Made available in DSpace on 2016-05-02T13:54:49Z (GMT). No. of bitstreams: 1 AndreiaMagelladaSilvaDuarteEsteves-dissertacao.pdf: 480009 bytes, checksum: 6d725edbfd0da5232a30389f24cb5223 (MD5) Previous issue date: 2009-10-09 / An intestinal stoma produces numerous changes in patients' lives, a fact that requires adaptation and can change their quality of life. Therefore, this study aimed at evaluating the quality of life of patients with intestinal stomas registered in the Ostomized Patient Program of Stoma of an outpatient service in a municipality in southern Minas Gerais, Brazil. This is an epidemiological, descriptive, cross-sectional quantitative study that included 13 ostomized patients who were interviewed at home in July and August 2007. Two instruments were used to collect data: (1) characterization of participants and (2) the WHOQOL-Bref, for the "quality of life". For data collection, the interviewees signed an informed consent form, and the protocol was approved by the UNIFENAS Committee of Ethics in Research. The software SPSS version 10 was used for data analysis and the Chi-square and the Cronbach alpha tests were used for the crossing of variables. The results showed that most of the patients were 61 years or older, female, from urban areas, catholic, had elementary school; widow / separated / divorced, had 1 to 3 children and family income of 4 to 6 times the minimum wage. With respect to the physiological need for sleep, 61.5% of the population studied had insomnia, a situation that was aggravated after ostomy. Most of them reported 1 to 2 intestinal evacuations per day, with a pasty consistency. Their greatest difficulty was to adapt themselves to the stoma. When crossing gender and marital status with the difficulty of adapting to the bag and self-care, there was statistical significance. Most respondents did not return to sports, work, and sexual and social activities after ostomy, and showed increased feelings of loneliness, contempt, tearfulness and dependence. Their family was the main help. The most evident complications were bleeding and peristomal dermatitis. With regard to the rights of the ostomized, 84.6% reported having been informed by the physician and / or outpatient clinic and the main way of acquiring the collection equipment is through the SUS, free of charge. The measurements of the quality of life of this population were: mean score of overall QOL, 3.61; physical domain, 3.40; psychological domain, 3.43; social relationships domain, 3.46;and the environment domain, 3, 49. The higher average scores rated the quality of life as being above the "neither bad nor good." The WHOQOL-bref was effective to evaluate the QOL of patients with intestinal stomas, with internal consistency above 0.72. Finally, it is important that the ostomized patients be informed about their disease, and receive emotional support and rehabilitation care in order to be able to lead an active, productive and self-sufficient life. / Um estoma intestinal gera inúmeras alterações na vida dos pacientes, fato que requer adaptação e pode alterar sua qualidade de vida. Sendo assim, o presente estudo objetivou avaliar a qualidade de vida dos portadores de estomias intestinais cadastrados no Programa de Estomizados de um serviço ambulatorial em um município do sul de Minas Gerais. Trata-se de um estudo epidemiológico, descritivo, transversal, quantitativo. Participaram do estudo 13 estomizados, que foram entrevistados em suas residências, nos meses de julho e agosto de 2007. Para a coleta dos dados utilizaram-se dois instrumentos: um, de caracterização dos participantes, e outro, referente à qualidade de vida , sendo usado o WHOQOL-Bref. A coleta de dados seguiu os preceitos éticos, onde os entrevistados assinaram um Termo de Consentimento Livre e Esclarecido e tiveram anuência do Comitê de Ética em Pesquisa da UNIFENAS. Para análise dos dados utilizou-se o software SPSS versão 10 e, no cruzamento das variáveis, aplicou-se o teste do qui-quadrado, além do Coeficiente Alfa de Cronbach. Os resultados demonstraram que a maioria dos pacientes estudados tinha 61 anos ou mais, era do sexo feminino; procedente da zona urbana; da religião católica; tinha o primeiro grau incompleto; estava viúvo/desquitado/divorciado; tinha 1 a 3 filhos e renda familiar de 4 a 6 salários mínimos. Com relação à necessidade fisiológica de sono, 61,5% da população estudada demonstrou apresentar insônia, situação que foi agravada após a confecção do estoma. Quanto à freqüência e características das eliminações intestinais, a maioria referiu de 1 a 2 eliminações diárias, com consistência pastosa. A maior dificuldade de adaptação referida pelos estomizados foi com relação ao estoma. Ao cruzar as variáveis sexo e estado civil com a dificuldade de adaptação à bolsa e ao autocuidado, houve significância estatística. A maioria dos entrevistados não retornou às atividades esportivas, de trabalho, sexuais e sociais após a realização da estomia, onde se observou um aumento de sentimentos, como solidão, desprezo, choro fácil e dependência. A principal ajuda referida pela população estudada foi da família. As complicações mais evidenciadas foram sangramento e dermatite periestomal. Quanto aos direitos dos estomizados, 84,6% referiram ter sido informados pelo médico e/ou serviço ambulatorial e a principal forma de aquisição dos equipamentos coletores é a gratuita através do SUS. Quanto à qualidade de vida desta população, o escore médio da QV geral foi de 3,61; do domínio físico, 3,40; domínio psicológico, 3,43; domínio relações sociais, 3,46; e domínio meio ambiente, 3,49, evidenciando elevados escores médios, que classificam a qualidade de vida como sendo acima do nem ruim, nem boa . O WHOQOL-bref mostrou-se eficaz para avaliar a QV de pacientes com estomias intestinais, apresentando consistência interna superior a 0,72. Por fim, é importante que o estomizado seja informado acerca de sua doença, recebendo aporte emocional que lhe garanta suporte e reabilitação, sendo capaz de levar uma vida ativa, produtiva e autossuficiente.

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Alors que le traitement standard du cancer du rectum (traitement néoadjuvant avec chirurgie d’exérèse et stomie temporaire) n’épargne ni la psyché ni le corps, peu d’études se sont intéressées à l’ajustement psycho-social des patients qui y sont confrontés. Le corps est bien souvent perçu, à la suite des traitements, comme dérivant de la norme et générant un sentiment de honte. Ainsi le premier travail de cette thèse a été de valider un outil, en population française, permettant de mesurer la honte liée à l’image du corps. Dans un deuxième travail, nous avons pu comparer la honte liée à l’image du corps ainsi que la qualité de vie, l’image du corps, et la détresse psychologique des patients ayant reçu un traitement standard à ceux traités par excision locale (nouvelle approche proposée aux patients présentant une bonne réponse clinique aux traitements néoadjuvants). Le traitement standard entraînant des difficultés psycho-sociales plus marquées, nous avons évalué plus spécifiquement ses conséquences sur la détresse psychologique et l’image du corps dans un troisième travail. La période avec la stomie temporaire représente un temps spécifique durant lequel les patients semblent mettre leur vie entre parenthèses. Ainsi, dans un quatrième travail, nous avons investigué le rôle du temps comme un déterminant possible de la qualité de vie de ces sujets. Nos résultats ont montré qu’il conviendrait de considérer, dans le parcours de soin du patient, la façon dont celui-ci perçoit le temps, en vue de prévenir une altération de sa qualité de vie. Cette altération persiste plusieurs mois après la fin des traitements mais peu d’études s’y sont, à ce jour, intéressées. Ainsi, dans un cinquième travail, nous avons exploré la qualité de vie, deux ans après le diagnostic de cancer, chez des survivants du cancer du côlon-rectum traités par chirurgie avec ou sans stomie temporaire. Nous avons alors constaté que la qualité de vie physique était significativement plus altérée chez les patients qui ont eu une stomie. Face à ces difficultés, il convenait de proposer une intervention psycho-sociale répondant aux besoins émotionnels de ces patients. Peu d’interventions ont été développées en ce sens. Dans un sixième travail, nous avons développé et mis à l’épreuve une intervention psycho-sociale qui semble s’inscrire davantage dans une approche préventive. L’ensemble de ces travaux pourrait contribuer à améliorer l’accompagnement proposé à ces patients, même s’il est nécessaire de souligner l’importance de promouvoir la recherche dans ce domaine pour mieux comprendre encore les enjeux psycho-sociaux de ce traitement. / While the standard treatment for rectal cancer (neoadjuvant treatment with rectal excision) has spared neither the psyche nor the body, few studies have focused on psychosocial adjustment of patients who have received this treatment. Following treatment, the body is often perceived as deviating from the norm, generating feelings of shame. The first objective of this thesis was to adapt, and validate, for the French population, a body image shame scale. The second step consisted in comparing body image shame, quality of life, body image, and psychological distress between rectal cancer patients treated by surgery with temporary stoma or local excision (a new treatment approach proposed for patients with rectal cancer after a good clinical response to neoadjuvant therapy). Since standard treatment leads to more psychosocial problems, in a third study, we examined the effects of standard treatment on psychological distress and body image. The temporary stoma period represents a specific time during which patients seem to temporarily suspend their lives. Thus, the fourth study of this thesis investigated how the role of time perspective might act as a determinant of quality of life for rectal cancer patients. The time perspective construct provides keys in order to improve quality of life of rectal cancer patients. Quality of life alterations persist several months after the end of treatments but, to date, few studies have focused on this topic. The fifth goal was to assess colorectal cancer survivors’ quality of life two years after diagnosis of colorectal cancer according to their stoma status (reversed or never formed). Participants with a reversed stoma score lower on the physical quality of life scale than participants without stoma. Patients with rectal cancer experience psychosocial challenges. To deal with these challenges, psychosocial interventions focused on emotional needs of rectal cancer patients treated by standard treatment should be proposed. There is a lack of this type of intervention for this population. The sixth purpose was to develop and test a psychosocial intervention which seems to be more in line with a preventive approach. Taken together, these works may contribute to improve the support offered to these patients, even though the importance of promoting research to deal with the psychosocial challenges of this treatment must be underlined.

Bakgrund: Det finns många olika tillstånd som kan leda till att en person får en tarmstomi, och detta kan påverka en persons syn på den egna kroppen. En persons kroppsuppfattning är starkt kopplad till sexualiteten som är en viktig del i människors liv. Stomioperationer kan även ge fysiska skador som medför problem i opererade människors sexualliv. Patienter med stomi finns i alla vårdinriktningar, och det är därför viktigt för alla sjuksköterskor att kunna bemöta dem. Syfte: Syftet var att belysa hur patienter med enterostomi upplever sin sexualitet. Metod: Metoden var en litteraturöversikt där 15 vetenskapliga artiklar granskades, varav fem var kvalitativa, nio kvantitativa och en använde mixad metod. Artiklarna söktes fram genom kombinationer av olika sökord i databaserna CINAHL Complete och Pubmed med ett tidsspann på år 2008-2017. Resultat: I resultatet kunde fyra huvudteman och sex underteman identifieras. De huvudteman som hittades var En förändrad kropp, Fysisk sexuell funktion, Ett förändrat sexliv och Stöd från omgivningen. Resultatet visade på att många patienter upplever problem med sin sexualitet relaterat till stomin, både fysiska problem och hinder som följd av patientens egna tankar om sin stomi. Ett ökat behov av stöd och information kunde också identifieras hos patienterna, både från en eventuell partner, men även från sjukvårdens sida. Diskussion: Resultatet diskuteras med utgångspunkt i Parse's teori om humanbecoming. I diskussionen tas upp teman kring hur stöd och information från vården saknas av patienterna. Även bristen på forskning kring kvinnors sexuella upplevelser med stomi i jämförelse med den forskning som finns kring män diskuteras. / Background: There are many reasons as to why a person receives a bowel ostomy, and this can affect the person’s view of their own body. A person's perception of the body is strongly linked to sexuality that is an important part of people's lives. Stoma surgery can also cause physical damage that causes problems in the sex life of the operated person. Patients with stoma will appear in all care settings, and it is therefore important for all nurses to be able to treat them. Aim: The aim was to illustrate how patients with an ostomy experience their sexuality Method: The method was a literature review where 15 scientific articles were reviewed, five of which were qualitative, nine quantitative and one used mixed method. The articles were identified through combinations of different keywords in the databases CINAHL Complete and Pubmed with a time span of the years 2008-2017. Results: In the results four main themes and six sub themes could be identified. The main themes were A Changed Body, Physical Sexual Function, A Changed Sex Life and Support from the Surroundings. The results showed that many patients experience problems with their sexuality related to their stoma, both physical problems and obstacles as a result of the patient's own thoughts about one's stoma. An increased need for support and information was also identified by the patients, both from an eventual partner and from the healthcare. Discussion: The result is discussed based on Parse's theory of humanbecoming. The discussion addresses topics about the lack of support and information for patients from the healthcare. The lack of research into women's sexual experiences with a stoma in comparison to the research that exists around men is also discussed.

1 Abstract This thesis presents an analysis of fossil plants from the Cenomanian Peruc-Korycany Formation of the Bohemian Cretaceous Basin and from the Bückeberg Formation of the Lower Saxony Basin in Germany. Based on earlier studies, both areas provide sediments that are considered to have developed in tidally influenced fluvial systems. Studied fossil plants are represented by ginkgoalean plant leaves (Ertemophyllum, Tritaenia), branches of conifers (Frenelopsis) and lauroid angiosperms (Eucalyptolaurus). Frenelopsis, Eretmophyllum and Tritaenia are considered to be halophytic plants, while Lauroid angiosperms were considered to grow in fresh water conditions. The fossil plants were studied using cuticle analysis and two methods of stable carbon isotope analysis: Bulk carbon isotope analysis and Compound Specific Isotope analysis. For cuticle analysis samples were observed and documented macroscopically and microscopically. To specify the environmental conditions, recent samples from three salt marshes in Great Britain were studied and analysed using the same methods as the fossil samples. The data from all observations and measurements were processed and their interpretation supported the modelled environment based on the sedimentological data. Frenelopsis were growing in a haline environment with low...