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

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

Aim and objectives. Although many international sources in literature describe the treatment regimes for the management of adult female rape survivors, very few actually evaluate if the care that is implemented, are beneficial and supportive towards an optimal level of health. The researcher initiated this study to specifically determine what the experiences of adult female rape survivors were with regards to the management they received from health care workers in the emergency care environment. This information that was gathered was then incorporated into the writing of recommendations for health care services towards the improvement of patient-centred care. Method. A qualitative phenomenological methodology guided the research process in which ten semi-structured voluntary interviews was held with adult female rape survivors. This study was conducted in a private hospital in Gauteng, South Africa, which is at the top of the international statistics list for the incidence of rape. Findings. Patient management with regards to accessibility to health care services, the forensic examination and the use of medications proved to be a major concern. Participants in this study emphasized the value and importance of the physical presence of family members or significant others. A positive attitude from these support-givers improved the patient’s psychological state, memory and co-operation. Prolonged waiting times in all areas of management contributed to an increased level of anxiety, where as the prompt and competent interventions by empathetic multi-disciplinary team members had improved patient satisfaction. Various patient responses after the rape incident warranted that minimal, but yet effective and professional health care workers be involved in rape survivor management. Confidentiality and honest, effective communication that is based on patient preference, should guide all interventions. Conclusion. The medical management of adult female rape survivors in this hospital compared favorably to international standards, however, the need to improve the level of specific patient-centred care exists in order to ultimately facilitate a better quality of service provision. Copyright / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

Domestic abuse is “the willful use of an intimidating action [physical assault, battery, sexual assault, and/or other abusive behavior as part of a systematic pattern] to exert power and control perpetrated by one intimate partner against another” (“What Is Domestic Violence?”, 2016). For African American women in the United States, “some studies have found that negative racial and sexist stereotypes portray African American women as aggressors rather than as victims due to their perceived rough, aggressive, and outspoken characteristics. Because of these persistent stereotypes of African American survivors, police can mistake the victim as the aggressor, thus reducing the amount of legal action taken to aid them. The past and present domestic violence responses have little positive economic or social effects on African American survivors. This thesis argues for educational changes to improve the legal response from law enforcement agencies for African American survivors of domestic violence. Realistic solutions such as, changing the stereotypical image of African American survivors, having law enforcement agencies enforce laws in domestic violence cases, and incorporating mandatory implicit bias and cross cultural communication trainings in a variety of educational areas can help resolve the low amount of law enforcement being used for African American domestic violence victims, unconscious racism in courtrooms, and ineffective mandatory arrest policies.

The protection of survivors of sexual violence during court proceedings is as important as the court proceedings themselves, as any mishaps may impact greatly on the well-being and future engagement of these survivors with the criminal justice system. The issue of secondary victimization remains a problem faced by many survivors of sexual violence who try to seek justice for their ordeal. It is against this background that several international, regional and national documents have been enacted with hopes of mitigating the issue of secondary victimizations from the criminal justice system and its actors. The court as an institution within the criminal justice system is established to handle all criminal and civil cases within a defined jurisdiction and as such is charged to handle all cases of sexual violence filed before it. However, the role of the court in protecting victims especially victims of sexual violence is increasingly being questioned. Therefore, the dissertation seeks to explore the issues surrounding the protection of survivors of sexual violence in the Ghanaian court. To adequately explore the issue under consideration, a qualitative research approach was adopted, which entailed on-site observations and interviews. As a case study, the gender court was selected as the site for the research. The findings of the study support a strong argument for an expansive approach from the court and all stakeholders of the criminal justice system, from both structural and legal approaches as well as the need for an attitudinal change to harness the protection of survivors of sexual violence who seek justice for their ordeal. Thus, the findings point to the need for urgent attention to help reduce the risk of secondary victimization in the court.

Bakgrund: Sepsis är ett globalt hälsoproblem ibland jordens befolkning. 49 miljoner drabbas runt om i världen och de patienter som överlevt riskerar att få komplicerade komplikationer som följd. Det innebär att de drabbade är i behov av hjälp och stöd för att kunna ta sig tillbaka till det vardagliga livet. Syfte: Syftet är att belysa hur eftervården upplevs av individer som drabbats av sepsis. Metod: Studien är en empirisk enkätstudie som analyserades med kvalitativ innehållsanalys. Informanterna kontaktades via ett sepsisforum på Facebook och även kontakter via sepsisfonden. Informanterna besvarade fyra frågor som berörde upplevelsen av eftervården. Resultat: Resultatet består av fyra olika teman: Frånvaro av uppföljning, försummad av vården, kunskapsbrist i vården och god vårdkontakt. Utifrån informanternas egna ord i studien, som beskriver individernas egen upplevelse av eftervården, kunna få en ökad förståelse om det finns positiva eller negativa erfarenheter om eftervården. Slutsats: Vården har ett ansvar att guida, informera och följa upp patienterna på bästa sätt. / Background: Sepsis has become a global health problem among the population in the world, about 49 million people are affected around the world. The patients who have survived are at risk of getting complications. This means that some people need care and support to be able to go back to their normal life. Aim: The purpose of the study is to illustrate how the aftercare is experienced by individuals affected by sepsis. Method: The study is made of a qualitative content analysis with a questionnaire. Participants were contacted on a sepsis-forum on Facebook and sepsis foundation. Participants answered four questions that concerned the experience of aftercare. Choice of method and analysis produced four themes that form the basis for the results. Result: The result is made of four different themes: Lack of follow-up, neglected by care, lack of knowledge care and god care. The study is based on the informant’s own words, which describe the people's own experience of aftercare, to gain an increased understanding of whether there are positive or negative experiences about aftercare. Conclusion: The healthcare system has a responsibility to educate, guide and follow up this group.

No description available.

Fatigue is a common problem among cancer patients, especially those who have received chemotherapy and radiation therapy. Stem cell transplant (SCT) patients are at a particular risk of persistent fatigue as they receive more aggressive therapies. This study examined the prevalence of fatigue after completion of SCT. Further, the level of fatigue symptom distress and its relationship with quality of life (QOL) among long term SCT survivors was examined. The study involved thirty-three patients, 21 males and 12 females, treated with autologous or allogeneic SCT in a comprehensive cancer center in Southwest Florida. Participants' ages ranged from 36 to 70 years, with a mean age of 53 years. All subjects completed the Cancer Related Fatigue Distress Scale and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant questionnaires. All the patients had to be at least six months from transplant. The results of this study showed that fatigue is quite prevalent among SCT survivors. Ninety-three percent of the patients reported some degree of fatigue, and 15% experienced severe fatigue. Patients who received autologous transplant (24%) reported less fatigue symptom distress (mean= 48, SD= 36.62) compared to the allogeneic transplant group (mean= 66.2, SD= 54.49). A strong negative relationship was found between fatigue symptom distress and QOL (r = 0.85, p < 0.0001) suggesting that patients with the greatest fatigue distress report the worst QOL. The time from transplant factor was significantly positively associated with fatigue symptom distress (r= 0.46, p= 0.007) indicating greater distress with the passage of time. A moderate negative relationship was also found between time from transplant and QOL (r= -0.34, p= 0.052) suggesting that QOL was less in some patients as time passed; however this was a weak relationship that did not achieve statistical significance. Although the sample size was small, this study was able to provide a confirmation that fatigue symptom distress and QOL are related to one another. Understanding the relationship between fatigue symptom distress and QOL should encourage interdisciplinary collaboration in planning proper interventions to minimize fatigue. This would improve the outcomes of SCT long term survivors, and would positively impact their overall QOL.

Researchers have not been able to ascertain how survivors of childhood trauma, especially sexual abuse, develop resilience. To explore resilience and what influences its development, this mixed-method study investigated the roles of cognitive emotion regulation and proactive coping by using a critical-realist ontology. The data was collected from eight women (between ages 25 and 56) who considered themselves to be resilient survivors of severe child sexual abuse. Harvey’s (2000) Multidimensional Trauma Recovery and Resiliency Interview (MTRR-I), the Cognitive Emotion Regulation Questionnaire (Garnefski, Kraaij&Spinhoven, 2002) and Greenglass’s (1999) Proactive Coping Inventory were used to gather the data necessary to determine whether resilience is influenced by cognitive emotion regulation strategies and proactive coping and to attempt to define what could be considered as traits of resilience in survivors or child sexual abuse. Through thematic analysis, approximately 50 a-priori codes were generated and grouped into 23 themes using the Atlas.ti program. The objective of this study is to explore the relationship between cognitive emotion regulation, proactive coping and resilience in order to better understand, and develop intervention processes that can provide survivors of child sexual abuse and other trauma with the resources needed to be more resilient. Although causality could not be determined between these variables, it became evident that the more often a participant employs adaptive cognitive emotion regulation strategies and the higher the scores on the Proactive Coping Inventory are, the more resilient the participant tends to be. The participants who displayed higher levels of resilience also verbalised that they felt they had dealt with the abuse and had managed to move on in their lives. Even though all the participants considered themselves to be resilient, half of them were functioning at a noticeably lower rate of resilience than the others. All the participants claimed to rely on spiritual strength in some way and attribute their resilience to their faith in God. The higher the levels of resilience, the more the participants used adaptive cognitive emotion regulation strategies and proactive coping; and the more optimistic their views of the future and the more they considered their lives to be meaningful. Because the study was based on the ecological model of human development (Bronfenbrenner, 1995, 2005,) the interplay of the proximal environment, the individual, the social context and the changes that have taken place over time, were all taken into consideration because resilience, cognitive emotion regulation and proactive coping skills all develop within and between the same systems in which an individual develops. However, Bronfenbrenner (2005) states that the family is no longer taking the responsibility for the upbringing of children as it should and that other settings in society have had to step in to fulfil the role. One aspect of mental health is the ability to develop spiritually and since schools may not include religious instruction because it is the responsibility of the family, it happens that children are not being developed spiritually and this could influence the way in which individuals deal with traumatic childhood experiences. / Thesis (PhD)--University of Pretoria, 2011. / Educational Psychology / unrestricted