Thesis (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Not embargoed. Vita. Bibliography: 132-150.

Thesis (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Not embargoed. Vita. Bibliography: 152-169.

Thesis (MComm (Industrial Psychology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Contemporary militaries are facing an increasing number of deployments compared to their previous counterparts. This is the result of globalisation and the acknowledgement of interdependence between various countries. The demand is even higher in the South African National Defence Force because of its geographical and socio-political position. Emanating from its position it is endowed with the task of stabilising the continent. This is an important task considering the fact that no country can experience stability and economic prosperity if its neighbours are unstable. The people performing the above highly venerated task are members of families with expectations. The demands posed by job demands in a form of deployment put tremendous pressure on even the healthiest of families. The situation is aggravated by the structure of most military families, cohesive nuclear families isolated from the support of extended families. The resulting conflict arising from the incompatibility affects all facets of a soldier’s life and his/her family. The inevitable consequences include stress, and attitudes such as job dissatisfaction, marital dissatisfaction, and low life satisfaction. The culmination of these negative consequences spill over to work performance and family stability. The family is the most disadvantaged domain because the military ethos enjoins soldiers to prioritise their work and treat the rest as secondary. This leads to an irrefutable destabilisation of families, which is a common experience in military families. The effects are more pronounced on women due to the social roles endowed on them. Their role in nurturance and emotional support make their absence more evident. The children are also not spared from the suffering. The effects of the fragmentation in the family affect their psychological wellbeing, their performance at school and their behaviour in general. The reunion often marks an apex of the tragedy. Returning parents find changes at home, some feel out of sync and others force their way into the families. The family roles have to be renegotiated, which is a process fraught with conflicts. The parents who gained prerogatives in the absence of their spouses are usually unwilling to relinquish their prominent positions. This result in conflicts, which prompt the dissolution of families, and in some cases, fathers withdraw and ask for unaccompanied long-term duties away from home.

Background: Dementia presents challenges for whole families requiring on-going adaptation. Family relationships provide important benefits, thus understanding the impact of dementia for families is critical to facilitating their wellbeing. Behavioural variant Frontotemporal Dementia (bvFTD) brings specific challenges for relationships, however little is understood about how these are experienced or how families adjust. Aims: This research sought to develop an in-depth understanding of the inter-generational family experience of bvFTD over time. Method: Using a qualitative design, nineteen people were interviewed from seven families, including people living with bvFTD. Interviews occurred over three time points. Narrative analysis and grounded theory were used to understand how relationships are affected and the psycho-social coping processes involved in adjustment over time. Results: Four themes emerged; - Cohesive and connected --- distant and disconnected - Challenges to we/ I - Assimilating, adjusting and reconstructing --- resisting, denying, being stuck - A changing we / I --- an entrenched we / I Results illustrate the influence of pre-existing relationships on family experiences of bvFTD. Challenges to family relationships occurred, including changes in mutuality and increased responsibility. Levels of awareness and understanding, influenced by factors such as proximity impacted upon individual and family adjustment. Assimilating these changes was critical to developing strategies for managing the impact on the relationship and adapting to ‘a changing we’. For closest family members including partners, grief and loss were experienced resulting in the need for a parallel adaptation to a changing ‘I’. Acceptance and adaptation was critical to supporting the wellbeing of the person with bvFTD.

Esta tese resultou de uma pesquisa que objetivou compreender a vivência dos dilemas pessoais de executivos bancários relativos à carreira em contexto de trabalho imaterial e suas repercussões nas relações familiares. Para tanto, em termos teóricos e com o objetivo de sustentar a tese, trabalhou-se com os conceitos de dilema, de subjetividade e estilos de vida apoiados especialmente em Bauman (2009; 2008; 2007a; 2007b; 2004), Pelbart (2000), Guatarri e Rolnik (2005) e Gaulejac (2007); de carreira, especialmente nos modelos que de carreira sem fronteira e proteana (SULLIVAN e ARTHUR, 2006; HALL, 1996), de trabalho imaterial amparado em autores tais como Lazzarato e Negri (2001), Lazzarato (2008; 2004), Negri (2009; 2008; 2003), Pelbart (2000; 2003) e Grisci (2008). Foram entrevistados dezesseis executivos bancários de Porto Alegre e da região metropolitana, bem como quinze representantes de suas relações familiares. As entrevistas estruturadas foram realizadas com os executivos bancários em seus ambientes de trabalho e com os familiares ocorreram em suas residências ou em estabelecimentos comerciais por eles indicados. A análise dos dados foi realizada de maneira qualitativa e seguiu as orientações propostas por Minayo (2001). Os resultados indicaram dilemas relativos à mobilidade espacial e funcional, e à privação da convivência. A existência dos dilemas não se mostrou inédita, porém, na contemporaneidade, eles tomam a vida profissional e pessoal dos sujeitos independentemente de limites espaço-temporais, afetando o modo de viver do executivo bancário e de sua família. Esta configuração está relacionada a um “modelo” de carreira profissional meteórica, de responsabilidade única do próprio trabalhador, em um contexto em que prevalece o trabalho imaterial (LAZZARATO e NEGRI, 2001). / This thesis stems from an exploratory research which aimed to discern the personal dilemmas related to the banking executives’ career are currently shaped and understand how these dilemmas are twisted with their family relationships. In order to do so, to theoretically support this thesis, the following concepts were taken up: dilemma, subjectivity and life style, particularly as regarded in Bauman (2009; 2008; 2007a; 2007b; 2004), Pelbart (2000), Guatarri and Rolnik (2005) and Gaulejac (2007); career, especially in the light of the models of borderless and protean career (SULLIVAN and ARTHUR, 2006; HALL, 1996); immaterial work, as approached by authors like Lazzarato and Negri (2001), Lazzarato (2008; 2004), Negri (2009; 2008; 2003), Pelbart (2000; 2003) and Grisci (2008). The interviews were conducted with sixteen banking executives from Porto Alegre and the metropolitan area, and also with fifteen representatives from their family relations. The structured interviews were conducted with the banking executives within their work environments, while the interviews with family members occurred in their homes or in stores suggested by them. Data were analyzed in a qualitative way and followed the guidelines proposed by Minayo (2001). Results suggest the existence of dilemmas related to spatial and functional mobility and social life dispossession. The existence of these dilemmas is not a novelty. However, nowadays they take over the individual’s professional and personal lives regardless of time and space limits. This, in turn, affects the executive and his family’s way of life. Such configuration is connected to a “model” of meteoric professional career, which is the responsibility of the worker alone, in a context where immaterial work prevails (LAZZARATO and NEGRI, 2001).

Esta dissertação objetivou analisar como o conflito conjugal circula nas famílias, compreendendo seu papel no desenvolvimento da prole. Foi realizada uma revisão sistemática da literatura nacional e internacional dos últimos 10 anos sobre o efeito spillover. Os resultados apontam as consequências de conflitos construtivos e destrutivos para casais e filhos, além da escassez de publicações brasileiras sobre a temática. Em seguida realizou-se um estudo empírico com 179 famílias, analisando as opiniões e comportamentos de filhos e casais durante seus conflitos, através das escalas Conflict resolution styles inventory, Children’s perception of interparental conflict e Children’s action tendency scale. Encontrou-se que os filhos identificam os desentendimentos entre seus pais e que isso tem um impacto em seus sentimentos e atitudes. Houve associação entre a forma como casais e filhos encaminham seus conflitos. Refletiu-se sobre as possibilidades de prática nesse contexto, dada a importância sobre a temática para a saúde familiar. / This work aimed to analyze how marital conflict runs in families. A systematic review about the spillover effect was performed in national and international literature of the last 10 years. The results showed the consequences of constructive and destructive conflicts to couples and their offspring. It also points out the dearth of Brazilian publication in that area. Following, an empirical study was done with 179 families. The reports of children and couples about their disagreements and their behavior in these occasions were analyzed by Conflict resolution styles inventory, Children's perception of interparental conflict and Children's action tendency scale. Results showed that children identify disagreements between their parents and that this has an impact on their feelings and attitudes towards life. There was an association between the conflict resolution strategies of couples and children. The possibilities of work in this context were discussed, given the importance of the theme to family health.

Coparenting emerges across the transition to parenthood and refers to the way individuals coordinate, support each other in their parental roles and share responsibility in childrearing. Despite the increase in research on coparenting, relatively few studies have focused on non- North American or non-European families, which has hindered practice and policy targeting diverse countries. Likewise, qualitative research on coparenting is relatively rare, yet critical to shed light on details and complexities not well captured by other methods, including insights into sociocultural factors linked to coparenting in distinct contexts. Moreover, a qualitative longitudinal approach is particularly well suited to examine important life course transitions and turning points, such as the transition to parenthood. To address these gaps, we investigated coparenting across the transition to parenthood in South-Brazilian families, using a qualitative, longitudinal, multiple case study. Semi-structured, face-to-face interviews were conducted with 12 first-time mother and fathers (six nuclear families altogether), at 6, 12, and 18 months postpartum (36 interviews altogether). In two families only the father was employed, with the mother caring for the child; in two families both parents were employed, and they hired a nanny to care for the child in their home; and, in two families both parents were employed, and the child started attending daycare at the end of maternity leave. Through the two articles that comprise the current doctoral dissertation, we explored three components of Feinberg’s (2003) coparenting framework: division of labor (how parents divide childcare tasks and household chores, as well as their satisfaction with this division); agreement/disagreement (e.g., regarding children’s emotional needs and discipline); and, support/undermining (appreciation and cooperation, or criticism and competition). The first article is focused on the division of labor, whereas the second is focused on agreement/disagreement and support/undermining. Deductive thematic analysis revealed similarities and singularities between families. As presented in the first article, we found weaker sharing of household chores over time, against greater sharing of childcare tasks during the first few days postpartum, followed by a downward tendency in the fathers’ contributions during the first few months postpartum. This more unequal division of labor remained stable over time only for families who had chosen maternal care, changing after the end of maternity leave for families who had chosen nanny care and daycare. Parental satisfaction regarding the division of labor remained relatively high over time only for families who had chosen nanny care, which suggests that counting on a domestic worker since the beginning of the transition to parenthood contributed to preventing parental feelings of overload or unfairness across the transition to parenthood. Findings were discussed in the 10 light of the role that instrumental and social support, as well as the prevailing Brazilian gender norms, may play in the division of labor for new parents. With respect to the second article, our findings showed that agreement among parents remained relatively stable during the first year, whereas disagreements concerning discipline demanded more parental negotiation as infants advanced toward toddlerhood. Support and undermining coexisted in the same families, although mothers and fathers expressed undermining differently. Aspects of the ecological context, such as family of origin, instrumental and social support, as well as labor market, also appeared to influence coparenting agreement/disagreement and support/ undermining. Following each article, we presented strengths, limitations, suggestions for future research, as well as implications for practice (e.g., counseling) and policy (e.g., childcare arrangements and parental leave).

Introdução: As consultorias de Bioética Clínica auxiliam no processo de reflexão para a tomada de decisão dos profissionais, dos pacientes ou das famílias quando surge algum problema ou conflito ético durante o atendimento assistencial. As relações familiares dos pacientes podem estar envolvidas nestas situações, inclusive de forma a dificultá-la. Objetivos: Avaliar a presença e a influência das famílias nas consultorias de Bioética Clínica. Assim como, estabelecer o perfil das consultorias nas quais as relações familiares dificultaram a resolução do problema ou conflito ético, quanto aos solicitantes, às especialidades, aos registros em prontuários eletrônicos, aos pacientes e às relações familiares. Métodos: Foram avaliados 307 registros de consultoria de Bioética Clínica, por demanda assistencial, realizadas pelo Serviço de Bioética do Hospital de Clínicas de Porto Alegre de 2010 a 2011. Os dados foram coletados a partir dos registros do Serviço de Bioética e dos prontuários eletrônicos dos pacientes. Foram excluídas as consultorias proativas realizadas nos Rounds Clínicos regulares das equipes assistenciais, as reuniões do Serviço de Bioética e do Comitê de Bioética Clínica. Para análise qualitativa foi utilizada a Análise de Conteúdo e a classificação de Nelson e Nelson, de sete aspectos para as relações familiares. A avaliação quantitativa foi feita por meio de medidas descritivas e por associações, utilizando o programa SPSS 18.0. Resultados: Em 57% dos 307 registros de consultoria avaliados as relações familiares dos pacientes estavam envolvidas, predominantemente (38%) dificultando a resolução do problema ou conflito ético. Destas consultorias, cujas famílias agregaram dificuldades (n=116), 71% das consultorias foram geradas por solicitações de médicos. Os serviços de Medicina Interna, Pediatria e Psiquiatria demandaram 56% das consultorias. Em 79% dos registros foi possível identificar os prontuários dos pacientes associados. Quanto a resposta, 71% das consultorias foram atendidas no mesmo dia ou no dia seguinte à sua solicitação. Quando às características dos pacientes, a distribuição em relação ao sexo foi equilibrada, com predomínio da faixa etária adulta, e 54% eram procedentes de Porto Alegre. As relações familiares naturalmente impostas foram as mais identificadas (72%). Nestas mesmas 116 famílias foram identificados os sete aspectos das relações familiares: intimidade; não substituição; motivos; responsabilidade; vínculos; enredos familiares e modelagem. Conclusão: A compreensão da presença e da influência das famílias, principalmente quando estas dificultam a resolução do problema ou conflito ético, a identificação do perfil destas consultorias, bem como a reflexão sobre os aspectos das relações familiares, pode ampliar as possibilidades de avaliar os casos de Bioética Clínica e de planejar estratégias institucionais que envolvem o processo de tomada de decisão no atendimento assistencial. / Introduction: Clinical Bioethics consultants assist professionals, patients or families in the reflection of decision-making process when a problem or ethical conflict arises during assistance services. Family relationships of patients may be involved in these situations, including how to hinder it. Objectives: To evaluate the presence and influence of families in Clinical Bioethics consultations. As well to establish the consulting profile in which family relationships difficult to resolve the problem or ethical conflict: applicants, specialty, records in electronic medical records, patients and family relations. Methods: We analyzed 307 records of Clinical Bioethics ondemand assistance consultations, conducted by the Bioethics Division, Hospital de Clinicas de Porto Alegre from 2010 to 2011. Data were collected from the records of the Bioethics Division and electronic medical records of patients. Were excluded proactive consultancies carried out in regular Clinical Rounds of healthcare, the regular meetings of the Division and the meetings of Clinical Bioethics Committe. For qualitative analysis was used content analysis and classification of seven aspects for family relationships (Nelson and Nelson). The quantitative evaluation was performed by descriptive measures and associations, using SPSS 18.0. Results: In 57% of the 307 records of family relations consultant evaluated the patients involved were predominantly (38%) making it difficult to resolve the problem or ethical conflict. These consultancies, whose families have added difficulties (n = 116), 71% of consultations were generated by requests from physicians. Internal Medicine, Pediatrics and Psychiatry Services demanded 56% of consultants. In 79% of the records was possible to identify patient records associated with it. As for response, 71% of consultations were seen on the same day or the day after your request. The patient characteristics, distribution in relation to gender, was balanced, with a predominance of adult age group and 54% were from Porto Alegre. Family relationships identified as naturally imposed were the most predominant (72%). In the same 116 families were identified the seven aspects of family relationships: Intimacy, Not Replacement, Reasons, Responsibility, Links, Family Plots and Modeling. Conclusion: The understanding of the presence and influence of families, especially when they hinder the resolution of the problem or ethical conflict, identifying the profile of these consultants, as well as reflections on aspects of family relationships, can extend the possibilities to assess cases of Clinical Bioethics and institutional policies that involve the process of decision making in health care services.

Esta dissertação objetivou analisar como o conflito conjugal circula nas famílias, compreendendo seu papel no desenvolvimento da prole. Foi realizada uma revisão sistemática da literatura nacional e internacional dos últimos 10 anos sobre o efeito spillover. Os resultados apontam as consequências de conflitos construtivos e destrutivos para casais e filhos, além da escassez de publicações brasileiras sobre a temática. Em seguida realizou-se um estudo empírico com 179 famílias, analisando as opiniões e comportamentos de filhos e casais durante seus conflitos, através das escalas Conflict resolution styles inventory, Children’s perception of interparental conflict e Children’s action tendency scale. Encontrou-se que os filhos identificam os desentendimentos entre seus pais e que isso tem um impacto em seus sentimentos e atitudes. Houve associação entre a forma como casais e filhos encaminham seus conflitos. Refletiu-se sobre as possibilidades de prática nesse contexto, dada a importância sobre a temática para a saúde familiar. / This work aimed to analyze how marital conflict runs in families. A systematic review about the spillover effect was performed in national and international literature of the last 10 years. The results showed the consequences of constructive and destructive conflicts to couples and their offspring. It also points out the dearth of Brazilian publication in that area. Following, an empirical study was done with 179 families. The reports of children and couples about their disagreements and their behavior in these occasions were analyzed by Conflict resolution styles inventory, Children's perception of interparental conflict and Children's action tendency scale. Results showed that children identify disagreements between their parents and that this has an impact on their feelings and attitudes towards life. There was an association between the conflict resolution strategies of couples and children. The possibilities of work in this context were discussed, given the importance of the theme to family health.

Este estudo foi realizado com o objetivo geral de compreender a situação biográfica de familiares de usuários de álcool residentes no meio rural e teve como objetivos específicos conhecer as expectativas dos familiares com o tratamento em uma unidade de internação psiquiátrica e descrever o típico da ação de familiares de usuários de álcool residentes no meio rural. Trata-se de uma pesquisa qualitativa, com abordagem da sociologia fenomenológica. O local de estudo foi uma unidade de internação psiquiátrica de um hospital geral localizado no estado de Santa Catarina, Brasil. Os participantes foram 15 familiares de usuários de álcool internados neste serviço. A coleta das informações foi realizada por meio de entrevista semiestruturada, de agosto de 2015 a julho de 2016. Os resultados foram organizados a partir de cinco categorias concretas que constituíram os „motivos porque‟ expressos nas experiências vividas dos familiares com o usuário de álcool, disponíveis em seu estoque de conhecimentos, que compunham suas situações biográficas no momento em que ocorreu a pesquisa, e os „motivos para‟ referentes às suas expectativas com relação ao tratamento do alcoolista. As categorias que fazem referência aos „motivos porque‟ revelaram a repetição de um histórico de alcoolismo na família, o quadro clínico do alcoolista interferindo no relacionamento entre os membros da família e trazendo sintomas para todo o grupo familiar, e o cuidado dispensado ao alcoolista devido aos vínculos de afetividade, à responsabilidade sentida pelos laços familiares, à compreensão da situação vivenciada pelo alcoolista por também já ter passado por um tratamento para alcoolismo e ao fato de o alcoolista manter uma boa convivência social quando não estava sob o efeito do uso do álcool. As categorias manifestadas nos „motivos para‟ mostraram que os familiares esperavam que o alcoolista mantivesse a abstinência e faziam planos sobre os cuidados a serem tomados após o período de internação do alcoolista. Foram pensadas em várias possibilidades, que envolveram desde o acolhimento do alcoolista em seus lares a projetos voltados para uma perspectiva de controle ou que traduziam o receio de não terem condições de cuidar constantemente dele. As experiências ouvidas apontam para a necessidade de ampliação do cuidado visando ao suporte aos familiares de usuários de álcool residentes no meio rural por meio de um olhar que focalize o seu mundo da vida cotidiana. Destaca-se a importância de favorecer a participação da família no cuidado e de fortalecê-la para enfrentar as dificuldades que possam surgir nas interações familiares oriundas da dependência de álcool, contribuindo para relações face a face saudáveis. / This study was performed with the general objective of understanding the biographical situation of relatives of alcohol users living in rural areas and had as specific objectives to know the expectations of these relatives with the treatment in a psychiatric hospital facility and to describe the typical actions of relatives of alcohol users living in rural areas. This is a qualitative research, with an approach based on phenomenological sociology. The place of study was a psychiatric hospital facility of a general hospital situated in the state of Santa Catarina, Brazil. The participants were 15 relatives of alcohol users admitted to this service. The information collection was done through semi-structured interviews, from August 2015 to July 2016. The results were organized from five concrete categories that made up the „reasons why‟ expressed in the lived experiences of the relatives with the alcohol user, available in their storage of knowledge, which comprised their biographical situations at the time of the research, and the „reasons for‟ regarding their expectations in relation to the treatment of the alcoholic. The categories that refer to the „reasons why‟ revealed a repetition of a history of alcoholism within the family, the clinical picture of the alcoholic interfering in the relationship among the family members and bringing symptoms to the whole family group, and the care given to the alcoholic due to the bonds of affection, the responsibility felt by the family ties, the understanding of the situation experienced by the alcoholic because he / she has already undergone a treatment for alcoholism and to the fact that the alcoholic managed to maintain a good social coexistence when he/she was not under the effect of the alcohol use. The categories manifested in the „reasons for‟ showed that the relatives expected that the alcoholic would maintain abstinence, and they made plans about the care actions to be taken after the period of admission of the alcoholic. Various possibilities were regarded, ranging from the welcoming of the alcoholic in their homes to projects oriented to a perspective of control or that reflected the fear of not being able to constantly care for him/her. The experiences heard through this survey highlight the need to broaden care actions with a view to supporting the relatives of alcohol users living in rural areas by means of a look focused on their world of everyday life. It is worth emphasizing the importance of fostering the family‟s participation in the care actions, as well as empowering it to deal with the difficulties that may arise in family interactions resulting from the alcohol addiction, thus contributing to healthy face-to-face relationships.