In Canada, the lifetime prevalence of the sexual abuse of boys is estimated at one in six (Dorais, 2009; Dube, Anda, Whitfield, Brown, Felitti, Dong, & Giles, 2005; Hopper, 2010; Briere & Elliot, 2003). Despite growing awareness of male victims of childhood sexual abuse, it is estimated that police reports are made in only 4.4% of cases (Priebe & Svedin, 2008). There continues to be little understanding as to why the reporting rate is so low. A sample of 155 male survivors of childhood sexual abuse was obtained through a community agency that provides support to this population. Data were gathered from participants’ intake forms on four variables that were expected to influence police reporting: 1) the survivors' age at the time of the first incident 2) the duration of the abuse; 3) the relationship between the survivor and the perpetrator; and 4) the sex of the perpetrator. It was predicted that the perpetrator's sex would be the most powerful predictor of a male's decision to report sexual abuse because of the ‘feminization of victimization’ phenomenon. This is the culturally based assumption that victims are female and perpetrators are male that leads male victims’ to question their own experiences and to a tendency by others to not take their victimization seriously. The findings revealed that perpetrator sex was not a significant predictor of police reporting. Only abuse duration was associated with whether a police report had been made. Other important findings were: 1) the mean age of this sample seeking support for childhood abuse was 50 years; 2) in almost 30% of cases, abuse began before the participant was six years old; 3) 49% of participants had been abused by family members; 4) 20% of participants had been abused by female perpetrators; and 5) in 75% of cases, a police report had not been made. Further research is needed to identify the factors influencing whether sexual abuse of boys is reported to police in order to enhance support services and police response. / May 2016

Bakgrund: Suicid är ett folkhälsoproblem och i Sverige suiciderar cirka 1400 människor varje år. Sorgen efter en närståendes suicid leder till en kris och ett lidande för de anhöriga. Sjuksköterskans roll i den vårdande relationen blir att bekräfta dessa känslor och upplevelser hos den anhöriga. Syfte: Beskriva anhörigas upplevelser om hur lidandet kan lindras i sorgen efter en närståendes suicid. Metod: Studien är en kvalitativ analys av berättelser där tre självbiografier, tre antologier samt en rapport analyserades utifrån ett omvårdnadsperspektiv. Resultat: Resultatet visade tre kategorier med utgångspunkt från att lindra de anhörigas lidande. Att ta avsked av den döde visade sig vara viktigt i sorgeprocessen men att ändå vara lyhörd för individens val var viktigt. De anhöriga upplevde en unik känsla i sorgen efter en närståendes suicid och hade ett stort behov av att bli bekräftade i detta från omgivningen. Till sist hade de anhöriga skiftande behov av stöd i att leva vidare som kunde innefatta både läkemedelsbehandling, samtalsstöd och hjälp i det vardagliga. Slutsats: Genom resultatet kan studien belysa sjuksköterskans roll i den vårdande relationen som är att se och bekräfta de anhöriga som unika individer och fungera som koordinator gentemot den anhöriga med övriga hälso- och sjukvården. / Background: Suicide is a public health problem and each year about 1,400 people commit suicide in Sweden. The grief after a loved one's suicide leads to a crisis and suffering of the survivors. The nurse's role in the caring relationship is to confirm the survivor’s feelings and experiences. Purpose: Describe suicide survivors’ experiences of how suffering can be alleviated after a loved one's suicide. Method: The study is a qualitative analysis of three autobiographies, three anthologies and a report, which were analyzed from a nursing perspective. Results: The result showed that saying goodbye to the deceased was important in the grieving process but also sensitivity to each survivor’s choice was paramount. Survivors experienced a unique feeling of grief after a loved one’s suicide and had a great need to be confirmed in this. Finally, the survivors had varying needs of support in order to continue living, which could include medical treatment, counseling or assistance in the everyday life. Conclusion: The results highlight the nurse's role in the caring relationship where acknowledging the survivors as unique individuals and coordinating their needs where among the nurse’s main tasks.

The work described in this thesis concerns the use and quality of primary care service use by people living beyond a diagnosis of breast, colorectal and prostate cancer and long-term risks associated with cancer. Firstly, the thesis provides a background for this work, with a definition of long-term survivors as those living at least five years past cancer, and the role of primary care in the care of this population. The second section describes use of the General Practice Research Database amongst a cohort of cancer survivors compared to a control population. Breast and colorectal cancer survivors consult more frequently than controls up to 10 years post-diagnosis, while prostate survivors continue to see their GP up to 3 times more for at least 15 years. Most survivors receive adequate preventative care and chronic disease monitoring, excepting mammography for long-term breast cancer survivors. Cancer survivors receive more prescriptions for pain relief, anti-depressants and erectile dysfunction, suggesting higher rates of pain, depression and sexual dysfunction. Breast cancer survivors have an elevated risk of incident heart failure, coronary artery disease and hypothyroidism, while colorectal survivors experience increased risk of dementia and diabetes. All three groups of cancer survivors had higher risks of osteoporosis and second cancers, all-cause, non-cancer and cancer mortality compared to controls. The third section describes a qualitative study of the primary care usage and unmet needs of 40 long-term survivors of breast, colorectal and prostate cancer. Most respondents did not need active GP involvement. Others had ongoing information and psychological service needs. Some felt that their GPs did not have the right expertise for cancer related issues or were too busy, while others had concerns about continuity of GP care. Overall, this thesis provides a background on how the increasing numbers of cancer survivors use and experience primary care in the UK, areas of good practice, and areas where care can be improved in the future.

O presente estudo tem o objetivo de compreender o que é ser adulto sobrevivente de câncer infantil. O método utilizado foi o fenomenológico-existencial e foi desenvolvido no Ambulatório de Curados do Serviço de Oncologia Pediátrica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo e contou com a colaboração de sete adultos que tiveram câncer na infância. Foi realizada uma entrevista a partir da questão norteadora: Conte-me como está a sua vida. A análise das entrevistas foi construída à luz de algumas idéias de Martin Heidegger em Ser e Tempo (2005). Ser-adulto-sobrevivente-de- câncer-infantil se desvelou como um ser que se lança e que já está lançado e se projetando, resgata o vigor de ter sido, que se atualiza a cada instante. Assim, a vivência do adulto sobrevivente de câncer infantil desvela-se na temporalidade: vigor de ter sido, atualidade e porvir. Dessa forma, ter vivenciado câncer na infância constitui o existir do adulto, ainda que não se queira lembrar, podendo esta vivência ser impulsionadora do existir. Dessa forma, ser-sobrevivente-de-câncer-infantil-no-mundo-com-os-outros é ser projeto, é porvir, é lançar-se, é existir na fluidez da existência, ora na busca de si mesmo, ora buscando ser igual a todo mundo, sendo impessoal, sendo normal, porém a busca pela normalidade dá-se a partir do ser diferente, da busca de si mesmo, pois somos singular e plural ao mesmo tempo. Foi possível perceber que os adultos sobreviventes de câncer infantil necessitam de programas de acompanhamento que atendam às suas demandas e necessidades Porém, esse acompanhamento não deve ficar restrito ao âmbito metafísico, é necessário abertura para estar, co-existir com esse adulto sobrevivente, para que assim possa compreender o seu modo de existir. Assim, o profissional de saúde, em sua atuação, lidará com as diferentes formas de ser no mundo do sobrevivente, além da dimensão biológica do funcionamento do corpo humano. E isso só é possível, quando a equipe de saúde e o paciente constróem relações autênticas. Porém, essa atuação convoca a equipe de saúde a se colocar, a perceber-se co-existente, tendo que cuidar do seu vir a ser, buscando ou se perdendo de si mesma. / The aim of this work is to comprehend what is be an adult survivor of childhood cancer using the method existential-phenomenologic. This work was developed in the Ambulatório de Curados do Serviço de Oncologia Pediátrica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo and it count on the colaboration of seven adults that had childhood cancer. An interview was held from the following guiding question: tell me how your live is. The analysis of the interviews were developed using the ideas of Martin Heidegger in the book Ser e Tempo (2005). Be-adult-survivor-of-childhood-cancer was viewed as a being that throws oneself and that is already thrown and that, projecting oneself, recovers the strength of have been that renews every instant. Thus, the experience of live of the adult survivor of childhood cancer manifests on the temporality: the strength of have been, the present and the future. Then, to have experienced cancer during the childhood is part of the existence of the adult, even if he does not want to remember and this experience can even stimulate his existence. Thus, be-adult-survivor-of-childhood-cancer-in-the-world-with-the-other is be project, is future, is to throw oneself, is to exist in the flow of the existence, once looking for oneself, once trying to be equal to the other, being impersonal, being normal. However, the search of the normality happens from the I am different looking for himself/herself, because we are singular and plural at the same time. It was noted that the adult survivors of childhood cancer need accompaniment programs that attend your necessities. Nevertheless, this accompaniment cannot be restricted to the metaphysic field. It is necessary to be open to be with and to coexist with this adult survivor in order to understand your way of existence. Then, in your actuation, the health professional will deal with the different ways of the be in the world of the survivor, besides the biological dimension of the work of the human body. This is only possible when the health team and the patient build an authentic relation. Although, this actuation requires that the health team to perceive coexistent taking care of your own will be, searching or loosing itself.

This thesis explores the experiences of young people who are survivors of childhood cancer, their parents, health care professionals (HCPs), and case note documentation, of the process of transition from paediatric to adult cancer services. A qualitative, collective case study approach (Stake, 1995), informed by a constructivist-interpretive position, allowed exploration of the multiple realities prioritised in this study. Whilst there is a significant body of literature relating to transition for conditions such as rheumatology and cystic fibrosis, there is little research undertaken into transition in a cancer context, specifically so from an experiences perspective. This study aimed to re-address this issue. The experiences of twelve young people were explored in this study. This resulted in the participation of twelve cases, meaning a total of 35 individual, semi-structured interviews were conducted with young people, parents and HCPs. Young people’s case notes (22 sets) were also reviewed. Data were analysed using matrix-based approaches advocated by Miles and Huberman (1994), at both the within- and between-case level. This generated a multi-dimensional and multiple perspective understanding of the experience of the process of transition. The results of this study clearly identified a central orienting theme: The experience of readiness in the context of transition. Three main themes and six sub-themes were also identified within the data, supporting the explanatory power of the orienting theme. The main themes identified were: The experience of childhood cancer; Planning and preparation: Transition or transfer?; and A process of change. The findings demonstrate that understanding the multi-faceted components of readiness is crucial in understanding people’s experiences of readiness. Readiness should embody people’s illness experiences, the numerous and associated losses intertwined with a move from paediatric to adult care and the simultaneous developmental changes occurring in people’s lives. Only by doing so shall a meaningful understanding of the experience of the process of transition for survivors of childhood cancer, their parents and health care professionals be developed. The thesis concludes by making recommendations for future research and clinical practice.

Alors que les survivants du cancer sont à risque plus élevé de second cancer, d’autres pathologies et de déclin fonctionnel ; les facteurs de mode de vie, comme une alimentation équilibrée, une pratique d’activité physique et le contrôle d’un poids sain, peuvent contribuer à prévenir ces risques et améliorer la qualité de vie des survivants du cancer. Dans ce contexte, les objectifs de cette thèse étaient, parmi les survivants du cancer de la cohorte française prospective NutriNet-Santé, 1) d’investiguer les variations du comportement nutritionnel entre avant et après diagnostic de cancer ainsi que la consommation de compléments alimentaires, et 2) d’évaluer les opinions vis-à-vis de certains facteurs nutritionnels, et de les mettre en regard de leurs pratiques alimentaires réelles d’une part, et de leurs sources d’information nutritionnelles d’autre part. Dans un premier temps, nous avons observé des tendances favorables à la santé comme une diminution de la consommation d’alcool et des boissons sucrées non alcoolisées, et d’autres moins favorables comme une diminution de la consommation de légumes et de plusieurs apports en vitamines et minéraux. Un déclin de l’activité physique globale et intense était observé. De manière cohérente, nous avons observé une augmentation des comportements sédentaires, particulièrement chez les femmes, les sujets plus âgés et les patients qui n’étaient pas actif professionnellement. Nous avons observé une perte de poids chez certains cas de cancers colorectaux, alors qu’une prise de poids était observée chez les cas de cancers du sein et de la peau. Les facteurs sociodémographiques et économiques semblaient influencer le risque de prise de poids, suggérant des inégalités sociales de santé (risque plus élevé chez les patients ayant des revenus et un niveau d’étude plus faible). Nos résultats suggéraient que la consommation de compléments alimentaires était largement répandue chez les survivants du cancer, en grande partie sans suivi médical, incluant une proportion non négligeable de patients ayant des pratiques de consommation de compléments alimentaires pouvant être considérées comme « à risque ».Dans un second temps, nous avons observé que les opinions des survivants du cancer concernant certains facteurs nutritionnels semblaient impacter leurs pratiques alimentaires et étaient eux-mêmes impactés par les sources d’informations auxquelles les survivants du cancer avaient eu accès depuis leur diagnostic de cancer. En particulier, les opinions concernant la consommation d’alcool étaient préoccupantes, avec une proportion importante de survivants du cancer qui pensaient que la consommation d’alcool (et plus encore concernant le vin rouge) avait un impact positif sur leur maladie. Les régimes restrictifs pour perdre du poids étaient pratiqués par une grande partie de notre échantillon ; le jeûne était moins pratiqué, mais était loin d’être un phénomène isolé. / While cancer survivors are at increased risk for negative conditions as second cancers, other comorbidities, and functional decline ; lifestyle factors, such as a healthy diet, regular exercise and weight control, may contribute to prevent these conditions and improve survivors' quality of life. In this context, aims of this thesis were, among cancer survivors from the French prospective NutriNet-Santé study, to 1) investigate nutritional variations between before and after cancer diagnosis as well as dietary supplements use, and 2) evaluate opinions relating to some diet factors and to weight-loss restrictive diets and fasting practices, and to link them on the one hand to their real practices, and, on the other hand, to their sources of nutritional information.In the first part, our results highlight some healthy behaviors such as a decrease in alcohol and sweetened drinks consumption, but also less favorable trends, such as a decrease in vegetable consumption and in many vitamin and mineral intakes. We also observed a decline in overall and vigorous physical activity after diagnosis, especially in prostate and skin cancers, in men and professionally inactive patients. Concomitantly, we observed an increase in sedentary behaviors, especially in women, older subjects and professionally inactive patients. We also observed that while weight loss was reported in many colorectal cancer patients, a substantial proportion of breast cancer patients gained weight. Sociodemographic and economic factors appeared as important determinants of weight gain, illustrating social inequalities in health (higher risk among patients with lower income and lower education). Our results suggest that dietary supplements use was widespread among cancer survivors, a large amount of which being used without any medical supervision, including a non-negligible proportion of patients having dietary supplement practices which can be considered as “at risk”. In a second part, we observed that opinions from cancer survivors regarding some nutritional factors seemed to impact their dietary practices and were themselves impacted by sources of nutritional information. In particular, opinions regarding alcohol consumption were concerning, with an important proportion of cancer survivors who thought that alcohol consumption (and even more regarding red wine) had a positive impact on their disease. Weight-loss restrictive diets were practiced by a large number of cancer survivors since their diagnosis, while fasting was less practiced, but was far from being an isolated phenomenon.

The current study sought to determine the utilization and effectiveness of art therapy with adult survivors of childhood sexual abuse, as perceived by mental health professionals. A total of 33 participants consisting of marriage and family therapists, masters of social work level clinicians and one doctorate level were surveyed. A self-constructed survey, created by the researcher was distributed to the participants. Results demonstrate that about one third of participants perceived art therapy to be moderately effective in reducing male and female issues surrounding childhood sexual abuse. No significant results were found when comparing the effectiveness of art therapy on males versus females. The study also shows that art therapy is under-utilized. The current study is limited by a small sample size, as well as little experience with art therapy utilization. This study contributes to social work knowledge by providing an awareness of art therapy treatment utilization with adult survivors of childhood sexual abuse. Future research regarding art therapy should consider mental health practitioners’ lack of knowledge and possible under-utilization of art therapy in order to determine its true effectiveness

This qualitative study sought to explore the personal experiences of those who have been victims of Domestic Minor Sex Trafficking (DMST), the challenges they faced as they transitioned into survivors, and the factors they attributed to their resiliency. DMST victims are among the marginalized populations enduring social injustices within our communities. Social workers seek to serve these individuals, and yet they are just one part of the system of helping professionals that will encounter these victims. The interactions that DMST victims have with each entity of the system makes a difference in the recovery process as they become a survivor. Much of the research that had previously been conducted focused on the therapist’s perspective of DMST as experienced through their own therapeutic relationships with the victims. In contrast, the primary goal of this research was to focus on the perspective of those who had been victims of DMST so those in the helping professions can more effectively help these individuals. In order to achieve such goals it is essential to build a foundation of knowledge. This involves providing educational aspects to understand the scope of the problem and the dynamics of the trafficking relationship. In the case of this research, the victims themselves provide the knowledge that was gained through their participation. In addition, the research participants were able to express their perspective of both effective and ineffective aspects of their recovery, as well as what modifications could be made to improve the experiences of those who have been DMST victims in the process of becoming a survivor. Despite the differences in the experiences of the participants, this research revealed major themes in terms of dysfunctional family dynamics in childhood, a lack of recognition of the signs of trafficking, a lack of appropriate recovery services, and provided insight into helpful strategies that could be implemented to improve the process as these individuals transition from victim to survivor. The personal experiences within the specific themes and categories provide beneficial knowledge for those involved in the helping professions as they encounter victims of DMST.

Thesis (M.A.) (Clinical Psychology) --University of Limpopo, 2009. / Aims: The aim of the study was to determine the psychological impact, coping strategies and social support structures among female survivors of domestic violence. Participants: 112 female survivors of domestic violence who came to a trauma centre in Thohoyandou, Limpopo Province to seek help were selected as participants of the study. The participants in this study came from around Thohoyandou in the Thulamela Municipality district. The participants’ ages ranged from 15 to 65 years. Instruments: The questionnaire used was consisted of the following: 6 items covering the demographic variables of the participants such as age, marital status, level of education, employment status, number of years married, number of children; 37 items dealing with assessing the psychological problems i.e. depression and post-traumatic stress disorder; and 42 items dealing with seeking social support and coping strategies. Results: A significant number of the physically abused women were suffering from depression (z=2.8434, p<0.05). The results further revealed that a significant number of physically abused women had PTSD (z=15.31, p<0.05). The findings of this study showed that physically abused women tend to seek help from informal social support rather than formal social support (t=-8.572, df=104, p<0.05 with Mean score=1.99, SD= 1.236 for informal support and Mean score= .78, SD = .951 for formal support). This study further shown a significant difference on the use of escape-avoidance coping strategies compared to the use of many other coping strategies such as problem solving strategy (t= 4.065, df= 110, p<0.05 ); confrontive coping strategy (t= -.42232, df=111 , p<0,05), seeking support strategy (t= -8.740, df= 111, p<0.05) and self –control coping strategy (t= -5.451, df= 111, p<0.05). There was no significant difference between the use of escape-avoidance coping strategy and the use of distance coping strategy (t=.03348, df=111, p>0.05) and responsibility coping strategy (t=-.842, df=111, p>0.05). 11 • Conclusion: This study provides data that can be used to motivate the implementation of intervention programmes to address domestic violence against women. Such programmes must include the implementation of cost-effective intervention aimed at reducing the psychological harm caused by physical abuse. The study also highlighted the need for psychological treatment services. These services must present an important venue to identify and manage depression and PTSD amongst physically abused women. Intervention strategies must include imparting physically abused women with help seeking and coping skills. / Not listed

Cancer affects millions of people every year and survivorship has increased substantially recently. Two cancers that affect older adults is non-Hodgkin's lymphoma and breast cancer, yet very little research has focused on cancer and survivorship in late life. Emerging research has suggested that chemotherapy could have deleterious consequences on cognition, but few studies have considered the long-term neurocognitive sequelae of chemotherapy. Furthermore, social support and optimism have been independently examined as predictors of quality of life in cancer patients, but little research has considered the effects of these variables on other outcomes, such as cognition. The aim of this study was to gain a better understanding of the relationship between social support and optimism on cognition, specifically in non-Hodgkin's lymphoma (NHLS) and breast cancer survivors (BCS). It was hypothesized that social support and optimism would be positively related to cognition, and that social support would mediate the optimism-cognition relationship. Twenty-seven BCS (M age = 71.96), twenty-five female (M age = 69.76) and twenty-five male (M age = 65.28) NHLS groups were recruited. Each participant completed a three-hour standardized neuropsychological battery designed to evaluate a range of cognitive abilities involving attention, premorbid and current intellect, memory, language, visuospatial skills, and executive functioning, as well as self-report measures of mood, social support, and optimism. Performances on cognitive tests were within normal limits, but differences were found in aspects of executive functioning (p < .01) with the men outperforming women in the NHLS group. Women in the NHLS group performed better on a measure of executive functioning (p < .05) and visuospatial functioning (p < .01) than women in the BCS group. Women from both groups performed better than the male NHLS group on verbal learning and memory measures (all p's < .05). The groups did not differ on psychosocial variables. Correlations between psychosocial variables (i.e., social support and optimism) were variably related to cognitive measures in both groups. Social support did not mediate the optimism-cognition relationship. This is the first study to consider the relationship between social support, optimism, and cognition and early interventions to improve cognition in cancer survivors is discussed.