The aims of this thesis were to increase the knowledge about the long-term psychological consequences in parents of children diagnosed with cancer, including parents of childhood cancer survivors (CCSs) and bereaved parents, and to take the first steps towards developing a psychological treatment for parents of CCSs. Study I was a systematic review synthesizing the literature on psychological long-term consequences in parents of CCSs. Study II had a longitudinal design assessing posttraumatic stress symptoms (PTSS) from shortly after the child’s diagnosis (T1, N=259) up to five years after end of the child’s treatment or death (T7, n=169). Study I and II concluded that while most parents show resilience in the long-term, a subgroup report high levels of general distress and/or PTSS. In Study III, interview data from the last assessment in the longitudinal project (T7, n=168) was used. Participants described particularly negative and/or positive experiences in relation to their child’s cancer, and results pointed to the wide range of such experiences involved in parenting a child with cancer. In Study IV and V, parents of CCSs reporting cancer-related psychological distress were included (N=15). In Study IV, a conceptualization of this distress was generated by aggregation of individual behavioral case formulations. The conceptualization consisted of two separate but overlapping paths describing development and maintenance of symptoms of traumatic stress and depressive symptoms. In Study V, cognitive behavior therapy (CBT) based on the individual case formulations were preliminarily evaluated in an open trial. The CBT appeared feasible, and at post-assessment participants reported significant decreases in PTSS (p<.001), depression (p<.001), and anxiety (p<.01) with medium to large effect sizes (Cohen’s d=0.65-0.92). Findings indicate that psychological long-term consequences in parents of children with cancer consist of a broad range of negative as well as positive experiences, and that while most parents show resilience in the long-term, a subgroup report high levels of psychological distress. For parents of CCSs this distress is suggested to primarily consist of symptoms of traumatic stress and depression, and a preliminary evaluation of CBT targeting hypothesized maintaining mechanisms showed promise in terms of feasibility and treatment effect. / Behandling av traumatisk stress hos föräldrar till cancerdrabbade barn med kognitiv beteendeterapi via internet / Förekomst, utveckling och behandling av posttraumatiskt stressymptom hos föräldrar till barn med cancer / Utveckling och utvärdering av ett webbaserat psykologiskt självhjälpsprogram för föräldrar till barn som tidigare behandlats mot cancer

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Survivors' pensions In my thesis I concerned myself with the issue of survivors' pensions, because it is a topic, which is topical at all times and it can affect anyone of us. My aim was to present a comprehensive overview, this is why I tried to handle the topic not only in terms of the current legal regulations, but also to describe the historical development of survivors' pensions, and to point out the changes, that have already been carried out in relation to the pension reform and which are planned for the future. The first chapter is devoted to the historical development of the survivors' benefits from the period of the First Czechoslovak Republic to the 1990s. I mentioned all the important laws and how the listing of the provided survivors' pensions and the conditions which entitle a person to the pension changed over the years. In the next chapter I name the current sources of law concerning the pension insurance, especially three main legal acts, from which I mostly derived the information while writing this thesis, but also the constitutional basis, significant international treaties concerning pensions and the sources of the European Union law. In the third chapter I concerned myself with the explanation of the terms, which often appear in the following chapters of my thesis, because they are...

130 Abstrakt v anglickém jazyce We comprehend the coordination of social security systems as an interconnection of social security systems of Member States therefore the free movement of persons can be carried out. The aim of Coordinating Regulations is to ensure that a migrant does not loose his/her claims on social rights due to his/her enjoyment of free movement. Concerning the large extent of this topic the thesis is focusing only on old-age and survivors' pensions according to valid Regulations (EC) No 883/2004 and No 987/2009 of the European Parliament and of the Council which entered into force on 1 May 2010. The preliminary chapter out of five at total generally presents the nature of the Coordinating Regulations. It clears up their development and aims. It further introduces other sources of coordination law and explains their relations with other sources of EU law and international law. The determination of personal and material scope of Coordinating Regulations is the indispensable part of this chapter as well. The second chapter highlights the cardinal importance of basic principles of Coordinating Regulations - the principle of equal treatment, the principle of single applicable legislation, the principle of aggregation of periods, the principle of export of benefits and the principle of good...

Doctor of Philosophy / Department of Family Studies and Human Services / Karen S. Myers-Bowman / The current study was conducted with women survivors of childhood sexual abuse (CSA) about their experiences of resilience in the context of interpersonal and sexually intimate relationships. Six women between the ages of 18 and 55, who self-identified as resilient on the pre-screening form, were invited to participate in the study. Qualitative methods with a phenomenological lens were employed. One-on-one interviews were conducted with participants. The results revealed the perspective and focus the survivors have regarding resilience and sexuality in interpersonal relationships. The participants had very similar thought patterns, which supports the idea that women survivors who self-identify as resilient have very similar experiences when it comes to resilience, relationship functioning and the view of themselves as sexual beings. Some of the main themes that emerged included but were not limited to bouncing back, moving forward, determination, confidence, use of voice, safe, loving relationships, empowered, church, God, religion, etc. Although each woman’s experience is not exactly the same, their views regarding their mental, emotional, and physical experiences as survivors of CSA were very similar.

Youth traumatized by natural disasters report high levels of posttraumatic stress as well as other types of impairing emotional distress symptoms (e.g., anxiety and depression) for many years post-trauma. Implementing school based screening and treatment programs for these youth eliminates barriers to traditional treatment settings and may provide symptom relief. The current study examines the feasibility of conducting school-based trauma-focused treatment program in the wake of disaster. Idiographic evaluation of the treatment process is incorporated into the treatment evaluation through use of multiple baseline design. Youth reporting at least severe levels of posttraumatic stress on the PTSD-RI were recruited for an expanded assessment and treatment (youth ages 8-13; N=6). Treatment (i.e., the StArT program) consisted of 10-weekly individual sessions during which different cognitive behavioral components were introduced. Youth were assessed at pre-treatment, weekly during treatment, and at post-treatment. Quantitative and qualitative findings relative to youth responses to intervention are presented and discussed in terms of the feasibility of conducting treatment in school settings and in terms of individual difference factors contributing to treatment responses. Findings from this study suggest the feasibility of school based interventions through the aid of school counselors and integration of treatment sessions into the school schedule. Youth responses to the intervention were very positive, point toward the efficacy of a disaster trauma focused cognitive behavioral therapy (the StArT program), and help to highlight particularly useful modules in youth.

Societal discourses and rigid gender norms, tenaciously reinforced by media representations, prevent men from being recognized as survivors of sexual violence (Gulas, McKeage, & Weinberger, 2010; Heber, 2017). Consequently, research on the ability of male survivors of sexual violence to acquire positive characteristics as a result of their victimization, termed posttraumatic growth (PTG), is limited (Tedeschi & Calhoun, 2004a). This thesis assesses the experience of PTG for male survivors of sexual violence, specifically analyzing the role of gender norms, coping styles, and service access in the production, or lack thereof, of PTG. Through the concepts of gender norms and coping, the experience of PTG for male survivors is contextualized, providing insight into how these forces individually and collectively facilitate or hinder the experience of PTG. A qualitative comparative analysis is conducted in order to establish a configuration of causal factors that are associated with the presence and absence of PTG for male survivors (N=9). Only one of the five hypotheses this thesis tests are supported; high stability (no interruption) of service access is associated with PTG. This thesis argues that the use of coping styles and service access is intertwined with conflicts between their gender and victimization, where male survivors utilize certain forms of coping or services depending on the degree to which they need to regain feelings of control.

Esta tese tem como objetivo geral investigar os significados que os adultos, sobreviventes de tumor de Sistema Nervoso Central (SNC) na infância, atribuem às suas experiências de vida durante o adoecimento e após o término do tratamento oncológico, a fim de oferecer subsídios para a formulação de novos dispositivos clínicos para o atendimento destes casos. Considera-se como adultos sobreviventes de câncer infanto-juvenil os pacientes, de 20 a 59 anos, que tenham concluído o tratamento oncológico há pelo menos cinco anos e estejam sem evidência da doença. A concepção de investigação que embasa esta tese é o modelo de pesquisa qualitativa em psicanálise que permite compreender os fenômenos em profundidade. Consta de uma pesquisa bibliográfica - uma revisão sobre a história da oncologia e da oncologia pediátrica no Brasil e sobre os textos psicanalíticos ligados ao tema aqui proposto - e de uma pesquisa de campo, através de entrevistas abertas que buscam o testemunho das experiências vivenciadas pelo sujeito a partir do diagnóstico. As entrevistas com onze adultos, pacientes do Hospital São Rafael / Unidade ONCO / Salvador, funcionam como material clínico para a discussão sobre alguns temas à luz da psicanálise Freud-lacaniana. Os temas estão divididos em cinco categorias: reações ao diagnóstico; sentidos e significados do adoecimento; lembranças do tratamento; vivências pós-tratamento; e percepção dos efeitos tardios. Os conceitos e as noções psicanalíticos norteadores para a discussão abarcam o trauma, o luto, o estádio do espelho, o narcisismo e o complexo de Édipo. Também são discutidos os desafios do psicanalista diante do inenarrável das vivências com o adoecimento e diante das condições que reproduzem, nas instituições de saúde, as situações socioculturais de preconceitos em relação a parcelas da população e que são decorrentes do contexto histórico brasileiro. Além disso, coloca-se em evidência a importância da presença do psicanalista nas equipes multidisciplinares que assistem os sobreviventes de câncer infanto-juvenil do SNC. E se discute as possibilidades de diferentes dispositivos clínicos, que preservem a ética e a escuta psicanalítica, poderem ser oferecidos pelo psicanalista, que deve levar em conta, também, as vicissitudes do trabalho nas instituições públicas de saúde / This thesis aims to investigate the meanings that adults, survivors of Central Nervous System (CNS) tumor in childhood, attribute to their life experiences during illness and after the end of the oncological treatment, to offer subsidies for the formulation of new clinical apparatus to treat these cases. The patients aged 20 to 59 years who have completed cancer treatment for at least five years and are without evidence of the disease are considered to be adult survivors of childhood cancer. The research conception that underlies this thesis is the qualitative model in psychoanalysis that allows understanding the phenomena in depth. It consists of a bibliographical research - a review on the history of pediatric oncology and oncology in Brazil and on the psychoanalytic texts related to the theme proposed in this thesis - and a field research, through open interviews that seek the testimony of experiences lived by the subjects since the diagnosis. Interviews with eleven adults, patients from São Rafael Hospital / ONCO / Salvador, serve as clinical material for the discussion of some themes in the light of Freud-Lacanian psychoanalysis. The themes are divided into five categories: reactions to diagnosis; meanings of illness; treatment recollection; post-treatment experiences; and perception of late effects. The psychoanalytic concepts and notions guiding the discussion include Trauma, Grief, the Mirror Stage, Narcissism, and the Oedipus Complex. Also discussed are the challenges of the psychoanalyst in view of the unspeakable experiences from the illness and the conditions that they reproduce, in healthcare institutions, the socio-cultural situations of prejudices in relation to portions of the population and that are derived from the Brazilian historical context. In the final considerations, it is highlighted the importance of the presence of the psychoanalyst in multidisciplinary teams that assist survivors of childhood CNS cancer. And it is discussed about the possibilities of different clinical apparatus, that preserve ethics and psychoanalytic listening, that could be offered by the psychoanalyst, who must also take into account the vicissitudes of work in public healthcare institutions

Com avanços na terapêutica, no diagnóstico precoce e nos estudos cooperativos, a sobrevida de crianças e adolescentes com câncer tem aumentado. A Sociedade Americana de Enfermagem Oncológica indica como prioridade, para o período de 2005-2009, pesquisas sobre os efeitos tardios do tratamento e qualidade de vida dos sobreviventes. Buscando contribuir com esta discussão, o objetivo do presente estudo é compreender como os pais e outros familiares de crianças e adolescentes com câncer percebem e vivenciam a experiência do término do tratamento. O estudo é de natureza descritivo-exploratória, com abordagem metodológica qualitativa. Foram selecionadas 10 famílias cujos filhos completaram a terapia de câncer e concordaram em participar do estudo. As técnicas de coleta de dados foram a entrevista no domicílio, a observação e o prontuário médico. Na análise, os dados foram organizados ao redor de três temas: a memória ─ o que foi vivido; o presente ─ o que se vive e o futuro ─ o que há de ser. Ao descrevermos a experiência dos pais e demais familiares da criança e do adolescente, sobre término do tratamento do câncer, pudemos evidenciar a vitalidade dos participantes de sobreviver ao tratamento e a tenuidade de viver após ele. O estudo mostrou que os pais e familiares começaram a resgatar o momento interrompido pelo diagnóstico e terapêutica, fizeram um movimento de reestruturação de suas vidas, porém, com cautela. Projetaram um futuro de vida com otimismo, mas permeado pelo medo e incerteza. Os resultados do estudo possibilitaram identificar, no cotidiano das famílias, aspectos que necessitam de intervenção, objetivando a melhoria da qualidade de vida de crianças, adolescentes e da própria família com o término do tratamento. / Advances in therapeutics, early diagnoses and cooperative studies have increased the survival of children and adolescents with cancer. The American Oncology Nursing Society has set research on the late effects of treatment and survivors’ quality of life as a priority for 2005-2009. In an attempt to contribute to this discussion, this study aims to understand how parents and other family members of children and adolescents with cancer perceive and undergo the experience of ending treatment. We carried out a descriptive and exploratory study and adopted a qualitative methodological approach. Ten families were selected whose children completed cancer treatment and who agreed to participate in the study. Interviews at home, observation and patient files were used for data collection. Data were organized around three themes: the memory ─ what was experienced; the present ─ what is being experienced and the future ─ what will be. Describing the experiences of parents and other relatives of these children and adolescents at the end of cancer treatment allowed us to evidence the participants’ vitality in surviving treatment and the fragility of life after treatment ends. The study showed that parents and relatives started to recover the moment that diagnosis and treatment had interrupted and moved to restructure their lives, although cautiously. They projected a future for their lives with optimism, but permeated by fear and uncertainty. These study results allowed us to identify aspects in the families’ daily reality that need intervention, with a view to improving the quality of life of children, adolescents and the family itself when treatment ends.

Sabemos que o câncer é considerado um problema de saúde pública, muitas são as pessoas acometidas por esta enfermidade e a tendência é que aumente cada vez mais. Paralelo às enormes proporções de incidência do câncer está o aumento no número de pessoas que alcançam sucesso no tratamento oncológico, surgindo um novo grupo: os sobreviventes de câncer. Neste trabalho, entendemos como sobrevivente de câncer o paciente que está há no mínimo cinco anos fora de tratamento, sem apresentar evidência da doença. Sendo assim, define-se como objetivo geral desta pesquisa: discutir os aspectos emocionais de pacientes que terminaram o tratamento oncológico há no mínimo cinco anos. A amostra é constituída por dez participantes que tiveram câncer adulto e terminaram o tratamento oncológico há no mínimo cinco anos em um hospital público da cidade de Aracaju. Para a coleta de dados desta pesquisa foi elaborado um roteiro de entrevista semi-estruturada. Os dados foram analisados de forma qualitativa, utilizando a técnica de análise de conteúdo. Assim, este trabalho mostra que, sobreviver ao câncer é uma experiência complexa, ligada ao modo de enfrentamento e adaptação de cada um. Constitui-se um desafio para os sobreviventes apropriar-se da condição de curado, uma vez que a possibilidade de volta da doença é algo a se considerar, sendo necessário que o sobrevivente consiga elaborar a experiência passada e conviva com a incerteza do futuro. O presente estudo reflete ainda sobre a importância de que não se trata apenas de curar o paciente, mas de oferecer meios para que possa retomar sua vida, integrar-se ao seu meio social. Nesse contexto, a equipe de saúde deve incluir em seus planos terapêuticos ações além dos aspectos clínicos da doença, preocupando-se também com o apoio emocional e social, promovendo o aprimoramento de habilidades de enfrentamento para lidar com a nova condição de saúde e libertar-se do passado, auxiliando os sobreviventes a conviver com esta dualidade que é inerente a vida / Cancer is considered a public health problem. Many people are affected by this illness and there is a tendency for its increasing. However, parallel to the large proportions of cancer incidence, there is the increasing number of people who reach success on cancer treatment. This causes the emergence of a new group: the cancer survivors. We understand a cancer survivor as the patient that hasnt been treated for five years and has no evidence of the disease. The general objective of this research is to discuss the emotional aspects of this group of patients. The sample is constituted by cancer survivors from a public hospital in the city of Aracaju. The data was organized through a semi-structured interview guide that had been previously elaborated. The data was analyzed on a qualitative way, using the content analysis technique. Thus, this research shows that surviving cancer is a complex experience, and it is connected to the way each patient confronts and get adapted to the cure process. Appropriated cure conditions constitute a challenge to survivors once the possibility of the disease return has to be analyzed. The survivor needs to succeed on elaborating the past experience and live with the uncertainty of the future. This study also emphasizes that it is not just a matter of getting the patient cured, but also providing means of resuming to his/her life, and reintegrating him/her into the social environment. In this context, the health care team should include in their treatment plans, actions that goes beyond the clinical aspects of the disease, offering emotional and social support, promoting the improvement of coping skills to deal with their new condition and to get rid of the past, helping survivors to live with the duality inherent in life