SAMMANFATTNING Bakgrund: Enligt Regionala Cancercentrums nationella vårdplan för cancerrehabilitering rekommenderas alla patienter med cancerdiagnos att försöka röra på sig lika mycket som en frisk människa rekommenderas. Trots detta så händer det att personer med cancerdiagnos minskar sin träning. Därför är det viktigt att få en fördjupad förståelse av hur dessa patienter upplever träning under sin behandling. Syfte: Beskriva hur cancerpatienter upplever träning under pågående behandling samt vilka faktorer som påverkar patienternas träning (egenvård) under pågående behandling. Metod: Kvalitativ intervjustudie. Elva intervjuer från en pilotstudie i Phys-Can projektet analyserades med hjälp av en kvalitativ innehållsanalys. Resultat: Stöd från professionella, personer i en likartad situation, anhöriga samt stöd från sig själv upplever deltagarna varit viktiga för att kunna utföra träningen. Praktiska faktorer som tid till träning, möjligheten att ta sig till träningen samt lokalen upplever deltagarna påverka hur träningen uppfattas. Deltagarna har upplevt att träningen påverkar psykiska och fysiska faktorer hos dem mestadels till det positiva. Träningen har även påverkat några av deltagarnas upplevelse av deras sjukdom. Slutsats: Deltagarna i denna studie har upplevt att stöd i olika former har varit viktigt för att kunna utföra träningen som egenvård. De praktiska förhållandena runt träningen har upplevts kunna både försvåra eller förenkla träningen. Deltagarna har även upplevt att träningen har påverkat deras psykiska och fysiska hälsa oftast till det positiva. Det är av vikt att kunna se varje individs förutsättningar att kunna utföra egenvården och sedan anpassa stödet så att träningsförutsättningarna blir så bra som möjligt. / ABSTRACT Background: According to the Regional Cancer Centre's national treatment plan for cancer rehabilitation all patients with a cancer diagnosis are recommended to try to move as much as a healthy person. Even so it happens that people with cancer reduces their physical activity. Therefore, it is important to get a deeper understanding of how these patients experience training during their treatment. Aim: Describe how cancer patients experience exercise during treatment and the factors that affect patients’ exercise (self-care) during treatment. Method: A qualitative interview study. Eleven interviews from a pilot study in the Phys-Can project were analyzed using qualitative content analysis. Result: Support from professionals, people in a similar situation, relatives and support from her/himself participants experienced as important to carry out their training. Practical factors as time to exercise, the ability to get to the training venue and how they experienced the venue the participants affected how their training was perceived. The participants have experienced that exercise affects mental and physical factors in them mostly for the better. The traning has also affectes som of the participants’ experince of their disease. Conclusion: The participants in this study have experienced various forms of support that has been experienced as important to be able to perform the exercise as self-care. The practical conditions around the training could both complicate or simplify training. Participants also felt that the training has affected their mental and physical health, usually for the better. It is important to be able to see each individual's ability to perform self-care, and then align support so that exercise becomes as good as possible.

Bakgrund Ett stort antal människor världen över lider idag av depression. Fysisk aktivitet har dokumenterat positiv effekt på fysiskt välmående och rekommenderas som en del i en hälsosam livsstil. Kopplingen mellan fysisk aktivitet och psykisk hälsa är inte fastställd med samma säkerhet, men forskningen tyder på att träning kan hjälpa till att förebygga eller lindra depressiva symtom. Målet med denna studie är att utforska om fysisk aktivitet har effekt vid behandling av depression. Enligt Dorothea Orems teori är egenvård grundläggande för tillfrisknande och välbefinnande. Att ge adekvat vägledning för detta är en viktig del i sjuksköterskans dagliga arbete.   Syfte Att undersöka evidensen för fysisk aktivitet som behandlingsform vid egentlig depression.   Metod Litteraturstudie baserat på tio vetenskapliga originalartiklar publicerade i PubMed eller CINHAL mellan 2004 och 2016. En systematisk litteraturstudie har utförts där kvaliteten på den litteratur som använts har granskats och bedömts enligt checklista för kvalitetsbedömning av randomiserade, kontrollerade studier.   Resultat En majoritet av de granskade studierna påvisar lindring av depressiva symtom vid fysisk aktivitet. Träning i olika utföranden visar sig effektiv i sig själv eller som tillägg till annan behandling vid egentlig depression av varierande svårighet. Huruvida träningsform, intensitet eller grad av fysisk träning har betydelse för behandlingen kunde inte klart säkerställas.   Slutsats Egentlig depression är en sjukdom som kan yttra sig på många olika sätt och vars behandling oftast består av psykoterapi och farmakologisk behandling. Resultaten i av denna studie understryker värdet av att införa fysisk aktivitet som en del av behandlingen. / Background A large number of people around the world suffer from depression. Physical activity has been proven to have a positive effect on the wellbeing and is recommended as part of a healthy lifestyle. The relationship between physical activity and mental health has not been as entirely determined, although research implies that exercise could help prevent or alleviate depressive symptoms. The aim of this is to further investigate if physical activity has a positive effect on depression. According to Dorothea Orems theory is self-care essential for recovery and well- being. As a nurse it is important to give such guidance in the daily work.   Aim To investigate what evidence there is in favor of physical activity as a form of treatment for patients suffering from major depressive disorder.   Method Literature review based on the results of ten original scientific articles published in the PubMed or CINHAL databases between 2004 and 2016. A literature review has been done where the checklist was used to assess the quality of the included studies.   Results The majority of the studies shows a decrease in depressive symptoms for patients who are physically active. Various forms of exercise seem to be effective on its own or as an addition to standard therapy in the treatment of major depressive disorder of diverse severity.  However, which type of exercise or level of intensity could not be confirmed.    Conclusion Major depressive disorder is expressed in many different ways and the treatment usually consists of psychotherapy and pharmacotherapy. The results of this study support physical activity as a part of this treatment.

Com o processo de transição demográfica vem ocorrendo o crescimento da população idosa e, consequentemente, mudanças no perfil epidemiológico, caracterizado pela alta prevalência das doenças crônicas não transmissíveis, que podem comprometer o desempenho para as atividades cotidianas, especialmente, a capacidade para o autocuidado, gerando prejuízos para a autonomia e dependência, fatores que refletem negativamente em todos os âmbitos da vida do idoso. Assim, os objetivos deste estudo foram: caracterizar os idosos em atendimento ambulatorial, segundo variáveis sociodemográficas, arranjo e suporte familiar; identificar a capacidade cognitiva; identificar a capacidade para o autocuidado e verificar a associação entre a capacidade para o autocuidado e as variáveis sociodemograficas e cognição. Trata-se de um estudo quantitativo, descritivo, transversal e exploratório. Realizado com idosos atendidos em dois Ambulatórios de Geriatria, de um Hospital Geral Terciário, do interior paulista. Para a coleta de dados utilizou-se o Mini Exame do estado Mental, a Classificação de Idosos quanto a Capacidade para o Autocuidado e uma ficha de dados complementares. Participaram do estudo 117 idosos; média de idade 79,8 anos; 75,2% eram mulheres; 54,7% sabiam ler/escrever informalmente ou possuía o primário incompleto; 77,8% eram aposentados e 63,2% procedentes da cidade de Ribeirão Preto. Quanto ao arranjo familiar e potencial de rede de suporte 13,7% viviam com cônjuge/filhos(as) e 12,8% viviam sozinhos, 10,3% com o cônjuge e 8,5% com filhos(as)/netos(as)/genro/nora; 26,5% relacionavam-se com os filhos de uma a duas vezes por semana e 25,6% quase todos os dias. Em caso de doença 93,1% referiram possuir alguém que cuide, sendo que 71,8% indicaram as filhas; o número médio de doenças foi de 4,4; as mais prevalentes foram, hipertensão arterial (74,3%), dislipidemias (37,6%), osteoporose (35,9%), demências (34,2%) e diabetes mellitus (27,3%). Quanto a avaliação cognitiva, 79,5% possuíam déficit cognitivo. No que se refere ao autocuidado, 71,1% dos idosos do ambulatório I apresentaram dificuldades tanto para o desempenho das atividades básicas da vida diária (ABVDs) quanto para as atividades instrumentais da vida diária (AIVDs), no entanto, verificou-se maior necessidade de ajuda para a realização das AIVDs para os idosos de ambos os ambulatórios estudados. As ABVDs que os idosos mais requeriam ajuda foram, banho (45,3%), cuidados com pele/cabelos/unhas/dentes/face (47,0%) e vestuário (47,0%); as atividades mais compensadas com estratégias para minimizar as dificuldades foram, continência (32,5%) e locomoção (37,6%). Para as AIVDs, 55,5% necessitavam de ajuda para tomar medicamentos e 50,4% nas tarefas domésticas; somente 9,4% compensam a atividade de tomar medicação, ou seja, os participantes adotaram mais práticas de compensação para as ABVDs do que para as AIVDs. Conhecer a capacidade de autocuidado dos idosos possibilita aos profissionais de saúde, em especial ao terapeuta ocupacional, o planejamento de intervenções voltadas tanto para os idosos quanto para os cuidadores, com a finalidade de prevenir, melhorar ou recuperar práticas de autocuidado prejudicadas, otimizando a qualidade de vida de ambos / The demographic transition process has entailed the growth of the elderly population and, consequently, changes in the epidemiological profile, characterized by the high prevalence of non-transmissible chronic conditions that can compromise the performance of daily activities, especially the self-care ability, impairing the autonomy and dependence, which are factors that negatively influence all spheres of these people\'s lives. Hence, the objectives in this study were: to characterize the elderly people in outpatient care according to sociodemographic variables, family arrangement and support; to identify the cognitive ability; to identify the self-care ability and verify the association between the self-care ability and the sociodemographic and cognitive variables. A quantitative, descriptive, cross-sectional and exploratory study was undertaken. The participants were elderly patients attended at two Geriatric outpatient clinics of a Tertiary General Hospital in the interior of the State of São Paulo, Brazil. To collect the data, the Mini-Mental State Examination, the Self-Care Ability Classification of Elderly and a complementary data form were used. In total, 117 elderly participated, with a mean age of 79.8 years, 75.2% women; 54.7% were able to read/write informally or had not finished their primary education; 77.8% were retired and 63.2% came from the city of Ribeirão Preto. As to the family arrangement and potential support network, 13.7% lived with their partner/children and 12.8% alone, 10.3% with their partner and 8.5% with children/grandchildren/son-in-law/daughter-in-law; 26.5% interacted with their children once or twice per week and 25.6% almost every day. In case of illness, 93.1% indicated having a caregiver, 71.8% indicating their daughter; the mean number of illnesses was 4.4; the most prevalent conditions were arterial hypertension (74.3%), dyslipidemias (37.6%), osteoporosis (35.9%), dementias (34.2%) and diabetes mellitus (27.3%). In the cognitive assessment, 79.5% had a cognitive deficit. As regards self-care, 71.1% of the elderly at outpatient clinic I experienced difficulties to perform the basic activities of daily living (BADLs) as well as the instrumental activities of daily living (IADLs), although it was verified that the elderly at both outpatient clinics under study needed more help to perform the IADLs. The BADLs the elderly most needed help with were bathing (45.3%), care for skin/hair/nails/teeth/face (47.0%) and dressing (47.0%); the activities that were most compensated for through strategies to minimize the difficulties were continence (32.5%) and locomotion (37.6%). For the IADLs, 55.5% needed help with medication intake and 50.4% with housework; only 9.4% compensated for the medication intake, that is, the participants adopted more compensation practices for the BADLs than for the IADLs. Knowing the elderly patients\' self-care ability allows health professionals, especially occupational therapists, to plan interventions focused on the elderly as well as their caregivers, with a view to preventing, improving or recovering impaired self-care practices, thus optimizing both groups\' quality of life

Este estudo objetivou analisar a relação entre as atividades de autocuidado com o diabetes mellitus (DM) e as variáveis sociodemográficas, de saúde, o desempenho funcional e a presença de sintomas de depressão em idosos com DM2. Trata-se de um estudo quantitativo, descritivo e transversal, realizado com 121 idosos com DM2, atendidos no Ambulatório de Diabetes, de um Hospital Geral Terciário, no interior paulista. Os dados foram coletados no período de fevereiro a junho de 2014. Para tanto, utilizaram-se o Miniexame do Estado Mental, o Índice de Katz, a Escala de Lawton, o Questionário de Atividades de Autocuidado com o Diabetes e a Escala de Depressão Geriátrica. A média de idade dos idosos foi 68,1 anos, 57,2% eram mulheres, 65,3%, casados e 32,2%, analfabetos; 29,8% moravam somente com cônjuge, e 71,9% eram aposentados. A média de diagnóstico médico foi 5,2, com maior prevalência de hipertensão arterial sistêmica (90,8%), dislipidemia (77,6%), nefropatias (32,2%) e retinopatias (42,1%); a média de complicações foi 2,6, destacando-se os problemas nos olhos (38,8%), a pressão alta (30,6%) e colesterol/triglicérides (26,5%). Quanto ao tipo de tratamento, 79,3% realizavam dieta e 55,4%, associação de antidiabético oral e insulina; 50% sempre faziam autoaplicação de insulina; 50% armazenavam a insulina na porta da geladeira; 80,2% não alteravam a dose de insulina e 85,9% realizavam o rodízio dos locais de aplicação. Para o desempenho das atividades básicas da vida diária, 93,4% eram independentes e para as atividades instrumentais de vida diária, 71,1% eram parcialmente dependentes. Quanto às atividades de autocuidado, as maiores médias de dias na semana foram para os itens: \"secar os espaços entre os dedos dos pés, depois de lavá-los\" 6,4(DP=1,8), \"tomar injeções de insulina conforme recomendado\" 6,1 (DP=2,3), \"avaliar o açúcar no sangue o número de vezes recomendado\" 5,5 (DP=2,5) e as menores médias foram para: \"realizar atividades físicas por 30 minutos\", 1,6 (DP=2,6), \"realizar exercício físico específico\" 1,6 (DP=2,5) e \"ingerir doces\" 0,8 (DP=1,5). Houve significância estatística entre a variável estado civil e a dimensão monitorização da glicemia (p=0,00), com menor média para os solteiros 3,3 (DP=3,3); e a variável renda e a dimensão alimentação específica (p=0,03), mostrando menor média 3,8 (DP=1,4) para os que possuíam renda de até R$ 1.300,00. Em relação ao tabagismo, 51,2% nunca fumaram. Os sintomas depressivos estavam presentes em 55,4% dos idosos, porém não houve diferença estatisticamente significativa entre as médias de dias na semana para as dimensões do QAD e a presença ou ausência de sintomas depressivos. Conhecer as características sociodemográficas, de saúde, o desempenho para as atividades diárias e a frequência das atividades de autocuidado de idosos com DM2 possibilita aos profissionais de saúde o planejamento da assistência, com intervenções específicas às necessidades dos mesmos / This study\'s aim was to analyze the relationship between self-care activities regarding diabetes mellitus (DM) and socio-demographic and health variables, functional performance, and the presence of depressive symptoms among elderly individuals with DM2. This quantitative, descriptive and cross-sectional study was conducted with 121 seniors with DM2 cared for by the endocrinology and metabolism care clinic of a tertiary general hospital in the interior of São Paulo, Brazil. Data were collected from February to June 2014. The Mini Mental State Exam, Katz Index, Lawton Scale, Summary of Diabetes Self-Care Activities Questionnaire, and Geriatric Depression Scale were used. The participants were 68.1 years old on average, 57.2% were women, 65.3% were married, 32.2% were illiterate, 29.8% lived with the spouse only, and 71.9% were retired. The individuals presented 5.2 medical diagnoses on average, the most frequent were: hypertension (90.8%), dyslipidemia (77.6%), nephropathies (32.2%), and retinopathies (42.1%); and presented 2.6 complications on average, mainly eye problems (38.8%), hypertension (30.6%), and cholesterol/triglycerides (26.5%). In regard to type of treatment, 79.3% complied with the diet and 55.4% used an association of oral anti-diabetic medication and insulin; 50% always self injected insulin; 50% stored insulin in the refrigerator\'s door; 80.2% did not change the insulin dose; and 85.9% alternated the sites where insulin was applied. In regard to basic activities of daily living, 93.4% were independent and 71.1% were partially dependent on others to perform instrumental activities of daily living. In regard to the most frequently performed self-care activities, the following items achieved the highest average of days/week: \"drying between toes after washing them\" 6.4 (SD=1.8), \"taking insulin shots as recommended\" 6.1 (SD=2.3), and \"checking blood sugar as many times as recommended\" 5.5 (SD=2.5), while the lowest averages were found for: \"exercise for 30 minutes\", 1.6 (SD=2.6), \"perform specific physical exercise\" 1.6 (SD=2.5) and \"eating sweets\" 0.8 (SD=1.5). Statistical significance was found between marital status and the blood glucose monitoring dimension (p=0.00), in which the lowest average was found among single people 3.3 (SD=3.3); and between income and the specific food dimension (p=0.03), in which the lowest average, 3.8 (DP=1.4), was found among those with income up to R$ 1,300.00. In regard to smoking, 51.2% never smoked. Depressive symptoms were experienced by 55.4% of the elderly individuals, though no significant difference was found between the average of days for the dimensions QAD and presence or absence of depressive symptoms. The identification of sociodemographic characteristics, health variables, performance of daily activities, and frequency with which self-care activities are performed by elderly individuals with DM2, enables healthcare workers to plan care delivery with interventions specifically designed to meet these patients\' needs

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No. of bitstreams: 1 Dissertação -Fabiola Silva dos Santos.pdf: 2227113 bytes, checksum: 78aeba1708883c804345eb24be9231c5 (MD5) Previous issue date: 2014-10-31 / FAPEAM - Fundação de Amparo à Pesquisa do Estado do Amazonas / With the change of the demographic profile of the population the aging became a theme discussed daily, several are the actions ruled in the National politics of the senior and active aging with the intention of improving the quality of life of the aging, among these actions is the senior's education, that has as main objective, to promote the health and as consequence the self-care. The open university of the third age appears as the favorable place to discuss the seniors' demands, as well as to insert them in the education method, approaching pertinent themes and promoting the life quality. This work has as objective to analyze the influence of the educational process in the quality of the seniors' life under the light of the theory of the self-care of Orem. It is about a transversal study, descriptive with quantitative/qualitative approach that resorting of the triangulation method of data; The participants of the study were 131 senior visitors of the workshops of the Open University related to the health of the Third Age (UnaTI), that answered two instruments of data collection, a questionnaire on the profile sociodemographic, socioeconomic, socioeducational and sociocultural of the seniors, the questionnaire of quality of life of Whoqol, of these, 11 seniors still answered an interview itinerary. The data demonstrated that the seniors participants of the workshops of health of UnaTI, are in majority women, (86,3%), with medium age of 66,7 years old, without spouse (65,9%), having from 01 to 03 children, living in their own homes, multigenerational, winning from 01 to 03 minimum salary. About the life quality the results found indicate the self-perception of life quality as "good" with a representation of (69,4%), in the environmental domain (67,7%), in the psychological domain (67,7%) and in the domain of social relationships (67,1%), indicating a good quality of the seniors' life. The searching for friendships, occupation of the free time, escape from the solitude, looks for education in health, the searching for vitality and ease of family problems and of health had been constituted in reasons that take the senior to enter in UnaTI. About the senior's existences, inside of the educational process the results found were: comfort, good sensation for feeling supported, good sensation for feeling respected in their limits, perception of rights broken, learning difficulty and unsafe sensation. About the modifications accomplished through the influence of the educational process, were identified the feeling of overcoming of fears and family problems, the elevation of the self-realization, and the self esteem sensation. In the face of the subjects discussed in the study, it is notorious the improvement of the life quality, the changes of habits and the accomplishment of the sel-care, motivated during the educational process, that provides to the senior the knowledge so that they identify their needs and practices, according to Dorothéa Orem theory, that works the promotion of the self-care through the diffusion of educational practices that provide the improvement of the life quality. In that scenery the nurse is the more qualified professional to act as coordinator identifying the senior's specificities for later work the most appropriate method, that promotes in a correct way the self-care, being able to be based in theoretical like Orem, because his premise is that the senior population should be oriented that the main responsible for their health are themselves. / Com a mudança do perfil demográfico da população o envelhecimento tornou-se um tema discutido diariamente, diversas são as ações pautadas na Política Nacional do Idoso e envelhecimento ativo com o intuito de melhorar a qualidade de vida dos envelhecentes, dentre estas ações está a educação do idoso, que tem como objetivo principal, promover a saúde e como consequência o autocuidado; A universidade aberta da terceira idade surge como o lugar propicio para discutir as demandas dos idosos, bem como inseri-los no método educacional, abordando temas pertinentes e promovendo a qualidade de vida. Este trabalho tem como objetivo analisar a influência do processo educacional na qualidade de vida dos idosos a luz da teoria do autocuidado de Orem. Trata-se de um estudo transversal, descritivo com abordagem quanti-qualitativa que lança mão do método de triangulação de dados; Os participantes do estudo foram 131 idosos frequentadores das oficinas relacionadas a saúde da Universidade Aberta da Terceira Idade (UnaTI), que responderam a dois instrumentos de coleta de dados, um questionário sobre o perfil sociodemográfico, socioeconômico, socioeducativo e sociocultural dos idosos, o questionário de qualidade de vida do Whoqol , destes, 11 idosos responderam ainda um roteiro de entrevista. Os dados demonstraram que os idosos participantes das oficinas de saúde da UnaTI, são em sua maioria mulheres, (86,3%), com idade média de 66,7 anos, sem conjugue (65,9%), tendo de 01 a 03 filhos, residindo em lares próprios, multigeracionais, ganhando de 01 a 03 salários mínimos. Quanto a qualidade de vida os resultados encontrados indicam a autopercepção de qualidade de vida como “boa” com uma representação de (69,4%), no dominio ambiental (67,7%), no dominio psicológico (67,7 %) e no dominio de relações sociais (67,1%), indicando uma boa qualidade de vida dos idosos. A busca por amizades, ocupação do tempo livre, fuga da solidão, busca por educaçao em saúde, busca por ânimo e amenização de problemas familiares e de saúde, se constituiram em motivos que levam o idoso a entrar na UnaTI Quanto as vivências do idoso, dentro do processo educacional os resultados encontrados foram: conforto, sensação boa por sentir-se suportado, sensação boa por sentir-se respeitado por seus limites, percepção de direitos infrigidos, dificuldade de aprendizado e sensação de inseguraça. Quanto as modificações realizadas por meio da influência do processo educativo, foram identificados o sentimento de superação de medos e problemas familiares, a elevação da autoestima, e a sensação de autorealização. Diante das questões discutidas no estudo,é notorio a melhoria da qualidade de vida, as mudanças de hábitos e a realização do autocuidado, incentivado durante o processo educacional, que proporciona ao idoso conhecimentos para que o mesmo identifique suas necessidades e prátique o,segundo a teoria de Dorothea Orem, que trabalha a promoção do autocuidado por meio da difusao de práticas educativas que proporcionem a melhoria da qualidade de vida. Nesse cenário o enfermeiro é o profissional mais capacitado para poder atuar como coordenador identificando as especificidades do idoso para posteriormente trabalhar o método mais adequado, que promova de maneira correta o autocuidado, podendo se basear em teóricos como Orem, pois sua premissa é que a população idosa deve ser orientada de que o principal responsável por sua saúde é ela própria.

Estudo quantitativo observacional, de intervenção do tipo antes e depois, com objetivo de analisar o efeito do apoio telefônico no conhecimento e atividades de autocuidado de pessoas com diabetes mellitus tipo 2. Foi realizado no Centro de Saúde Escola de uma cidade do interior paulista. A amostra foi constituída por 48 pessoas que participaram do programa Apoio telefônico para o monitoramento em Diabetes mellitus - ATEMDIMEL/EERP/USP, em 2013. Para avaliação, foi utilizado um questionário para avaliação das variáveis sociodemográficas, clínicas e antropométricas, e os instrumentos Diabetes Knowledge Questionnaire e Questionário de Atividades de Autocuidado com o Diabetes. Para análise, utilizou-se estatística descritiva, os testes Qui-Quadrado de Pearson e Exato de Fisher. A idade dos participantes variou de 47 a 87 anos, com predomínio do sexo feminino (52,1%). A maioria era casado (64,6%) e aposentados (60,4%). A média de anos de estudo foi de 7 anos. O tempo de diagnóstico foi de 11 a 20 anos (37,5%), sendo o tratamento medicamentoso com insulina o mais utilizado (97,9%). A hipertensão arterial foi a comorbidade predominante (75,0%). A maior parte apresentava obesidade grau I (41,7%) antes e após a intervenção. Pela circunferência abdominal, a maioria apresentou alto risco cardiovascular (83,3%) antes da intervenção e após houve aumento para 87,5% dos participantes. A maioria antes da intervenção apresentou hiperglicemia (54,2%), com HbA1c alterada (77,1%), LDL-C classificado com ótimo (64,6%) e HDL-C alterado (95,8%). Para os triglicerídeos e colesterol, a maior parte foi classificado como ótimo. Após a intervenção, a maioria apresentou glicemia de jejum dentro da normalidade (52,1%) e HbA1c também alterada (85,4%). Os níveis de LDL-C permaneceram classificados com ótimo (66,7%) e os de HDL-C alterados (95,8%). Triglicerídeos e colesterol total mantiveram a classificação como ótimo. A maioria das pessoas apresentaram conhecimento maior ou igual a 8 (87,4%) antes da intervenção e 83,3% após. Sobre o autocuidado, antes da intervenção, os itens que obtiveram seguimento em cinco ou mais dias na semana foram relacionados ao \"consumo de doces\", \"avaliar o açúcar no sangue\", \"secar entre os dedos dos pés\", \"tomar os medicamentos do diabetes\", \"utilizar a insulina conforme o recomendado\" e \"tomar os comprimidos do diabetes\". Após a intervenção, verificou-se que além destes, também houve seguimento em cinco ou mais dias da semana no que se refere a \"seguir uma dieta saudável\", \"consumo de frutas e vegetais\", \"examinar os pés\" e \"examinar dentro dos sapatos\". Os itens que apresentaram maiores escores antes e após a intervenção foram \"uso dos medicamentos e insulina\" e os menores escores à \"prática de atividade física por 30 minutos\" e realizar \"exercício físico específico\". O apoio telefônico mostrou- se como uma ferramenta importante para favorecer o cuidado à pessoa com DM, pois permite identificar as reais necessidades da população para a mudança de comportamento e adesão ao tratamento proposto. Esta investigação oferece subsídios para novos estudos de intervenção com amostras maiores e tempo prolongado com intuito de melhorar o acompanhamento longitudinal da pessoa com DM / Observational quantitative study, of the \"before and after\" type of intervention, that aims to verify the effects of telephone coaching in the knowledge and self-care activities of people with type 2 diabetes mellitus. It was performed at Centro de Saúde Escola - CSE Prof. Dr. Joel Domingos Machado. Forty-eight people participated in the intervention, which were part of the Telephone coaching for monitoring in Diabetes mellitus - ATEMDIMEL/EERP/USP, in the year of 2013. In the data collection, a questionnaire was used for the evaluation of socio-demographic, clinic and anthropometric variables, in addition to the instruments Diabetes Knowledge Questionnaire and Self-care Activities with Diabetes Questionnaire. For analysis, descriptive statistics were used, besides Pearson\'s Chi-Square test and Fisher\'s Exact test. It was identified that the participants\' ages ranged from 47 to 87 years old, with female predominance (52,1%). The majority of the participants were married (64,6%) and retired (60,4%). The average of schooling years was 7 years. The time of diagnosis was of 11 to 20 years (37,5%), being the drug treatment with insulin the most common (97,9%). Arterial hypertension was the predominant comorbidity (75,0%). The majority of the people presented class 1 obesity (41,7%) before and after the intervention. Most part of the participants presented high cardiovascular risk (83,3%) before the intervention, with an increase after it (87,5%). Previously to the intervention, the majority of patients showed hyperglycemia (54,2%), with altered HbA1c (77,1%), LDL-C classified as great (64,6%) and altered HDL-C (95,8%). About triglycerides and cholesterol, most part remained in great rating. After the intervention, most people presented fasting glycaemia within the normal range (52,1%) and HbA1c also altered (85,4%). LDL-C levels remained classified as great (66,7%), and HDL-C levels, altered (95,8%). Triglycerides and total cholesterol maintained great as their classification. The evaluation of knowledge revealed that before the intervention, 87,4% of the participants showed adequate knowledge in relation to DM, with a discreet reduction after it (83,3%). In the self-care activities evaluation, it was verified that, previously to the intervention, the activities that were most joined were related to the assessment of blood sugar, drying between toes, drug and insulin usage. After the intervention, beyond that, were also identified with fine adherence such activities as following a healthy diet, fruits and/or vegetables intake and examining the feet. It was verified that telephone coaching can be a good tool to assist in the care of a person with DM. This investigation offers subsidies for new intervention studies with larger samples and extended time in order to improve the longitudinal tracking of a person with DM

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-11T20:22:22Z No. of bitstreams: 1 ClarissaSilva.pdf: 1338092 bytes, checksum: 88748a1261e4efc9259f90f82be7a663 (MD5) / Made available in DSpace on 2017-05-11T20:22:22Z (GMT). No. of bitstreams: 1 ClarissaSilva.pdf: 1338092 bytes, checksum: 88748a1261e4efc9259f90f82be7a663 (MD5) Previous issue date: 2016-03-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The Diabetes mellitus (DM) is a heterogeneous group of metabolic disorders has in common hyperglycemia, result from defects in insulin action or insulin secretion or both. This is one of the health problems of greater magnitude in Brazil. So the selfcare activities are essential in carriers of diabetes mellitus type two to maintain and improve their health. However represent challenge for carries and health professionals. The research aimed to analyze the factors associated to knowledge about diabetes and to self-care activities of carries of Diabetes mellitus type two. For that was conducted a cross-sectional analytical study with a quantitative approach with 360 carries of diabetes mellitus type two attended at Ambulatory Endocrinology of Federal University of Maranhão. The data collect was conducted in the period from february to july 2015. For data collection was used three instruments, one containing identification data with open and closed questions concerning sociodemographic and clinical variables, self-care activities questionnaire with Diabetes (QAD) and questionnaire of scale knowledge of Diabetes (DKN). We used Spearman coefficient in the correlation between self-care activities with age and time of disease, the MannWhitney test for association of self-care of scores with the sociodemographic and clinical variables and the Chi Square test to association between knowledge and sociodemographic and clinical variables. For interpretation of statistic has adapted results the significance level of 5% (p < 0.05). The research has shown that carries of diabetes mellitus type 2 have generally low self-care for items general food, physical activity and monitory glycemia and the best self-care activities are related the specific food, medication and care of the feet. Observed that most participants had higher scores to 8, indicates a high degree of knowledge about disease. If found associations between the scores of knowledge and self-care activities with the socioeconomic and clinical variables. It was concluded that there are factors related to socioeconomic and clinical features that interfere with the self-care activities and the knowledge of carries with diabetes mellitus type 2 against disease. / O Diabetes Mellitus (DM) é um grupo heterogêneo de distúrbios metabólicos que apresenta em comum a hiperglicemia, resultado de defeitos na ação da insulina, na secreção de insulina ou em ambas. Esta constitui um dos problemas de saúde de maior magnitude no Brasil. Assim, as atividades de autocuidado são essenciais nas pessoas que têm diabetes mellitus tipo 2 para manter e melhorar a sua saúde, porém, representam desafio tanto para o indivíduo que a sofre quanto ao profissional da saúde. A pesquisa teve como objetivo analisar os fatores associados ao conhecimento sobre o diabetes e às atividades de autocuidado dos portadores de diabetes mellitus tipo 2. Para tanto, foi realizado um estudo analítico de corte transversal com abordagem quantitativa com 360 portadores de DM tipo 2 atendidos no Ambulatório de Endocrinologia do Hospital Universitário da Universidade Federal do Maranhão. A coleta dos dados foi realizada no período de fevereiro a julho de 2015. Para a coleta de dados, utilizaram-se três instrumentos, um contendo dados de identificação com questões abertas e fechadas referente às variáveis sociodemográficas e clínicas, o Questionário de Atividades de Autocuidado com o diabetes (QAD) e o Questionário da Escala de Conhecimento de Diabetes (DKN). Utilizou-se o coeficiente de Spearman na correlação entre as atividades de autocuidado com a idade e o tempo de doença, o teste Mann-Whitney para associação dos escores do autocuidado com as variáveis sociodemográficas e clínicas e o teste Qui Quadrado para associação entre o conhecimento e as variáveis sociodemográficas e clínicas. Para a interpretação estatística dos resultados foi adotado nível de significância de 5% (p<0,05). A pesquisa mostrou que os portadores de diabetes mellitus tipo 2 têm autocuidado geral baixo para os itens alimentação geral, atividade física e monitoramento da glicemia; e as melhores atividades de autocuidado estão relacionadas à alimentação específica, à medicação e ao cuidado com os pés. Observa-se que a maioria dos participantes obtiveram escores superiores a 8, indicando um grau elevado de conhecimento sobre a doença. Verificaram-se associações entre os escores de conhecimento e das atividades de autocuidado com as variáveis socioeconômicas e clínicas. Concluiu-se que existem fatores relacionados às características socioeconômicas e clínicas que interferem nas atividades de autocuidado e no conhecimento do portador de diabetes mellitus tipo 2 frente à doença.

Syfte Syftet med studien var att undersöka effekten på astmakontroll och lungfunktion av ett web-baserat stödprogram för astmapatienter inom primärvården. Metod Studien var en 2-armad randomiserad, kontrollerad studie med kvantitativ ansats som pågick under 6 månader. Båda grupperna fick astmavård utifrån hur den bedrivs på vårdcentralerna och interventionsgruppen fick även tillgång till ett nyskapat web-baserat stödprogram (Astmakollen) för astmapatienter. Totalt slutförde 83 deltagare studien, varav 39 ingick i interventionsgruppen och 44 i kontrollgruppen. Resultat Denna studie visade signifikant förbättring av astmakontroll hos de patienter som haft tillgång till det web-baserade stödprogrammet Astmakollen under 6 månader. Medelvärdet på astma kontroll test i interventionsgruppen steg med 2,23 poäng medan värdet i kontrollgruppen var tämligen oförändrat. Effektstorleken för denna förändring mätt i Cohens d var 0,57. Medelvärdet av lungfunktionen i interventionsgruppen steg med 0,3% under studietiden medan den försämrades i kontrollgruppen och effektstorleken uppgick till 0,45. Skillnaden mellan grupperna var signifikant. Konklusion I denna studie framkommer det att e-hälsa kan ge en förbättrad astmakontroll och bibehållen lungfunktion samt vara ett komplement till dagens astmavård genom att öka tillgängligheten av individanpassad och evidensbaserad vård. / Objective The aim of this study was to examine the impact on asthma control and lung function of a web-based support program for asthma patients in primary care. Method The study was a quantitative, parallel, 2-arm, randomized controlled trial over a 6-month period. Both groups received asthma care based on how it was conducted at the health centers and the intervention group also gained access to a newly created web-based support program (Astmakollen) for asthma patients. In total, 83 participants completed the study, of whom 39 were in the intervention group and 44 in the control group. Results This study has showed significant improvement in asthma management in the sample group who had access to the web-based support program for 6 months. The mean score for asthma control test in the intervention group increased by 2,23 points while the score in the control group remained almost the same. The effect size for this change measured in Cohens d was 0,57. The mean score of lungfunction in the intervention group increased by 0,3% during the study period, while it deteriorated in the control group and the effect size amounted to 0,45. The difference between the groups were significant. Conclusions In this study, it appears that eHealth can provide improved asthma control and maintained lung function and be a complement in today's asthma care by increasing accessibility of personalized and evidence-based care.

Bakgrund: Patienter kan med hjälp av sin egenvård minska risken för ytterligare komplikationer från sin typ 2 diabetessjukdom såsom följdsjukdomar. Diabetes typ 2 är ett mycket stort problem för samhället där det fortfarande finns stora vinster att göra för patienten och för hälso- och sjukvården. Om fler patienter sköter sin egenvård skulle dessa problem minska och sjukdom samt lidande av diabetes typ 2 minskas. Syfte: Syftet är att beskriva möjliga faktorer som kan påverka patientens följsamhet till egenvård vid diabetes typ 2 Frågeställning: På vilket sätt kan sjuksköterskan påverka patientens följsamhet till egenvård? Metod : Examensarbetet är en litteraturöversikt. Litteratursökning har skett via de vetenskapliga databaserna Pubmed och Cinahl där artiklar har hög kvalitet och med ett etiskt korrekt innehåll valts. Resultat: Resultatet visar främst att patienternas kunskap om diabetes typ 2 påverkar följsamhet av egenvård i stor grad. Även egenvårdsstöd var en viktig faktor som verkar skydda mot bristfällig följsamhet av egenvård vid diabetes typ 2. Andra faktorer som framkommer är duration, motivation, kön och arv, psykiska faktorer och livsstil. Sjuksköterskan visas på flera olika sätt kunna vara till god hjälp för patienten för att uppfylla skötsamhet till egenvård. Slutsats: Kunskap, utbildning och egenvårdsstöd är av vikt för patienter med diabetes typ 2 för att minimera de faktorer som påverkar följsamheten negativt vid sjukdomen. Resultaten visar exempel på områden som sjuksköterskan bör ha kunskap om och där han eller hon kan stödja patienter i processen till god följsamhet i sin egenvård. Vidare forskning behövs inom detta område för att ytterligare stärka patientens egenvård. / Background: Patients can reduce their risk of further complications from their type 2 diabetes disease, such as sequelae, by their self-care. This is linked to current legislation and a self-care theory by Orem. It is further described that type 2 diabetes is a very big problem for society, where there are still great benefits to get for the patient and for the health and medical care. If more patients take care of their self-care, these problems will decrease and the disease and suffering of type 2 diabetes will be reduced. Aim: To describe factors that can affect the patient's adherence to self-care in type 2 diabetes. Question formulation: In what way can the nurse influence the patient's adherence to self-care? Method: The graduate thesis is a literature review. Literature search has been done via the scientific databases Pubmed and Cinahl where articles are of high quality and with an ethically correct content chosen. Result: The result shows that the patient’s knowledge of type 2 diabetes greatly affects adherence to self-care. Self-care support was an important factor that seems to protect against poor adherence to self-care in type 2 diabetes. Other factors that arise are duration, motivation, gender and inheritance, mental factors and lifestyle. The nurse is shown in several different ways to be able to help the patient well in order to fulfill care for self-care. Conclusion: Knowledge, education and self-care support are important for patients with type 2 diabetes to minimize the factors that negatively affect the adhesion of the disease. The results show examples of areas that the nurse should have knowledge of and where he or she can support patients in the process to good compliance in their self-care. Further research is needed in this area to further strengthen the patient's self-care.

Background: Diabetes prevalence in Scotland is increasing at ~4.6% annually; 247,278 (4.7%) in 2011. My Diabetes My Way (MDMW) is the NHS Scotland information portal, containing validated educational materials for people with diabetes and their carers. Internet-based interventions have potential to enhance self-management and shift power towards the patient, with electronic personal health records (PHRs) identified as an ideal method of delivery. In December 2010, a new service was launched in MDMW, allowing patients across Scotland access to their shared electronic record. The following thesis aims to identify and quantify the benefits of a diabetes-focused electronic personal health record within NHS Scotland. Methods: A diabetes-focused, population-based PHR was developed based on data sourced from primary, secondary and tertiary care via the national diabetes system, Scottish Care Information - Diabetes Collaboration (SCI-DC). The system includes key diagnostic information; demography; laboratory tests; lifestyle factors, foot and eye screening results; prescribed medication and clinical correspondence. Changes are tracked by patients over time using history graphs and tables, data items link to detailed descriptions explaining why they are collected, what they are used for and what normal values are, while tailored information links refer individuals to facts related to their condition. A series of quasi-experimental studies have been designed to assess the intervention using subjectivist, mixed-methods approaches incorporating multivariate analysis and grounded theory. These studies assess patient expectations and experiences of records access, system usage and uptake and provide preliminary analysis on the impact on clinical process outcomes. Survey questionnaires were used to capture qualitative data, while quantitative data were obtained from system audit trails and from the analysis of clinical process outcomes before and after the intervention. Results: By the end of the second year, 2601 individuals registered to access their data (61% male; 30.4% with type 1 diabetes); 1297 completed the enrolment process and 625 accessed the system (most logins=346; total logins=5158; average=8.3/patient; median=3). Audit trails show 59599 page views (95/patient), laboratory test results proving the most popular (11818 accesses;19/patient). The most utilised history graph was HbA1c (2866 accesses;4.6/patient). Users are younger, more recently diagnosed and have a heavy bias towards type 1 diabetes when compared to the background population. They are also likely to be a more highly motivated ‘early adopting’ cohort. Further analysis was performed to compare pre- and post-intervention clinical outcomes after the system had been active for nearly two and a half years. Results of statistical significance were not forthcoming due to limited data availability, however there are grounds for encouragement. Creatinine tests in particular improved following 1 year of use, with type 1 females in particular faring better than those in patient other groups. For other clinical tests such as HbA1c, triglycerides, weight and body mass index improvements were shown in mean and/or median values.96% of users believe the system is usable. Users also stated that it useful to monitor diabetes control (93%), improve knowledge (89%) and enhance motivation (89%). Findings show that newly diagnosed patients may be more likely to learn more about their new condition, leading to more productive consultations with the clinical team (98%). In the pre-project analysis, 26% of registrants expressed concerns about the security of personal information online, although those who actually went on to use it reported 100% satisfaction that their data were safe. Engagement remains high. In the final month of year two, 44.6% of users logged in to the system. 55.3% of users had logged in within the previous 3 months, 78.9% within the previous 6 months and 91.4% within the previous year. Some legacy PHRs have failed due to lack of uptake and deficiencies in usability, so as new systems progress, it is essential not to repeat the mistakes of the past. Feedback: "It is great to be able to view all of my results so that I can be more in charge of my diabetes".Conclusion: The MDMW PHR is now a useful additional component for the self-management of diabetes in Scotland. Although there are other patient access systems available internationally, this system is unique in offering access to an entire national population, providing access to information collected from all diabetes-related sources. Despite its development for the NHS Scotland environment, it has the potential to connect to any electronic medical record. This local and domain-specific knowledge has much wider applicability as outlined in the recommendations detailed, particularly around health service and voluntary sector ownership, patient involvement, administrative processes, research activities and communication. The current project will reach 5000 patients by the end of 2013.