One in three employees in Sweden experiences work-related health problems due to stress, high workload etc. This can result in ill health with problems such as anxiety and sleep problems. An increasing number of adults are changing careers due to these circumstances. This study examines which factors can impact a decision of changing careers, how the decision-making process is carried out and how a midlife career change can affect the individual’s well-being for the better. The study was based on aqualitative method with seven respondents, who had all made a career change. The study aims to answer the following questions:- Which influencing factors can lead to a career change?- What does the process of decision-making within career change look like for individuals experiencing ill health?- Can a career-change result in a better well-being, health and self-esteem?The following theories have been applied in the study: Hodkinson and Sparkes Careership theory, Albert Bandura's Theory of Self-efficacy and Work-life balance. The results of the study show that the main factors leading to a career change are mental health issues, stress and general well-being. Other common factors have been the desire to find a more meaningful job and achieve better balance in life. The result of the study also shows that the decision-making process for individuals with ill health changing careers can vary, where some underwent voluntarily and others involuntarily breaking points. The result also shows that individuals often make choices based on their action-horizon and well-known fields, but that logic, reason and emotions all come to play when changing careers. In the result it has emerged that support from relatives such as family and friends has been a significant part, but also that study and career-counselors had an important part. In terms of well-being, health and self-esteem, the results show that all respondents experience an improved overall-health after their career change.

This study investigated social contextual factors influencing poor uptake of HIV counselling and testing (HCT) services by middle-aged black men in Ratanda, Heidelberg. A qualitative research approach was used in which ten men and two key informants were interviewed. Themes explored were the participants’ biographical characteristics; knowledge of HIV and AIDS; health-seeking behaviours; understanding of multiple sexual partnerships and male circumcision and challenges in utilising HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors largely contributed to poor HCT uptake. Moreover despite the men’s high HIV risk perceptions, behaviour change lags behind. Greater efforts to establish a men’s forum to discuss sexual health matters in Ratanda is recommended. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)

This study investigated social contextual factors influencing poor uptake of HIV counselling and testing (HCT) services by middle-aged black men in Ratanda, Heidelberg. A qualitative research approach was used in which ten men and two key informants were interviewed. Themes explored were the participants’ biographical characteristics; knowledge of HIV and AIDS; health-seeking behaviours; understanding of multiple sexual partnerships and male circumcision and challenges in utilising HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors largely contributed to poor HCT uptake. Moreover despite the men’s high HIV risk perceptions, behaviour change lags behind. Greater efforts to establish a men’s forum to discuss sexual health matters in Ratanda is recommended. / Health Studies / M. A. (Social Behaviour Studies in HIV/AIDS)

This study investigated the social factors influencing the poor uptake of HIV Testing and Counselling (HCT) services by middle-aged black men in Pimville, Soweto. A qualitative research approach was used for this study in which ten men and two key informants were interviewed. Themes explored were the participants’ biographical characteristics, knowledge of HIV and AIDS, health-seeking behaviours, understanding of multiple sexual partnerships, male circumcision, and challenges in using HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors are major reasons for the poor HCT uptake. Despite the men’s high HIV risk perceptions, behaviour change lags behind. Greater efforts to establish a men’s forum to discuss sexual health matters in Pimville are recommended. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

本論文的研究目的，是以「老化態度」及「老年準備」之概念架構，探索中年男同志關於老化的生命經驗，希望藉由中年男同志的自身經驗，來理解他們對老化的意義詮釋、老年生活的想像及所從事的老年準備情形。 本研究使用質性取向的研究方法，以半結構式的深度訪談進行資料蒐集，訪談了十二位居住在大台北地區或桃園縣市，年齡介於四十歲至五十三歲的中年男同志，主要的研究結果如下：（一）受訪者談論的老化意義，是由生理、心理及社會文化等多方面所交織而成的概念，在不同的面向上也有不同程度的正、負向評價，整體來說，他們傾向於否定自己是老人、離老尚遠的「老年拒斥觀」；至於對老的界定，最明顯的是，當他們和同年齡層的異性戀者相比時，多半覺得自己保有年輕化的優勢。另外，許多受訪者也提到年輕男同志對中、老年同志的負面態度或刻板印象，某種程度上反映出男同志族群的怕老心態。（二）在受訪者描繪的老年生活圖像中，對「社會支持網絡」的老年想像尤其重視朋友及伴侶關係等非正式網絡，其中幾位已婚男同志也提及對婚姻家庭的老年生活想像（例如「含飴弄孫」）；在「社會參與」方面，他們期待能夠「參與志願服務」、「出錢出力貢獻社會」、「老年的再教育」、「工作者角色的延續」及「從事休閒活動與興趣」等，其共同的目的是為了達到自我成長及自我實現，但也可能因同志身份而面臨參與的障礙；至於「對老年的焦慮、擔心或害怕」，他們談論得最多、最擔心的是「怕重病」、「怕醜」，以及「怕失去外在吸引力」。（三）在受訪者實際從事的老年準備內容中，他們認為最需要準備、且實際準備程度較高的是「經濟準備」（工作收入及其他財務規劃），其次則是「抗老化的準備」（基於身體健康或外在吸引力而進行的保養）、「從事興趣或休閒活動」（偏向動態性、團體式的型態）以及「社會支持網絡維繫」，至於目前積極從事「社會學習與志願服務」及「老年居住安排」的受訪者則較少。總括來說，受訪者提及的準備內容都是屬於非正式的準備，較不重視正式組織（如政府、公司企業或非營利組織）在老年準備中扮演的角色。 再由生命週期觀點來檢視，則發現中年男同志的老化態度、老年生活想像及老年準備情形與中年異性戀者之間具有相似性，但也有差異性，同時，也呈現出一些動態歷程的改變。 值得深思的是，「老年準備」的概念本身有可能隱含著個人本位的意識型態，當政府的老年政策強調老年人的自我照顧責任時，也就忽視了對社經地位較弱勢者應有的保障。此外，本研究也發現，娶外籍新娘的已婚中年男同志，其婚姻關係凸顯出「性傾向弱勢」與「性別弱勢」之間的相互擠壓現象，基於自身利益的考量，弱勢者本身（已婚男同志）也可能會去壓迫比自己更弱勢的人（外籍新娘）。 / With “attitudes toward aging“ and “preparation for old age” as the conceptual framework, this study aims to explore the aging experience of middle-aged gay males, and tries to understand their interpretations, imaginations, and preparation of aging. This study employs qualitative research approach. The participants are twelve middle-aged gay males living in the Taipei metropolitan area and Taoyuan county, aging from forty to fifty-three. The researcher conducted semi-structural interview with them individually, and collected in-depth data. The study findings after data analyzed are listed below: First, the meaning of aging discussed by the twelve participants during the interview is a complicated complex, comprising of physical, psychological and social cultural dimensions, which are evaluated with different positive and negative appraisals separately. As a whole, participants tended to think they were not old and resist to aging. Most obviously, when compared with their heterosexual counterparts, they considered themselves much younger. Besides, many participants mentioned the negative stereotypes and prejudices young gay males tended to have against older ones, which reflects the fear of age widespread in this population, too. Second, The imaginations of later life participants in this study had involved “social support networks”, “social participation”, and “anxiety, worry and fear of old age”. They thought highly of informal support networks particularly, such as their friends and intimate partners, when it came to “social support networks”. Of participants entering traditional heterosexual marriage, some discussed their positive expectations that they hope to enjoy marriage and family life in later life as the heterosexual do. On the topic of “social participation”, they expected themselves to be volunteers, contribute to society with money and effort, pursue further education, keep working, and get engaged in their interests or hobbies. Their common purpose of social participation in old age was self-achievement, but they may encounter some obstacles because of their sexual orientation. In terms of their anxiety, worry, and fear of old age, what they talked and worried about most was getting ill, becoming ugly and unattractive. Third, as for preparation for old age, what the participants in this study considered most important, and thus prepared more was economic security. And other preparations included health maintenance, engagements in interests or hobbies, and connections to their social support networks. By and large, their preparations tended to be informal, and don’t emphasize the importance of formal preparation planning from formal organizations like the government, companies or non-profit organizations. With the life course developmental perspective, when we compare the attitudes toward aging, imaginations of later life, and preparation for old age between these middle-aged gay men and their heterosexual counterparts, we can find that some dimensions are similar and the others are different, and their attitudes, thinking or action about aging may change over time. Furthermore, the concept of “preparation for old age” itself may imply certain ideology of individualism inexplicitly. While aging policies emphasize the obligation of self-care of the elderly, it may ignore the security of those persons in lower social-economic status. Besides, this study also finds that the marriage relationships of middle-aged gay males who married “foreign brides” are some kind of mutual oppression in essential, the disadvantages itself（middle-aged gay males）are likely to oppress the other disadvantages in worse condition（”foreign brides”）.

The purpose of this thesis is to analyze the dynamics of family support and public pension systems, and their impact on late-life happiness in contemporary South Korea. For this, three specific research questions, namely (1) the dynamics of intergenerational solidarity, public pension systems, and happiness; (2) the association between intergenerational solidarity and happiness; and (3) the association between public pension systems and happiness, are analysed by exploiting the Korean Longitudinal Study of Ageing. The analyses show that (1) the structural solidarity of older people is relatively stronger than of middle-aged people; (2) contacting is the key player in associational solidarity in later life; (3) middle-aged people supply more financial aid to their adult children than they receive from them, but the reverse applies to older people. Both middle-aged and older people actively exchange food, household items, and health-care supplies; (4) more older men receive the National Pension Scheme benefit than older women but the reverse is true for the Basic Old-Age Pension benefit; (5) the level of happiness in later life is very high but decreases as people age; (6) the number of adult children, frequency of contact, and amount of financial support are positively associated with the happiness of older people; and (7) the National Pension Scheme is positively associated with the happiness of older men while the Basic Old-Age Pension is negatively associated with the happiness of older people. The results suggest some policy implications for late-life happiness in contemporary South Korea. At the individual level, increased frequency of contact, availability of the children, and the amount of financial support can enhance late-life happiness. At the governmental level, the research suggests that the gendered structure of the National Pension Scheme and means-tested structure of the Basic Old-Age Pension should be reformed.

Le vieillissement démographique augmente rapidement la représentation des personnes âgées de plus de 50 ans parmi les utilisateurs d’aides à la mobilité motorisées (AMMs), telles que le fauteuil roulant motorisé et le quadriporteur. Le but général de la thèse est de rendre compte d’une démarche d’analyse des effets des AMMs au cours des premiers 18 mois d’utilisation chez les adultes d’âge moyen et les aînés. Notre question de recherche concerne la nature et l'importance des effets sur le fonctionnement, la pertinence sociale et le bien-être subjectif, ainsi que les liens entre les divers facteurs impliqués dans leur impact optimal. La thèse s’articule en trois volets, synthétique, méthodologique et analytique, dont les principaux résultats sont présentés dans quatre articles scientifiques. Le volet synthétique comprend une recension systématique qui révèle la représentation marginale des personnes âgées de plus de 50 ans dans les publications scientifiques sur les effets des AMMs et le faible niveau de preuve dans ce champ d’études. Les travaux liés à ce volet proposent également un cadre d’analyse reliant l’intention d’utiliser l’AMM, les habitudes de déplacements, les dimensions d’effets des AMMs sur le fonctionnement, la pertinence sociale et le bien-être subjectif, ainsi que quatre catégories de cofacteurs associés à l’utilisation (personne, aide technique, intervention, environnement). Le volet méthodologique assemble un dispositif de mesure comprenant 5 questionnaires et 18 indicateurs arrimés au cadre d’analyse et démontre l’applicabilité de l’ensemble des questionnaires pour une administration téléphonique. La validation transculturelle de deux questionnaires implique deux études réalisées auprès d’utilisateurs d’AMMs âgés de 50 à 84 ans (n=45). Ces travaux confirment la fidélité test-retest et l’équivalence des questionnaires traduits avec la version d’origine. Finalement, le volet analytique se concentre sur l’étude des habitudes de déplacements chez 3 cohortes (n=116) de personnes âgées de 50 à 89 ans, recrutées en fonction du stade d’utilisation de l’AMM. Les résultats suggèrent une amélioration de l’aire de mobilité après l’utilisation initiale ou long terme de l’AMM en comparaison avec une cohorte en attente de l’AMM, ainsi qu’une augmentation significative de la fréquence des déplacements autour du domicile et dans le voisinage. Trois facteurs associés à une aire de mobilité optimale, à savoir le genre, la nature des objectifs de participation de l’utilisateur et le type d’appareil utilisé, sont identifiés par des analyses de régression linéaires contrôlant pour l’âge. La thèse soutient l’importance de tenir compte de l’environnement et d’une combinaison de facteurs reliés à la personne et à l’aide technique pour saisir les effets des AMMs au cours des premiers mois d’utilisation. Ces résultats ouvrent la voie au suivi systématique des utilisateurs d’AMMs par les professionels de réadaptation, puisqu’ils confirment l’utilité du dispositif pour en mesurer les effets et ciblent les déterminants de la mobilité des utilisateurs d’AMMs âgés de plus de 50 ans. / Mobility-related subsidy programs are being challenged by the aging of the population as adults aged over 50 years become the most prevalent users of power mobility devices (PMDs), such as power wheelchairs and scooters. The thesis examines the impacts of PMDs for middle-aged and older adults during the first 18 months of use. Our research question concerns the nature and magnitude of outcomes pertaining to effectiveness, social significance and subjective well-being, as well as the factors associated with outcomes. The thesis comprises three sections: conceptual, methodological and analytical. The main results are presented in four manuscripts. The conceptual section includes a systematic review that reveals the limited coverage and low level of evidence of PMD outcomes for middle-aged and older adults. Moreover, this section supports a conceptual framework linking intention to use the PMD, mobility habits, three dimensions of outcomes (effectiveness, social significance, subjective well-being) and four categories of co-factors asociated with the use of assistive technology (person, assistive device, intervention, environment). The methodological section assembled 5 questionnaires and 18 indicators, matched to the conceptual framework, and verified their applicability for a telephone administration. Two questionnaires required transcultural validation studies with PMD users (n=45, age 50-84 years) that confirmed the test-retest reliability and the equivalence of the questionnaires with the original versions. Finally, the analytical section examined the impact of PMDs on 3 cohorts (n=116, age 50-89 years), recruited as a function of stage of usage, and explored key factors asociated with greater life-space mobility. Cohort comparisons showed significantly greater life-space mobility for initial and long term users than for the reference group waiting for the PMD. Moreover, frequency of outings was higher for PMD users in the neighbourhood and around home. Age-adjusted linear regression analyses found greater life-space mobility associated with gender, the nature of PMD activities and device type. The thesis supports considering the environment and a combination of personal and device factors to appreciate PMD outcomes during the first months of use. The results are useful for rehabilitation services as they confirm the utility of following up PMD outcomes and identify key determinants of mobility for middle-aged and older PMD users.

Title: Obesity monitoring in middle aged men in Hradec Kralove Targets: The targets of thesis is to determine prevalence of the obesity in men at age 30 - 50 years in Hradec Kralove. The necessary data for this empirical research will be obtained on the basis of the questionnaires distributed among 30 active athletes and 30 pacients of prof. Martinik's diabetology office, who suffer from obesity and undergo treatment in his office. Subsequently, I will perform a deep analysis of all the data obtained from the questionnaries, in order to identify hazard factors for obesity, stress management, physical aktivity, fixed daily routine and life management or the prevalence of the genetic load in the group of surveyed athletes and surveyed obese patients of prof. Martiník's diabetology office. These data will be then compared in order to identifily the main differences between active athletes and obese patients. Methods: The empirical research was conducted at 30 randomly selected active athletes (at age 30 - 50 years), who live in Hradec Kralove and at 30 random patients (also at age 30 - 50 years) of prof. Martiník, who also live in Hradec Kralove and undergo medical treatment on the basis of the questionnaire, which I created myself and filled personally with the patients and athletes in order to...

OBJECTIVES: The integrin α4β7 is the gut-homing receptor for lymphocytes. It also is an important co-receptor for human immunodeficiency virus (HIV) via glycoprotein (gp)120 binding. Depletion of gut cluster of differentiation (CD)4 T cells is linked to chronic inflammation in patients with HIV; however, measuring CD4 cells in the gut is invasive and not routine. As such, establishing a peripheral marker for CD4 depletion of the gut is needed. We hypothesized that α4β7 CD4 T cells are depleted in the peripheral blood of treatment-naïve patients with HIV compared with healthy controls. METHODS: The study groups were treatment-naïve patients with HIV and uninfected controls. Subjects were included if they were 18 years or older with no history of opportunistic infections, active tuberculosis, or cancer. We collected peripheral blood and examined on whole blood using flow cytometry for the following cell surface markers: CD4, CD45RO, chemokine receptor type 5, C-X-C chemokine receptor type 4 (CXCR4), and the integrin β7. We collected demographic information, including age, sex, and ethnicity, as well as viral load (VL) and CD4 count. Two-samplettests and Fisher exact tests were used to compare the differences between the two groups. Spearman correlation coefficients were calculated between CD4 count and log10-VL and percentage of CD4+/CD45RO+/β7+and log10-VL in patients. RESULTS: Twenty-two subjects were enrolled in the study (12 patients with HIV and 10 controls). There were no differences in age or sex between the two groups. There were more Hispanics and fewer Asians in the group comprising patients with HIV compared with the control group (7 vs 2 and 0 vs 4,P= 0.05, respectively). Patients infected with HIV had significantly lower frequencies of CD4+/CD45RO+/β7+cells (median 12%, range 5-18 compared with uninfected controls: median 20%, range 11-26,P= 0.0007). There was a statistically significant difference in the percentage of CD4+/CD45RO+/C-X-C chemokine receptor type 4+cells between patients (72%, range 60%-91%) compared with controls (79%, range 72%-94%,P= 0.04). The percentage of CD4+/CD45RO+/chemokine receptor type 5+did not differ between the group of patients with HIV and the control groups (22%, range 11%-57% vs 27%, range 14%-31%;P= 0.8, respectively). There was no correlation between percentage of CD4+/CD45RO+/β+cells and log10-VL as measured by the Spearman correlation coefficient (r= 0.05,P= 0.88) in patients infected with HIV. CONCLUSIONS: Memory CD4 β7+cells are reduced significantly in the peripheral blood of untreated patients infected with HIV, which could be used as a noninvasive indicator of intestinal CD4 T cell loss and recovery. Further studies are needed to examine whether depletion of these CD4+/CD45RO+/β7+cells in the peripheral blood parallels depletion in the gut of treatment-naïve patients with HIV and whether levels return to control levels after treatment.

Introdução: Estudos têm demonstrado a associação de doença arterial coronária (DAC) grave com triglicérides (TG) pós prandial. No entanto, a relação entre a aterosclerose leve a moderada e TG pós prandial não está bem estabelecida. No presente estudo avaliamos a relação entre TG pós prandial e DAC detectada por angiografia coronária por tomografia computadorizada (TC cor). Material e Métodos: Foram incluídos 130 pacientes (85 com DAC detectado pelo TC cor coronária e 45 sem DAC), submetidos a um teste de tolerância oral de gordura. Estudamos a lipemia pós prandial medindo TG de T0h para T6H com intervalos de duas horas, e analisamos a mudança TG ao longo do tempo através de um modelo linear misto multivariável longitudinal, utilizando como desfecho primário o log normal do TG. Resultados: Os pacientes com DAC eram mais velhos (56,5 ± 6,8 vs. 50,4 ± 7,1 anos, p < 0,001), predominantemente do sexo masculino (68,2% vs. 37,8%, p < 0,001) e com HDL-colesterol (HDL-C) menor (49 ± 14 vs. 54 ± 12 mg / dl, p = 0,015). A maioria dos indivíduos com DAC tinha aterosclerose leve com doença não obstrutiva (63,5%). Pacientes com DAC tiveram uma depuração mais lenta TG pós prandial de 4h a 6h (p < 0,05) em comparação com pacientes sem DAC. Estes resultados permanecerem significativos mesmo após ajuste para o TG de jejum, idade, sexo, índice de massa corporal e glicemia de jejum. No entanto, essas diferenças não foram significativas após o ajuste para o HDL-C de jejum. Conclusão: Os pacientes com DAC leve e moderada detectados pelo TC cor demonstraram alteração do metabolismo de TG pós prandial, com remoção mais lenta de TG, especialmente entre 4h e 6h quando comparados a indivíduos sem DAC. Esta diferença foi explicada em parte pelo menor HDL-C de jejum no grupo com DAC. Assim, embora TG pós prandial possa contribuir para o desenvolvimento de DAC, esta associação é parcialmente relacionada com a menor concentração de HDL-C em indivíduos com DAC / Background: Studies have demonstrated the association of severe coronary artery disease (CAD) with postprandial triglycerides (TG). Nevertheless the relationship between less severe atherosclerosis and postprandial triglycerides is less established. Objective: to study the relationship between postprandial TG and CAD detected by coronary computed tomographic angiography (CTA). Material and Methods: We enrolled 130 patients, (85 with CAD detected by coronary CTA and 45 without); who underwent an oral fat tolerance test. We studied the postprandial lipemia measuring TG from T0h to T6h with 2 hour intervals, and analyzed the TG change over time using a longitudinal multivariable linear mixed effects model with the log normal of the TG as the primary outcome.Results: Patients with CAD were older (56.5 ± 6.8 vs. 50.4 ± 7.1 years, p < 0.001), predominantly male (68.2% vs. 37.8%, p < 0.001) and had lower HDL-cholesterol (HDL-C) (49 ± 14 vs. 54 ± 12 mg/dL, p=0.015). The majority of individuals with CAD had mild atherosclerosis with non-obstructive disease (63.6%). Patients with CAD had a slower clearance of postprandial TG change from 4h to 6h (p < 0.05) compared to patients without CAD. These results remained significant after adjustment for fasting TG, age, gender, body mass index and glucose. However, those differences did not reach statistical significance after adjustment for fasting HDL-C. Conclusion: Patients with mild and moderate CAD detected by coronary CTA had an impaired postprandial metabolism, with a delayed TG clearance, when compared to individuals with no CAD. This difference was partially explained by the lower HDL-C. Thus, though postprandial TG may contribute to the development of CAD, this association is partially related to the low HDL-C in individuals with CAD