Background: The death of a spouse is among the most distressing life events faced by older adults and frequently follows long periods of providing extensive care and support. Although many spouses are resilient following loss, a number of bereaved spousal caregivers have poor psychological well-being and may benefit from clinical services. However, it can be difficult to determine who may most benefit from bereavement services and why some individuals are at greater risk for poor bereavement; thus, there is a need for greater understanding of the process of bereavement. Therefore, the purpose of this dissertation was to investigate a number of theoretically relevant factors within the context of bereavement after caregiving as possible predictors of psychological well-being following loss. Specifically, former caregivers' perceptions of loved ones' end-of-life suffering, rumination, and feelings of relief were investigated as possible predictors of caregivers symptoms of depression, grief, and complicated grief following loss. Method: Participants included 61 former spousal caregivers of hospice patients 50 years of age or older who lost a spouse in the last 6-18 months. Individuals completed an interview that included retrospective recall of perceptions of loved ones' physical, emotional, and existential suffering, current frequency of thoughts about loved ones' suffering, stress-reactive rumination, and feelings of relief following the death. Participants also completed measures assessing current symptoms of depression, present feelings of grief, and complicated grief. Descriptive information about care recipients was obtained via retrospective review of hospice electronic medical records following participant interview. Several regression analyses were conducted to investigate the relationship of possible predictor variables to bereavement outcomes and interactions among predictor variables. Results: Findings revealed important relationships between rumination, feelings of relief, and former caregivers' psychological well-being follow loss. Higher rumination and less feelings of relief were associated with worse bereavement outcomes. In addition, interaction analyses revealed that rumination and feelings of relief moderated the relationship between participants' perceptions of their spouses' emotional end-of-life suffering and psychological distress. Other descriptive predictors of depression, grief, and complicated grief were identified. Discussion: Participants were highly distressed former caregivers who were highly engaged in caregiving duties prior to loss. About 40% reported no feelings of relief following the loss, and over one-fourth of participants still had frequent ruminations about their loved ones' suffering. High stress-reactive rumination was an important predictor of bereaved spouses' psychological distress. Clinical interventions, such as cognitive behavioral therapy, could focus on identifying, redirecting, and reducing distressing thoughts or the negative feelings associated with them, such as ruminations associated with loved ones' end-of-life suffering. Future longitudinal research should examine the relationships between rumination, feelings of relief, perceived suffering, and bereavement outcomes in order to identify patterns that may inform clinical interventions.

Imaging Iodine-125 requires an increased focus on developing an understanding of how fundamental processes used by imaging systems work to provide quantitative output for the imaging system. Isotopes like I-125 pose specific imaging problems that are a result of low energy emissions as well as how closely spaced those emissions are in the spectrum. This work seeks to characterize the performance of a small animal SPECT-CT imaging system with respect to imaging I-125 for use in a preclinical translational research environment and to understand how the performance of this system relates to critical applications such as attenuation and scatter correction. The specific aims of this work examined several key areas of system function and performance with respect to I-125 imaging. The first aim examined the geometric SPECT calibration routine used for the Inveon imaging system with a particular focus on determining the accuracy of the calibration as well as the robustness of the algorithm under routine and adverse imaging conditions. The second aim was to characterize detector uniformity issues that may arise by comparing the uniformity performance of the system with both I-125 and Co-57 as well as examining the possibility of altering the acquisition method for normalization scans to increase the uniformity performance. The third aim sought to optimize the energy window used for acquisition of I-125 data and to determine the effects the selection of the window had on valid and scatter events. The fourth aim used the optimized windows, determined by the third aim, to assess the performance of a reconstruction algorithm, currently under development, that corrects for attenuation and scatter effects. The fifth and final aim of this work sought to assess the feasibility acquiring SPECT-CT data simultaneously and to assess the quality of data that could be achieved if simultaneous acquisition of the two imaging modalities was, in fact, possible. This work met these aims by performing an extensive series of studies examining the response of the system to I-125 imaging. These included multiple series of phantom imaging using both manufacturer as well as custom-designed sources for use with measurements involving I-125 and Co-57. Statistics from over 60 datasets with analysis in greater than 480 regions of interest were used for the analysis of attenuation and scatter correction data alone. The final study involving simultaneous SPECT-CT acquisition required modification of the imaging hardware to enable this type of data collection as well as development of a reconstruction algorithm to correctly handle the CT data acquired in a step-and-shoot helical mode. A number of key findings resulted from this work including the validation of the calibration routine of this imaging system, even under non-ideal imaging conditions for both the SPECT and CT modalities. Uniformity performance with I-125 was found to be a challenge with this imaging system but reductions in performance compared to other isotopes were not significant enough to introduce severe artifacts into the image data. Optimization of I-125 parameters resulted in improvements of the processed data indicating that the recommended settings provided by the manufacturer could be altered to provide results that better balance between minimizing scatter effects and maximizing detection of valid events. Assessment of the proposed scatter and attenuation correction algorithm for this system showed marked improvement as compared to data processed without these corrections. The final study of simultaneous SPECT-CT imaging proved this acquisition method to be feasible on a commercial system with minimal The primary conclusions drawn from this study indicate that the system is adequate for imaging with I-125 when care is taken to properly maintain the system as well as keeping sources current and properly centered in the scanner field of view during calibration. The study strongly illustrates the necessity of compensating any data collected using I-125 for attenuation and scatter effects; with some regions showing greater than 25% attenuation and approximately 30% improvement in quantitative values for scatter affected regions with the corrections applied. The study also concludes that simultaneous SPECT-CT is feasible with minor adjustments to a commercial platform.

Cardiovascular health is a major determinant of quality of life and mortality, especially in older adulthood. With the world’s oldest population increasing at expedited rates, challenges from cardiovascular conditions and its implications are spawning. Although it is well known that dyslipidemia may lead to cardiac events, less is known about the effects on cognitive and physical function in older adults. Epidemiological studies show that optimizing current preventive strategies even at older ages may reduce the incidence of cardiovascular comorbidity (e.g. hypertension, stroke) and increase quality of life. Determining the association between lipoproteins and cognitive and functional performance in older adults may help develop interdisciplinary interventions designed to maintain independence longer and improve the overall quality of life. The current dissertation contains two studies examining serum lipoproteins, specifically total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) in older adults in relation to cognitive and functional outcomes. The first study examined the association between lipoproteins and cognitive performance in a cognitively normal older adult population. Results showed an association between low levels of TG and higher composite cognitive scores (CCS), but this association disappeared when apolipoprotein ε4 allele (APOE ε4 allele) was adjusted for in the model. High levels of HDL-C were also associated with the CCS and this association remained significant even after adjusting for APOE ε4 allele. Furthermore, these associations were only significant among women. High HDL-C remained linked with visuospatial function and attention and working memory even after adjusting for APOE ε4 allele. Further moderation analysis indicated that the association between TGs, HDL-C and cognitive performance was moderated by the APOE ε4 allele. Stratification by carriers and non-carriers of the ε 4 allele indicated that the previous association was only significant for non-carriers. The second study of this dissertation is a longitudinal analysis, which explored the association between TC, LDL-C, TG and HDL-C and physical function. Random effects analysis was used to assess whether lipoprotein levels affect subsequent change in physical function. All models were adjusted for baseline age, sex, education, and perceived current economic situation, cardiovascular risk factors and comorbidity inclusive of cognitive disability. Results showed that lower levels of TC and HDL-C had cross-sectional associations with more ADL disability but not longitudinally, and higher levels of TG were related to better grip function. Moderation analysis of the previous significant association indicated that only cognitive disability moderated the cross-sectional association between TC and for ADLs. Further stratification showed that the association was only pertinent for participants with cognitive disability. Independent of cardiovascular risk factors and an extensive list of comorbidities, older adults living in the community with higher levels of TC, TG and HDL-C were associated with better physical function outcomes. Lipid patterns in older adults may be indicative of physical function and may serve clinicians as a tool to compress morbidity in older adults and help them maintain independence and a high quality of life for as long as possible. In conclusion, lipid levels in older adults play an important role in maintaining cognitive and physical function into older ages, thus maintaining a good quality of life. Higher HDL-C seemed to be the lipid associated with maintaining cognitive function, while TC dominated the association with physical function.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-11-06T13:20:47Z No. of bitstreams: 1 anacarmendossantosribeirosimoesjuliano.pdf: 2399268 bytes, checksum: 2d408565e43bdaeafd0fa433fc57d917 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-11-09T14:23:51Z (GMT) No. of bitstreams: 1 anacarmendossantosribeirosimoesjuliano.pdf: 2399268 bytes, checksum: 2d408565e43bdaeafd0fa433fc57d917 (MD5) / Made available in DSpace on 2017-11-09T14:23:51Z (GMT). No. of bitstreams: 1 anacarmendossantosribeirosimoesjuliano.pdf: 2399268 bytes, checksum: 2d408565e43bdaeafd0fa433fc57d917 (MD5) Previous issue date: 2017-08-24 / O uso de medicamentos potencialmente inapropriados em idosos (MPI) é um problema de saúde pública que demanda muita atenção, especialmente no ambiente hospitalar. Poucos estudos avaliaram mais detalhadamente a prevalência de MPI em momentos distintos da internação, assim como os fatores associados e as especialidades médicas envolvidas. Entender o padrão de prescrição inapropriada entre as diferentes especialidades pode auxiliar na identificação de medicamentos que poderiam ser substituídos por outros mais seguros. O presente estudo tem como objetivo avaliar a prevalência de MPI em um hospital geral terciário, comparando quatro diferentes momentos e investigando os fatores associados a esse padrão de prescrição, incluindo a comparação dos padrões de prescrição entre as especialidades médicas. Estudo de coorte retrospectivo, que incluiu todos os idosos que estiveram internados de janeiro a maio de 2015 nas especialidades clínicas de um hospital geral terciário. Todos os medicamentos prescritos foram coletados e divididos em quatro grupos: medicamentos de uso domiciliar, medicamentos da admissão, medicamentos acrescentados durante os dias subsequentes da internação e medicamentos da prescrição final, realizada no último dia da internação hospitalar. Os MPI foram identificados através dos critérios de Beers 2015 nos quatro grupos, e STOPP 2015 no primeiro e último dia da internação. As especialidades médicas (clínica médica, cardiologia, gastroenterologia, infectologia, nefrologia, neurologia, pneumologia e outras) também foram comparadas em relação à prevalência de MPI e aumento de MPI entre o primeiro e o último dia de internação. Um total de 1900 idosos foram incluídos. Para avaliação dos quatro grupos, foram excluídos os que não tinham prescrição domiciliar registrada no prontuário, totalizando 1381 pacientes. Neste grupo, encontrou-se importante aumento do número de medicamentos em geral e de MPI na admissão e durante a internação, persistindo até o último dia da internação. A prevalência de MPI foi em média 38% no domicílio, aumentando para 62,2% na admissão e 68,9% no último dia. Para comparação de Beers e STOPP e comparação entre as especialidades no primeiro e último dia da internação, foram incluídos os 1900 pacientes. A prevalência de MPI aumentou significativamente com ambos os critérios (62,3% para 66,6% com Beers e 43,4% para 50% com STOPP). Os MPI mais comuns foram insulina em escala móvel, antipsicóticos, óleo mineral, benzodiazepínicos, espironolactona e ácido acetilsalicílico. Os fatores associados a MPI foram idade, uso de MPI no domicílio, tempo de internação e óbito. Neurologia, infectologia e pneumologia tiveram maior utilização de MPI, e neurologia, pneumologia e cardiologia tiveram maior aumento de PIM durante a internação. Os achados do presente estudo reforçam o caráter iatrogênico hospitalar, enfatizando que o acréscimo desses medicamentos pode fazer com que eles se perpetuem até o último dia da internação. A especialidade médica é importante fator associado a MPI. Esforços são necessários para adoção de medidas educacionais e intervenções farmacêuticas que possam modificar essa situação. / The use of inappropriate prescribing in the elderly (PIM) is a public health problem that requires attention, especially in hospitalized patients. Few studies have evaluated in more detail the prevalence of PIM at different moments of hospitalization, as well as the associated factors and the medical specialties involved. Understanding the inappropriate prescribing pattern among the different specialties may help in the identification of drugs that could be replaced by safer options. The present study aims to evaluate the prevalence of PIM in a general tertiary hospital, comparing four different moments and investigating the factors associated with it, including the comparison of prescription patterns among medical specialties. A retrospective cohort study, including all the elderly who were hospitalized between January and May 2015 in the clinical specialties of a general tertiary hospital. All prescripted drugs were collected and divided into four groups: home-use drugs, admission medications, medications added during the subsequent days of hospitalization, and final prescription medications, performed on the last day of hospital stay. The PIM were identified using the Beers 2015 criteria in the four groups, and STOPP 2015 on the first and last day of hospitalization. The medical specialties (medical clinic, cardiology, gastroenterology, infectology, nephrology, neurology, pneumology and others) were also compared in relation to the prevalence of PIM and increase in PIM between the first and the last day of hospitalization. A total of 1900 elderly were included. The patients who did not have home prescription registered in the medical record were excluded of the evaluation of the four groups, totaling 1381 patients. There was an important increase in the number of medications in general and PIM at admission and during hospitalization, and persisted until the last day of hospitalization. The prevalence of PIM was about 38% at home, increasing to 62.2% on admission and 68.9% on the last day. For the comparison of Beers and STOPP and between the specialties on the first and last day of hospitalization, all the 1900 patients were included. The prevalence of PIM increased significantly with both criteria (62.3% to 66.6% with Beers and 43.4% to 50% with STOPP). The most common PIM were insulin on sliding scale, antipsychotics, mineral oil, benzodiazepines, spironolactone and acetylsalicylic acid. Factors associated with PIM were age, use of PIM at home, length of hospitalization and death. Neurology, infectology and pneumology had highest use of PIM, and neurology, pneumology and cardiology had a highest increase in PIM during hospitalization. These findings reinforce the hospital iatrogenic character, emphasizing that the addition of these medications on admission can be perpetuated until the last day of hospitalization. The medical specialty is an important factor associated with PIM. Educational measures and pharmaceutical interventions are important tools that may help to change this situation.

Musculoskeletal pain alters physiological function and these changes may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for chronic pain and report functional limitations similar to older adults. However, few studies have explored the unique individual factors (e.g., sociodemographic, health, and psychosocial characteristics) that may drive the pain experience; and more research is needed that examines the relationships between musculoskeletal pain and physical function, using objective performance measures, in a sample of racially and socioeconomically diverse adults. Data from the Healthy Aging in Neighborhoods of Diversity across the Life Span Study (HANDLS) were analyzed across two cross-sectional studies. The first study examined the association between subjective (self-reported) and objective measures of pain (passive range of motion) of the hands, neck and low back. Additionally, this study explored the unique predictors that may be associated with inconsistency between subjective and objective measurements of pain. Results indicated weak but significant correlations between subjective and objective hand- pain measurements. However, there were no significant correlations identified between subjective and objective neck-pain measurements, or subjective and objective low back pain measurements. Three binary logistic regression models were conducted to explore the relationship between sociodemographic (Model 1), health (Model 2), and psychosocial characteristics (Model 3) of consistent and inconsistent pain measurements for each pain site. There were no significant relationships between sociodemographic, health, or psychosocial characteristics and consistent and inconsistent hand pain measurements. However, individuals who reported a history of depressive symptoms were nearly 1.8 times more likely to report inconsistent neck pain. Follow-up analyses to explore two-way interactions across unique predictors identified that individuals with a history of depressive symptoms, who were below poverty status, were nearly 3 times more likely to report inconsistent neck pain. Additionally, females, individuals with a greater number of comorbidities, and those with a history of depressive symptoms tended to demonstrate inconsistent low back pain. Follow-up analyses identified that those who identified a history of depressive symptoms, and reported the quality of their neighborhood as “poor” to “fair”, were 3.3 times more likely to demonstrate inconsistent low back pain measurements. The second study examined the relationship between pain, pain interference and a global measure of physical function. Additionally, the study investigated whether relationships between pain, pain interference, and global physical function were moderated by sociodemographic characteristics (e.g., age, sex, race, and measures of socioeconomic status). In multivariable regression analyses, musculoskeletal pain was significantly associated with physical function, particularly among middle-aged and older individuals. Additionally, pain interference was significantly associated with physical function, particularly among older adults. This dissertation strives to further our understanding of the unique factors that contribute to individualized pain experiences among under-represented populations, and to identify functional deficits that may be evidenced earlier in the life course. Furthermore, this dissertation is intended to motivate further research that explores appropriately timed non-pharmacological interventions that are tailored to the needs of diverse groups, in efforts to reduce musculoskeletal pain, pain interference, and sustain functional independence in later life.

Since the late 1980s, policymakers have attempted to reduce the institutional bias of their long-term services and supports by investing in more accessible home and community-based services for older adults with long-term care needs and adults with disabilities. To further advance rebalancing discussions, this study examined the resident, facility, and state characteristics associated with the admission of community-dwelling older adults to the nursing home and the subsequent discharge of this population back to community settings. Data from the Minimum Data Set (MDS) 2.0 were used to construct episodes of care for all newly-admitted residents aged 65 and older to any free-standing U.S. nursing home. Several secondary datasets including the Online Survey, Certification, and Reporting Database (OSCAR), LTCFocus.org website, Nursing Home Compare, Nursing Home Data Compendium, and U.S. census estimates were used in the study analyses. On average, approximately 5.3% of all newly admitted nursing home residents were admitted directly from home with substantial variations across states. Most residents admitted directly from home had limited to extensive dependency in activities of daily living and moderate cognitive impairment. The most common diagnoses on admission included dementia and diabetes. While 31% of residents admitted from home remained in the facility at least 365 days after admission, 32% were discharged to the community, 15% were discharged to the hospital, and 21% died. Most residents admitted from assisted living communities, either remained in the facility or died by the end of the study. Findings from multivariate analyses suggest that resident-level factors, including demographics and health status, influenced the community transition of nursing home residents. Facility characteristics, including ownership, deficiency scores, the ratio of Medicare and Medicaid residents, and urban location were associated with discharge to the community but the effect of these factors differed according to length of stay. The commitment of a state to home and community-based services was also predictive of community discharge. Collectively, findings suggest that resident, facility, and state characteristics influence the community discharge of residents admitted from home or assisted living communities. By understanding the reasons for admission to the nursing home and the factors influencing discharge from the facility, policymakers and administrators can better anticipate and care for community-dwelling older adults with long-term care needs.

The senior population is growing faster than any other population group, and life expectancy is increasing. E-mail and social media enable people of all ages to stay in touch, and find information, resources, and entertainment. Positive effects are associated with computer and internet use for older adults, but not all seniors have embraced technology and some seniors feel negatively about it. Several different methods have been used to teach seniors computer skills, including mentoring, lecturing, and providing instructions, but not many procedures have been evaluated for effectiveness. In the current study, we recruited three to five seniors, taught them to use Facebook using instructions and behavioral skills training as needed, and then tested their skills. This study investigated the effectiveness of instructions alone with supplemental behavioral skills training as necessary to improve community-dwelling seniors’ social media skills on Facebook.

As we age, the risk for gut issues, such as smooth muscle tone, may be an underlying indirect or direct cause or risk factor for many age-related issues, such as frailty. Consequences of decreased motility and depleted epithelial barrier may result in nutrient deficiencies that may increase the risk for malnutrition (Brownie, 2006). Further, there is increasing evidence that there is a gut-brain-axis relationship that may influence cognition and mental health issues, such as depression and anxiety. While there are relationships established, the interconnections of these factors have yet to be fully understood. This dissertation examined several relationships specific to nutrient intake, physical function, and depression in older adults while probing for a moderating effect of gut health. Looking further at this theory of the gut-brain bi-directional relationship, an additional gut health assessment was further examined to investigate the relationship with cognitive performance. Participants were from two separate but complementary data sets. The first data set from the National Health and Nutritional Examination study included a depression outcome analytic sample and a physical function analytic sample who had valid data on nutrient intake, bowel measures, demographic characteristics, depression scores, physical function measurements, and total BMI. The depression analytic sample had a total of 1918 participants with a mean age of 73.76 years, and 1864 participants with a mean age of 73.28 years in the physical function analytic sample. The available nutrients within the data set were further broken down into several different components by a component factor analysis and each component used as a predictor. Two separate bowel measures were examined with one as a fecal incontinence measure and the other, the Bristol Stool Form Scale, as categorical (normal, constipation, or diarrhea). The second data set, the Nutraceutical Blueberry Study, had a total of 108 participants with a mean age of 73.42 years who had valid data on cognitive measures and a complete gut assessment. Among the depression analytic sample, there were significant moderating effects of fecal incontinence between several nutrient components and depression after accounting for the control variables. An additional moderated multivariate regression with only the significant components was carried out and resulted in only Component 9 (carbohydrates, sugar, beta-cryptoxanthin, and vitamin C) and Component 12 (alcohol) having the fecal incontinence measure as a significant moderator with depression as the outcome. Within the physical function analytical sample, the Bristol Stool Form Scale categorical measure was a significant moderator among Component 6 (MFA22_1, PFA18_4, PFA20_5, PFA22_5, and PFA 22_6) and physical function. Both the constipation and diarrhea categories were related to worse physical function, while in all groups, increase in nutrients from Component 6 resulted in better physical function. Within the second data set, AVLT and AVLT Delay had a significant quadratic relationship with bowel function. Within the four different groups in the bowel measure (gastric function, gastrointestinal inflammation, small intestine and pancreas, and colon), gastrointestinal inflammation with a negative association and the colon category with a positive association were significant. Among the AVLT Delay, gastrointestinal inflammation was also negatively associated significant predictor. Outcomes from the current study suggest that fecal incontinence was indicative as a moderator among the first data set, as well as significant predictor for AVLT and AVLT Delayed in relation to cognition in older adults. Although there were many relationships not found with bowel function as a moderator, the current findings suggest that more thorough measures in additional to microbiota measures could further provide possible directions for new therapeutics in psychological and cognitive therapy, as well as improving physical function in older adults.

Submitted by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T14:12:22Z No. of bitstreams: 1 Dissertação Fernando Mendonça.pdf: 2995559 bytes, checksum: d6d706f0d71822d6778e1ad38dbb4a20 (MD5) / Approved for entry into archive by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T14:15:56Z (GMT) No. of bitstreams: 1 Dissertação Fernando Mendonça.pdf: 2995559 bytes, checksum: d6d706f0d71822d6778e1ad38dbb4a20 (MD5) / Approved for entry into archive by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T14:20:03Z (GMT) No. of bitstreams: 1 Dissertação Fernando Mendonça.pdf: 2995559 bytes, checksum: d6d706f0d71822d6778e1ad38dbb4a20 (MD5) / Made available in DSpace on 2018-07-31T14:22:13Z (GMT). No. of bitstreams: 1 Dissertação Fernando Mendonça.pdf: 2995559 bytes, checksum: d6d706f0d71822d6778e1ad38dbb4a20 (MD5) Previous issue date: 2018-02-24 / Introduction: The choice of a medical specialty and knowledge of the labor market are essential items for professional successfulness and the good functioning of the health services. Objective: To investigate the factors that influence the choice of specialty and the apprentice expectations on the issues that involve the effectiveness of practicing medicine and the labor market. Methodology: Standardized questionnaires on factors related to the choice of medical specialty were applied to medical students from the 9th to 12th periods at Jose do Rosario Vellano University – UNIFENAS, Campus Belo Horizonte. Results: 179 questionnaires were given, predominantly women (64.8%). Participants are from all regions of the country. 84.1% completed high school in private schools and the monthly family income was over R$9,000.00 in 69.9% of the students. The majority (84.4%) were involved in academic leagues; only a few (33.5%) did extracurricular internships or participated in some scientific research (25.7%). Choosing a medical specialty mostly occurred during the internship (37.4%) and most of the rejections occurred between the 2nd and 4th year of the course (39.1%). We highlight the number of students (21.2%) that already enters the school with a defined specialty. Most specialties chosen were pediatrics (16.2%) and surgery (14%) and the most rejected was also pediatrics (37.4%) and surgery (31.8%). The main factors identified as choice influences are: aptitude, work performance, satisfactory training in the specialty field and autonomy. When asked where they intended to practice their profession, they answered as follows: in a private office (79.9%), private hospital (73.7%) and public hospital (66.5%). Most students (52%) think they will work between 49 and 60 hours per week, with 3 different employers (50.8%); making more than R$20,000.00 (47.5%) after five years of practice. The majority (86%) imagine themselves working in shifts, on an average of 14.5 years. 82.7% of the students stated that at no point in their medical course, they had information on labor laws and 78.8% denied having received information about the labor market. 98.3% of the students would like the schools to offer more information on the medical specialties, labor market and labor laws. Conclusion: The medical student chooses his specialty for several factors, but he does not know the labor market. The school does not prepare graduates for the effective insertion in the professional world. / Introdução: A escolha da especialidade médica e os conhecimentos sobre o mercado de trabalho são fundamentais para o sucesso profissional e um bom funcionamento dos serviços de saúde. Objetivo: Investigar os fatores que influenciam a escolha da especialidade e expectativas do acadêmico sobre as questões que envolvem o efetivo exercício da medicina e o mercado de trabalho. Metodologia: Foram aplicados questionários padronizados sobre fatores relacionados à escolha da especialidade médica aos estudantes de medicina do 9º ao 12º período do Curso de Medicina da Universidade José do Rosário Vellano – UNIFENAS, Câmpus Belo Horizonte. Resultados: Foram aplicados 179 questionários, com público predominante de mulheres (64,8%). Os participantes são oriundos de todas as regiões do país. 84,1% concluíram o ensino médio em escolas particulares, e a renda mensal familiar era superior a R$ 9.000,00 em 69,9 % dos alunos. A maioria (84,4%) atuou em ligas acadêmicas; poucos (33,5%) realizaram estágios extracurriculares ou participaram de alguma pesquisa científica (25,7%). O momento de escolha das especialidades foi durante o internato (37,4%) e a maioria das rejeições ocorreu entre o 2º e 4º ano do curso (39,1%). Destaque para o percentual de alunos (21,2%) que já entram na escola com sua especialidade já definida. As mais escolhidas foram pediatria (16,2%) e cirurgia (14%). As mais rejeitadas também foram pediatria (37,4%) e cirurgia (31,8%). Os principais fatores apontados como influência na escolha: aptidão, forma de trabalho, rodízio satisfatório na especialidade e autonomia. Quando perguntados onde pretendem exercer sua profissão, responderam: consultório (79,9%), hospital privado (73,7%) e hospital público (66,5%). A maior parte dos alunos (52%) acha que vai trabalhar, por semana, entre 49 e 60 horas; com três vínculos de emprego (50,8%); ganhando, após cinco anos de formados, mais de R$ 20.000,00 (47,5%). A maioria (86%) se imagina trabalhando em plantões, por 14, 6 anos em média. 82,7% dos alunos afirmaram que, em nenhum momento do curso, tiveram informações sobre legislação trabalhista e 78,8% negam ter recebido informações sobre mercado de trabalho. 98,3% dos alunos gostariam que a faculdade ofertasse mais informações sobre especialidades médicas, mercado de trabalho e legislação trabalhista. Conclusão: O estudante de medicina escolhe sua especialidade por vários fatores, mas desconhece o mercado de trabalho. A escola não prepara o graduando para sua efetiva inserção no mundo profissional.

This dissertation analyzes narratives (written and mediated) about widows’ post-loss experiences—specifically the ways in which these women embody and adjust/adhere to their post-loss widow identities—and whether or not the canonical/formula stories about widows reflect current experiences of widowhood. I look at older widowed women—both those in well-read widow memoirs and also in media portrayals of widows on film. The canonical view of widows as not attractive, not useful, and not interesting needs to be reexamined in light of changing ideas about gender roles and increased longevity. Surely older women have experiences, desires, and goals that encompass more than being socially invisible and caring for grandchildren. Given that 80% of women outlive their husbands (Mastekaasa, 1994; Peters & Liefbroer, 1997) and are an understudied and often overlooked population (Lopata, 1996), this heartfelt research is important.