published_or_final_version / Obstetrics and Gynaecology / Master / Master of Philosophy

Sverige är ett av världens mest individualistiska länder. Befolkningen utgörs till 46 procent av singlar och den största gruppen singlar är kvinnor i åldersgrupperna övre medelålder och äldre (Statistiska centralbyrån, 2012). Syftet med den här uppsatsen är att öka kunskapen kring hur svenska heterosexuella kvinnor i gruppen övre medelålder upplever singellivet. Jag använde mig utav välkända teorier och begrepp inom sociologin. De tillämpade teorierna och teoretiska begreppen var individualism, rena relationer, tvåsamhetsnormen och identitetsskapande utifrån teorier som spegeljaget och könsidentitet/könsroller. Undersökningsproblemet bestod i att beskriva kvinnornas upplevda positiva och negativa aspekter utav singellivet, hur deras förutsättningar av att leva som singlar i samhället påverkades av omgivningens attityder samt vilken betydelse det hade för deras identitet. Jag valde en deskriptiv metodansats och genomförde en kvalitativ studie i form av semistrukturerade intervjuer. Jag genomförde fyra semistrukturerade intervjuer med kvinnor mellan 53 och 64 år som var skilda och hade barn från tidigare äktenskap. Resultatet visade att de positiva aspekterna av singellivet var upplevelsen av självständighet, frihet och kontroll. Till de negativa aspekterna hörde ensamhet, försämrad ekonomi och att det var svårt att hitta en partner i deras ålder. Det visade sig att omgivningens attityder påverkade kvinnornas självbild negativt. Kvinnorna hade fått andra förväntningar på sig sedan de blivit singlar och hade därför varit tvungna att ändra sitt sociala beteende. Resultatet visade även att singelkvinnornas identitet var motsägelsefull då den slets mellan tvåsamhetsnormen och samhällets individualistiska ideal. Jag drar slutsatsen att upplevelsen utav singellivet för kvinnor i övre medelåldern är mångsidig. Deras handlingsutrymme är i och med singellivet både begränsat och utökat – de har större frihet att bestämma över sin vardag men samtidigt är de hämmade vid deltagandet i sociala sammanhang. Omgivningen har en stark inverkan på deras identitetsskapande och därmed ofta en negativ inverkan på deras självbild. Kvinnorna påverkas i hög grad av tvåsamhetsnormen men också utav individualismen vilken är mycket stark i Sverige. Dessa två begrepp står i ett motsatsförhållande till varandra vilket gör kvinnornas identitet ambivalent. För att leva upp till båda idealen framstår särboförhållandet för kvinnorna som det mest ultimata alternativet till singellivet. / Sweden is one of the most individualistic countries. The population consists of 46 percent of singles and the largest group singles are women in the age groups of upper middle age and older (Statistiska centralbyrån, 2012). The aim of this paper is to increase the knowledge of how Swedish heterosexual women in the upper middle age group are experiencing the single life. I used well-known theories and concepts in the field of Sociology. The applied theories and theoretical concepts were individualism, pure relationships, the norm of twosomes and identity formation based on theories like the looking glass self and gender identity/gender roles. The research problem was to describe women's perceived positive and negative aspects of the single life, how their conditions of living as singles in the community were affected by the attitudes and the importance of that for their identity formation. I chose a descriptive research approach and conducted a qualitative study in the form of semi-structured interviews. I conducted four semi-structured interviews with women between 53 and 64 years who were divorced and had children from previous marriages. The results showed that the positive aspects of single life were the experience of independence, freedom and control. The negative aspects consisted of loneliness, deteriorating economy and difficulties to find a partner in their age. It turned out that the attitudes from the surrounding society affect the women's self-image negatively. The women had different expectations about themselves since they became singles and had therefore been forced to change their social behaviour. The results also showed that single women’s identity was inconsistent when it was torn between twosomes norm and society's individualistic ideals. I conclude that the experience of the single life for women in late middle age is versatile. Their room for maneuvers are in the single life both limited and extended - they have more freedom to make decisions in their everyday life, yet participating in social contexts inhibits them. The surrounding society has a strong impact on their identity and thus often a negative impact on their self-image. The women are greatly affected by the standard twosome norm but also out of individuality ideals that are very strong in Sweden. These two concepts are in opposition to each other, which makes women's identity ambivalent. To live up to both ideals living apart relationships appear for the women as the most ultimate alternative to the single life.

Hälsorelaterade sjukdomar ökar och medicinska kostnader för samhället växer. Mycket av detta skulle kunna förebyggas med ett hälsosammare levnadsmönster. Samtidigt visas det att barn i skolan har mindre motivation till fysisk aktivitet än tidigare. Denna studie vill undersöka om de yttre, inre och autonoma motivationsfaktorer som fått några vuxna att göra livsstilsförändringar är desamma som motiverade dem att vara fysiskt aktiva som unga. Syftet är också att studera vad som motiverar dessa vuxna att fortsätta var fysiskt aktiva. Tre semistrukturerade kvalitativa studier genomfördes på en träning- och motionsanläggning i mellersta Sverige. Målgruppen var tre stycken medelålders kvinnor som varit fysisk aktiv som unga men som haft ett uppehåll för att sedan göra en livsstilsförändring och börja med fysisk aktivitet. Resultaten i studien visar att samtliga deltagare motiverats av positiv inre och yttre motivation som unga och att den autonoma motivationsfaktorn ”glädje” är viktigaste delen för dem både när de var yngre och som vuxen. Positiv motivation och en fördomsfri miljö fick dem att fortsätta träna efter livsstilsförändringen. / Health-related diseases and medical costs in society are growing. Much of this could be prevented with healthier lifestyles. At the same time, it appears that children in schools have less motivation for physical activity than before. This study wants to examine whether the internal, external and autonomous motivation factors with some adults to make lifestyle changes are the same that motivated them to be physically active as young. The aim is also to study what motivates these adults continue to be physically active. Three semi-structured qualitative studies were carried out on a training and exercise facilities in central Sweden. The target group was three middle-aged women who were physical active as young but have had a break and then gone through a lifestyle change and start getting physical active again. The results of the study shows that all participants were motivated by positive internal and external motivation that young and that autonomous motivation like joy is the most important part for both when they were younger, and as an adult. Positive motivation and an open-minded environment prompted them to continue training after the lifestyle change.

The overall aim of the present thesis was to describe the meaning of living with heart failure as a middle-aged person. In particular, the relation between the persons’ life-situations and formal care was explored. An additional aim was to uncover the meaning of support as experienced by people living with heart failure in middle age. The study used a caring science perspective and a reflective lifeworld approach, founded on phenomenological philosophy. Interviews were used for data collection and data were analyzed using essence-seeking analysis. The thesis is based on four empirical studies and the results were synthesized into a general structure, presented in the thesis. The results of study I illuminate influences and changes to the life-situation that people living with heart failure in middle age can experience. The social world, i.e. intersubjective relationships, vocational situations, and formal care emerge as fundamental to the individuals, as well as the individuals’ own experiences of themselves and their body. The life-situation is frail and depicted by insecurity and uncertainty. The results of study II illuminate that people living with heart failure in middle age experience exposure and vulnerability in relation to formal care. While the context of formal care provides alleviation and medical treatments, the results at the same time revealed experiences of dependency and unclear participation. The results from studies III and IV clarify that support means to know that help is available concerning practical matters or flexibility at work. However, it also reveals that support means a sense of security or safety in relation to other people, such as friends, families, employees, and formal carers. Knowledge, and control are central aspects of the phenomenon of support in relation to heart failure. The phenomenon’s general structure illustrate that living with heart failure as a middle-aged person is depicted by ambiguity in relation to other persons, daily life and formal care. The general structure is intertwined with an altered experience of the body, and a life-situation in a borderland between health and illness. The phenomenon is illuminated by the meaning constituents: A borderland between health and illness, and A tension between what is supportive and what is not. The phenomenon’s outer horizon is understood as A changed body and a threat against life, meaning that the phenomenon stands out against a background of the limits which the body sets on the persons. The present study illustrates that support from others give people living with heart failure in middle age inner strength which they need if they are to adjust their life goals. However, the results also revealed that formal care at times is insufficient and the support which the patient’s need is forsaken. When people living with heart failure in middle age are to take on their own responsibilities for their health process they need information, knowledge and to be participating in care. Furthermore, formal carers need to focus more on the patient’s social roles and networks. A lifeworld-led perspective in formal care can unite a biomedical and a caring science perspective, and formal carers will be able to pay more attention to the patients’ changed life-situation rather than focusing the patient’s failing hearts.

A presente pesquisa tem por objetivo demonstrar a finalidade catequética da obra intitulada Laudes e Cantigas Espirituais escrita pelo beneditino André Dias na primeira metade do século XV. Os versos de Mestre André parecem assumir um valor pedagógico à medida que visam a transmitir a mensagem do Evangelho inclusive com o propósito de edificar os cristãos a partir da exemplaridade de Jesus e Maria. Sob esta ótica, o laudário parece enfatizar uma religiosidade mais intimista, mais palpável e acessível à esfera divina sem prescindir, contudo, de seu aspecto devocional. Desta forma, através das análises de três grupos temáticos do laudário de Mestre André (Loas de Natal, Loas e Prantos de Nossa Senhora e Laudas da Paixão), este estudo visa a evidenciar os elementos que assinalam a finalidade doutrinária das composições em questão. À luz da tradição laudística medieval - cujo centro difusor fora a Península Itálica -, procuraremos apontar, ainda, o possível diálogo entre as laudes portuguesas e os escritos dos italianos Feo Belcari e Jacopone da Todi. / This research aims at showing the catechetic function of Laudes e Cantigas Espirituais written by the Benedictine Monk Andre Dias in the first half of the fifteenth century. The verses of Master André seem to assume an educational value as they aim at transmitting the Gospels message in order to edify christians through the exemplarity of Jesus and Mary. Within this scope, the lauds seem to emphasize some kind of more intimist, more palpable sense of religiosity, as well as more accessible to the divine sphere. However, the lauds still do not neglect their devotional aspect. Thus, through the analyses of three thematic groups, Master Andres laudarium (Loas de Natal Christmas Loas - , Loas e Prantos de Nossa Senhora Loas and Sorrows from Our Lady - and Laudas da Paixão Lauds of the Passion), this study seeks to highlight the elements which determine the doctrinary functions of analyzed compositions. Based on the medieval laudistic tradition, which was mainly diffused in the Italian Peninsula, we shall attempt at pointing out a possible relationship between the Portuguese Lauds and the writings by the Italian writers Feo Belcari and Jacopone da Todi.

Thesis advisor: Callista Roy / <bold>Problem</bold>: Cancer patients lack information and support needed to make the transition to survivorship. This problem was addressed by testing a psycho-educational group intervention, the Mid-Life Directions Workshop, for its effect on hope and quality of life in midlife cancer survivors. <bold>Participants</bold>: Twenty-six midlife adults (23 women, 3 men, mean age = 54.3 years, range 40-65) with breast cancer (n = 19), colorectal cancer (n = 4), lung cancer (n = 2), and malignant melanoma (n = 1) stages I, II and III were recruited from two hospital-affiliated Cancer Centers in the Northeastern United States. Mean time since completion of active primary treatment was 11.5 months (SD = 6.67, range, 0-28 months). Most participants were non-Hispanic (96.2%) and white (100%) with some college or a college degree (88.5%). <bold>Method</bold>: A multimethod experimental design randomly assigned 17 participants to the treatment group, receiving the workshop in six 2-hour sessions, and 9 participants to the control group, receiving a nutrition program in six 1-hour sessions. Hope was measured pre- and post-intervention using the Herth Hope Index as was quality of life using the Quality of Life Instrument, Patient/Cancer Survivor Version. Written reflections were created by treatment group participants post-intervention. <bold>Findings</bold>: The quantitative measures revealed a significant increase in hope (p = .047) for the control group. The treatment group reported positive effects on hope and quality of life by means of written reflections. Six themes emerged: 1) examining what is, 2) feeling connected, 3) accepting what is, even the painful, 4) embracing one's life experiences, 5) exploring new possibilities, and 6) moving forward with enthusiasm. <bold>Implications</bold>: The Mid-Life Directions Workshop demonstrated positive effects on hope and quality of life for this group of midlife cancer survivors. The richness of the qualitative findings highlights the importance of multimethod design for future studies. The Nutrition Program also merits further study. This study provides an increased understanding of interventions that may support hope in midlife cancer survivors following active primary treatment. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

La vision du monde rural du haut Moyen Age a été profondément modifiée durant ces dernières décennies grâce à l'archéologie préventive. Les grands travaux d'aménagement franciliens depuis les années 1980 ont offert l'occasion de fouiller de nombreux sites d'habitat avec plusieurs étapes dans cette exploration et un changement d'échelle dans les ouvertures. Jusqu'à cette période, les rares exemples d'habitats connus avaient nourri une vision pessimiste des historiens tels Georges Duby et Robert Fossier (Nissen sous presse) sur les conditions de vie et des pratiques agricoles durant le haut Moyen Age. / No English summary available.

Partindo de um contexto social demarcado por transformações sociais, como o incremento do uso de tecnologia e a inserção da mulher no mercado de trabalho, com a necessidade de maior flexibilização e preparo para nele se inserirem os cidadãos, bem como por transformações no âmbito das relações interpessoais, em especial as familiares, objetivamos, nesta tese, compreender como homens na meia-idade vivenciam esta fase do seu desenvolvimento. A meia-idade é um período demarcado por mudanças, em especial psicológicas para os homens. Isso porque a percepção do envelhecimento, da proximidade da fase adulta dos filhos e a competição com pessoas mais jovens no mercado do trabalho podem deflagrar a chamada “crise da meia-idade". Esse momento pode tanto levar a uma reflexão e a um re-direcionamento existencial como a uma estagnação, demarcada pelo marasmo e receio de empreender mudanças, pois pode haver uma percepção de que a proximidade da morte faz parte de sua vida. Nosso olhar para os homens, nessa fase do desenvolvimento, norteou-se pelas facetas da paternidade, da sexualidade e de seus projetos de vida. A metodologia utilizada foi a fenomenologia ontológico-hermenêutica de Martin Heidegger em que a interpretação do existir humano é a principal tônica. Foram entrevistados sete homens com idade entre 41 e 52 anos, nível socioeconômico A e B, casados e com filhos adolescentes. Os resultados evidenciam que a inautenticidade – modo de ser em que o referencial são “os outros" – mostrou-se como principal norteadora da vida desses homens, embora a autenticidade – assunção das responsabilidades existenciais –, também tenha se revelado. A afetividade, desvelada na preocupação com os filhos foi o principal sentido dos discursos. A inautenticidade revelou-se quando o futuro pessoal dos homens mesclou-se ao dos filhos, não havendo uma percepção de indivíduo, mas sim de que seu papel social norteia seu existir. A autenticidade foi vislumbrada quando a preocupação com suas relações afetivas e seus projetos de vida foram colocados em pauta. O envelhecimento mostrou-se tanto como impeditivo de mudanças, tendo no comodismo sua principal marca, como despertou questionamentos a respeito do modo de vida individual e afetivo. Esses aspectos evidenciam que a meia-idade, vivenciada no mundo pós-moderno, pode propiciar, por meio dos questionamentos que envolvem o existir humano, oportunidades de transformação no contexto das relações interpessoais, abrangendo o mundo familiar, bem como o social mais amplo. Essa fase do desenvolvimento pode proporcionar às novas gerações valores e crenças que lhes oportunizem reflexões e modelos de conduta que sejam alternativos aos que estão presentes nos relacionamentos sociais. A aproximação entre as gerações e a transmissão de questionamentos, dúvidas e anseios podem ser importantes caminhos a serem trilhados por todos os que se preocupam com o existir humano. Como horizontes, percebemos que os sentidos e significados do existir humano são múltiplos e que a fenomenologia ontológico-hermenêutica pode trazer contribuições para a ampliação da compreensão da existência ao desvelar, por intermédio da linguagem, nosso modo de ser. / Starting from a social context marked by social transformations such as the improving use of technology and the influx of working women in the job market and the necessity of a greater flexibility and education of the citizens to make part of it, as well as the transformations occurring in the interpersonal relations, specially those happening within the family, this thesis aims at understanding how the middle-aged men act and experience this development phase of life. The middle age is a period that is marked by changes, specially those psychological ones to men. This happens due the perception of getting old, the proximity of the adult phases of the children and the competition with younger people in the job market, which can blow up the “middle age crisis". This moment can lead to a deeper thinking and to a re-direction of his existence as well as it can lead to stagnation marked by apathy and fear of making changes once the perception of the proximity to death makes part of his life. The glancing to the men at this phase of development was given emphasizing aspects as paternity, sexuality and projects of life. The method employed was based on the Martin Heidegger’s ontological-hermeneutical phenomenology, which focuses the human existence as main point. Seven men with age ranging from 41 to 52 years old were interviewed, having a socio-economical level A or B, married, and having adolescent children. The results show that inauthentic existence - a way of being where the reference is based on the “others" - revealed that main guiding line to those men in this period of their life, although the authentic existence – the assumption of existence’s responsibilities – has been shown up. The affection mixed up the deep worries towards the children was the main sense in the discourses. The inauthentic existence appeared when the future of the children was mixed up with their future, not existing a perception of the individual but the social role that guided his existence. The authentic existence was glimpsed when his worries and preoccupations with affective relations and projects of life were put in evidence. The aging process showed as being an obstacle to changes due to the self-indulgence as well as it raised some questions about of his individual and affection way of living. Those aspects put in evidence the middle age happening in a post-modern world may cause by means of questioning the human existence, in a series of transformation opportunities in a context of interpersonal relations, including the family and the society. This phase of development may proportionate to the coming generations values and beliefs that may give them opportunity to reason over the models and behavior patterns that are alternative ones to those present in the social relationships. The coming up of generations and the transmission of questionings doubts and hopes may be important tracks to be followed by those who really worry about the human existence. We can perceive as horizons that the meanings of the human existence are multiple and the phenomenology ontological-hermeneutical may contribute to wide the comprehension of the existence and may unveil by means of the language our way of living.

institutochedraui@gmail.com / Objective: To assess predictors of sexual function in mid-aged women. Methods: We analyzed data of 262 healthy sexually active women (40–59 years) who filled out the Female Sexual Functioning Index (FSFI), the Menopause Rating Scale (MRS) and a general questionnaire containing female/partner data. Correlations between these two measures were also analyzed. Results: Significant inverse correlations were found between all FSFI and MRS scores. This was most evident for the MRS urogenital score in relation to FSFI total, pain and lubrication scores. Multiple linear regression analysis determined best model predicting total FSFI index scores that explained a 66% of the variance. In this model, MRS urogenital score was an important predictor of female sexual function (total FSFI scores) with a significant inverse relation. Additionally total FSFI scores displayed a significant positive correlation with female educational level and HT use and an inverse relation with partner age and female parity. Conclusion: Several female/partner factors predicted female sexual function in this mid-aged series. MRS urogenital scores significantly correlated with total FSFI scores.

O conceito de paternidade e sua vivência tornaram-se alvos de intensa investigação na literatura científica a partir do início dos anos 1970. Os estudos realizados destacam os acelerados processos de mudanças estruturais e organizacionais que incidem na família e na sociedade, que redefinem constantemente o entendimento que se tem sobre a paternidade, intensificando assim, o interesse em compreender a vivência paterna nos mais diversos contextos. Apesar da discussão que gravita em torno dessa temática, no que diz respeito à idade, os estudos existentes se concentram na vivência de pais adolescentes e adultos e na relação destes com seus filhos e companheiras. O objetivo do presente estudo foi compreender a experiência da paternidade na meia-idade a partir da perspectiva de pais, mães e filhos envolvidos. Trata-se de um estudo de caráter exploratório, descritivo, de corte transversal, amparado na abordagem qualitativa de pesquisa, no qual utilizou-se o estudo de caso múltiplo como estratégia metodológica. Os participantes deste estudo foram membros de quatro famílias, denominadas de: Família Campos, Família Sampaio, Família Azevedo e Família Pires. Os instrumentos utilizados para a coleta de dados foram: (a) Formulário de Dados Sociodemográficos, que engloba o Critério de Classificação Econômica Brasil; (b) Roteiro de Entrevista Semiestruturada realizada com o pai; (c) Roteiro de Entrevista Semiestruturada realizada com a mãe; (d) Roteiro de Entrevista Semiestruturada realizada com o(a) filho(a); (e) Desenho da Família (DF), aplicado nos filhos menores de 12 anos; (f) Genograma, aplicado a todos os membros da família em conjunto e, (g) Diário de campo. As entrevistas foram gravadas em áudio e, posteriormente, transcritas na íntegra. O corpus de pesquisa foi organizado por meio de análise de conteúdo temática e a análise e interpretação dos dados pautou-se na teoria psicanalítica e na literatura disponível sobre o tema da paternidade. A partir da análise do material coletado, pôde-se elaborar, em diálogo com a literatura, três categorias temáticas: (a) Construindo uma família: Adaptações da conjugalidade às novas experiências de ser pai; (b) Que pai eu sou e que pai eu quero ser? e, (c) Potencialidades e dificuldades da paternidade na meia-idade. Os resultados permitiram desvelar a paternidade na meia-idade como uma vivência composta por múltiplas articulações. A conjugalidade e a reavaliação do modelo transmitido pelo próprio genitor revelaram-se como aspectos importantes no exercício paterno e nas expectativas em relação ao desempenho desse papel. Dentre as especificidades da experiência paterna na meia-idade, a maturidade e a estabilidade financeira foram apontadas como potencialidade desejáveis dessa vivência, enquanto que a indisposição física e o receio de talvez não ser capaz de acompanhar o processo de desenvolvimento da(o) filha(o) foram caracterizados como barreiras/dificuldades. Espera-se que este estudo possa fomentar novas investigações acerca da vivência paterna em diferentes etapas do ciclo de vida, a partir do relato dos seus próprios protagonistas e daqueles que com eles compartilham tal vivência. / The concept of fatherhood and its experience became subject of intense research in scientific literature from the beginning of the 1970s. Studies emphasize the accelerated processes of structural and organizational changes that affect both family and society, which constantly redefine the understandings about paternity, thus intensifying the interest in comprehending paternal experience in several diverse contexts. Despite many discussions surrounding this subject, regarding age, most of the studies focus on the experience of fatherhood during adolescence and young adulthood, and their relations with their children and spouses. The present study aimed to comprehend the experience of fatherhood in middle-age from the perspective of fathers, mothers and children. This is an exploratory, descriptive and cross-sectional study. Participants were members of four families named: Campos, Sampaio, Azevedo and Pires. Instruments used for data collection were: (a) Sociodemographic form, which includes the Brazilian Economic Classification Criterion; (b) Semistructured interview with fathers; (c) Semistructured interview with mothers; (d) Semistructured interview with sons and/or daughters; (e) Family Drawing (FD), used with children younger than 12 years old; (f) Genogram, used with all members of the Family together; and (e) Field diary. Interviews were audiorecorded and transcribed in full. Corpus of research was organized through content analysis in thematic modality, and data interpretation was based on psychoanalytic theory and on the available literature regarding fatherhood. The analysis of collected data, along with dialogues with literature, enables the development of three thematic categories: (a) Building a family: Adaptations of conjugality to the new experiences of being a father; (b) What father am I and what father do I want to be?; and (c) Strengths and weaknessess of fatherhood in middle-age. Results showed fatherhood in middle-age as an experience composed by multiple articulations. Conjugality and reassessment of the model provided by their own parents were revealed as important aspects to the exercise of fatherhood and to the expectations regarding performance of this role. Among the specifities of the experience of fatherhood in middle-age, maturity and financial stability were considered desired strengths, whereas physical indisposition and the fear of not being able to follow children´s development were characterized as weaknesses/barriers. We expect that this study can foment new research approaching the experience of fatherhood in different stages of life cycle, from the perspective of the main characters and those with whom they share such experience.