Undergarment needs after breast cancer surgery: a key survivorship consideration.

An important aspect of breast cancer survivorship is finding comfortable undergarments that work for women's post-treatment bodies. Patients who undergo mastectomy, including both those who do and do not receive reconstruction, need bras that can accommodate new breast shape, size, and feel, as well as scarring and skin sensitivity. Our research with breast cancer patients and the literature reveal that ready-to-wear bras are inadequate for the variety of patients' needs, and many women lack support and guidance to make decisions about undergarments after cancer. This commentary describes a major quality-of-life challenge for breast cancer survivors and makes recommendations for future research. Healthcare providers need more guidance and resources to be able to help their patients prepare for this aspect of survivorship. New technologies, such as biomechanical modeling, 3D body scanning, and manufacturing techniques, should be pursued in collaboration with patients, healthcare providers, and clothing designers to ease this burden for breast cancer patients.

Envelhecimento e aparência: percepções de uma mulher transexual heterossexual / Aging and appearance: perceptions of a heterosexual transgender woman / Envejecimiento y apariencia: percepciones de una mujer transgénero heterosexual

A autonomia na construção da aparência e seus significados têm estado presentes na edificação das identidades e condições sociais ao longo do curso da vida, promovendo o bem-estar. Nem sempre essa dinâmica psicossocial acontece tem acontecido de forma simples e democrática. Estudo de caso qualitativo sobre a trajetória da construção da aparência de uma mulher transexual heterossexual. Uso do método etnográfico. Obteve-se que a aparência se trata de variável complexa, reunindo uma constelação de variáveis para além do próprio sexo ou gênero.

Autonomy in the construction of the appearance and its meanings have been presented in the edification of identities and social conditions throughout life course, promoting well-being. This psychosocial dynamic has not always happened in a simple and democratic way. Qualitative case study on the path of appearance construction of a heterosexual transgender Brazilian woman. Use of an ethnographic method. It was found that appearance is a complex variable, bringing together a constellation of several variables beyond gender or sex itself.

La autonomía en la construcción de la apariencia y sus significados han estado presentes en la construcción de identidades y condiciones sociales a lo largo de la vida, promoviendo bienestar. Esa dinámica psicosocial ni siempre ocurre de manera simple y democrática. Estudio de caso cualitativo acerca de la trayectoria de la construcción de la apariencia de una transgénero heterosexual. Se utilizó de método etnográfico. Se observó que la apariencia es una variable compleja que abarca una constelación de distintas variables más allá del género y sexo.

Orthopaedic Physician Attire Influences Patient Perceptions in an Urban Inpatient Setting.

BACKGROUND: Prior research suggests that physician attire has an important effect on patient perceptions, and can influence the patient-physician relationship. Previous studies have established the effect of specialty, location, and setting on patient preferences for physician attire, and the importance of these preferences and perceptions on both the physician-patient relationship and first impressions. To date, no studies have examined the influence of attire in the inpatient orthopaedic surgery setting on these perceptions. QUESTIONS/PURPOSES: (1) Do differences in orthopaedic physician attire influence patient confidence in their surgeon, perception of trustworthiness, safety, how caring their physician is, how smart their surgeon is, how well the surgery would go, and how willing they are to discuss personal information with the surgeon? (2) Do patients perceive physicians who are men and women differently with respect to those endpoints? METHODS: Ninety-three of 110 patients undergoing orthopaedic surgery at an urban academic medical center participated in a three-part survey. In the first part, each patient was randomly presented 10 images of both men and women surgeons, each dressed in five different outfits: business attire (BA), a white coat over business attire (WB), scrubs alone (SA), a white coat over scrubs (WS), and casual attire (CA). Respondents rated each image on a five-point Likert scale regarding how confident, trustworthy, safe, caring, and smart the surgeon appeared, how well the surgery would go, and the patient's willingness to discuss personal information with the surgeon. In the second part, the respondent ranked all images, by gender, from the most to least confident based on attire. RESULTS: Pair-wise comparisons for women surgeons demonstrated no difference in patient preference between white coat over business attire compared with white coat over scrubs or scrubs alone, though each was preferable to business attire and casual attire (WS versus WB: mean difference [MD], 0.1 ± 0.6; 95% CI, 0.0-0.2; p = 1.0; WS versus SA: MD, 0.2 ± 0.7; 95% CI, 0-0.3; p = 0.7; WB versus SA: 0.1 ± 0.9; 95% CI, -0.1 to 0.2; p = 1.0). The same results were found when rating the surgeon's perceived intelligence, skill, trust, confidentiality, caring, and safety. In the pair-wise comparisons for male surgeons, white coat over scrubs was not preferred to white coat over business attire, scrubs alone, or business attire (WS versus WB: MD, -0.1 ± 0.6; 95% CI, 0-0.1; p = 1.0; WS versus SA: MD, 0 ± 0.4; 95% CI, -0.2 to 0; p = 1.0; WS versus BA: MD, 0.2 ± 0.8; 95% CI, 0-0.4; p = 0.6). WB and SA were not different (MD, 0.0 ± 0.6; 95% CI, -0.1 to 0.2; p = 1.0), though both were preferred to BA and CA (WB versus BA: MD, 0.3 ± 0.8; 95% CI, 0.1-0.5; p = 0.02; WB versus CA: 1.0 ± 1.0; 95% CI, 0.8-1.2; p < 0.01). We found no difference between SA and BA (MD, 0.3 ± 0.7; 95% CI, 0.1-0.4; p = 0.06). We found that each was preferred to CA (SA versus CA: 0.9 ± 1.0; 95% CI, 0.7-1.2; p < 0.01; BA versus CA: 0.7 ± 1.0; 95% CI, 0.5-0.9; p < 0.01), with similar results in all other categories. When asked to rank all types of attire, patients preferred WS or WB for both men and women surgeons, followed by SA, BA, and CA. CONCLUSIONS: Similar to findings in the outpatient orthopaedic setting, in the inpatient setting, we found patients had a moderate overall preference for physicians wearing a white coat, either over scrubs or business attire, and, to some extent, scrubs alone. Respondents did not show any difference in preference based on the gender of the pictured surgeon. For men and women orthopaedic surgeons in the urban inpatient setting, stereotypical physician's attire such as a white coat over either scrubs or business attire, or even scrubs alone may improve numerous components of the patient-physician relationship and should therefore be strongly considered to enhance overall patient care. LEVEL OF EVIDENCE: Level II, therapeutic study.

The Brazilian Army nurses' uniforms: visual identity in World War II / Uniformes de enfermeras del Ejército Brasileño: identidad visual en la Segunda Guerra Mundial / Uniformes de enfermeiras do Exército Brasileiro: identidade visual na II Guerra Mundial

ABSTRACT Objective: To analyze the symbolic effects of the official military uniform of the nurses from Brazilian Army in World War II. Method: This research was developed using the historical method, with iconographic sources. The data were discussed based on the concepts of the social world theory, by Pierre Bourdieu. Results: The images selected demonstrate the own meaning of the uniforms, evidencing the functions and the social position of those who wear it, being private and obligatory to use it in the military field. Final considerations: In the case of the nurses from the Brazilian Expeditionary Force, the appropriation of uniforms promoted the visual communication representing military nurse in the context of war, at the same time it served for distinction purposes in the army, but not necessarily in the nursing field. Symbolically, they remained amongst the walls of the barracks even after the end of the war and, thus, they remained unknown and marked by the symbols of forgetfulness.

RESUMEN Objetivo: Analizar los efectos simbólicos de la vestimenta militar oficial de las enfermeras del Ejército Brasileño en la II Guerra Mundial. Método: La investigación fue desarrollada usando el método histórico con fuentes de imágenes. Los datos fueron discutidos a la luz de conceptos de la teoría del mundo social, de Pierre Bourdieu. Resultados: Las imágenes seleccionadas demuestran el significado propio de los uniformes, explicitando las funciones y la posición social de quien los porta, siendo de uso privativo y obligatorio en el campo militar. Consideraciones finales: En el caso de las enfermeras de la Fuerza Expedicionaria Brasileña, la apropiación de uniformes promovió la comunicación visual de la figura-tipo de la enfermera militar en el contexto de la guerra, al tiempo que confería distinción en el ámbito del ejército, pero no necesariamente en el campo de la enfermería. Simbólicamente, permanecieron entre los muros de los cuarteles incluso después del término de la guerra, y, por consiguiente, se mantuvieron desconocidas y marcadas por los signos del olvido.

RESUMO Objetivo: Analisar os efeitos simbólicos do vestuário militar oficial das enfermeiras do Exército Brasileiro na II Guerra Mundial. Método: A pesquisa foi desenvolvida usando o método histórico, com fontes imagéticas. Os dados foram discutidos à luz de conceitos da teoria do mundo social, de Pierre Bourdieu. Resultados: As imagens selecionadas demonstram o significado próprio dos uniformes, explicitando as funções e a posição social de quem os porta, sendo de uso privativo e obrigatório no campo militar. Considerações finais: No caso das enfermeiras da Força Expedicionária Brasileira, a apropriação de uniformes promoveu a comunicação visual da figura-tipo da enfermeira militar no contexto da guerra, ao mesmo tempo que conferiu distinção no âmbito do exército, mas não necessariamente no campo da enfermagem. Simbolicamente, elas permaneceram entre os muros dos quartéis mesmo após o término da guerra e, por conseguinte, mantiveram-se desconhecidas e marcadas pelos signos do esquecimento.

The Effect of an Orthopedic Hand Surgeon's Attire on Patient Confidence and Trust.

Background: Multiple studies have concluded that patients are more likely to understand and trust physicians who dress in more formal attire (shirt and tie) as opposed to casual attire (t-shirts and jeans). The white coat has repeatedly been reported as a major source of trust and confidence in a patient's eyes. Methods: This study explores the effect an orthopedic hand surgeon's attire has on a patient's perception of their surgeon's clinical values. All patients 18 years of age and older who visited our orthopedic hand surgeon's suburban outpatient practice were asked to participate in our survey-based study. Results: Ninety-seven surveys were completed and included. A majority of our responders are female (n = 59, 60.8%), Caucasian (n = 83, 85.6%) between the ages of 55 and 74 years (n = 40, 41.2%), currently employed (n = 59, 60.8%) with private health insurance (n = 69, 71.1%), and married (n = 64, 66.0%). Patients rated male and female hand surgeons wearing a white coat highest using the Likert scale and when asked about their perceived clinical qualities. Patients consistently poorly rated their surgeons wearing casual attire. Patients did note that the white coat, or any specific attire, was not necessary during the initial encounter to build a strong patient-surgeon relationship. Finally, goatees and beards do not positively or negatively impact a surgeon's patient-constructed image. Conclusions: Combining strong clinical skills with appropriate clinical attire highlighted by the physician wearing a white coat appears to be an effective way to enhance patient satisfaction while ultimately gaining the trust and respect needed to properly care for patients.

Clothing and professional identity in the training of nurses in the city of Juiz de Fora / Vestuario e identidad profesional en la formación de enfermeros en Juiz de Fora / Vestuário e identidade profissional na formação de enfermeiros em Juiz de Fora

ABSTRACT Objective: To understand the meaning of the transformations that occurred in the clothing of EEHB students and their role in the construction of a professional identity of nurses in Juiz de Fora. Method: Historical and social qualitative study from 1965 to 1978. Oral and written sources were used. Oral sources were produced with the Thematic Oral History technique, with 10 collaborators. The theoretical frameworks used were the concepts of identity of Claude Dubar, and concepts of clothing and their symbolic meanings of Roland Barthes. Results: The EEHB nursing students' uniform represented a brand, an essential symbol in the construction and consolidation of the nurse's identity in the city of Juiz de Fora. Conclusion: The uniform was recognized as an object of identification of nurses in the city, giving them a social image of credibility for their training.

RESUMEN Objetivo: Comprender el significado de las transformaciones ocurridas en el vestuario de los alumnos de la Escuela de Enfermería Hermantina Beraldo (EEHB) con el fin de construir una identidad profesional de los enfermeros en Juiz de Fora. Método: Se trata de un estudio histórico social, cualitativo, cuyo recorte temporal comprende el período entre 1965 y 1978. Se utilizaron fuentes orales y escritas. Las fuentes orales se produjeron mediante la técnica de la Historia Oral Temática, con 10 colaboradores. Como referencial teórico, se utilizaron los conceptos de identidad de Claude Dubar, y del vestuario y sus significados simbólicos, de Roland Barthes. Resultados: El uniforme de las alumnas de enfermería de la EEHB se consolidó como una marca, un símbolo esencial en el movimiento de construcción y consolidación de la identidad de la enfermera en la ciudad de Juiz de Fora. Conclusión: El uniforme fue reconocido por la EEHB como un objeto de identificación de las enfermeras diplomadas en la ciudad, otorgándoles una imagen social de credibilidad por su formación.

RESUMO Objetivo: Compreender o significado das transformações ocorridas no vestuário dos alunos da Escola de Enfermagem Hermantina Beraldo (EEHB) para a construção de uma identidade profissional de enfermeiros em Juiz de Fora. Método: Estudo histórico-social, qualitativo, cujo recorte temporal compreende o período de 1965-1978. Utilizaram-se fontes orais e escritas. As fontes orais foram produzidas pela técnica da História Oral Temática, com 10 colaboradores. Como referencial teórico, foram utilizados os conceitos de identidade, de Claude Dubar, e de vestuário e seus significados simbólicos, de Roland Barthes. Resultados: O uniforme das alunas de enfermagem da EEHB configurou-se como uma marca, um símbolo essencial no movimento de construção e consolidação da identidade da enfermeira na cidade de Juiz de Fora. Conclusão: O uniforme foi reconhecido como um objeto de identificação das enfermeiras diplomadas na cidade, pela EEHB, conferindo-lhes uma imagem social de credibilidade pela sua formação.

¿La imagen importa? Influencia de la vestimenta del traumatólogo en la elección y confianza del paciente / The impact of the orthopedic surgeons' attire on patient preferences

Background: The formal appearance of health care professionals may influence their trustworthiness. Aim: To determine the effect of the orthopedic surgeon's attire on patients' perceptions of credibility and reliability of professionals. Material and Methods: In a cross-sectional design, 351 patients (mean age 43 ± 17 years, 62% males) from the Department of Orthopedics and Traumatology of a Chilean regional hospital in southem of Chile were chosen to complete a questionnaire of attire preferences, in which five photographs with male and female orthopedic surgeons appeared (executive, formal attire, informal attire, scrubs and casual clothing). The influence of attire in the perception of physicians' trustworthiness to resolve medical situations was analyzed. Results: Forty four percent of patients had no physician gender predilection (p = 0.32). Forty three percent of male and 38% of female patients preferred the use of formal attire. In situations of credibility or confidence, all patients chose mostly the use of white coats with formal attire by professionals. The probability of choosing an orthopedic surgeon with a formal attire was significantly higher among patients who considered the attire and appearance of the professional to be very important (Odds ratio = 3.74; p < 0.01). Conclusions: Patients prefer orthopedic surgeons wearing white coats and formal attire, which improves credibility of these professionals to correctly solve medical situations.

No compelling positive association between ovarian hormones and wearing red clothing when using multinomial analyses.

Several studies report that wearing red clothing enhances women's attractiveness and signals sexual proceptivity to men. The associated hypothesis that women will choose to wear red clothing when fertility is highest, however, has received mixed support from empirical studies. One possible cause of these mixed findings may be methodological. The current study aimed to replicate recent findings suggesting a positive association between hormonal profiles associated with high fertility (high estradiol to progesterone ratios) and the likelihood of wearing red. We compared the effect of the estradiol to progesterone ratio on the probability of wearing: red versus non-red (binary logistic regression); red versus neutral, black, blue, green, orange, multi-color, and gray (multinomial logistic regression); and each of these same colors in separate binary models (e.g., green versus non-green). Red versus non-red analyses showed a positive trend between a high estradiol to progesterone ratio and wearing red, but the effect only arose for younger women and was not robust across samples. We found no compelling evidence for ovarian hormones increasing the probability of wearing red in the other analyses. However, we did find that the probability of wearing neutral was positively associated with the estradiol to progesterone ratio, though the effect did not reach conventional levels of statistical significance. Findings suggest that although ovarian hormones may affect younger women's preference for red clothing under some conditions, the effect is not robust when differentiating amongst other colors of clothing. In addition, the effect of ovarian hormones on clothing color preference may not be specific to the color red.

Creating beauty: the experience of a fashion collection prepared by adolescent patients at a pediatric oncology unit.

AIMS AND BACKGROUND: Adolescent patients with cancer need psychological support in order to face the traumatic event of cancer diagnosis and to preserve continuity with their normal lives. Creative projects or laboratories may help young patients express their thoughts and feelings. METHODS: The Youth Project developed activities dedicated to adolescents to give them a chance to vent their creative spirit and express themselves freely. In the first project, the teenagers designed their own fashion collection in all its various stages under the artistic direction of a well-known fashion designer, creating their own brand name (B.Live), and organized a fashion show. RESULTS: In all, 24 patients from 15 to 20 years old took part in the project. The fashion project proved a fundamental resource in helping the young patients involved to regain a positive self-image and the feeling that they could take action, both on themselves and in their relations with others. CONCLUSIONS: Facilitating the experience of beauty may enable hope to withstand the anguish caused by disease. This experience integrated the usual forms of psychological support to offer patients a form of expression and support during the course of their treatment.

Understanding the role of physician attire on patient perceptions: a systematic review of the literature--targeting attire to improve likelihood of rapport (TAILOR) investigators.

OBJECTIVES: Despite a growing body of literature, uncertainty regarding the influence of physician dress on patients' perceptions exists. Therefore, we performed a systematic review to examine the influence of physician attire on patient perceptions including trust, satisfaction and confidence. SETTING, PARTICIPANTS, INTERVENTIONS AND OUTCOMES: We searched MEDLINE, Embase, Biosis Previews and Conference Papers Index. Studies that: (1) involved participants ≥18 years of age; (2) evaluated physician attire; and (3) reported patient perceptions related to attire were included. Two authors determined study eligibility. Studies were categorised by country of origin, clinical discipline (eg, internal medicine, surgery), context (inpatient vs outpatient) and occurrence of a clinical encounter when soliciting opinions regarding attire. Studies were assessed using the Downs and Black Scale risk of bias scale. Owing to clinical and methodological heterogeneity, meta-analyses were not attempted. RESULTS: Of 1040 citations, 30 studies involving 11 533 patients met eligibility criteria. Included studies featured patients from 14 countries. General medicine, procedural (eg, general surgery and obstetrics), clinic, emergency departments and hospital settings were represented. Preferences or positive influence of physician attire on patient perceptions were reported in 21 of the 30 studies (70%). Formal attire and white coats with other attire not specified was preferred in 18 of 30 studies (60%). Preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs; four of five studies in intensive care and emergency settings also found no attire preference. Only 3 of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions. CONCLUSIONS: Although patients often prefer formal physician attire, perceptions of attire are influenced by age, locale, setting and context of care. Policy-based interventions that target such factors appear necessary.

The effects of attention deficit hyperactivity disorder on clothing selection and habits among Turkish University students.

The purpose of this study was to identify the factors that influence the shopping attitudes of college students with and without ADHD. This study also examined the effects of ADHD on the academic and social lives of college students. The sample consisted of 219 university students. These students were interviewed by a psychiatrist with regard to ADHD symptoms according to the DSM-IV. The Adult ADHD Self Report Scale (ASRS), the Teen Interpersonal Influence Scale, and a demographic information form were used as measurement devices. The ADHD and control groups were classified in three different ways: (1) met the ADHD criteria for both Clinical Diagnosis and the ASRS; (2) met only the criteria for Clinical Diagnosis; or (3) met only the criteria of the ASRS. Our research shows that individuals with ADHD experience more problems with money management and are more affected by the media, friends, and brands compared with individuals without ADHD. Smoking and alcohol use disorders, accidents, being held back, and disciplinary actions often accompany ADHD in college students. To the best of our knowledge, the shopping attitudes of young adults with ADHD and the influence of the media, peers, family, and brands have not been studied until now.

Physician use of white coats in pediatric ophthalmology.

PURPOSE: Recent literature reports that patients and parents of pediatric patients prefer their physician to wear a white coat and to address them informally. This study aims to characterize current practice patterns of pediatric ophthalmologists regarding their use of white coats and salutations during outpatient pediatric encounters. METHODS: An eight-question survey was e-mailed to members of the American Academy of Pediatric Ophthalmology and Strabismus in 2012. The questions focused on clinical setting, use of white coats in out-patient encounters, and preferred language used to address the patient's parents. Surveys not completed in full were excluded from data analysis. RESULTS: Of approximately 1,266 members who received the survey, 606 completed the survey. Five hundred ninety-nine surveys were included in the data analysis. Sixty-three percent of attending physicians and 80% of fellows reported they did not routinely wear white coats while examining outpatient children. Forty-six percent of attending physicians and 48% of fellows addressed the patient's parents as "mom" or "dad". There was no significant association between wearing a white coat and type of practice setting, practice characteristics, or location in a children's hospital for attending physicians or fellows. CONCLUSIONS: Contrary to preferences expressed by patients and their parents, a majority of pediatric ophthalmologists do not routinely wear white coats during pediatric outpatient examinations. Practice patterns appear to be in line with previously reported parental greeting preferences.

Feminilidade: um detalhe / Femininitie: a detail

O presente texto pretende abordar a questão da feminilidade em relação ao tema das roupas. Freud havia concluído que a mulher "trançava e tecia" para encobrir a falta fálica e Lacan no rememorou com seu texto, que a mulher se portava como uma "autêntica tecelã" nos rearranjos pulsionais que empreendia em sua vida anímica. Partimos de alguns autores da literatura para demonstrar que a tese freudiana e lacaniana somente corroboram com a hipótese de que há uma relação intrincada entre mulheres e roupas, melhor dizendo: entre a feminilidade e a "função do véu". Entretanto, o feminino lança mão do véu que são as roupas, segundo a psicanálise, para encobrir uma suposta falta da mulher. Nesse sentido a roupa é uma saída fálica que encobriria a castração. O texto aponta então uma via de apreensão do feminino pelo tema do detalhe, pois as qualidades desse objeto ínfimo e sutil apresentam uma saída pelo estilo próprio e feminino de cada uma das mulheres. Ou seja, se a roupa apresenta uma saída pela via do falo, o detalhe marca o todo com um corte e reabre a questão da mulher com a própria falta.

The present text intends to approach the question of femininity in relation to the theme of clothing. Freud concluded that "braiding and weaving" was meant to cover the phallic lack, and Lacan reminded us with his text of the behavior of women as authentic weavers in the rearrangements of the drives that they have set up in their animic lives. We depart from some authors of the literature to demonstrate that the Freudian and Lacanian thesis only corroborate the hypothesis that there is an intricate relationship between women and clothing, that is, between femininity and "the function of the veil". However, the feminine employs the veil-which is the clothes, according to psychoanalysis- to cover a women's supposed lack. In this sense, the clothing is a phallic exit that would hide castration. The text points to another possibility of apprehension of the feminine through the theme of the detail, since the qualities of this little and subtle object present an exit through each woman's feminine and unique style. That is, if clothing presents an exit through the phallus, the detail marks the whole with a cut that reopens the issue of the woman with her own lack.

Rectal cancer patients' quality of life with a temporary stoma: shifting perspectives.

BACKGROUND: Patients with rectal cancer who have a temporary ostomy report good quality of life despite identifying a number of stoma-related difficulties. OBJECTIVE: This study aimed to qualitatively explore the experiences of patients with rectal cancer who have a temporary ileostomy to better understand the discordant findings of previous quantitative quality-of-life studies. DESIGN/SETTING: We conducted in-depth qualitative interviews with patients with stage I to III rectal cancer who underwent sphincter-preserving surgery that resulted in a temporary ileostomy. PATIENTS: Twenty-six patients (54% male, median age 54) participated. Sixty-five percent had stage III disease, and 88% received neoadjuvant therapy. MAIN OUTCOME MEASURES: Interviews examined preoperative expectations, overall experience, and stoma impact on quality of life. With the use of grounded theory, 2 investigators independently performed line-by-line content analysis to identify key themes. Analysis continued until data saturation. RESULTS: Two major themes were identified: stoma-related difficulties and perceived response shift. Patients reported difficulty in exercise, sleep, social activities, sexuality, and clothing. Patients' perception of quality of life with a temporary stoma appears to have undergone a response shift through recalibration of their standards for measuring quality of life (internal measurement scale altered by side effects of neoadjuvant/adjuvant treatment, temporary nature of stoma, and accommodation to stoma) and reconceptualization of what "good quality of life" is (stoma difficulties were felt to be less important in comparison with cancer-related mortality). LIMITATIONS: Although qualitative research is, by design, not generalizable, these data support our previous quantitative work. This convergence of findings suggests that our data may be representative. CONCLUSIONS: A temporary ileostomy represents significant difficulties for patients with rectal cancer. However, because of response shift, these difficulties may not be perceived as important to overall quality of life when considered within the context of the cancer experience. Our results can inform preoperative consultations with patients who have rectal cancer to assist in aligning patient expectations of what life with a temporary ileostomy may be like.

Rituais e símbolos na atenção formal à saúde: o caso do vestuário profissional, na ótica de pacientes da Atenção Básica / Rituals and symbols in the formal health care: the case of professional clothing, from the viewpoint of primary care patients

Este trabalho teve como objetivo analisar e interpretar as reflexões e experiências de usuários frequentadores do serviço de Atenção Primária à Saúde / Unidades de Saúde da Família (USF) sobre o uso do jaleco branco ou roupas brancas por médicos e outros profissionais de saúde. O método utilizado foi o de entrevistas individuais com questões abertas, em profundidade, com usuários de USF, transcritas integralmente e analisadas quanto ao conteúdo e enunciados. A amostra foi fechada por saturação teórica. Como resultado, identificou-se nas 11 entrevistas uma marcante assimetria sociocultural e psicológica como pano de fundo dos três núcleos de sentido identificados: vestuário como marca identitária; vestuário não valorizado como símbolo de competência profissional e vestuário interferindo, positiva ou negativamente, nas relações entre clínicos e pacientes. Discutem-se a premência à simbolização na área da saúde, as dificuldades dos participantes em discorrer sobre o tema e sobre o porquê da emergência de possíveis novos símbolos de competência. Finalmente, concluiu-se que compreender os significados atribuídos pelos usuários dos sistemas de saúde aos atos e práticas realizados por seus cuidadores pode contribuir para o aperfeiçoamento progressivo dessas práticas formais de cuidado. Embora as funções ritualísticas dos comportamentos e objetos utilizados nos atos de cuidado à saúde sejam mais facilmente observadas nas chamadas práticas informais e populares, elas persistem nas maneiras formais ou profissionais de agir. Esse tipo de fenômeno se deu após a emergência da medicina científica moderna, com o jaleco branco, por exemplo, e ainda se dá, na atualidade, embora novos símbolos pareçam surgir e ocupar esse espaço ritualístico.

This study aimed to analyze and interpret the thoughts and experiences of service users attending Primary Care / Family Health Units (FHU) on the use of white coat or white clothes by physicians and other health professionals. The method used was interviews with open questions, in depth, with users of FHU, transcribed and analyzed for content and statements. The sample was closed by theoretical saturation. As a result, eleven interviews were identified in a marked asymmetry and psychological and socio-cultural background of the three identified clusters of meaning: clothing as a mark of identity; clothing is not valued as a symbol of professional competence and clothing interferes, positively or negatively, in relations between clinicians and patients. We discuss the urgency of symbolization in health, the difficulties of the participants discuss the topic and why the emergence of possible new symbols of power. Finally, it was concluded that understanding the meanings assigned by users of health systems to the acts and practices carried out by their caregivers may contribute to the progressive refinement of these formal practices of care. Although the functions of ritualistic behaviors and objects used in acts of health care are more easily observed in so-called informal and popular practices, they persist in formal or professional ways of acting. This type of phenomenon occurred after the emergence of modern scientific medicine, with the white coat, for example, and remains at present, although new symbols appear to arise and occupy this ritual space.