleep quality results showed improvement only if yoga was practiced at least twice a week. Conclusion: Although the outcome of the literature study produced a mixed result, the main result reflects the yoga's positive effects on the mental symptoms of people suffering from breast cancer. Increased knowledge of the effects of yoga can give nurses a better understanding of how yoga can be used in rehabilitation with the aim of providing an improved quality of life for the specific patient group.

Objectives: Violence victimization is common in youth, and the association between victimization and ill-health is well established. Youth is also the period when alcohol risk drinking is most prevalent. At youth clinics in Västernorrland, Sweden, a randomized controlled intervention was conducted examining health outcomes and risk drinking after implementing routine inquiry about violence victimization and alcohol consumption. Methods: Participants in the intervention group underwent routine inquiry about violence victimization and alcohol consumption. Victimized participants received empowering strategies and were offered further counseling. Risk drinkers received motivational interviewing (MI). All participants answered questionnaires about sociodemography and health at baseline, at 3 months and at 12 months. Of 1,445 eligible young women, 1,051 (73%) participated, with 54% of them completing the 12-month follow-up. Males were excluded from the quantitative analysis owing to the low number of male participants. Fifteen research interviews examining the experience of routine inquiry were conducted. Results: Violence-victimized young women reported more ill health than non-victimized women did. This was especially evident for those who had been multiply victimized. There were no differences in health outcomes between the baseline and the 12-month follow-up for the intervention group and for the control group. Of the victimized women in the intervention group, 14% wanted and received further counseling. There was a significant decrease in risk drinking from baseline to follow-up, but no differences between the MI group and the controls. There was a large intra-individual mobility in the young women’s drinking behavior. In interviews, the participants described how questions about violence had helped them to process prior victimization. For some, this initiated changes such as leaving a destructive relationship or starting therapy. The participants considered risk drinking in terms of consequences and did not find unit-based guidelines useful. Conclusion: Violence victimization, especially multiple victimization, was strongly associated with ill health in young women. Routine inquiry about violence and subsequent follow-up led to a high degree of disclosure but did not improve self-reported health. However, victimized participants described talking about prior victimization as very helpful. Participants viewed risk drinking in terms of consequences rather than in quantity or frequency of alcohol, which may render unit-based drinking guidelines less useful when addressing risk drinking in youth.

Introduction: Work-related stress is one of the most challenging issues on workplaces. Reduced ability to relax and recover has been proposed as a key factor behind the increase of stress-related illness among workers. Massage and mental training are two commonly used techniques which may have positive effects on the ability to recover. One technique to help workers recover is a “recovery chair” which include both mechanical massage and mental training programs. However, it has not been scientifically evaluated yet whether using the techniques included in the “recovery chair”, both separately and in combination, as a health promotion tool. Aim: The overall aim of this thesis was to explore the psychological and physiological effects of the mechanical massage and mental training programs included in the “recovery chair”, both separately and in combination, as a health promotion tool for Swedish workers. Methods: In this study workers were randomly assigned to one of the following groups: i) Mechanical massage combined with mental training (n=19), ii) Mechanical massage (n=19), iii) Mental training (n=19), iv), Pause (15 min break in the armchair, n=19), v) and a Control group (n=17). Psychological effects were measured by the ”Swedish Scale of Personality” (SSP) and physiological effects were measured by heart rate, blood pressure and fingertip temperature, immediately before the randomization, after four weeks and after eight weeks (end-of-study). Results: Psychological effects: The results showed that receiving mechanical massage was associated with a significant decrease in “Somatic Trait Anxiety”. The participants in the mental training group showed a tendency to decrease in “Somatic Trait Anxiety”. The participants who received both mechanical massage and mental training showed a significant decrease in “Stress Susceptibility” between four and eight weeks. The results also showed a significant decrease in “Somatic Trait Anxiety” and a significant increase in “Detachment” for the paus group. Physiological effects: As compared to pre-intervention assessments, participants in the massage group condition showed significantly reductions in their resting heart rate, systolic and diastolic blood pressure and an increase in their fingertip temperature directly after the intervention (post-intervention). The mechanical massage and mental training group showed a significant increase in diastolic blood pressure during the last four weeks of the study. The participants in the mental training group showed a significant decrease in their heart rate, when compared the start of the study to week four. The pause group tended to have lower systolic blood pressure at post-intervention assessment when compared to the pre-intervention assessment. The participants in the control group showed significantly decrease in heart rate and their systolic blood pressure. Conclusion: The workers’ who used the “recovery chair” with mechanical massage or mental training programs, either separately or in combination, for eight weeks during working hours reported a positive impact on their levels of anxiety and stress sensitivity. The results also showed positive effects on the workers' blood pressure, pulse and fingertip temperature. The effect was particularly strong for workers' who received only mechanical massage. This indicate that stress management interventions as work place health promotion activities clearly have a potential to provide significant benefit for health and wellbeing for workers.

Introduction: More than half of all patients seeking care for chest pain do not have a cardiac cause for this pain. Despite recurrent episodes of chest pain, many patients are discharged without a clear explanation of the cause for their pain. A lack of explanation may result in a misinterpretation of the pain as being cardiac-related, causing worry and uncertainty, which in turn leads to substantial use of healthcare resources. Psychological distress has been associated with non-cardiac chest pain (NCCP), but there is limited research regarding the relationship between different psychological factors and their association with healthcare utilization. There is a need for interventions to support patients to manage their chest pain, decrease psychological distress, and reduce healthcare utilization and costs. Aim: The overall aim of this thesis was to improve care for patients with  non-cardiac chest pain by describing related psychological distress, healthcare utilization and societal costs, and by evaluating an Internet-delivered cognitive behavioural intervention. Designs and methods: This thesis presents results from four quantitative studies. Studies I and II had a longitudinal descriptive and comparative design. The studies used the same initial cohort. Patients were consecutively approached within 2 weeks from the day of discharge from a general hospital in southeast Sweden. In study I, 267 patients participated (131 with NCCP, 66 with acute myocardial infarction (AMI), and 70 with angina pectoris (AP)). Out of these, 199 patients (99 with NCCP, 51 with AMI, 49 with AP) participated in study II. Participants were predominantly male (about 60 %) with a mean age of 67 years. Data was collected on depressive symptoms (Study I), healthcare utilization (Study I, II), and societal costs (Study II). Study III had a cross-sectional explorative and descriptive design. Data was collected consecutively on depressive symptoms, cardiac anxiety and fear of body sensations in 552 patients discharged with diagnoses of NCCP (51 % women, mean age 64 years) from four hospitals in southeast Sweden. Patients were approached within one month from the day of discharge. Study IV was a pilot randomized controlled study including nine men and six women with a median age of 66 years, who were randomly assigned to an intervention (n=7) or control group (n=8). The intervention consisted of a four-session guided Internet-delivered cognitive behavioural therapy (CBT) program containing psychoeducation, exposure to physical activity, and relaxation. The control group received usual care. Data was collected on chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. Results: Depressive symptoms were prevalent in 20 % (Study IV) and 25 % (Study I, III) of the patients, and more than half of the patients still experienced depressive symptoms one year later (Study I). There were no significant differences in prevalence and severity of depressive symptoms between patients diagnosed with NCCP, AMI or AP. Living alone and younger age were independently related to more depressive symptoms (Study I). Cardiac anxiety was reported by 42 % of the patients in study III and 67 % of the patients in study IV. Fear of body sensations was reported by 62 % of the patients in study III and 93 % of the patients in study IV. On average, patients with NCCP had 54 contacts with primary care or the outpatient clinic per patient during the two-year study period. This was comparable to the number of contacts among patients with AMI (50 contacts) and AP (65). Patients with NCCP had on average 2.6 hospital admissions during the two years, compared to 3.6 for patients with AMI and 3.9 for patients with AP (Study II). Four out of ten patients reported seeking healthcare at least twice during the last year due to chest pain (Study III). On average, 14 % of patients with NCCP were on sick-leave annually, compared to 18 % for patient with AMI and 25 % for patient with AP. About 11-12 % in each group received a disability pension. The mean annual societal costs for patients with NCCP, AMI and AP were €10,068, €15,989 and €14,737 (Study II). Depressive symptoms (Study I, III), cardiac anxiety (Study III) and fear of body sensations (Study III) were related to healthcare utilization. Cardiac anxiety was the only variable independently associated with healthcare utilization (Study III). In the intervention study (Study IV), almost all patients in both the intervention and control groups improved with regard to chest pain  frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. There was no significant difference between the groups. The intervention was perceived as feasible and easy to manage, with comprehensible language, adequate and varied content, and  manageable homework assignments. Conclusions: Patients with NCCP experienced recurrent and persistent chest pain and psychological distress in terms of depressive symptoms, cardiac anxiety and fear of body sensations. The prevalence and severity of depressive symptoms in patients with NCCP did not differ from patients with AMI and patients with AP. NCCP was significantly associated with healthcare utilization and patients had similar amount of primary care and outpatient clinic contacts as patients with AMI. The estimated cumulative annual national societal cost for patients with NCCP was more than double that of patients with AMI and patients with AP, due to a larger number of patients with NCCP. Depressive symptoms, cardiac anxiety and fear of body sensations were related to increased healthcare utilization, but cardiac anxiety was the only variable independently associated with healthcare utilization. These findings imply that screening and treatment of psychological distress should be considered for implementation in the care of patients with NCCP. By reducing cardiac anxiety, patients may be better prepared to handle chest pain. A short guided Internet-delivered CBT program seems to be feasible. In the pilot study, patients improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but this did not differ from the patients in the control group who received usual care. Larger studies with longer follow-up are needed to evaluate both the short and long- term effects of this intervention.