The purpose of this study was to explore how elderly people in Gävle cope with their life by using of Internet and what are their perceived benefits and barriers of the use of Internet. Qualitative methods were used with face-to-face interviews and email correspondence to gather the data. Six elderly people participated in this study. Coping theory was used to analyse the results. The results were divided into three parts. They were describing the use of Internet, benefits and barriers of using the Internet and reasons behind using the Internet and coping. Benefits include connectedness, gratification, usefulness, and active learning experience. Barriers include limitation, distrust and frustration. This paper used the coping theory to try to describe how these persons adjust the way of thinking and the way of behaving and how they use these strategies to cope with the daily life. It was found that Internet for elderly people is becoming more important nowadays and also it is significant to know how they think about the Internet.

Bakgrund: En pågående trend inom hälso- och sjukvården är införandet av marknadsreformer. Den lag som ska tillämpas när ett vårdvalssystem införs är lagen om valfrihetssystem (LOV). På grund av att landstingen är självstyrande kan formerna för organisation och styrning variera. Syfte: Att undersöka och beskriva hur landsting praktiskt arbetar med att följa upp privata vårdgivare inom primärvården, med avseende på kvalitet i vården. Metod: Deskriptiv fallstudie med triangulering. Resultat: I alla de tre fallen framhålls att uppföljningen av de offentliga och privata vårdcentralerna är likadan. Det görs uppföljning av samtliga vårdcentraler en gång per år. Till denna samlas data in från olika källor. Stockholm och Sörmland gör även månadsvis mätningar av några indikatorer. Vilka indikatorer som används till uppföljningarna skiljer sig något mellan de olika landstingen. Om avvikelser upptäcks vidtas olika former av åtgärder, exempelvis utskick av skriftliga frågor eller möten där avvikelsen, eventuella orsaker samt vad som ska göras diskuteras. Andra åtgärder kan vara besök hos vårdgivaren, fördjupad granskning eller medicinsk revision. I landstingens förfrågningsunderlag finns beskrivet vad som följs upp. Vissa indikatorer kopplas till målrelaterad ersättning, viten eller bonus. Det framgår även under vilka förutsättningar ett avtal skulle kunna sägas upp i förtid. Förtida uppsägning baserat på kvalitetsskäl har endast skett i Stockholm. Exempel på ett område där samtliga landsting har pågående utvecklingsarbete är utformning av kvalitetsindikatorerna. Samarbeten sker med andra landsting i olika nätverk för utveckling av uppföljningsarbetet. Exempel på svårigheter som ses är att kvaliteten på data som rapporteras in kan brista, tillgång till olika datasystem samt att mäta och fråga rätt saker. Slutsats: Det finns likheter i hur landstingen har utformat sina uppföljningsverksamheter men också skillnader, exempelvis att Stockholm rutinmässigt gör uppföljningsbesök hos nystartade enheter och att Uppsala gör en generell fördjupad uppföljning. / Background: An ongoing trend in health care is the implementation of market reforms. The applicable law when implementing a system of choice is lagen om valfrihetssystem (LOV). Because of the fact that the county councils have home rule the forms of organization and governance can vary. Aim: To study and describe how county councils work with following up private actors in primary care, with regard to quality. Method: Descriptive case study with triangulation. Results: In all three cases it is stressed that the follow up is the same for private and public district health care centres. A follow up of each centre is carried out annualy. For this data is collected from different sources. Stockholm and Sörmland also measure some indicators monthly. Which indicators that are used in the follow ups differ somewhat between the county councils. If deviations are detected different steps are taken, for instance written questions or meetings where the deviation, possible causes and interventions are discussed. Other steps could be to visit the actor, have an intensed review or medical revision. The county councils’ rule books describe what is included in the follow ups. Some indicators are connected to a goal related payment, fine or bonus. It is also stated under what circumstances a contract could be terminaded prematurely. Premature termination based on quality reasons has only occurred in Stockholm. An example of an area where all county councils have an ongoing developement is formation of the quality indicators. There are cooperations with other county councils in different networks regarding development of the follow ups. Difficulties that have been noted are for example that the quality of data that is reported in might be lacking, access to different computer systems and measuring the correct things. Conclusion: There are similarities between the county councils with regard to how they have chosen to design their follow up work, but there are also differences, for instance that Stockholm routinely makes follow up visits to newly started units and that Uppsala does a general intensed review.

Syftet med studien var att undersöka tonåringar och föräldrars uppfattning om vad en bra familj är. Genom kvalitativ metod med en induktiv utgångspunkt har tonåringar och föräldrars beskrivning av ämnet undersökts. 100 deltagare har skriftligt berättat vad en bra familj är för dem. 50 tonåringar har författat en uppsats, 10 av dessa var 18 år och 40 var 13 år. 50 föräldrar, med barn i motsvarande ålder har som en del i en enkät svarat på samma öppna fråga. Av föräldrarna var hälften mammor och hälften pappor. Med utgångspunkt från Grounded Theory har resultatet analyserats. Genom studien har deltagarnas egna skildringar av familjen framställts. Det har visat sig att en bra familj består av fem teman engagerat föräldraskap, gemensamt familjeliv, bra atmosfär, hel familj och god standard. Engagerat föräldraskap består av stödjande föräldrabeteende som jobba, läxhjälp och fritidsstöd samt familjeskapare som konflikter och sätta gränser. Bra atmosfär består av gott emotionellt klimat vilket innehåller kärlek, snäll, trygghet, ärlighet samt bra relationer vilket innefattar öppenhet, delaktighet, ansvarstagande och jämställdhet. Gemensamt familjeliv består av dagliga, veckovisa och årliga umgängestillfällen, dessa består av familjestund, måltiden, husdjur, fritidsaktiviteter, fredagsmys och semester. Hel familj innefattar mamma och pappa, syskon och övrig släkt. God standard innefattar bra bostad och drömfamiljen. Tre typfamiljer har gått att urskilja, relationsfamiljen, aktivitetsfamiljen och strukturfamiljen. / The aim of the study was to investigate teenagers and parent’s opinion of what a good family are. To find out this a qualitative method was used. The teenagers and parents have written down their thoughts on this issue. 100 participants have written down what a good family means for them. 50 teenagers have written an essay, 10 of those were 18 years and 40 were 13 years. 50 parents, with children in corresponding age has, as a part of a survey answered the same open question. There were equal distribution between participating mothers and fathers. The results have been analyzed with base on Grounded Theory. Through the study, teenaged children’s and parents’ own view of the family has been expressed. It is evident that a good family consists of five themes, involved parental role, joint family-life, good atmosphere, whole family and good standard. Involved parental role consists of supportive parental behavior such as go to work, help with homework and support during leisure time as well as physiologic aspects as conflicts and setting limits. Good atmosphere consists of a good emotional climate which contains love, kindness, confidence, honesty and good relationship which includes openness, sharing, responsibility and equality. The joint family-life consists of daily, weekly and yearly get-together’s, these are gathering of the family, eating together, pets, recreation, “fredagsmys” and holiday. Whole family contains mother and father, siblings and other relatives. Good standard consists of the nice home and a fantasy family. Three typical families have been distinguished, family of relations, family of activity and family of structure.

Att åldras innebär flera förändringar i en persons liv. Nedsatt fysisk förmåga och pension kan påverka vilka aktiviteter en person utför och kapaciteten att utföra dem. Syftet med examensarbetet var att beskriva hur ensamboende i åldersgruppen 75 - 84 år uppfattar sin aktivitetsbalans. Metoden som valdes var en kvalitativ induktiv ansats. Nio deltagare rekryterades genom ett snöbollsurval i södra Sverige och data samlades in genom semistrukturerade intervjuer. Intervjuerna analyserades enligt kvalitativ innehållsanalys. Resultatet kom fram till tre huvudkategorier: Uppfattning om olika aktivitetskategorier,förändringar som påverkar aktivitetsutförandet och faktorer som påverkar aktivitetsmönstret. Dessa huvudkategorier omfattades av tio underkategorier. Resultatet visade att de flesta informanter var nöjda med sin aktivitetsbalans men hade fått anpassa vissa aktiviteter på grund av nedsatt fysisk förmåga. Det framkom även att sociala aktiviteter var de som värderades högst och samt att informanterna valde att acceptera att åldrandet innebar förändringar i aktivitetsutförandet. Slutsatsen författarna kom fram till var att sociala aktiviteter var de viktigaste aktiviteterna för att upprätthålla en tillfredställande aktivitetsbalans. / The process of aging means several changes in a person's life. Decreased physical capacity and retirement can affect what kind of activities that are performed and the capacity to perform them. The purpose of this paper was to describe how people in the age-category of 75-84 experiences their occupational balance. The method chosen was a qualitative inductive approach. Nine participants were recruited through a snowball selection in southern Sweden. The data was collected through structured interviews. The interviews were analyzed through qualitative content analysis. The result found three main categories: views of different categories of activity, changes that affect performance of activity and factors that affect the activity pattern. These main categories were comprised of nine sub-categories. The result showed that most of the participants were satisfied with their occupational balance but had to adapt certain activities because of decreased physical capacity. It also emerged that social activities were the most valued and that the participants to a large degree accepted that ageing meant changes in performance of activity. The conclusion the authors came to was that social activities was the most important activity for maintaining a satisfying occupational balance.

Background: In Sweden, approximately 440 children die in intrauterine fetal death annually. Losing a child before birth causes great sadness and despair to the parents. Midwives' have a significant role in supporting and nurturing parents in those situations, which is often experienced as a difficult and emotional task. Aim: To describe midwives' experiences associated to intrauterine fetal death. Method: Focus group interviews made with midwives working at a delivery ward in central Sweden, data were analyzed with  qualitative content analysis. Result: The data analysis resulted in ten subcategories,four categories and an overall theme. The categories were Presence, A meaningful task, Being both professional and a human being, and Support at work. The overall theme was To make meaning of the seemingly meaningless. The midwives needed time to be able to be fully present with the parents. According to the midwives it was a meaningful experience to be supportive and make a difference for the parents. To be professional while at the same time dealing with their own feelings appeared as a difficult task. They received the best support from their colleagues. Conclusion: Supporting the parents and creating a memorable moment with their stillborn baby was experienced as the most eager in these situations, and made the task meaningful for the midwives.

abstract: This qualitative study investigated the postpartum experiences of mothers who used hypnosis to birth. This research project was based on a constructivist version of Grounded Theory. Qualitative inquiry and analysis were conducted on 15 semi-structured interviews; two pilot interviews were also conducted. Phone and in-person interviews were completed with Caucasian, Hispanic, and multiracial mothers who were between one month and 15 months postpartum. The following 12 major themes emerged: bonded with child, development of self-efficacy, breastfeeding success, family criticism, online support, impact on family, practice effect, amazement to misevaluation, induction overwhelm, holistic benefits, minimal post partum depression, and birth stories. Mothers of two or more children appreciated birth more, reported an increased sense of calm and closeness within their nuclear and extended family, believed that the benefits of hypnosis for birthing assisted in the areas of bonding with their newborn, self-efficacy, breastfeeding and overall postpartum success. First-time mothers appreciated the physical aspect of recovery after delivery. They emphasized the birth narrative despite cultural differences in sharing their stories. Although they attributed much success to the use of hypnosis for birthing, they tended to make more indirect attributions to the bond with their child, self-efficacy, breastfeeding, and overall postpartum success. Mothers who required a c-section, epidural, or induction during birth experienced feelings of guilt and viewed hypnosis as an isolated tool for birth and a tool to reduce guilt and stress postpartum. Mothers who birthed naturally used hypnosis postpartum in more ways. Hispanic mothers expressed greater difficulty with balancing their roles as a career woman and mother. They had different expectations around the participation of their partner during birth preparation and postpartum. Breastfeeding was most important to this group and reflected communal values. Hypnosis for birthing was described as being helpful for mothers who had a psychological history with depression, anxiety, or trauma. Participants reported overall effectiveness of hypnosis for birthing methods despite mixed reactions from birthing professionals, family, and friends. The importance of these findings for counseling psychology is discussed. / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2015

O impacto de uma doença traz alterações significativas no núcleo familiar, sobretudo ao entrar em contato com a possibilidade de finitude, visto que os recursos e procedimentos utilizados já não são mais eficazes no combate ao câncer. Esta pesquisa qualitativa objetivou compreender os significados atribuídos à vivência da terminalidade por familiares de pacientes com câncer, no contexto domiciliar. Trata-se de um estudo clínico-qualitativo que tem como particularidade valorizar os seguintes aspectos: atitude existencialista, atitude clínica e atitude psicanalítica; elementos reconhecidos como pilares que sustentam o método escolhido. Foram realizadas sete entrevistas com familiares considerados como principais cuidadores de pacientes, sendo estes assistidos por entidades filantrópicas. A técnica utilizada para realizar a coleta de dados neste estudo foi a entrevista semidirigida com questões abertas. Mediante consentimento prévio foram audiogravadas e, posteriormente, transcritas na íntegra. Os dados coletados foram submetidos à análise de conteúdo, de acordo com o método clínico- qualitativo, utilizando-se para a discussão dos resultados conceitos extraídos da teoria psicanalítica e materiais encontrados na literatura da psicologia da saúde. Após as leituras flutuantes do conjunto de todas as entrevistas e subsequente análise, observou-se que vivenciar o processo de terminalidade revelou-se para os familiares como uma experiência densa, difícil e dolorosa. O modo como os familiares receberam inicialmente o diagnóstico da doença foi sentido como uma situação marcante envolvida de incertezas e dúvidas, dada a dificuldade na comunicação entre profissional de saúde e familiar. O encontro com a doença e ao mesmo tempo, em alguns casos, também com um prognóstico restrito e fechado foi descrito como uma realidade em que se viram sozinhos e desprovidos de suporte. Nas teias dos discursos, foram feitas algumas associações sobre o surgimento do câncer e sua gravidade, relacionadas a comportamentos dos pacientes julgados como \"inadequados\", como também atribuíram vivências de dificuldades emocionais para o aparecimento da enfermidade. À medida que tomavam contato com um tratamento não mais centrado na cura, mas baseado em intervenções paliativas, expressaram desespero e angústia pela possibilidade de morte do ente deixando de ser uma realidade distante, passando a figurar como possibilidade concreta. Os familiares trouxeram a experiência de terminalidade como um processo de dimensão ampla e profunda de perdas, evidenciada pela fragilidade e progressiva ausência de saúde dos entes, tendo de vivenciar um processo de luto anterior à morte dita concreta. Diante da vulnerabilidade de seus entes, os familiares, assumiram o papel de principal cuidador sentindo esta função como complexa e pontuada por muitas renúncias pela dedicação incondicional equivalente à relação entre mãe e filho. Nesse sentido, para os familiares, esta experiência mostrou-se como algo doloroso e ausente de acolhimento e de espaço para seu sofrimento. Desse modo, considera-se essencial que, nesse momento, profissionais de saúde possam oferecer assistência condizente com o processo no qual estão inseridos, abrindo com isso possibilidades de escutas sensíveis consoante com as ações e princípios preconizados nos cuidados paliativos. / The impact of a disease causes significant changes in the household, especially when in contact with the possibility of finiteness, since the resources and procedures used are no longer effective in fighting cancer. This qualitative research aimed to understand the meanings attributed to the experience of relatives of terminally ill cancer patients in the home context. This is a clinical-qualitative study with a point to valorize the following aspects: existentialist attitude, clinical attitude and psychoanalytic attitude - elements recognized as pillars that support the chosen method. Seven interviews were conducted with family considered as the primary caregiver of patients, who are assisted by charities. The technique used to perform data collection in this study was the semi structured interview with open questions. Upon consent, the interviews were audio recorded and later transcribed. The data collected were subjected to content analysis according to clinical-qualitative method, using the concepts from psychoanalytic theory and materials found in the literature of health psychology for result discussion. After the readings fluctuating set of all the interviews and subsequent analysis, it was found that experiencing the terminal process proved to be a dense, difficult and painful experience for the family. The way the family initially received the diagnosis was felt to be an involving situation marked by uncertainty and doubt, given the difficulty in communication between health professionals and family. Coming across with the disease while, in some cases, also with a closed and narrower prognosis is described as a situation in which they were alone and lacking support. In the webs of the speeches some assumptions were made about the emergence of cancer and its severity, related to patients\' behaviors which were judged as \"inadequate\", but also experiences of emotional difficulties were attributed to the raising of the disease. As they were coming into contact with a treatment no more focused on the cure, but based on palliative interventions, they expressed despair and anguish by the possibility of death of the entity that is no longer a distant reality, renumbered as possibility. The family brought the experience of finiteness as a process of deep and broad scale of loss evidenced by weakness and progressive lack of health of loved ones, having to experience a grieving process before real death. Given the vulnerability of their loved ones, family members, assumed the role of primary caregiver feeling this function as complex and marked by many sacrifices for the unconditional dedication equivalent to the relationship between mother and child. In this sense, for the family, this experience proved to be a painful thing missing host and space for their suffering. Thus, it is essential that at this time, health professionals could provide assistance consistent with the process in which they are inserted, creating possibilities for sensitive listening in sync with the actions and principles advocated in palliative care.

Cuidados paliativos são definidos como uma abordagem que visa a melhorar a qualidade de vida de doentes que enfrentam problemas decorrentes de uma doença incurável e/ou com prognóstico limitado. Autores afirmam que a morte se faz velada e interdita no contemporâneo e apontam para o sofrimento do morrer frente ao isolamento e solidão, quando o paciente não é ouvido pela família em seus desejos e necessidades. O objetivo geral desta pesquisa qualitativa é compreender os aspectos psicológicos de pessoas com câncer em cuidados paliativos em um Hospital Universitário, no interior de São Paulo. Foram entrevistados sete pacientes com câncer em cuidados paliativos, em um contexto ambulatorial de um hospital, maiores de 18 anos e que aceitaram participar voluntariamente do estudo, formalizado por um Termo de Consentimento Livre e Esclarecido. As entrevistas foram audiogravadas e, posteriormente, transcritas na íntegra. O material transcrito foi submetido à análise qualitativa de conteúdo. Os resultados obtidos possibilitaram a elaboração de três categorias, sendo estas: a) As origens da doença e seus significados para cada um: relações entre o uso de álcool e a origem do câncer; categoria que aponta algumas crenças dos pacientes relacionadas ao uso excessivo de álcool como causa do adoecimento; b) Convivendo com o câncer: mudanças na rotina; categoria que abrange as perdas vivenciadas pelos pacientes em relação a atividades e funções perdidas após o diagnóstico; as mudanças na comunicação com a família e a presença do desejo de autonomia nos discursos; e finalmente, c)A esperança na cura e o significado de cuidados paliativos; categoria que demonstra que todos os pacientes entrevistados acreditam na cura, seja esta pela medicina ou pela fé e, apesar de afirmarem não saber o que são os cuidados paliativos onde fazem acompanhamento, o sabem na prática: para eles, percebem cuidados paliativos como sendo uma equipe acolhedora, um local em que são escutados; onde a dor é diminuída e sentem-se acolhidos. É importante enfatizar que o estudo possui limites, já que considerou uma amostra de pacientes com retornos ambulatoriais espaçados que permitiram à pesquisadora a realização de uma só entrevista com cada um dos participantes; porém espera- se que o trabalho realizado possa contribuir para a compreensão de importantes vivências dos pacientes supracitados, bem como iluminar alguns aspectos psicológicos velados, conferindo aos pacientes espaço e voz para se expressarem nesse momento da vida / Palliative Care are defined as an approach that aims to improve the quality of life of sick people that go through problems that comes from an n incurable and / or with limited disease prognosis. Authors claim that death is veiled and banned in contemporary and point to the suffering of the dying against isolation and loneliness, when the patient is not heard by the family in their desires and needs. The general objective of this qualitative research is understand the psychological aspects of people with cancer in palliative care in an Hospital from the University in the state of São Paulo. Seven patients were interviewed, they had cancer, were in palliative care, more than 18 years old, and accepeted to participate of the study as voluntareers, upon consent. The interviews were audio recorded and later transcribed. The data collected were subjected to content analysis according to clinical-qualitative method. It was found that: a) the origins of the illness and their meanings for each one: relations among the use of alcohol and the origins of cancer; that brings some beliefs from the patients related to the abuse of alcohol as a cause for their illness; b) living with cancer: changes in the routine, category that shows the loss lived by the patients in relation to the activities and functions lost after the diagnosis, changes in the communication with the family and the presence of autonomy in the speeches; and finally c) hope in the cure and the meaning of palliative care; that shows that all the patients interviewed believe in cure, this being by medicine or by faith, and, thought they affirm not knowing what palliative care are, they know it as a warm health team, a place where they can be heard, where their pain is reduced and where they feel protected. It is important to emphasize that this study has limits, considering that is was made with patients were interviewed once, but it is hoped that this research can contribute to the comprehension of important experiences of the patients, also give light to some psychological aspects not showed so easily, giving the patients space and voice to express themselves in this moment of life

Studies have highlighted the prevalence of sedentary behaviours in the university student population and have noted the significant potential for the promotion of physical activity in educational settings for young adults. Following the epidemiological procedure and ecological approach, the main purpose of this thesis focused on the university student population to review the previous research results by a systematic review method (first study), to compare the differences between UK and Taiwanese participants' and relevant effective variables by using a quantitative study method (second study), to have a deeper understanding of the Taiwanese university students' physical activity behaviours by using a qualitative study method (third study), then to evaluate the efficiency of designed interventions in university settings (fourth study). The whole thesis applied the ecological approach to classify the survey variables' effect to university students' physical activity behaviours. A total of 55 published papers were reviewed and majority of studies were conducted in the US using a cross-sectional design. Finding variables consistently related to university students physical activity level were female gender(-), attitude self-efficacy perceived barrier (-), family support (+), physical activity and sport history (+). These survey variables were more consistent in the literature and corresponded to previous adults' study. Some survey variables linked to university student were also found in the literature but still need more studies for this target population to come to a robust conclusion. Seven days recall design measurement and stage of changes survey for physical activity levels were more identified and have been more frequent using in the reviewed papers. Also, more studies on different ethnicity, environmental variables and intervention with different methodology such as qualitative study method are needed to enrich the knowledge of university's students' physical activity behaviours.

The work describes problems of creating CBA. The theoretical part of the work defines the CBA, its drawbacks and strengths. An important part of it is a different view of economic orientations to the CBA. The work also deals with the current institutional situation that determines the obligation of drawing up the CBA for the selected projects seeking public support. The aim of this work is to evaluate the production of any obligation of the CBA. For this purpose, will be used as well interviews with experts.