Patients with cancer transitioning from completing their final cancer treatments to survivorship are particularly at risk for experiencing psychosocial stress, and the Institute of Medicine (IOM) has referred to these cancer patients as “lost in transition.” In this study, patients with cancer in their transition phase after completing their final radiation treatment were defined as cancer survivors (CS). CS must deal with chronic stressors such as the fear of cancer recurrence as well as the resumption of their roles in their family and work lives. Chronic stress impacts the nervous system and increases secretion of stress hormones (e.g. cortisol) from the endocrine system, which in turn influences immune function. These systems are particularly relevant for CS since research has shown associations between abnormal cortisol patterns and increased mortality in breast CS and immune dysfunction in CS can increase susceptibility to infections. The theoretical framework of psychoneuroimmunology (PNI), which describes the interactions between the psychosocial, neuroendocrine and immune systems, guided the choice of outcomes for this study. The IOM has identified a lack of theory-driven interventions for managing psychosocial stress in CS. We reviewed the literature and identified two major types of PNI-based psychosocial interventions for cancer patients, namely cognitive-behavioral and complementary medical. One promising brief and inexpensive psychosocial intervention was expressive writing, which involved participants disclosing their deepest thoughts and feelings regarding their cancer in four 20-30 minute writing sessions over four consecutive days. We conducted a two-arm randomized controlled trial to determine the efficacy of an online expressive writing (EW) intervention delivered to CS who were 2-12 months post-radiation treatment completion. The results of this study revealed that EW was effective in regulating stress in our sample of CS over a period of six weeks as measured by lowered salivary cortisol levels and lowered self-reported fear of cancer recurrence. Online EW is a low-cost and convenient approach for delivering stress-management interventions for CS during survivorship. However, coordinated efforts are needed from health researchers, professionals and policy makers to define standardized approaches for testing psychosocial interventions and using PNI biomarkers to help develop evidence-based psychosocial cancer-care for CS during survivorship.

Qualitative phenomenological methodology was used to explore the lived experiences of African American women diagnosed with breast cancer. Phenomenology focuses on the meaning of the lived experiences of individuals experiencing a concept, structure, or phenomenon (Creswell, 2007). The purpose of phenomenological research is to identify phenomena as perceived by the individual. Utilizing an existential perspective, the focus of this study was to uncover meaning which defined the essence of the participants’ experiences. Seven African American women diagnosed with breast cancer participated in this study. The participants’ ages ranged from 33-63 years. A semi-structured interview process with open-ended questions was utilized to gain an understanding of the participants’ personal experiences related to the phenomenon. Data was analyzed using Interpretative Phenomenological Analysis (Smith, 2004) to ascertain emergent themes and to interpret the meaning of the participants’ breast cancer experience. Seven common themes emerged from the cases. Those themes included: spirituality; support systems; self-care; resiliency; existential meaning; education; and perception of counseling. These seven themes will help to provide insight into how counselors can help to facilitate emotional wellness within this particular population. Implications and recommendations for counselor educators, counselors, and counselors-in-training with this population are also addressed.

This study examined the lived experiences of adult children of mid-later life parental divorce. It was designed and conducted to address the gap in the current literature regarding this phenomenon. The experiences of 5 Adult Children of Divorce (ACD) ages 25 to 45, who experienced mid-later life parental divorce, were examined using in-depth semi-structured interviews. The researcher employed an interpretive phenomenological analysis (IPA) of which the findings illustrated various outcomes for adults experiencing their parents’ mid-later life divorce. The results of this study showed that parents’ waiting until the children are “grown” does not mitigate potentially detrimental outcomes for these “adult children.” Some of these concerns shared by the ACDs interviewed included: dealing with the shock of the divorce, the acrimonious parental relationships post divorce, feeling the need to choose sides, effects of the divorce on the ACDs' children, among others. Future studies and implications for the field of marriage and family therapy were offered.

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Made available in DSpace on 2016-04-25T16:44:41Z (GMT). No. of bitstreams: 1 Rosania Nascimento Pereira.pdf: 2711948 bytes, checksum: 5c1b840d79102ba92f01dda7cae403ed (MD5) Previous issue date: 2014-10-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Part of the Reform Plan of the State's strategy was to transfer at the end of the 90s, to the non public sector producing services such as health, education and culture, seeking to promote greater efficiency and quality services. A key strategy was the creation of social organizations (OS). Since 1998, the State Health Department of São Paulo (SES) transferred the management of hospitals to these organizations through management contracts that discriminated objectives and targets to be achieved for the production of health services. Due to the fact that it was the management of public money, the corporate governance issue was relevant to public administration. The research evaluates the governance in the social organization of health SPDM - Association for the Development of Medicine as the criteria for accountability (account responsibility) and transparency through the analysis of existing, contracts and reports that regulate OSS legislation. The research results show that the criteria for accountability and transparency - important to ensure good governance in the public sector elements - according to the literature examined were not achieved considering that: the government of Sao Paulo is the main buyer, payer and performance controller of these organizations; in compliance with the time limits due to law enforcement for accountability; the quality of information of the S.E.S. to the departments of external control and the difficulty of access to information for stakeholders / Parte da estratégia do Plano Diretor da Reforma do Estado foi transferir, no final da década de 90, para o setor público não estatal a produção de serviços tais como saúde, educação e cultura, procurando promover maior eficiência e qualidade dos serviços. Uma das principais estratégias foi a criação das organizações sociais de saúde (OSS). A partir de 1998, a Secretaria de Estado de Saúde de São Paulo (SES) tem repassado a gestão de hospitais para essas organizações mediante contrato de gestão que discrimina objetivos e metas para a produção de serviços de saúde. Por se tratar da gestão do dinheiro público, o tema governança corporativa é relevante para a administração pública. A pesquisa avalia a governança na organização social de saúde SPDM - Associação para o Desenvolvimento da Medicina - quanto aos critérios de accountability (responsabilidade em prestar conta) e transparência por meio da análise da legislação vigente, contratos e relatórios que regulam as OSS. Os resultados da pesquisa demonstram que os critérios de accountability e transparência - elementos importantes para garantir uma boa governança no setor público , de acordo com a literatura examinada, ainda não foram alcançados tendo em vista que o governo de São Paulo é o principal comprador, pagador e controlador do desempenho dessas organizações; que há necessidade do cumprimento dos prazos previstos na lei para prestação de contas; que a qualidade das informações pela S.E.S. junto aos órgãos de controle externo é primordial, e que há dificuldade de acesso às informações para os stakeholders

Orientador: Abílio da Costa-Rosa / Banca: Cristina Amélia Luzio / Banca: Rosana Onocko Campos / Resumo: A história da construção da Reforma Psiquiátrica no Brasil elucida o processo de implantação dos serviços extra-hospitalares, substitutivos ao modelo hospitalocêntrico. A presente pesquisa realizou um levantamento de iniciativas das gestões municipais e estadual no interior do Estado de São Paulo, objetivando visualizar a implantação e construção dos programas de Saúde Mental, propiciando dados que permitem analisar a matiz das possíveis mudanças paradigmáticas, levando em conta também que este lócus necessitava de uma leitura sistematizada de suas transformações e possíveis contribuições à Reforma Psiquiátrica no Brasil. O estudo teve como balizador as diretrizes preconizadas nas Conferências Nacionais de Saúde Mental e portarias ministeriais refletidas nas experiências e práticas do interior do Estado de São Paulo, analisadas em referência aos paradigmas Psiquiátricos e Psicossocial (Amarante, 1966 e Costa-Rosa, 2000). Foi possível verificar que a Reforma Psiquiátrica encontrada, tanto nos discursos dos gestores municipais quanto nos dados quantitativos, referentes à natureza dos dispositivos implantados, evidencia uma compreensão do processo de transformação, num sentido amplo do termo Reforma, mais próximo do modelo preventivo-comunitário, do que do ponto de vista de um movimento substitutivo das práticas hospitalocêntricas, quando consideramos como parâmetro de análise o Paradigma Psicossocial. O banco de dados possibilitará o desenvolvimento de futuras pesquisas sobre as mudanças do setor de Saúde Mental no interior do Estado de São Paulo, bem como a análise de outras vicissitudes presentes no processo de construção das práticas substitutivas ao Paradigma Psiquiátrico (hospitalocêntrico e asilar), neste contexto. / Abstract: In Brazil, the process of implementation of out-of-hospital services is explained by the evolvement of the Psychiatric Reform that replaced the hospital-centered model. This study surveyed the actions of municipal and state governments in the area of mental health in the countryside of Sao Paulo State, Brazil. This paper aims at pointing out the implementation and the planning process of such Mental Health Programs while providing data to allow a deeper analysis of the generating factors of changes and pinpointing contributing factors to the Psychiatric Reform in Brazil. This study took into account the guidelines proposed by the National Conferences on Mental Health and government decrees reflecting the practices and experience in the countryside of Sao Paulo State analyzed from the psychiatric and psychosocial paradigm standpoint (Amarante, 1966 & Costa Rosa 2000). It was possible to conclude that the headways of the Psychiatric Reform in Brazil found in municipal managing policies and confirmed by quantitative data shows a better understanding of the transformation process leading to the proposal of a model which is closer to community prevention rather than a replacement for the hospital-centered practice. The databank may allow both further research work on the changes occurred in the area of Mental Health in the countryside of Sao Paulo State and further analysis of other issues involved in the process of constructing of new practices to replace the Psychiatric Paradigm (hospital-centered or asylum) / Mestre

There is limited data on the quality of life of individuals who exercise in a group versus individuals who exercise alone. The purpose of this study was to determine if there is a difference in the quality life between adults who attend an exercise class and those who exercise alone. Using the WHOQOL-BREF, 27 adult females were surveyed in Central California at two Church of Latter Day Saints locations. Ten females were enrolled in a group exercise class while 17 were individual exercisers. The data was analyzed using a t-test for independent samples to determine if there is a significant difference in scores. There was not a significant difference in overall quality of life, environmental domain, and physical domain, but there was a significant difference in the psychological and social domains. Further research is recommended and benefits are detailed.

The empirical study of the salutary relationship between spirituality/religiousness and psychological well-being is burgeoning. However, mechanisms of this association have received less empirical attention. Theory suggests that spirituality/religiousness may lead to positive psychological characteristics such as hope, which may function as a means of coping in the context of a significant stressor or stressful situation. The perceived burden and stress associated with caring for individuals with chronic illnesses such as ALS is significant, and caregivers may be at risk for increased symptoms of depression, symptoms of anxiety, somatic symptoms, and other deleterious psychological well-being related outcomes. Within the context of ALS caregiving, spirituality/religiousness may lead to hope and less perceived stress, ultimately contributing to increased caregiver psychological well-being. Cross-sectional mediation-based analyses were conducted on data collected from a sample of 85 ALS caregivers throughout the U.S., The Netherlands, and Belgium. Participants were 78.8% female, 92.9% Caucasian, 48.2%, spent over 100 hours per week caregiving, and the average age was 55.2 years. Ritualistic spirituality was not related to psychological well-being in ALS caregivers in a direct or indirect fashion. Theistic spirituality was directly, positively related to psychological well-being in ALS caregivers. Existential spirituality was directly related to psychological well-being, but in a deleterious fashion. However, when hope and perceived stress were considered as mediators within the model, the effect changed such that existential spirituality contributed salutarily to psychological well-being when operating though hope alone and also in conjunction with perceived stress. This study may be the first of its kind to explicitly model spirituality and psychological well-being in ALS caregivers, thus more research to investigate the caregiving process, barriers, promotion, and means of coping is warranted.

This project was designed to determine if significant differences existed between the level of psychological differentiation, as determined by the Group Embedded Figures Test (GEFT), of individuals entering a treatment center for chemical dependency and the length of stay at the facility. The subjects consisted of 43 white males who were seeking treatment for addiction to mood altering chemicals at a regional treatment facility in Bowling Green, Kentucky. Each subject was interviewed to collect pertinent background information pertaining to past substance abuse and was evaluated to determine psychological differentiation, utilizing the GEFT. It was determined through an analysis of variance that significant differences did not exist between individuals classified as Field Dependent or Field Independent, relative to length of stay. A post hoc analysis determined that significant differences did exist between those individuals who were categorized as Unclassified (not consistently Field Dependent or consistently Field Independent) and those categorized as Field Dependent and Field Independent.

The purpose of this study was to determine the effect of a single-session group music therapy songwriting session on grief processing in hospice clinicians. The study design was quasi-experimental. Participants were cluster randomized into a control group and a treatment group. The researcher led a 50-minute songwriting session focused on sharing and processing experiences of grief-related stress and burnout in hospice work. Grief processing was measured using a self-report survey for n=25. Overall differences between control and treatment groups were not found to be statistically significant. Significant differences were also not found in treatment score differences for type of hospice clinician or years of experience. For future research with hospice clinicians, a new measurement tool should be developed that is more specific to measuring an actual difference before and after a treatment. The current measurement tool is best used as an inventory for stress and grief levels that result from caregiving. Any new measurement tool should be kept under twenty questions. A single-session, though convenient for busy hospice clinicians, may not provide a complete treatment for grief and stress. Further research with hospice clinicians may require several treatment sessions to achieve a more complete grief processing experience.