Thesis (Ph. D.)--West Virginia University, 2006. / Title from document title page. Document formatted into pages; contains xii, 128 p. Includes abstract. Includes bibliographical references (p. 75-84).

Thesis (Ph.D.)--University of Iowa, 2006. / Supervisor: David Watson. Includes bibliographical references (leaves 102-115).

Proefschrift Maastricht. / Met lit. opg. - Met een samenvatting in het Nederlands.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 84-95). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 100-118). Also available on the Internet.

Cette recherche porte sur la question de la mort, et de ses effets dans la pratique clinique pour un psychologue clinicien orientée par la psychanalyse. Il en découle la reprise de la question de la mort dans les œuvres de Sigmund Freud, de Jacques Lacan, et d’autres auteurs, et une critique possible du concept de pulsion de mort. Par là même, la mort se donne à entendre comme intimement liée à la question du désir. Le lien social postmoderne marquant une tendance à clore parallèlement ces deux dimensions, la question du discours qui le sous-tend en tant qu’il ne s’écrit pas, peut s’associer au passage d’un sujet s’organisant autour du fantasme, à un sujet s’organisant autour de l’image, ce qui souligne la différence à opérer entre image et imaginaire. Il en découle pour l’auteur, la remise à plat des trois questions qui l’interrogent le plus dans sa clinique : ce qu’il doit en être du désir du clinicien pour opérer des cures par la parole, ainsi que la mise en jeu de l’angoisse et du transfert dans ce type d’accompagnement thérapeutique. / This research is about the question of death, and her effects in the clinical practice of the psychologist clinician directed by the psychoanalysis. It ensues from it the resumption of the question of the death in the works of Sigmund Freud, Jacques Lacan, and other authors, and a possible criticism of the concept of death drive. Thereby, the death suggests as confidentially connected to the question of the desire. The postmodern social link marking a tendency to close at the same time these two dimensions, the question of the speech which underlies it as it does not spell, can join to the passage of a subject getting organized around the fantasy, to a subject getting organized around image, what underlines the difference to be operated between image and imagination. It ensues from it for the author, the thorough review of three questions who question him most in clinical : that he has to be the desire of the clinician there to operate for cure by the words, as well as the involvement of the anxiety and for the transfer in this type of therapeutic support.

Background: The aims of this qualitative research were to explore a range of challenges encountered by mothers coping with infant sleep difficulties, and subsequent impacts on the transition to becoming a parent. The intention was twofold – to raise awareness amongst practitioner psychologists that “many new mothers experience some level of emotional distress and all deserve systematic and compassionate support” (Boots Family Trust, p.1), with particular reference to early relationship formation, and to encourage opportunities for translation from multidisciplinary research into practice. Method: Five semi-structured interviews were conducted. Four with mothers who were either experiencing, or had in the past experienced sleep difficulties with their babies. The fifth was with a professional ante-natal educator, herself a mother. The interviews were transcribed and analysed according to a constructivist version of grounded theory methodology guided by Charmaz (2006). Analysis: A central narrative of ‘the wearing mask of transition’ was developed from four analytic categories: being me’, ‘being pushed to the limit’, ‘relationships’ and ‘coping, learning and trusting’. The interconnectedness of the categories was conveyed via the visual translation of the proposed pluralistic model – ‘the coping mask of transition’. Conclusion: After having been neglected within mainstream mental health services, perinatal mental wellbeing is currently being prioritised, representing a unique opportunity for multidisciplinary consultation and sharing of expertise and training. The ‘normal’ experiences of the women interviewed were revealed as emotionally complex. They worked through their sleep deprivation and distress feeling largely unsupported, and often unwilling to disclose even to partners the extent of their difficulties. It is hoped that this small-scale study, with its focus on a non-clinical population, and the significance of maternal mental and emotional wellbeing and outcomes for children, will encourage professionals to consider the distressing impacts of ‘normal’ sleep disturbance and deprivation within the broader context of this major life transition.

Midwives experience both occupational and organisation episodes of work-related psychologicl distress. As the wellbeing of health professionals is linked with the safety and quality of care, these episodes of distress should be met with adequate support. Midwives can be reluctant to speak openly about episodes of work-related distress. Additionally, they may not be able, or prefer not to access, face-to-face support. As such, an online intervention may be one option that midwives turn to when seeking support, as it can provide confidential and flexible access to support. This research makes a case for the development of an online interevention, designed to effectively support midwives in work-related psychological distress. Firstly, a narrative literature review integrates contemporary research to build an overview of the nature, prevalence, and origin, of work-related psychological distress in midwifery populations. A critical literature review then explores some of the ethical considerations in relation to providing midwives with anonymous and confidential online support. This review concludes that the provision of anonymity and confidentiality online would ensure the greatest benefit overall to the greatest number of people using and working within maternity services. A systematic mixed-methods literature review then concludes that there are currently very few targeted interventions designed to support midwives in work-related distress, none of which are currently delivered online. Moreover, this review identifies insufficient high-quality research to comprehensively understand which particular interventions or techniques could deliver effective support to midwives in work-related psychological distress. Lastly, a multi-stakeholder Delphi study is presented to establish consensus in relation to the content development, design and delivery of an online intervention to support midwives and/or student midwives in work-related psychological distress. In this case, an expert panel prioritised confidentiality and anonymity, along with 24-hour mobile access, effective moderation, an online discussion forum, and additional legal, educational, and therapeutic components. Consensus also supported the inclusion of a simple user assessment to identify people at risk of either causing harm to others or experiencing harm themselves, in order to direct them to appropriate support. The impact of any future intervention of this type will be optimised by utilising the findings from this Delphi study throughout the intervention development process. Furthermore, as the ethical, practical and evidence based arguments for the development of an online intervention designed to support midwives in work-related psychological distress have now been formed, it will be important to build and rigorously test this intervention in response to the identified gaps in research. This thesis demonstrates that there is a case for the development of an online intervention designed to support midwives in work-related psychological distress. Future research will require feasibility studies, pilot studies and adequately powered randomised controlled trials in order to sercure the evidence base for any new online support for this professional population.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Educação Física, Programa de Pós-Graduação em Educação Física, 2016. / Submitted by Fernanda Percia França (fernandafranca@bce.unb.br) on 2016-12-08T15:12:39Z No. of bitstreams: 1 2016_LorenaCruzResende.pdf: 1412995 bytes, checksum: 240ef8e9a449e45aee29dd40aa598d93 (MD5) / Approved for entry into archive by Raquel Viana(raquelviana@bce.unb.br) on 2017-01-06T20:19:53Z (GMT) No. of bitstreams: 1 2016_LorenaCruzResende.pdf: 1412995 bytes, checksum: 240ef8e9a449e45aee29dd40aa598d93 (MD5) / Made available in DSpace on 2017-01-06T20:19:53Z (GMT). No. of bitstreams: 1 2016_LorenaCruzResende.pdf: 1412995 bytes, checksum: 240ef8e9a449e45aee29dd40aa598d93 (MD5) / Resumo: Linfoma de Hodgkin é um câncer hematológico que atinge o sistema linfático, os tratamentos que o combatem são citotóxicos e trazem efeitos colaterais pontuais e tardios que podem alterar a composição corporal, níveis de força e tecido muscular, e essas alterações estariam associadas à fadiga oncológica e ao distresse psicológico ao sobrevivente desta doença. Estas alterações levariam o sobrevivente a um pior prognóstico e à uma pior qualidade de vida em sua sobrevida. Objetivo: Verificar associações da composição corporal e do pico de torque com as variáveis fadiga e distress psicológico em sobreviventes de LH e compará-las a pessoas aparentemente saudáveis. Materiais e Métodos: 12 sobreviventes de linfoma de Hodgkin (GL: 31,75 ± 7,99 anos), que concluíram o tratamento há mais de seis meses e 79 indivíduos aparentemente saudáveis como grupo controle (GC: 31,48 ± 8,02 anos) foram submetidos a avaliação subjetiva de fadiga (IMF-20), distress psicológico, análise da composição corporal e mensuração do pico de torque isocinético da extensão de joelho a 60º.s-1. Média e desvio padrão das variáveis foram feitas para estatística descritiva, enquanto a comparação das variáveis entre os dois grupos foi feita através do teste T de student para amostras independentes – que apresentaram normalidade – e teste Wilcoxon-Mann-Whitney para amostras que não apresentarem distribuição normal. Sendo assim, para as variáveis que apresentaram normalidade, a correlação foi feita usando teste de Pearson (r), enquanto as variáveis não-paramétricas foram correlacionadas através do teste de Spearman O cálculo do tamanho do efeito das estatísticas descritivas foi obtido através do teste de Cohen (d). Resultados: Apenas o percentual de gordura, fadiga geral e fadiga mental foram significativamente maiores no GL. Houve correlações significativas para o GL nas variáveis pico de torque absoluto e relativo com a composição corporal, distress psicológico e fadiga. Conclusão: Os resultados desse estudo confirmam que os sobreviventes de LH possuem maior percentual de gordura, maiores níveis de fadiga e maior distresse psicológico que o GC; possuem uma frequência maior de preocupações com problemas de ordem de saúde e do cotidiano. No entanto, um maior percentual de gordura parece não se associar com os índices de fadiga e distresse relatados pelo GL, seus os níveis de força parecem ser apenas parcialmente associados aos domínios da fadiga, porém, estão negativamente relacionados ao percentual de gordura. __________________________________________________________________________________________________ ABSTRACT / Hodgkin's Lymphoma is a hematological cancer that affects the lymphatic system, its treatments are cytotoxic and bring punctual and late side effects that can alter body composition, strength levels and muscle tissue, and these changes would be associated with cancer fatigue and psychological distress to cancer survivors. These changes would lead to a worse prognosis and a worse quality of life. Objective: To verify associations of body composition and peak torque with the variables fatigue and psychological distress in LH survivors and compare them to apparently healthy people. Methods: 12 Hodgkin's lymphoma survivors (GL: 31.75 ± 7.99 years), who have completed treatment for more than six months and 79 apparently healthy individuals as a control group (CG: 31.48 ± 8.02 years) underwent subjective assessment of fatigue (MFI-20), psychological distress, body composition analysis and measurement of peak torque isokinetic knee extension to 60º s-1. Mean and standard deviation were made with descriptive statistics, while the comparison of the variables between the two groups was performed using the Student's T test for independent samples and Wilcoxon T test for samples that do not show normal distribution. Thus, correlations were performed using the Pearson test (r), while non-parametric variables were correlated using the Spearman test The calculation of the effect size of descriptive statistics were obtained through the Cohen‘s test (d). Results: Only fat percentage, general fatigue and mental fatigue were significantly higher in the GL. There were significant correlations for the GL in absolute and relative torque peaks variables to body composition, psychological distress and fatigue. Conclusion: Results of this study confirm that LH survivors have a higher fat percentage, higher levels of fatigue and greater psychological distress than the GC; They have a higher frequency of concerns about their health and daily life activities. However, a higher percentage of fat does not seem to be associated with fatigue indices and distress reported by GL, their strength levels seem to be only partially associated with the areas of fatigue, however, are negatively related to the percentage of fat.

O presente estudo teve por objetivo examinar a relação entre dor em crianças enfermas e hospitalizadas e a percepção materna sobre a dor, a qualidade de vida da criança e indicadores psicológicos da mãe e da criança. A amostra foi composta por 30 crianças de seis a 12 anos internadas na Enfermaria Pediátrica e suas mães. Os instrumentos utilizados foram: Escala de Faces Revisada e Escala de Stress Infantil com as crianças e Escala de Faces Revisada, Inventário de Sintomas de Stress para Adultos de Lipp, Escala de Modos de Enfrentamento de Problemas e Questionário de Qualidade de Vida relacionado à Saúde com as mães, Roteiros de Caracterização da Criança e Socioeconômica. Os dados foram submetidos à análise de estatística descritiva, à análise de relação entre variáveis por meio do teste de correlação de Pearson, do teste de Qui-quadrado e do teste de Mann-Whitney. Foram examinados os modelos de predição por meio da análise de regressão linear múltipla, tendo a variável predita qualidade de vida da criança e as variáveis preditoras estresse infantil e enfrentamento de problemas materno. Em relação à dor, quanto maior a intensidade de dor avaliada pela criança, maior era o estresse e as reações fisiológicas e psicológicas das crianças. Em relação ao estresse materno, as mães com estresse apresentaram maiores escores nos modos de enfrentamento focalizados na emoção. Em relação à qualidade de vida, quanto mais estresse na criança e quanto mais respondia com reações físicas e psicológicas ao estresse, menor a qualidade de vida relacionada à capacidade física, à dor e desconforto corporal e menor a qualidade de vida física. Quanto maior a intensidade da dor avaliada pela criança menor o índice de qualidade de vida relacionada a capacidade física. Quanto menores os índices de qualidade de vida dos itens relacionados à qualidade de vida física, capacidade física e a limitação social devido à saúde física, maiores eram os enfrentamentos baseados na busca de práticas religiosas e pensamentos fantasiosos nas mães. Quanto menor a qualidade de vida relacionada à dor e desconforto corporal, maior era o enfrentamento das mães focalizado na emoção. As análises de predição identificaram os seguintes modelos para a qualidade de vida: (a) o pior índice de qualidade de vida física associou-se a maiores índices de enfrentamento baseado na busca de práticas religiosas e pensamentos fantasiosos e a maiores valores de estresse infantil, reações físicas e reações psicológicas ao estresse; (b) maiores valores de reações físicas e psicológicas ao estresse e maiores valores de enfrentamento baseado na busca de práticas religiosas e pensamentos fantasiosos relacionavam-se significativamente com pior índice de qualidade de vida relacionada à capacidade física; (c) pior qualidade de vida relacionada à dor e desconforto corporal relacionou-se a maiores valores de enfrentamento focalizado na emoção e maiores índices de reações psicológicas ao estresse. O suporte psicológico, a fim de assegurar melhor qualidade de vida de crianças hospitalizadas, deve considerar os aspectos relacionados à dor, desconforto e estresse experimentados pela criança e os modos de enfrentamento do estresse materno. / The aim of this study was to examine the relationship among the pain in hospitalized and unwell children, the maternal perception of pain, childrens quality of life, and the psychological indicators of both mother and child. The work studied a sample of 30 children with ages ranging from 6 to 12, who were admitted in a pediatric infirmary accompanied by their mothers. The instruments used in this study were: Faces Pain Scale-Revised and Children Distress Scale with children and Faces Pain Scale-Revised, Inventory of Distress Symptoms- Lipp, Modes of Coping Scale and Child Health Questionnaire with mothers, questionnaires of both socioeconomic and the childrens characteristics. The data were analyzed using descriptive statistics, such as the analysis of the relationship between variables using the Pearson Correlation Test, the Chi-square and Mann-Whitney methods. Furthermore, this study examined the prediction models through multiple regression analysis. The predicted variable was the children quality of life, and the prediction variables used were children distress and the coping of the mothers. The results regarding the pain showed that the high intensity of the pain felt by the children was associated with the increasing distress, and physiological and psychological reactions of the children. With regards the maternal distress, results showed that the mothers who presented stress tend to cope more focalized in emotions. Results also reported that in terms of quality of life, children with higher level of distress and more physical and psychological reactions towards distress were more associated with both lower quality of life and lower physical capacity, as well as pain and body discomfort. Therefore, the more intensity of the pain the lower the physical capacity of quality of life. Results also showed that the lower physical quality of life, physical and social limitations was more associated with mothers coping based on the search for religious practices and hopeful thinking. On the other hand, lower quality of life related to pain and body discomfort was more associated to mothers coping based on emotions. In summary, this study identified the following prediction models for quality of life: (a) the lower score on physical quality of life was associated with higher levels of mothers coping based on religious practices and hopeful believes, and higher level of children distress and their physical and psychological reactions to distress; (b) higher values of physical and psychological reactions to children distress, and mother coping based on religious practices and hopeful believes was significantly related to lower score on quality of life related to physical capacity; (c) lower score on quality of life related to pain and body discomfort was more associated to higher values of mother coping based on emotions, and higher levels of children psychological reactions to distress. The authors concluded that in order to ensure better quality of life of hospitalized children, the psychological support must consider the aspects related to pain, discomfort, and the distress experienced by the children and the way mothers cope with distress.