The research approach is an embedded-single case study, focusing on survivors of APM in Vista Hermosa, Colombia. The first unit of analysis discloses the current challenges of survivors in light of the historical and legal background. The civilian population of Vista Hermosa was caught between the frontlines of the various fighting parties during the Colombian conflict. The demilitarized zone (DMZ) - active from 1999 to 2002 - left civilians in the municipality abandoned by the government; its termination let to a further increase of violence and significant anti-personnel mine (APM) contamination. After the Final Peace Agreement in 2016, illegal armed groups are still conducting violent attacks. The legal background presents a plurality of legislative instruments to regulate the necessary assistance to survivors of APM in Colombia. The most relevant international document in this regard is the Ottawa Convention which became effective in Colombia in 2001, enforced from 2011 by ‘The Victims’ Law’, its national counterpart. Despite the comprehensive legal rights to rehabilitation and compensation, the empirical section of this study detects a variety of challenges for survivors of APM. Despite the fact that most APM accidents date back more than 10 years, many survivors still suffer from physical and psychological impairments. The poor local health infrastructure, the insurance companies and the lacking knowledge about rights often impeded survivors to access adequate recovery means. Additionally, compensation mechanisms do not function effectively. The violence during the conflict and the fear of reprisal acts often prevented survivors from claiming their compensation rights in the required timeframe. The bureaucratic and opaque procedures of the Unidad para las Victimas constitute a barrier which the survivors can often only overcome with judicial support. The inefficient assistance of the municipality in this regard often causes survivors to abandon their claims.  The second unit of analysis of the research elaborates the humanitarian activities of Humanity and Inclusion and Pastoral Social on their ability to increase the resilience of the vulnerable group. The comprehensive assistance of the NGOs seeks to improve conditions for survivors of APM by empowering them in a sustainable manner. The approach offers adaptive capacities such as physical rehabilitation to solve immediate needs. However, most of the projects offer transformational capacities to tackle fundamental issues. Although much progress is still needed before it will be feasible to evaluate potential enduring improvement, intermediate results demonstrate enhanced resilience conditions of the benefiting survivors of APM. This approach is not functionally limited to Vista Hermosa or the beneficiary group of survivors of APM. The positive effects of the assistance can serve as an example for the wider humanitarian field.  The research findings are mainly based on open-ended interviews which were conducted in 2017 during a four-month internship with Humanity and Inclusion in Vista Hermosa. More interviews were undertaken afterwards via Skype. In addition, the research is based on a literature review including academic findings, reports, and legal documents.

Made available in DSpace on 2016-07-27T14:20:20Z (GMT). No. of bitstreams: 1 VIVIANE CRUVINEL DI CASTRO.pdf: 813393 bytes, checksum: 790833513dd373c807559cd7fdfb5ae6 (MD5) Previous issue date: 2014-03-27 / Despite the high number of Mergers and Acquisitions (M&A) visible all over the world, a phenomenon explained since there is a process of globalization and internationalization of markets, little is known about how to prevent the failure of these operations, failure that is very common nowadays. It seems that there is a lack of reliable theoretical elaborations on the topic, especially those concerning the human side of M&A. On this basis, this study sought to highlight the human and the identity aspects of mergers using theories like the Social Identity Theory and the Social Categorization Theory, which are elements of the Intergroup/Intercategorial perspective reinforced in this investigation. This study sought to evaluate the relationship between social categories (organizations) pre-merger and post-merger, the different degrees of merger survivors and the perceptions of the employees concerning mergers under study. In this study, Merger Survivors are employees who were part of the staff of the companies before the merger, passed by the merger process and remained in the new company with psychological remnants of pre-merger environment and also without proper acceptance; acceptance that goes from the employees towards the new company and from the new company towards them.The study included 128 workers, 37 portuguese and 91 brazilian workers. One unique questionnaire divided into 5 parts was used for the research. The parts are: an adaptation of social identity questionnaire developed by Moreira (2007), a question about the passage through the merger process, a question about the perception of the merger, six questions about survivors of the merger , and lastly, socioorganizational and socio-demographic variables. Analyzes were performed based on the two samples together. The results of the analyzes from the T test for independent samples, Chisquare test and nonparametric tests such as Mann-Whitney, Kruskal-Wallis and Spearman correlation showed that a less favorable perception of the merger and less identification with post/pre-merger categories, are significantly related to a higher merger surviving degree. This research contributed to the understanding of human aspects involved in mergers and, consequently, contributes to the success of these operations. / Apesar do número cada vez mais alto de Fusões e Aquisições (F&A) em todo o mundo, dado o processo de globalização e internacionalização dos mercados, pouco se sabe a respeito de como evitar o insucesso destas operações, algo recorrente nos dias atuais. Nota-se uma ausência de elaborações teóricas confiáveis acerca do assunto, principalmente no que diz respeito ao lado humano das F&A. Com base nisso, este estudo procurou evidenciar o aspecto humano e identitário das fusões utilizando como arcabouço teórico as teorias da Identidade Social e da Categorização Social, integrantes da Perspectiva Intergrupo/Intercategorial reforçada nesta investigação. Assim, este trabalho buscou avaliar a relação entre as categorias sociais (organizações) pré-fusão e pós-fusão apontadas pelos colaboradores, os diferentes graus de sobrevivência à fusão e as percepções dos referidos sujeitos acerca das fusões em estudo. Neste estudo, Sobreviventes da Fusão são colaboradores que fizeram parte do quadro de funcionários das empresas antes da fusão e que passaram pelo processo de fusão, permanecendo na nova empresa com resquícios psicológicos do ambiente pré-fusão e sem a devida aceitação , tanto destes colaboradores para com a nova empresa quanto da nova empresa para com eles. Participaram do estudo 128 trabalhadores, sendo 37 portugueses e 91 brasileiros. Foi utilizado um único questionário para coleta composto por cinco partes principais: uma adaptação do questionário de identidade social desenvolvido por Moreira (2007), uma questão sobre a passagem pelo Processo de Fusão, uma questão sobre a Percepção da Fusão, seis perguntas relativas aos Sobreviventes da Fusão, e por último, variáveis Sócio-organizacionais e Sócio-demográficas. Foram realizadas análises tendo por base as duas amostras em conjunto. Os resultados das análises feitas a partir do test T para amostras independentes, teste Qui-Quadrado e testes nãoparamétricos, tais como Mann-Whitney, Kruskal-Wallis e Correlação de Spearman demonstraram que quanto menos favorável é a percepção da fusão e quanto menos os colaboradores se identificam com as organizações pós e pré-fusão, maior é o grau de Sobrevivência à fusão. Esta investigação contribuiu para a compreensão dos aspectos humanos envolvidos em processos de fusão e, consequentemente, contribui para o sucesso destas operações.

研究背景: 隨著乳腺癌患者存活率的不斷上升及其存活時間的不斷延長，癌病倖存已成為一個重要的慢性疾病管理問題。之前在該領域的研究主要集中於生活質量的測量。然而，癌病倖存研究應該超出這一範疇而更好地去瞭解乳腺癌倖存者的真實體驗。癌病倖存是一個新興而複雜的概念，它包含了動態的、多維的以及社會文化的觀點。但是，衛生專業人員受限於現有的知識未能為中國大陸乳腺癌患者的長期倖存做好準備。 / 研究目的: 本研究目的是從中國大陸女性的視角詳盡闡述乳腺癌倖存者的親身體驗。具體研究目標包括：1）乳腺癌倖存者的生活質量；2）與乳腺癌倖存者生活質量相關的因素；3）乳腺癌患者的倖存體驗；4）社會人口學及臨床學特徵對於乳腺癌倖存體驗的影響；5）建立一種與文化相關的概念模型用以解釋中國婦女乳腺癌患者的倖存體驗。 / 研究方法: 本研究採用混合研究方法，分兩個階段進行。先是定量法（第一階段），其次是定性法（第二階段）。第一階段是對乳腺癌倖存者其生活質量及相關因素進行橫斷性調查。測量工具包括生活質量-癌症倖存者量表及社會支持問卷簡表。該階段的調查結果將指導第二階段的目的性抽樣並建立半結構式訪談計劃。第二階段是對選定倖存者進行深入訪談以探究她們的癌症倖存體驗。採用內容分析法對訪談數據的潛在及顯性內容進行分析。然後對不同定義組中的定性數據進行比較，探索社會人口學及臨床學特徵對乳腺癌倖存體驗的影響。最後對定量和定性數據進行對比和比較，以確定並探討癌病倖存體驗的組成元素和模型開發。 / 研究結果：在完成第一階段的100位倖存者中，平均年齡為53.75 歲 (SD=7.27)，治療完成後存活時間的中位數為44 個月 (四分位範圍=23-61)。總體生活質量平均值為6.55，範圍3.68 - 8.89。在身體分量表中顯示生活質量最高值，而在靈性分量表找到其最小值。多元回歸分析表明，存活期的長短、對社會支持的滿意度以及家庭年收入與生活質量均顯著相關。 / 29位倖存者完成了第二階段的研究。結果顯示用於描述倖存經驗的七個範疇，包括：體驗令人痛苦的症狀；與不確定性進行抗爭；在女性特質及性行為上的改變；忍受社會壓力；被關照和支持；反思和個人成長；生存並向前發展。定性數據的比較顯示，對於存活時間低於5年，或者家庭年收入較低，亦或感知的生活質量較低的女性，她們傾向於報告負面的倖存經驗。通過提取定量和定性階段上主要的研究結果建立一個概念模型，用以解釋中國女性是如何理解乳腺癌倖存經驗的。它表明，乳腺癌倖存經驗在本質上是多維的。治療完成後，乳腺癌患者在生活變化上會有消極與積極的雙重性，會對生活質量評估產生影響。此外，乳腺癌倖存經驗也不是一成不變的。它是一個動態的應對過程，具有幾種策略以應對癌症導致的生活變化。 / 研究結果：本研究對中國文化背景下乳腺癌倖存經驗提供了證據。本研究全面而深入的瞭解乳腺癌患者倖存經驗，並為進一步發展測量工具以及具備文化敏感性的心理干預提供了基礎，以解決中國女性的倖存經驗的問題。 / Background: With the increasing survival rate and length of survival in breast cancer, cancer survivorship has become an important chronic illness management issue. Previous studies in this area mainly focus on appraisal of quality of life (QOL). However, cancer survivorship studies should go beyond QOL to better understand breast cancer survivor’s experience of living with the disease. Cancer survivorship appears as an emerging but complex concept incorporating dynamic, multidimensional, and socio-cultural perspectives. Little information exists addressing breast cancer survivorship experience in mainland China that impedes health professionals’ ability to deliver quality of cancer care. / Aim: To develop an understanding of breast cancer survivorship experience from the perspective of mainland Chinese women. Specific objectives included exploring 1) women’s perceived QOL; 2) factors associated with women’s QOL; 3) women’s perception of breast cancer survivorship experience; 4) the influence of socio-demographic and clinical characteristics on the women’s perception of their survivorship experience after breast cancer; and 5) to develop a culturally relevant conceptual model to explain Chinese women’s breast cancer survivorship experience. / Methods: A mixed methods study with two phases was conducted, quantitative approach (Phase One) followed by qualitative approach (Phase Two). Phase One was a cross-sectional survey on Chinese breast cancer survivors to investigate their QOL and its associating factors. Instruments included Quality of Life -- Cancer Survivor Scale and six-item Social Support Questionnaire. Findings in this phase contributed to inform the purposive sampling and develop a semi-structured interview schedule for Phase Two. In-depth interviews on selected survivors were conducted to explore their perceptions of cancer survivorship experience. Content analysis was used to analyze both latent and manifest meaning of interview data. Comparisons of qualitative data across defined groups were made to explore the influence of socio-demographic and clinical characteristics on breast cancer survivorship experience. Quantitative and qualitative data were compared and contrasted to identify and explore elements in cancer survivorship experience and model development. / Results: Among 100 survivors who completed Phase One, the mean age was 53.75 years (SD=7.27), and the median length of survivorship since completion of treatment was 44 months (IQR=23-61). The mean overall QOL was 6.55, with a range of 3.68 -8.89. The highest QOL was found in the physical subscale, and the lowest in the spiritual subscale. Multivariate regression analysis identified that length of survivorship, satisfaction with social support, annual household income were significantly associated with QOL. / Twenty-nine survivors completed Phase Two. Seven categories emerged describing the survivorship experience included experiencing distressful symptoms; struggling with uncertainty; alterations in femininity and sexuality; living with social stress; being cared for and supported; reflections and personal growth; and surviving and moving forward. Comparisons of qualitative data revealed that women with less than five years of survivorship, or low annual household income, or low perceived QOL tended to report negative survivorship experience. A conceptual model was developed by drawing the key findings of quantitative and qualitative phases to explain how Chinese women perceive the breast cancer survivorship experience. It reveals that breast cancer survivorship experience is multidimensional in nature, with a duality for the negative and positive aspects of life changes after completion of treatment, contributing to influence appraisal of QOL. Furthermore, breast cancer survivorship experience is not static but a dynamic coping process with several strategies for dealing with life changes that result from cancer. / Conclusions: The study provides evidence of several components of breast cancer survivorship within Chinese cultural context. This offers a comprehensive and insightful understanding of the experience after surviving breast cancer, and a basis for further inquiry for developing an instrument and culturally sensitive psychosocial intervention to address Chinese women’s survivorship experience. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Cheng, Huilin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 252-283). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes inchludes Chinese. / Chapter CHAPTER ONE --- INTRODUCTION --- p.1 / Background of the study --- p.2 / Breast cancer incidence --- p.2 / Breast cancer diagnosis and treatments --- p.3 / Breast cancer survival --- p.5 / Cancer survivorship --- p.7 / Overview of cancer survivorship --- p.7 / Breast cancer survivorship research --- p.10 / Rationale for the study --- p.12 / Purpose of the study --- p.13 / Organization of the thesis --- p.13 / Chapter CHAPTER TWO --- LITERATURE REVIEW --- p.15 / Literature search --- p.15 / Search strategy --- p.15 / Selection criteria --- p.16 / Definition of cancer survivor --- p.17 / Concept of cancer survivorship --- p.18 / Concept of quality of life (QOL) --- p.22 / Definitions --- p.22 / Measurements --- p.25 / Generic instrument --- p.26 / Cancer-specific instrument --- p.26 / Cancer survivor-specific instrument --- p.27 / Distinctions between cancer survivorship and QOL --- p.29 / Quantitative studies on breast cancer survivorship --- p.30 / Overall QOL and QOL across different domains of breast cancer survivors --- p.30 / Overall QOL --- p.30 / Physical effect --- p.31 / Psychological effect --- p.34 / Social effect --- p.36 / Spiritual effect --- p.37 / Factors affecting the QOL of breast cancer survivors --- p.40 / Socio-demographic factors --- p.41 / Clinical factors --- p.42 / Social support --- p.47 / Ethnicity --- p.49 / Methodological critique of quantitative studies --- p.52 / Qualitative studies on breast cancer survivorship --- p.54 / Multidimensional nature of breast cancer survivorship --- p.54 / Dynamic nature of breast cancer survivorship --- p.57 / Influence of ethnicity on breast cancer survivorship --- p.60 / Methodological critique of qualitative studies --- p.62 / Mixed methods study on breast cancer survivorship --- p.63 / Summary --- p.65 / Chapter CHAPTER THREE --- METHODOLOGY --- p.67 / Study aim and objectives --- p.67 / Definitions of terms --- p.68 / An overview of mixed methods research --- p.69 / Philosophical foundation of mixed methods research --- p.71 / Research design: Sequential explanatory mixed methods --- p.72 / Overview of the selected design --- p.72 / Justification for the selected design --- p.74 / Integration of data from Phases One and Two --- p.76 / Study setting --- p.78 / Description of the Phase One study method --- p.79 / Sampling --- p.80 / Sample size --- p.80 / Sampling criteria --- p.80 / Instruments --- p.81 / Socio-demographic and clinical characteristics --- p.81 / Perceived social support --- p.81 / QOL --- p.82 / Sexual QOL --- p.85 / Willingness to participate in Phase Two --- p.86 / Data collection procedures --- p.86 / Quantitative data analysis --- p.87 / Descriptive analysis --- p.87 / Regression analysis --- p.88 / Description of the Phase Two study method --- p.88 / Sample and sampling --- p.89 / Sampling and selection criteria --- p.89 / Sample size --- p.90 / Data collection method --- p.91 / Semi-structured face-to-face interview --- p.91 / Interview schedule --- p.92 / Data collection procedure --- p.93 / Qualitative data analysis --- p.94 / Content analysis --- p.94 / Comparative analysis in qualitative research --- p.97 / Ensuring rigor of qualitative inquiry --- p.99 / Justification for using validity and reliability --- p.99 / Strategies for achieving validity --- p.100 / Strategies for achieving reliability --- p.101 / Ethical considerations --- p.101 / Pilot study --- p.102 / Pilot study of Phase One --- p.102 / Pilot study of Phase Two --- p.104 / Chapter CHAPTER FOUR --- FINDINGS FOR PHASE ONE --- p.106 / Characteristics of participants --- p.106 / Socio-demographic characteristics --- p.106 / Clinical characteristics --- p.108 / Perceived social support --- p.110 / QOL --- p.111 / Physical domain --- p.112 / Psychological domain --- p.113 / Social domain --- p.114 / Spiritual domain --- p.115 / Sexual domain --- p.116 / Factors associated with QOL --- p.117 / Differences in overall QOL and QOL domains by socio-demographic and clinical characteristics, as well as perceived social support --- p.118 / Factors associated with overall QOL and different QOL domains --- p.126 / Participants’ willingness to participate in Phase Two of the study --- p.129 / Contribution of Phase One findings to the development of Phase Two --- p.132 / Selection criteria for purposive sampling --- p.132 / Development of interview schedule --- p.134 / Summary --- p.135 / Chapter CHAPTER FIVE --- FINDINGS FOR PHASE TWO --- p.137 / Characteristics of participants --- p.137 / Categories identified from content analysis --- p.140 / Experiencing distressful symptoms --- p.142 / Memory and concentration problems --- p.142 / Lymphedema --- p.142 / Fatigue --- p.143 / Struggling with uncertainty --- p.144 / Fear of recurrence --- p.144 / Fatalism --- p.145 / Unpredictability of illness --- p.146 / Alterations in femininity and sexuality --- p.147 / Poor body image --- p.147 / Changes in sexual activity --- p.149 / Living with social stress --- p.150 / Being stigmatized --- p.150 / Financial burden --- p.151 / Being cared for and supported --- p.152 / Family members and close friends --- p.153 / Cancer self-help group --- p.154 / Workplace --- p.155 / Health professionals --- p.155 / Reflections and personal growth --- p.156 / Re-prioritizing life perspectives --- p.156 / Change in personal character --- p.157 / Gaining inner strength --- p.158 / Surviving and moving forward --- p.159 / Performing self-care --- p.159 / Attitude towards having cancer --- p.160 / Hope for the future --- p.162 / Sense of normalcy --- p.163 / Comparison of categories and subcategories by selected characteristics --- p.164 / Comparison of categories between participants with high- and low-perceived QOL --- p.164 / Comparison of categories between participants with high- and low-annual household income --- p.167 / Comparison of categories between participants with short- and long- term survivorship --- p.169 / Summary --- p.170 / Chapter CHAPTER SIX --- DISCUSSION --- p.171 / Purpose of integration --- p.171 / Convergent findings --- p.172 / Complementary findings --- p.173 / Socio-demographic background of the participants --- p.174 / Clinical characteristics of the participants --- p.176 / Women's perception of QOL --- p.178 / Women's perceived levels of overall QOL and specific domains --- p.178 / Overall QOL --- p.178 / QOL in the physical domain --- p.179 / QOL in the psychological domain --- p.180 / QOL in the social domain --- p.181 / QOL in the spiritual domain --- p.182 / QOL in the sexual domain --- p.183 / Factors associated with women’s perceived levels of QOL --- p.184 / Socio-demographic factors influencing women’s perceived QOL --- p.184 / Clinical characteristics influencing women’s perceived QOL --- p.185 / Women's perception of social support and QOL --- p.186 / Social network and support --- p.186 / Social network and QOL --- p.188 / Satisfaction with social support and QOL --- p.189 / Women's perception of the breast cancer survivorship experience --- p.190 / Symptom distress --- p.191 / Uncertainty --- p.192 / Body image --- p.194 / Sexuality --- p.196 / Cancer-related stigma --- p.197 / Financial burden --- p.198 / Meaning in life --- p.200 / Self-identity --- p.202 / Fatalism --- p.203 / Attitude towards having cancer --- p.205 / Self-care/self-management --- p.206 / Hope --- p.207 / Summary --- p.208 / Chapter CHAPTER SEVEN --- A CONCEPTUAL MODEL TO EXPLAIN CHINESE WOMEN’S BREAST CANCER SURVIVORSHP EXPEREINCE --- p.210 / Overview of the proposed conceptual model --- p.210 / Content of the conceptual model --- p.211 / Function of the conceptual model --- p.212 / Perceived negative life change --- p.218 / Symptom distress --- p.218 / Uncertainty --- p.219 / Concern about body image --- p.220 / Cancer-related stigma --- p.222 / Financial burden --- p.223 / Perceived positive life change --- p.224 / Meaning in life --- p.224 / Positive self-identity --- p.225 / Social support --- p.226 / Co-existence of perceived negative and positive life changes --- p.228 / Perceived quality of life --- p.228 / Coping --- p.229 / Fatalistic voluntarism --- p.230 / Maintaining hope --- p.231 / Positive attitude --- p.232 / Performing self-care/self-management --- p.233 / Comparison between previous theory and the present model --- p.234 / Summary --- p.238 / Chapter CHAPTER EIGHT --- CONCLUSION --- p.239 / Limitations --- p.239 / Implications for nursing practice --- p.243 / Recommendations for future research --- p.248 / Conclusion --- p.251 / REFERENCE --- p.252 / APPENDIX --- p.284

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2017-04-26T14:08:21Z No. of bitstreams: 1 ligiamarciacontrin_tese.pdf: 1241733 bytes, checksum: 57a793e742045cbb63ca3f9eea759db3 (MD5) / Made available in DSpace on 2017-04-26T14:08:21Z (GMT). No. of bitstreams: 1 ligiamarciacontrin_tese.pdf: 1241733 bytes, checksum: 57a793e742045cbb63ca3f9eea759db3 (MD5) Previous issue date: 2011-09-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Background: Sepsis has acquired a great epidemiological importance due to its incidence in the last decade. Particularly long term outcomes are yet unknown. Sepsis continues to increase by 1.5% every year. The mortality rates from sepsis are increasingly high worldwide. The aim of this nested case-control study was to evaluate the quality of life in survivors from severe sepsis with EuroQol-5 Dimensions (EQ-5D) and “Visual Analogue Scale” (EQ-VAS). Methods. This nested case-control study was carried out in patients discharged from a tertiary teaching Hospital after been admitted in the ICU with severe sepsis. From the sepsis registry containing 349 patients, patients who survived and were discharged from the hospital were identified. Each patient with sepsis was considered as a case and the patient who was admitted immediately after was selected as a control as long as they did not have sepsis and survived ICU admission. Fifty patients from each group were eligible to take part in the study. Results: A total of 100 patients were included in the study. The patients in the sepsis group had higher mortality at 1 year (36.5%) compared to the critically ill patients without sepsis in the control group (19.7%) (RR 1.85; 1.07-3.19; p<0.05). Survivor’s mean age at hospitalization was 51.3 years in sepsis group and 52.2 years in the control group. The EQ-5D Index of the control group is 0.678 ± 0.427 in the sepsis group; 0.747 ± 0.327; (p=0.66). Older patients (>60 years old) in the sepsis group had a significantly higher prevalence of moderate to severe problems (levels 2 and 3) in all dimensions. There were no differences in EQ-VAS (79.7 ± 21.1, sepsis group and 72.7 ± 26.2, control group; p=0.19) between respondents from the both groups. A median value of 60 was obtained for septic patients older than 60 years in comparison to 88 obtained for the patients in the control group (p=0.09). Conclusion: After discharge from ICU survivors of sepsis had higher mortality rate than critically ill patients without sepsis. Older patients with sepsis had more moderate and severe problems in all dimensions evaluated for quality of life. / Introdução: Sepse adquiriu uma grande importância epidemiológica em função do aumento da incidência na última década. Resultados a longo prazo ainda são especificamente desconhecidos. A sepse continua a aumentar aproximadamente 1,5% a cada ano, com taxas de mortalidade decorrentes de sepse cada vez mais elevadas em todo o mundo. O objetivo deste estudo caso-controle aninhado foi avaliar a qualidade de vida de pacientes sobreviventes de sepse grave, usando os instrumentos de avaliação EuroQol-5 Dimensions (EQ-5D) e “Visual Analogue Scale” (EQ-VAS). Metodos: Este estudo caso-controle aninhado foi realizado em pacientes que receberam alta de um hospital de ensino, após admissão na UTI com sepse grave. A partir dos registros de sepse contendo 349 pacientes, aqueles que sobreviveram e receberam alta hospitalar foram identificados. Cada paciente com sepse foi considerado como um caso e o paciente admitido imediatamente após a seleção foi relacionado como um caso controle, desde que não tivessem sepse e sobrevivessem à admissão na UTI. Cinquenta pacientes de cada grupo foram registrados para participarem do estudo. Resultados: Um total de 100 pacientes foi incluído no estudo. Os pacientes no grupo sepse tiveram uma mortalidade mais elevada em 1 ano (36,5%) comparados com pacientes críticos, porém, sem sepse no grupo controle (19,7%) (RR 1,85; 1,07-3,19; p<0,05). A média de idade dos sobreviventes, na hospitalização, foi de 51,3 anos no grupo sepse e 52,2 no grupo controle. O índice EQ-5D do grupo sepse é 0,678 ± 0,427 e do grupo controle é 0,747 ± 0,327; (p=0,66). Pacientes mais velhos (>60 anos de idade) no grupo sepse tiveram uma prevalência significativamente maior de problemas de moderados a graves (níveis 2 e 3) em todas as dimensões. Não houve diferenças no EQ-VAS (79,7 ± 21,1 no grupo sepse; 72,7 ± 26,2, grupo controle; (p=0,19)) entre os respondentes de ambos os grupos. Um valor mediano de 60 foi obtido para pacientes sépticos com idade acima de 60 anos, em comparação ao valor mediano de 88 obtido para pacientes no grupo controle (p=0,09). Conclusão: Após receberem alta da UTI, os pacientes que sobreviveram à sepse tiveram uma taxa de mortalidade mais elevada do que os pacientes críticos sem a doença. Pacientes idosos com sepse tiveram problemas variando de moderado a grave em todas as cinco dimensões avaliadas para qualidade de vida.

Intimate partner violence (IPV) is a serious social problem and a noteworthy health issue internationally. In the United States, approximately 1.3 million women and 835,000 men experience a combination of cruel and violent treatment by an intimate partner. This phenomenological study used lived experiences from both men and women ranging in various ages from 40-70 years to understand their coping and resiliency strategies post-separation from an abusive relationship for 10 or more years. The conceptual framework was guided by Lazarus' transactional theory of coping and psychological stress and the theory of psychological resiliency, which is linked to understanding the ways long-term survivors are able to master, minimize, and tolerate the events of a stressful situation. Data were gathered on 15 participants through semistructured, in-depth interviews using a series of open-ended questions that captured the details of the participants' lived experiences, and provided a textual description to understanding their coping and resiliency strategies after leaving an abusive relationship. Interviews were analyzed using a phenomenological technique by extracting themes. The central themes that emerged based on the 6 interview questions were encounters of physical and emotional abuse, passive and submissive behaviors, supportive services, becoming self-sufficient, and developing their self-efficacy. The findings and recommendations from this study can advance positive social change and interventions for mental health professionals providing services and enhance the IPV survivors' ability to find a continuum of care that could be effective in keeping a positive change while shaping the outcome of future life events.

Suicide has immediate and long-term negative effects on surviving family members and adverse effects in the school and community. Suicide rates for children and adolescents have increased in the United States since 2009. As part of suicide prevention efforts, information about risk factors and warning signs are typically addressed in schools, private organizations, and communities. In addition to academic literature for professional audiences, various therapeutic resources are available to assist those who grieve the suicide of a loved one. In particular, practical and easy-to-implement interventions are needed by those who offer support to suicidal individuals and survivors of suicide. Practical resources are needed to address suicide prevention, intervention, and postvention needs. This study is based on a questionnaire that was given to 250 registered individuals at an annual state suicide prevention training conference. Of those attending, 60 (24%) completed the questionnaire. Participants who did not have experience working with suicidal youth did not participate, so the actual participation rate was influenced by this factor. Questions explored the recommendations of mental health professionals (N=60) who worked with (a) suicidal youth, (b) siblings of youth who completed suicide, and/or (c) youth whose parent completed suicide. More specifically this study investigated specific strategies and resources for working with these three specific groups of survivors. Findings from this study indicated that mental health professionals recommend a variety of suicide prevention resources and strategies such as implementing evidenced-based prevention programs, accessing community resources, offering individual and group counseling for survivors, involving or creating support systems, and listening to the affected youth. Also, recommended therapeutic approaches should include an action plan where students are able to receive appropriate mental health services. Based on this study, mental health professionals may be more effective as they acquaint themselves with available resources such as counselors, school psychologists, and community services to comprehensively care for struggling individuals. Mental health professionals, educators, and staff members should obtain relevant information and utilize effective intervention models in order to better address the prevention, intervention, and postvention needs of surviving individuals.Recommendations are made for future research in identifying the combination of resources that are most helpful. Recommendations are also made regarding specific content and training strategies to more effectively prepare and equip professionals to engage more fully in effective and supportive suicide prevention efforts.

<p>Organisations are by nature, dynamic entities that continuously undergo transformation in response to both internal and external pressures, which are imposed on them (Robbins, Odendaal &amp / Roodt, 2003). Government departments are by no means immune to these changes, which pose challenges that affect their service delivery. During periods of fundamental transformation, individuals typically experience changes in their levels of organisational commitment, which impacts on effective and efficient service delivery. Organisational commitment as an area of research is one of the factors that could lead to greater morale, strong organisational climate, motivation and productivity in many organisations facing transformation (Salami, 2008). The aim of this study was to investigate the level of organisational commitment after a transformation process at a Provincial Government Department. Recent organisational transformations (both in the private and public sector) have included the redrawing of divisional boundaries, flattening of hierarchic levels, spreading of spans of control, revising compensation, streamlining processes and reforming governance (Ndlovu &amp / Brijball Parusumar, 2005). The results of the research indicate that employees are moderately committed to the organisation. Statistically significant relationships were found between the dimensions of organisational commitment, except for affective commitment and total commitment which were not significant.&nbsp / Furthermore, results indicate that statistically significant differences exist based on the biographical characteristics (namely, gender, race, tenure, marital status, age and job level) but these characteristics do not significantly explain the variance in organisational commitment for this organisation. A limitation of the research is that the sampling composition and research design preclude the results of this study being generalised to other organisations and it is recommended that a stratified random sampling design be utilised for future research.</p>

Eudaimonic psychological well-being (PWB) refers to a lifelong process of purposeful engagement in goal-driven tasks or activities resulting in positive psychological functioning. These activities reflect autonomy, purpose in life, self-acceptance, personal growth, positive relations with others, and environmental mastery. While more women are surviving breast cancer, they face a multitude of late and long term physiopsychosocial challenges that result from being diagnosed and treated. Protective health effects associated with the experience of PWB can potentially mitigate ill-being and benefit overall health of breast cancer survivors (BCS). Adequate preparation by healthcare teams to transition them from primary treatment to early survivorship is critical for the immediate and long term PWB of BCS. The purpose of this dissertation was to: 1) summarize current literature addressing PWB among BCS; 2) describe the helpfulness of information BCS satisfied and dissatisfied receive from their healthcare team to prepare to transition into life immediately after treatment; and 3) examine relationships between PWB and factors that negatively influence BCS’ ability to successfully transition to early survivorship Three manuscripts describe results of data analysis. From a literature review, factors that correlate with PWB among BCS were identified: coping, social support, self-esteem, post-traumatic growth, religious struggles and the impact of physical symptoms. Based on qualitative responses, BCS who are satisfied and dissatisfied with information received to prepare for transition into early survivorship emphasized the importance of receiving comprehensive information on: (1) what to expect physically and emotionally post-treatment, and (2) how their lives moving forward will be unlike their lives prior to being diagnosed. Among a convenience sample of 56 BCS, significant negative relationships between PWB and a) cancer problems frequently experienced by early survivors of breast cancer, b) psychological distress, and c) satisfaction with information received to transition from primary treatment into early survivorship was noted from a prospective, cross-sectional research design study. PWB is becoming increasingly important given that BCS live longer. Information learned from this dissertation can be used by healthcare teams to promote or maintain positive psychological functioning among these survivors, focusing initially on preparing them for life immediately after treatment.

The most common form of childhood cancer is Acute Lymphoblastic Leukemia (ALL). Patients treated for ALL may experience short- and long-term physiological and cognitive effects due to treatment. However, delayed emotional and behavioral effects in pediatric survivors, as well as risk-factors that may make them more susceptible to developing problems with psychological and behavioral functioning are less understood. Studies investigating pediatric survivors have demonstrated that negative emotional and behavioral late effects can and do occur (Hobbie et al., 2000; Buizer et al. 2006; Novakovic et al., 1996; Mulhern, Wasserman, Friedman, & Fairclough, 1989), and it has been purported that survivors experience higher rates of depression, anxiety and low self-esteem (Koocher, O’Malley, Gogan, & Foster, 1980; Kazak, 1994). Anxiety in particular, has been identified as one of the longest lasting psychological sequelae of cancer (Kazak, 1994). Still, the data on long-term psychological sequelae is mixed, with some studies suggesting healthy, long-term, psychological adjustment (Brown et al., 1992; Fritz, Williams & Amylon, 1988; Greenberg, Kazak, & Meadows, 1989). This pilot study attempted to investigate emotional and behavioral late effects of cancer as reported by survivors and their caregivers on the Behavior Assessment System for Children, Second Edition (BASC-2). This study also investigated potential risk factors that made it more likely to develop emotional and behavioral late-effects. This study hypothesized that females, those undergoing high intensity chemotherapy, and those starting chemotherapy at an earlier age, would report significantly more internalizing and externalizing problems. Analysis revealed significant differences in reporting of anxiety, depression, attention and hyperactivity symptoms combined based on the age when treatment started. No other significant findings were uncovered; however, in an effort to provide directions for future research, patterns in the data were examined by comparing overall means on BASC-2 subscales. For example, females reported more hyperactive symptoms than males. In general, individuals who started treatment at younger ages reported more difficulty with emotional and behavioral functioning. Additionally, males and females adaptive behavior fell within normal limits. Overall, no BASC-2 mean scores were in the at-risk or clinically significant range of impairment suggesting adequate emotional, behavioral and adaptive functioning overall. / text

<p>Organisations are by nature, dynamic entities that continuously undergo transformation in response to both internal and external pressures, which are imposed on them (Robbins, Odendaal &amp / Roodt, 2003). Government departments are by no means immune to these changes, which pose challenges that affect their service delivery. During periods of fundamental transformation, individuals typically experience changes in their levels of organisational commitment, which impacts on effective and efficient service delivery. Organisational commitment as an area of research is one of the factors that could lead to greater morale, strong organisational climate, motivation and productivity in many organisations facing transformation (Salami, 2008). The aim of this study was to investigate the level of organisational commitment after a transformation process at a Provincial Government Department. Recent organisational transformations (both in the private and public sector) have included the redrawing of divisional boundaries, flattening of hierarchic levels, spreading of spans of control, revising compensation, streamlining processes and reforming governance (Ndlovu &amp / Brijball Parusumar, 2005). The results of the research indicate that employees are moderately committed to the organisation. Statistically significant relationships were found between the dimensions of organisational commitment, except for affective commitment and total commitment which were not significant.&nbsp / Furthermore, results indicate that statistically significant differences exist based on the biographical characteristics (namely, gender, race, tenure, marital status, age and job level) but these characteristics do not significantly explain the variance in organisational commitment for this organisation. A limitation of the research is that the sampling composition and research design preclude the results of this study being generalised to other organisations and it is recommended that a stratified random sampling design be utilised for future research.</p>