The dissertation deals with holistic approach of nursing staff of the Rescue Service by providing pszchosicial support and crisis communication to the survivors or direct sudden death participants from nurse´s }member of the Rescue Service team]perspective. The goal of the dissertation has been 1. To detect problems which nursing staff members of the Rescue Service are prepared for communication with the survivors.

This diploma thesis is trying to figure out how is oncological disease and it´ s treatment affecting survivors life after curing the disease. Acute leukemia and its challenging and often aggressive treatment leaves many different late effects. Quality of life is a subjective assessment which to some extent depends on the nature of the individual. Even so, it is necessary to evaluate and examine the quality of life beacuse the results of researches can help other patients, but also nurses, doctors, psychologists and other helping professions. The theoretic part of the thesis describes the current state of the problem, introduces the basic and fundamental specifics of children's cancer, the treatment, the after-effects, deals with the description of the psychological problems of patients and their caregivers, which provides diagnosis itself, but also the treatment of the disease. It also introduces the psychological care about oncological ill patiens and the roles of the nurses in careing for the oncological patiens. Another part of the theoretical work is an introduction to the measurement and evaluation of quality of life. Work also introduces the leukemia disease, which is one of the most commonly diagnosed cancer diseases in children. The thesis has three goals. The first one is to determine how the treatment of the oncological disease affects life of survivors. The second one is to determine how children perceive various limitations of social contact that the treatment brings. The last third objective is to determine whether the cancer experience affects the attitude of the survivor children to live. In the practical part of the research was used quantitative research. The technique of data collection was standardized questionnaire Minneapolis Manchester Quality of Life Instrument which is divided into two versions for younger and older children. The research was also used for statistical evaluation of hypotheses. The questionnaire was distributed to children aged 8 - 18 years who were 2 - 5 years after treatment. The control group were the same aged healthy peers. Four hypotheses were determined. H1: Cured children have more difficulties in social functioning than healthy children. It was found that cured children have better outcomes in social functioning than their peers, hypothesis H1 is thus not confirmed. H2: Cured children have less energy for physical activities than healthy children. This hypothesis was confirmed neither in older or younger children. H3: Cured children are more satisfied with their appearance than healthy children. This hypothesis was based on the research and statistical verification verified. Last investigated hypothesis was H4: Cured children have more problems in cognitive functioning than healthy children. Based on the statistical verification hypothesis was not confirmed. The research and statistical studies show that cured children have the same or in some areas even better quality of life than their healthy peers 2 - 5 years after the end of active treatment. The nurse should be able to help and advise the patient and should emphatically and nicely cooperate with the family for which it is often even worse than for the patients themselves. This diploma thesis will be used for making of an internal seminars for nurses working at the Clinic of Pediatric Oncology. Nurses working at the bedsides of the patiens can use this theses as a feedback of thein work. Knowledge of late effects of anticancer therapy is essential to providing a high - quality care and application of evidence - based nursing in practice.

abstract: Decades of research and empirical studies support the belief that traumatic life events lead to a multitude of negative outcomes (Tedeschi & Calhoun, 1996), however, new research suggests that some survivors of trauma experience significant psychological growth, known as posttraumatic growth (PTG) (Tedeschi, Park, & Calhoun, 1998). The current study focused on the trauma of a traumatic brain injury (TBI) and its relation to the development of PTG. A TBI is both a psychological trauma and a type of acquired brain injury that occurs when physical injury causes damage to the brain (National Institutes of Health [NIH], 2013). Empirical studies examining TBIs and PTG are minimal. The current study focused on survivors who have sustained a TBI from a motor vehicle accident to help control for contextual factors of the injury that are known to affect outcomes. The aim of this study was to elucidate the physical, sociodemographic, contextual, and psychological factors that helped predict the development of PTG among a population of TBI survivors. In addition, another aim of this study was to gain a better understanding of the relationship between PTG and posttraumatic stress disorder (PTSD) symptomatology. Cross-sectional data from self-identified TBI survivors of motor vehicle accidents (n = 155) were used to construct a model of prediction of PTG. Preliminary analyses revealed a reliability issue with the measure that assessed participants’ personality, and these variables were not used in planned analyses. Results revealed that the majority of participants were female, Caucasian, highly educated, and unemployed. Overall, the sample indicated significant injury severity, disability, and lower than average mental and physical functioning. The final model accounted for approximately 15% of the variance in PTG and significant predictors included: gender, time since injury, and the interaction between PTSD symptoms and time since injury. The findings of this research can help inform treatment programs and rehabilitation services as well as funding that can aim to improve outcomes from survivors of TBI. Study limitations included the use of cross-sectional data, a homogenous and unrepresentative sample of TBI survivors, recruitment concerns, and low reliability observed in one of the integral measures of the study. / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2016

RESUME Introduction: Le cancer du sein (CS) est le cancer le plus fréquent chez la femme. Le risque de CS est influencé par de nombreux facteurs. Le traitement hormonal de la ménopause (THM) est l’un d’entre eux. Le risque de CS associé au THM varie probablement en fonction de la population traitée, du type de traitement utilisé, de la durée du traitement et du moment où il est instauré par rapport au début de la ménopause. Il existe des alternatives au THM pour soulager les symptômes de la ménopause. Quelques traitements ont montré une certaine efficacité mais présentent des effets secondaires. D’autres traitements doivent faire l’objet d’études plus approfondies. Objectifs: 1) Contribuer à l’analyse de l’influence du THM sur le CS. 2) Contribuer à l’amélioration de la qualité de vie des patientes ayant eu un CS. Résultats: 1) Nous avons analysé l’évolution de l’incidence du CS et des ventes de THM en Belgique et montré une corrélation entre ces deux paramètres. Nous avons réalisé une revue systématique des études analysant l’association entre l’incidence du CS et l’utilisation de THM. Toutes présentaient des limitations et leur hétérogénéité les rendait difficilement comparables. Nous avons analysé l’évolution des ventes de THM en Europe et montré une diminution importante au cours de la dernière décennie dans l’ensemble des pays étudiés. Nous avons analysé l’évolution de l’incidence du CS et de l’utilisation des THM dans différents pays européens et n’avons pas trouvé d’association entre ces deux paramètres. Nous avons réalisé une revue systématique des études évaluant l’influence du THM sur les caractéristiques du CS et montré que les CS développés sous THM n’étaient pas de meilleur pronostic. 2) Nous avons réalisé deux revues systématiques sur la sécurité d’emploi des THM et des traitements non hormonaux de la ménopause chez les femmes ayant eu un CS. Nous avons montré que le CS représentait une contre-indication au THM et que peu de données existaient concernant les traitements alternatifs. Nous avons mené deux études concernant l’utilisation de traitements de la ménopause chez les femmes ayant eu un CS et montré qu’une proportion importante des femmes ayant eu un CS présentait des symptômes de la ménopause mais que peu d’entre elles utilisaient un traitement. Certains de ces traitements pouvaient potentiellement réduire l’efficacité de leur traitement contre le CS. Conclusions: 1) L’influence exacte du THM sur l’incidence du CS reste difficile à déterminer. D’autres facteurs interviennent également. Nous avons montré l’importance du temps lorsqu’on observe l’évolution de deux paramètres. 2) Les traitements sûrs et efficaces des symptômes de la ménopause chez les femmes ayant eu un CS sont limités. La qualité de vie des patientes ménopausées, ayant souffert d’un CS, peut cependant être nettement améliorée. / ABSTRACT Introduction: Breast cancer (BC) is the most common cancer in women. BC risk is influenced by many factors. Menopausal hormone therapy (MHT) is one of them. BC risk associated with MHT may vary depending on the treated population, the type of MHT used, the treatment duration and the delay between the beginning of the treatment and the onset of the menopause. There are alternatives to MHT for the treatment of menopausal symptoms. Some of them have shown some efficacy but have side-effects. Others need further research. Objectives: (1) To contribute to the analysis of the influence of MHT on BC; (2) to contribute to the improvement of the quality of life of BC patients. Results: (1) We analysed changes in BC incidence and MHT sales in Belgium and showed a correlation between these two parameters. We made a systematic review of studies analysing the association between BC incidence and MHT use. All the studies had limitations and were heterogeneous, making them difficult to compare. We analysed changes in MHT sales in Europe and showed an important decrease during the last decade in all the studied countries. We analysed changes in BC incidence and MHT sales in several European countries and found no association between these two parameters. We made a systematic review of studies assessing the influence of MHT on BC characteristics and showed that cases of BC developed under MHT did not have a better prognosis. (2) We made two systematic reviews on the safety of MHT and non-hormonal treatments in BC patients. We showed that BC was a contra-indication to MHT and that few data on alternative treatments were available. We conducted two studies on the use of treatments to alleviate menopausal symptoms in BC patients and showed that an important proportion of these women suffered menopausal symptoms but that few of them were using a treatment. Some of these treatments could reduce the efficacy of their BC treatment. Conclusions: (1) The exact influence of MHT on BC incidence is difficult to evaluate. Other factors are also involved. We showed that long follow-ups are needed when analysing time trends. (2) Efficient and safe treatments for menopausal symptoms in BC patients are limited. However, the quality of life of BC patients may be improved. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

Submitted by AGDA JESSICA DE FREITAS GALLETTI null (aj.mat@hotmail.com) on 2018-03-23T18:26:29Z No. of bitstreams: 1 Dissertacao Agda.pdf: 8703134 bytes, checksum: 38fab95cf6a37646cb9076182d7acefe (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-26T17:31:07Z (GMT) No. of bitstreams: 1 galletti_ajf_me_bot.pdf: 8692893 bytes, checksum: 24ce44d5b41a0465faf8c7d5f279a7bb (MD5) / Made available in DSpace on 2018-03-26T17:31:07Z (GMT). No. of bitstreams: 1 galletti_ajf_me_bot.pdf: 8692893 bytes, checksum: 24ce44d5b41a0465faf8c7d5f279a7bb (MD5) Previous issue date: 2018-02-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A cirrose é uma doença hepática assintomática que, muitas vezes, é descoberta quando o quadro é irreversível. Por isso, o tratamento consiste em uma série de medidas para controlar o avanço da enfermidade, visto que a principal consequência da cirrose é o aumento da pressão na veia portal, que por sua vez, acarreta no surgimento de varizes e no seu respectivo rompimento, podendo ser fatal. Estudos relacionados à esta doença são muito importantes, pois a análise estatística é uma ferramenta que permite auxiliar na tomada de decisões nos procedimentos médicos e acompanhamento de pacientes. Um método estatístico bastante explorado nas ciências biomédicas é a análise de sobrevivência, que consiste em descrever o tempo de um evento inicial até a ocorrência de um outro de interesse. No entanto, existem situações em que uma proporção da amostra não vivencia o desfecho de interesse, mesmo que acompanhado por um período longo de tempo. Nestes casos, tais observações são dita imunes ao desfecho de interesse e as metodologias tradicionais de análise de sobrevivência não são indicadas. Logo, os modelos de fração de cura ou de longa duração, desenvolvido a partir do modelo de mistura, são os utilizados nestas situações. Neste trabalho diverso modelos foram considerados para analisar os tempos de vida de pacientes submetidos à Ligadura Elástica de Varizes Esofágicas, ao qual foram anotados os tempos até o óbito durante o acompanhamento de 129 pacientes do Hospital das Clínicas da Faculdade de Medicina da UNESP, Campus Botucatu (SP), no período de 2006 a 2010. O modelo Weibull Modificado com fração de cura foi considerado adequado, indicando que quanto maior a idade e o grau da doença hepática, se os pacientes não usam o medicamento Beta-Bloqueador e são homens, menor é a chance deles serem sobreviventes de longa duração. / Cirrhosis is an asymptomatic liver disease that is often discovered when the patient's condition is irreversible. Therefore, the treatment consists of a series of measures to control the progression of the disease, since the main consequence of the cirrhosis is the increase of the portal venous pressure, which causes the appearance of varices and their respective rupture may be fatal. Studies related to that disease are very important, so the statistical analysis is a tool that helps to make decisions in medical procedures and patient follow-up. The most applied statistical method in the biomedical sciences is survival analysis, which consists of describing the time of occurrence until the event of interest. However, there are situations in which a proportion of the sample does not experience the interest outcome, even if they are accompanied by a long period of time. In such cases, such observations are said to be immune to the outcome of interest and traditional survival analysis methodologies are not appropriated. Therefore, the care fraction or long duration models can be used in these situations because they incorporate mixtures of models to solve the complexity inherent in the actual study. In this work, some statistical models were considered to analyze the survival times of patients, after surgery of Endoscopic Band Ligation of the Esophageal Varices, such as Exponential, Gamma and Weibull models. The data is related to survival times of 129 patients, who were treated in the Hospital das Clínicas of the Medical School of UNESP, Campus Botucatu (SP), from 2006 to 2010. The Modi ed Weibull distribution with cure rate was considered adequate to the data, indicating that older male patients with higher Child-Pugh score without taking beta blockers medicine are more likely not to be a long-term survivor.

This master's thesis focusses on long-term effects of the Holocaust on the generation of survivors as well as on their offspring. Firstly, the theoretical part defines the terms 'stress' and 'trauma'. This is followed by an outline of possible reactions to severely stressful situations as well as questionnaires that can be used to measure the levels of traumatization. Afterwards, attention is focused on the phenomenon of posttraumatic growth, mainly based on the perspectives of L. G. Calhoun and R. G. Tedeschi who identify five domains of growth. The possibility of facilitating posttraumatic growth is briefly mentioned alongside with one inventory that can be used to measure the extent of positive change following traumatic experiences. Furthermore, the complexity of the Holocaust is discussed and generations of the Holocaust survivors and their offspring are characterised. In conclusion, attention is drawn to the studies that are concerned with the transgenerational transmission of trauma. The empirical component of the thesis is dedicated to the mapping of specific aspects of posttraumatic stress and growth in Holocaust survivors and their offspring. This data was collected by using a PTSD CheckList (PCL-C) and a Posttraumatic Growth Inventory (PTGI), and afterwards was processed by quantitative...

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T12:22:51Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PriscilaDaTrindadeFlores.pdf: 2196013 bytes, checksum: 3585bf1887deb2633df831a4f6bb10a2 (MD5) / Made available in DSpace on 2018-08-22T12:22:51Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PriscilaDaTrindadeFlores.pdf: 2196013 bytes, checksum: 3585bf1887deb2633df831a4f6bb10a2 (MD5) Previous issue date: 2018-07-20 / Breast cancer is the most frequent cause of death associated with cancer in women worldwide and in Brazil. The objective of the present study was to evaluate the epidemiological profile, nutritional status and quality of life of women with breast cancer. The study population was composed of women diagnosed with breast cancer under treatment at the Hospital Universitário de Santa Maria, RS, Brazil. The study was developed in two stages: In step 1, a retrospective cross-sectional study of the Hospital Registry of Cancer, from 2010 to 2013. In stage 2, a cross-sectional study was carried out from January to August 2017. Socio-demographic, anthropometric, lifestyle, quality of life (QoL) data were collected using the Short-Form Health Survey (SF-36) and food frequency questionnaire to assess adherence to lifestyle recommendations from the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR). To evaluate the association between the variables were performed Chi-square test and Kruskal Wallis test. The association between independent variables and outcomes was determined by univariate analysis using crude odds ratios, assuming 95% confidence intervals. Variables with a value of p <0.20 in the univariate analysis will be included in the regression model. Article 1 aimed to evaluate the epidemiological profile and to determine the factors associated with the presence of more than one primary tumor. The sample consisted of 699 women, 88.6% referred to as white. After adjustment, the occurrence of more than one primary tumor was higher in women over 57 years old and exposed to alcohol. In article 2, the objective was to evaluate adherence to the new WCRF / AICR recommendations by Brazilian women in adjuvant hormone therapy and its associated factors. The average adherence score to the WCRF / AICR recommendations was 4.4 points out of a total of 8 points. The highest score is associated with higher adherence, and was correlated with higher schooling. The objective of article 3 was to evaluate the predictive factors associated with QoL of breast cancer survivors in adjuvant hormone therapy with tamoxifen. A total of 143 women were evaluated. Patients who had: external occupation, current smoking, did not practice physical activity, had ≥ 2 associated diseases, presence of ≥ 3 side effects in all domains of quality of life, elevated body mass index (BMI), high waist circumference (WC), high waist-hip circumference (WHR). We can observe in the present articles, the studied population was represented by women of low education, self-declared white in the age group of 50 years. The side effects resulting from the treatment and not practicing physical activity negatively impact the physical and mental quality of life. Most of the women present high anthropometric indexes of BMI, CC and WHR and were associated with worse physical quality of life. The WCRF / AICR recommendations presented low adherence in this population, and were associated with lower schooling. / O câncer de mama é a causa mais frequente de morte associada ao câncer em mulheres no mundo e no Brasil. O objetivo do presente estudo foi avaliar o perfil epidemiológico, estado nutricional e a qualidade de vida de mulheres com câncer de mama. A população do estudo foi composta por mulheres diagnosticadas com câncer de mama em tratamento no Hospital Universitário de Santa Maria, RS, Brasil. O estudo foi desenvolvido em duas etapas: Na etapa 1, estudo transversal retrospectivo de dados do Registro Hospitalar de Câncer, no período de 2010 a 2013. Na etapa 2, foi realizado estudo transversal de janeiro a agosto de 2017. Foram coletados dados sociodemográficos, antropométricos, hábitos de vida, qualidade de vida (QV) através do questionário Short-Form Health Survey (SF-36) e questionário de frequência alimentar para avaliação da adesão as recomendações de estilo de vida do World Cancer Research Fund (WCRF) e American Institute for Cancer Research (AICR). Para avaliar a associação entre as variáveis foram realizados teste de Qui-quadrado e teste de Kruskal Wallis. A associação entre variáveis independentes e os desfechos foi determinada por análise univariada, por meio de odds ratio brutas, assumindo-se intervalos de 95% de confiança. As variáveis com valor de p <0,20 na análise univariada serão incluídas em modelo de regressão. O artigo 1, teve como objetivo avaliar o perfil epidemiológico e determinar os fatores associados à presença de mais de um tumor primário. A amostra foi composta por 699 mulheres, 88,6% auto referidas brancas. Após ajuste, a ocorrência de mais de um tumor primário foi maior em mulheres com mais de 57 anos e expostas ao álcool. No artigo 2, o objetivo foi avaliar a adesão às novas recomendações do WCRF/AICR, por mulheres brasileiras em terapia hormonal adjuvante e os seus fatores associados. O escore médio de adesão às recomendações da WCRF/AICR foi de 4,4 pontos, de um total de 8 pontos. A maior pontuação é associada a maior adesão, e esteve correlacionada à maior escolaridade. O objetivo do artigo 3 foi avaliar os fatores associadas a QV de mulheres sobreviventes do câncer de mama em terapia hormonal adjuvante com tamoxifeno. Foram avaliadas 143 mulheres. Apresentaram menores escores de QV nos domínios e componentes do SF-36 as pacientes que tiveram: ocupação externa, tabagismo atual, não praticavam atividade física, apresentar ≥ 2 doenças associadas, presença de ≥ 3 efeitos colaterais a todos os domínios de qualidade de vida, índice de massa corporal (IMC) elevado (dor), circunferencia da cintura (CC) elevada, relação da circunferência da cintura-quadril (RCQ) elevada. Podemos observar nos presentes artigos, a população estudada foi representada por mulheres de baixa escolaridade, autodeclaradas brancas na faixa etária de 50 anos. Os efeitos colaterais decorrentes do tratamento e não praticar atividade física impactam negativamente na qualidade de vida física e mental. A maioria das mulheres apresentam índices antropométricos de IMC, CC e RCQ elevados e foram associados a pior qualidade de vida física. As recomendações do WCRF/AICR apresentaram baixa adesão nesta população, e esteve associada a menor escolaridade.

O progresso no diagnóstico precoce do câncer e terapias, bem como longevidade e o crescimento populacional, remete no aumento do número de indivíduos sobreviventes do câncer em todos os países, e com ele surge uma nova nomenclatura, a da sobrevivência ao câncer (SC). Este estudo teve como objetivo geral, analisar o conceito da SC na literatura de saúde e entre adoecidos adultos e/ou idosos diagnosticados com a doença. Para alcançar este propósito elaboramos mais quatro objetivos específicos que nos fez organizar a tese em três grandes etapas. A primeira etapa tem como objetivo analisar o conceito da SC apresentado na literatura de saúde, segundo o modelo evolucionário de análise conceitual de Rodgers. Este modelo está disposto em seis etapas, preconizando a análise dos estudos levantados pela análise temática indutiva e interpretados segundo o referencial teórico do conceito de cultura. Como resultado obtivemos os componentes do conceito, que nos auxilia na compreensão do mesmo, são eles: antecedente - ser diagnosticado com câncer; consequente - qualidade de vida dos sobreviventes do câncer (StC) e crescimento pessoal; atributos - processo de liminaridade e cuidado culturalmente congruente; termos substitutos - StC, sobrevivência em longo prazo e aquele que está vivendo após o diagnóstico do câncer, e por último os termos relacionados - sobrevida e reabilitação do câncer. Para a segunda etapa dessa pesquisa o propósito foi apreender os sentidos atribuídos a ser StC entre adoecidos, assim como, descrever os sentidos atribuídos ao conceito da SC entre adoecidos adultos e idosos por meio de sínteses narrativas. Desse modo, construímos um estudo qualitativo, com método narrativo e com referencial da antropologia médica. Realizamos entrevistas semi-estruturadas com 14 participantes diagnosticados com os diferentes tipos de câncer urológico de ambos os sexos, adultos e idosos, com no mínimo três meses pós-tratamento. Após transcrição dos dados, os mesmos foram analisados segundo a análise temática indutiva e duas sínteses narrativas foram elaboradas, a primeira delas é as dualidades da vida após o tratamento: da perda do autocontrole, da incerteza da recorrência da doença ao otimismo e esperança. Nessa síntese, discutimos acerca da experiência do sobrevivente com a doença, a perda de controle que a doença desencadeia e o consequente crescimento pessoal e aquisição do otimismo apesar das circunstâncias vividas. A segunda síntese é intitulada, o que eu sou? Sou um sobrevivente do câncer? Autorreflexão da identidade após o tratamento primário do câncer. Nela apreendemos a reflexão dos participantes sobre como se enxergam e veem a si mesmo e atribuem sentidos a ser ou estar doente, curado, vítima e principalmente StC. Com essas duas sínteses narrativas conseguimos descrever e nos aproximar dos sentidos atribuídos a SC. A terceira etapa foi desenvolvida em três tópicos, o primeiro consiste na comparação dos resultados da etapa um com a etapa dois, complementando com a importância da enfermagem oncológica no cuidado aos StC e uma reflexão sobre as políticas de saúde públicas atuais. Essa tese atualiza o conceito da SC e traz novas perspectivas sobre ele, contribuindo para a enfermagem oncológica / The progress in the early diagnosis of cancer and therapies, as well as the longevity and population growth remit to an increased number of cancer survivors around the world, giving rise to a new term, that of cancer survivorship (CS). The general objective in this study was to analyze the concept of CS in the health literature and among adult and/or elderly patients diagnosed with the disease. To achieve this objective, we elaborated four specific objectives, which made us organize the dissertation in three main phases. The objective of the first phase is to analyze the concept of CS presented in the health literature, according to Rodgers\' evolutionary model of concept analysis. This model is arranged in six steps, recommending the analysis of the studies surveyed by means of inductive thematic analysis and their interpretation according to the theoretical framework of the culture concept. As a result, we obtained the components of the concept, which help us understand it. These are: antecedent - being diagnosed with cancer; consequent - quality of life of cancer survivors (StC) and personal growth; attributes - liminality process and culturally congruent care; substitute terms - StC, long-term survival and individuals living after the cancer diagnosis, and finally the related terms - cancer survival and rehabilitation. For the second phase, the purpose was to apprehend the meanings attributed to being StC among the patients, as well as to describe the meanings adult and elderly patients attribute to the CS concept through narrative syntheses. Thus, we built a qualitative study, using the narrative method and the reference framework of medical anthropology. We held semistructured interviews with 14 participants diagnosed with different types of urological cancer, male and female, adult and elderly, with at least three months post-treatment. After transcribing the data, they were analyzed according to inductive thematic analysis and two narrative syntheses were elaborated, the first being the dualities of life after the treatment; from loss of self-control, the uncertainty of the disease relapse to optimism and hope. In this synthesis, we discuss the survivor\'s experience with the disease, the loss of control the disease triggers and the consequent personal growth and gaining of optimism despite the circumstances experienced. The second synthesis is entitled: Who am I? Am I a cancer survivor? Self-reflection on the identity after the primary cancer treatment. In this synthesis, we apprehend the participants\' reflection on how they see themselves and attribute meanings to being ill, cured, victim and mainly StC. These two narrative syntheses allowed us to describe and get closer to the meanings attributed to CS. The third phase was developed in three topics, the first being the comparison between the results of phase one and phase two, complemented with the importance of oncology nursing in care for StC and a reflection on the current public health policies. This dissertation updates the concept of CS and offers new perspectives, contributing to oncology nursing

M.A. / Widowhood is a condition of an incomplete family structure resulting from death. Its consequences such as the absence of the father and husband can be aggravated, decreased or neutralised due to the effects of other conditions, relating to the availability of funds, relatives and community services. Widowhood presents problems and difficulties that most widowed people have to face. The elderly widows are faced with learning to live alone; leaving their own homes and adjusting to life with relatives; financial problems; and immediate care and support. The young widows, in addition, are faced with problems relating to decision-making; managing large sums of money; child upbringing; dispute with in-laws, relatives and older children over the death benefits and estate; lack of support and development programmes for young widows. Widows experience multiple problems that are more common in nature and necessitate a more preventative and developmental approach. Widows' problems are often ignored as, in most instances, they are classified as single mothers, like divorced or unmarried mothers, without paying special attention to the specific condition of widows in particular. Special community and organisational programmes to support and empower widows to cope with social, emotional and economic situations are lacking. Delamont (1980:221) argue that, yet not only is the evidence that being widowed catches most women unprepared financially, socially and emotionally, the study of women in this predicament has been neglected. The problems and factors associated with the management of death benefits by widows have also been neglected.

Contexte : Le cancer de l'endomètre est le plus fréquent des cancers gynécologiques. Il a été suggéré que les traitements oncologiques entraînent des dysfonctions des muscles du plancher pelvien. Ces dysfonctions pourraient contribuer au développement de conditions débilitantes comme la douleur lors des relations sexuelles (dyspareunie) qui atteint plus de la moitié des survivantes. Or, à l'heure actuelle, aucune étude n'a investigué la fonction des muscles du plancher pelvien en lien avec la dyspareunie chez des survivantes d'un cancer de l'endomètre. Objectifs : L'objectif principal vise à explorer les différences quant à la fonction des muscles du plancher pelvien entre des survivantes d'un cancer de l'endomètre atteintes de dyspareunie et des femmes sans douleur ayant subi l'hystérectomie totale pour des raisons bénignes. L'objectif secondaire est d'explorer les différences entre les deux groupes quant aux variables urogynécologiques, sexuelles, psychologiques et sociales. Méthodologie : Dans cette étude comparative exploratoire bicentrique, des survivantes d'un cancer de l'endomètre atteintes de dyspareunie (n=7) et des femmes asymptomatiques (n=7) ont assisté à une séance d'évaluation menée par une physiothérapeute. Les deux groupes ont été équilibrés selon l'âge, l'indice de masse corporelle et le nombre d'accouchements par voie vaginale. La fonction des muscles du plancher pelvien, y compris le tonus, la force maximale, la vitesse de contraction, la coordination et l'endurance, a été évaluée à l'aide du spéculum dynamométrique. Des questionnaires validés ont permis d'évaluer les variables secondaires. Des tests de Mann-Whitney ont été employés pour comparer les deux groupes quant à la fonction des muscles du plancher pelvien et les variables urogynécologiques, sexuelles, psychologiques et sociales (!=0,050). Résultats : Concernant la fonction des muscles du plancher pelvien, les survivantes atteintes de dyspareunie ont démontré un tonus à une ouverture vaginale minimale supérieur (p=0,018) et une endurance inférieure (p=0,048) aux femmes asymptomatiques. Les survivantes ont également présenté plus d'incontinence fécale (p=0,005) et une fonction sexuelle inférieure (p=0,004) comparativement aux femmes asymptomatiques. Aucune différence n'a été détectée pour les variables psychologiques et sociales. Conclusion : Les résultats de cette étude exploratoire suggèrent des dysfonctions des muscles du plancher pelvien, notamment un tonus supérieur et une endurance inférieure, chez les survivantes d'un cancer de l'endomètre atteintes de dyspareunie. D'autres études sont nécessaires afin de confirmer ces résultats. Ces constats préliminaires pourraient servir d'assises pour mieux comprendre les dysfonctions des muscles du plancher pelvien impliquées dans la dyspareunie chez cette population. / Abstract : Context: Endometrial cancer is the most common cancer in gynecological cancers. Oncological treatments are suggested to cause pelvic floor muscle dysfunction that could contribute to the development of debilitating conditions such as pain during sexual intercourse (dyspareunia), which affects more than half of survivors. However, to date, no study investigated pelvic floor muscle function in relation to dyspareunia in endometrial cancer survivors. Objectives: The main objective is to explore differences in pelvic floor muscle function between endometrial cancer survivors with dyspareunia and women without pain who underwent a total hysterectomy for benign conditions. The secondary objective is to explore differences between the two groups on urogynecological, sexual, psychological and social variables. Methodology: In this exploratory, bicentric comparative study, endometrial cancer survivors with dyspareunia (n=7) and asymptomatic women (n=7) attended one evaluation session conducted by a physiotherapist. The two groups were balanced in terms of age, body mass index and number of vaginal deliveries. The pelvic floor muscle function, including tone, maximal strength, contraction speed, coordination and endurance, was assessed with the dynamometric speculum. Validated questionnaires were used to evaluate secondary variables. Mann-Whitney tests were used to compare the two groups on muscular, urogynecological, sexual, psychological and social variables (!=0.050). Results: Concerning pelvic floor muscle function, survivors with dyspareunia demonstrated higher tone at a minimal vaginal aperture (p=0.018) and lower endurance (p=0.048) compared to asymptomatic women. Survivors also presented more fecal incontinence (p=0.005) and lower sexual function (p=0.004) compared to asymptomatic women. No differences were detected for psychological and social variables. Conclusion: The results of this exploratory study suggest impaired pelvic floor muscle function, notably higher tone and lower endurance, in endometrial cancer survivors with dyspareunia. Further studies are needed to confirm these findings. This preliminary evidence can be used as empirical data to better understand pelvic floor muscle impairments implicated in dyspareunia in this population.