Einleitung: Brustkrebspatientinnen sind im Rahmen ihrer Erkrankung in klinisch relevantem Ausmaß psychisch belastet. Die Stärke der Belastung wird durch verschiedene Faktoren determiniert. Ziel dieser Arbeit war die Untersuchung des Zusammenhangs der psychischen Belastung mit Erwerbstätigkeit und dem Vorhandensein eigener Kinder unter Einbeziehung der Zeit seit Diagnosestellung. Material und Methodik: Im Rahmen einer randomisierten klinischen Studie wurden 724 Brustkrebspatientinnen im Alter von 18–65 Jahren im kurativen Stadium mit einer Zeit seit Diagnosestellung von 0–12 Monaten hinsichtlich ihrer psychischen Belastung (Ängstlichkeit und Depressivität) mit der Hospital Anxiety and Depression Scale (HADS) beurteilt. In uni- und multivariaten Analysen wurde der Zusammenhang von Ängstlichkeit und Depressivität mit den Variablen Erwerbstätigkeit, Elternschaft und Zeit seit Diagnosestellung geprüft. Ergebnisse: Patientinnen mit längerer Zeit seit Diagnosestellung (4–12 Monate) zeigen geringere Werte für Ängstlichkeit (6,28) als die Patientinnen, bei denen die Diagnosestellung erst 0–3 Monate zurück liegt (7,24; p < 0,01). Zwischen Elternschaft und Ängstlichkeit gibt es keinen eindeutigen Zusammenhang. Das Alter der Kinder ist entscheidend. Auch unter Kontrolle des Lebensalters der Patientinnen zeigt sich Ängstlichkeit bei Frauen mit Kindern unter 16 Jahren signifikant höher (7,84) als bei kinderlosen Patientinnen (6,42) oder solchen mit Kindern ab 16 Jahren (6,87; p = 0,04). Erwerbslose Frauen zeigen signifikant höhere Depressivitätswerte als alle anderen Studienteilnehmer (p = 0,02). Wechselwirkungen zwischen den untersuchten Variablen treten nicht auf. Schlussfolgerung: Zwischen der Zeit seit Diagnosestellung, dem Erwerbsstatus sowie dem Vorhandensein eigener Kinder und psychischen Belastung bei Brustkrebspatientinnen ergeben sich differenzielle Zusammenhänge. Bei der Erfassung der psychischen Belastung im 1. Jahr nach der Diagnosestellung sollte besondere Aufmerksamkeit auf erwerbslose Patientinnen und Patientinnen mit jüngeren Kindern gerichtet werden.:1 Einführung in die Thematik.................................................................................................4 1.1 Psychische Belastungen bei onkologischen Patienten..........................................................4 1.1.1 Entstehung und allgemeine Risikofaktoren psychischer Erkrankungen bei Tumorpatienten.....4 1.1.2 Folgen ....................................................................................................................................6 1.1.2.1 Folgen psychischer Komorbidität für Tumorpatienten.............................................................6 1.1.2.2 Folgen psychischer Komorbidität für das Gesundheitssystem..................................................6 1.1.3 Defizite in der Erkennung und Ursachen.................................................................................8 1.2 Psychische Belastung bei Brustkrebspatientinnen ..............................................................9 1.2.1 Epidemiologie von Brustkrebs in Deutschland........................................................................9 1.2.2 Epidemiologie komorbider psychischer Störungen bei Brustkrebspatientinnen........................9 1.2.3 Risikofaktoren für Ängstlichkeit und Depressivität bei Brustkrebspatientinnen .......................9 1.2.3.1 Soziodemografische und psychosoziale Risikofaktoren.........................................................10 1.2.3.2 Krankheits- und behandlungsbezogene Risikofaktoren..........................................................10 1.2.3.3 Erwerbstätigkeit ...................................................................................................................11 1.2.3.4 Eigene Kinder ......................................................................................................................12 1.2.3.5 Zeit seit Diagnosestellung.....................................................................................................13 1.3 Zusammenfassende Betrachtung der Studienlage.............................................................15 1.4 Ableitung der Fragestellung und Zielstellung ...................................................................15 2 Publikation „Children and employment- Resource or stressors after Breast Cancer?“ ......17 3 Zusammenfassung der publikationsbasierten Dissertation ..............................................25 3.1 Fragestellung........................................................................................................................25 3.2 Ausgangssituation ................................................................................................................26 3.3 Methoden .............................................................................................................................26 3.4 Ergebnisse............................................................................................................................26 3.5 Zusammenfassung der Arbeit und der Ergebnisse .................................................................27 3.6 Praxisimplikation .................................................................................................................28 4 Anlagen ...............................................................................................................................30 4.1 Tabellen- und Abbildungsverzeichnis ...................................................................................30 4.2 Literaturverzeichnis ..............................................................................................................31 4.3 Erklärung über die eigenständige Abfassung der publikationsbasierten Dissertation..............35 4.4 Lebenslauf............................................................................................................................36 4.5 Danksagung..........................................................................................................................38 / Introduction: Breast cancer patients suffer clinically relevant levels of psychological stress because of their disease. Various factors can affect the level of stress experienced. This study aimed to investigate the relationship between the level of psychological stress and employment and children, including time since diagnosis. Material and Methods: A randomised clinical study was done of 724 breast cancer patients aged between 18 and 65 years; all were in the curative stage of disease and had been diagnosed 0–12 months previously. Patients were investigated for their levels of psychological stress (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS). The relationship between anxiety and depression and the variables "employment", "parenthood" and "time since diagnosis" were investigated, using univariate and multivariate analysis. Results: Patients with a longer time since diagnosis (4–12 months) were found to have lower levels of anxiety (6.28) compared to patients who had been diagnosed only 0–3 months previously (7.24; p < 0.01). There was no unambiguous relation between parenthood and anxiety. The age of the children was crucial. Even when results were controlled for patient age, the anxiety levels of women with children below the age of 16 years were significantly higher (7.84) compared to patients without children (6.42) or patients whose children were older than 16 years (6.87; p = 0.04). Women who were not employed had significantly higher levels of depression compared to all other participants in the study (p = 0.02). No reciprocal effects were found between investigated variables. Conclusion: We found a differentiated relationship between the variables "time since diagnosis", "employment" and "children" and the level of psychological stress experienced by breast cancer patients. When determining the level of psychological stress in the 1st year after diagnosis, particular attention should be paid to patients who are not employed and patients with children below the age of 16 years.:1 Einführung in die Thematik.................................................................................................4 1.1 Psychische Belastungen bei onkologischen Patienten..........................................................4 1.1.1 Entstehung und allgemeine Risikofaktoren psychischer Erkrankungen bei Tumorpatienten.....4 1.1.2 Folgen ....................................................................................................................................6 1.1.2.1 Folgen psychischer Komorbidität für Tumorpatienten.............................................................6 1.1.2.2 Folgen psychischer Komorbidität für das Gesundheitssystem..................................................6 1.1.3 Defizite in der Erkennung und Ursachen.................................................................................8 1.2 Psychische Belastung bei Brustkrebspatientinnen ..............................................................9 1.2.1 Epidemiologie von Brustkrebs in Deutschland........................................................................9 1.2.2 Epidemiologie komorbider psychischer Störungen bei Brustkrebspatientinnen........................9 1.2.3 Risikofaktoren für Ängstlichkeit und Depressivität bei Brustkrebspatientinnen .......................9 1.2.3.1 Soziodemografische und psychosoziale Risikofaktoren.........................................................10 1.2.3.2 Krankheits- und behandlungsbezogene Risikofaktoren..........................................................10 1.2.3.3 Erwerbstätigkeit ...................................................................................................................11 1.2.3.4 Eigene Kinder ......................................................................................................................12 1.2.3.5 Zeit seit Diagnosestellung.....................................................................................................13 1.3 Zusammenfassende Betrachtung der Studienlage.............................................................15 1.4 Ableitung der Fragestellung und Zielstellung ...................................................................15 2 Publikation „Children and employment- Resource or stressors after Breast Cancer?“ ......17 3 Zusammenfassung der publikationsbasierten Dissertation ..............................................25 3.1 Fragestellung........................................................................................................................25 3.2 Ausgangssituation ................................................................................................................26 3.3 Methoden .............................................................................................................................26 3.4 Ergebnisse............................................................................................................................26 3.5 Zusammenfassung der Arbeit und der Ergebnisse .................................................................27 3.6 Praxisimplikation .................................................................................................................28 4 Anlagen ...............................................................................................................................30 4.1 Tabellen- und Abbildungsverzeichnis ...................................................................................30 4.2 Literaturverzeichnis ..............................................................................................................31 4.3 Erklärung über die eigenständige Abfassung der publikationsbasierten Dissertation..............35 4.4 Lebenslauf............................................................................................................................36 4.5 Danksagung..........................................................................................................................38

本研究主要以衝突論(CONFLICT THEORY) 的觀點, 探討教育成就 (以教育程度為代表 ) 對社會流動(SOCIAL MOBILITY) 的影響. 研究目的有三: 一．探討我國收入的分配是否不均 ? 二．探討不同的從業分析（EMPLOYMENT STATUS） 中, 教育成就對收入的影響力如何 三．探討教育成就對於個人進入不同從業身份的影響力如何? 研究以民國七十三年行政院主計處家庭收支調查資料為樣本. 全文共一冊, 約六萬言 結果指出, 樣本顯示不同從業身份會造成收入不均, 而教育成就對不同從業身份的收入有不同的影響力, 但是教育成就對於個人進入不同 從業身份影響力顯著, 亦即只部份支持衝突論的看法.

I dagens samhälle finns det ett antal arbetstagare som har anställning på begränsad tid. Denna uppsats utreder regleringarna kring visstidsanställningar samt vilket förhållande som finns mellan visstidsanställningar och samhället. Fokus i detta arbete är att undersöka hur visstidsanställningar regleras och hur dessa inverkar på individer i Sverige. För att få full förståelse behandlar uppsatsen vidare EU:s syn på Sveriges reglering av visstidsanställda. Samhällets utveckling behandlas kort för att nå en djupare kännedom om behovet av visstidsanställningar i Sverige. I anslutning till samhällsutvecklingen undersöks konsekvenser för arbetstagare och arbetsgivare vid tillämpning av visstidsanställningar. Slutligen kartläggs fördelningen av visstidsanställningar bland grupper av individer i samhället. Underlaget för denna uppsats baseras främst på berörda lagrum, förarbeten, rättsfall och doktrin. Materialet kompletteras med statistik på antalet visstidsanställningar i samhället samt fördelning av visstidsanställningar i samhället.I uppsatsen har det framkommit att det är enkelt för arbetsgivare att anställa en arbetstagare på begränsad tid. Uppsatsen belyser att det finns två typer av visstidsanställningar där den ena är mer fördelaktig än den andra för anställda. Av uppsatsen framgår det att främst kvinnor har den mindre fördelaktiga visstidsanställningen, som inte är frivilligt vald. Män är något överrepresenterade vad gäller den mer fördelaktiga visstidsanställningen, som är frivilligt vald och har positiv inverkan på löneutvecklingen. En slutsats från detta resonemang är att många visstidsanställda kvinnor missgynnas. För att uppnå jämställdhet på den svenska arbetsmarknaden borde kvinnor och män vara lika representerade även i de mindre fördelaktiga visstidsanställningarna. / In today’s society there are a number of employees who are hired for a limited time. This paper investigates the regulations regarding fixed-term employment and the relationship between this type of employments and the society. To focus on this work regulation regarding fixed-term employments must be investigated and also how these affect the individuals in Sweden. To gain a full understanding the paper also deals with how other countries within EU relate to how Sweden handles the regulation of the fixed-term employments. The development of the society is shortly treated to reach a deeper understanding about the needs of temporary employments in Sweden. In connection with the development of the society, the consequences are investigated how the application of fixed-term employments will affect the employees and the employers. Finally, the distributions of temporary employments among groups of individuals in the society are mapped. The foundation of this paper is mainly based on the relevant section of law, preparation work, legal cases and doctrines. The material will be completed with statistics on the number of fixed-term employments and the distribution of these in the society.The paper shows that it is easy for employers to hire an employee for a limited time. The paper also shows that there are two types of fixed-term employments for employees, where one is more favorable than the other. It is mostly women who have less favorable fixed-term employments, and most of these jobs are not freely chosen. Men are slightly over-represented in terms of more favorable fixed-term employments which are often freely chosen and have a positive impact on the wages. The conclusion of this reasoning is that many temporary employed women are mistreated. In order to achieve equality on the Swedish labor market, both women and men should be equally represented even in the less favorable fixed-term employments.

Ce mémoire a pour but de vérifier l’existence possible d’un lien entre le rapport des individus aux nouvelles technologies d’information et de communication (NTIC) et leur niveau de bien-être psychologique. Également, il a comme intention de vérifier si ce lien est modéré en fonction de la génération à laquelle appartiennent les individus. Le dernier objectif est d’évaluer si le genre et le type d’emploi influencent ce lien entre le rapport aux NTIC et le niveau de bien-être psychologique. L’étude a été réalisée auprès de 1034 panélistes de l’Observateur. Les données utilisées ont été recueillies lors de l’étude Relations et différences intergénérationnelles. Les résultats de cette étude montrent qu’il existe un lien entre certaines dimensions du rapport aux NTIC des individus et le niveau de bien-être psychologique. De plus, ce lien est parfois modéré en fonction de la génération à laquelle appartiennent les individus. En ce qui concerne l’influence du genre et du type d’emploi sur le lien entre le rapport aux NTIC et le niveau de bien-être psychologique, nos résultats ne montrent aucun lien entre le genre ou le secteur d’activité et le niveau de bien-être psychologique. Cependant, plus un individu a un niveau de scolarité élevé, plus son niveau de bien-être psychologique est élevé. Aussi, le fait d’occuper un emploi à temps partiel est associé à une diminution du niveau de bien-être psychologique chez les individus appartenant à certaines générations. / The aim of this dissertation is, firstly, to verify the link between the predisposition of individuals towards new information and communication technologies (NICTs) and their level of psychological well-being. It then seeks to verify whether this link varies when individuals belong to different generations. Finally, it assesses whether gender and type of employment influence the link between the relationship to NICTs and the level of psychological well-being. The study was carried out among 1034 panelists of the Observer. The results of this study show that there is a link between specific dimensions of individuals' relationship to NICTs and the level of psychological well-being. Moreover, this relation is sometimes moderate depending on the generation to which the individuals belong. Furthermore, our results show no connection between gender or sector of activity and the level of psychological well-being. However, the higher an individual's level of education, the higher his or her level of psychological well-being. Part-time employment is also associated with a decrease in the level of psychological well-being among individuals belonging to certain generations.

Due to physical, cognitive and emotional impairments, many individuals are unemployed or under-employed following a traumatic brain injury. The research evidence links the rigour of a vocational evaluation to future employment outcomes. Despite this link, no specific guidelines exist for vocational evaluations. Using the research evidence and a diverse panel of clinical and academic experts, the primary objective of this doctoral research was to develop an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. The objective of the guideline is to make explicit the processes and factors relevant to vocational evaluation, to assist evaluators (i.e. clients, health and vocational professionals, and employers) in collaboratively determining clients’ work abilities and developing recommendations for work entry, re-entry or vocational planning. The steps outlined in the Canadian Medical Association's Handbook on Clinical Practice Guidelines were utilized to develop the guideline and include the following: 1) identifying the guideline’s objective/questions; 2) performing a systematic literature review; 3) gathering a panel; 4) developing recommendations; 4) guideline writing; 5) pilot testing. The resulting guideline includes 17 key recommendations within the following seven domains: 1) evaluation purpose and rationale; 2) initial intake process; 3) assessment of the personal domain; 4) assessment of the environment; 5) assessment of occupational/job requirements; 6) analysis and synthesis of assessment results; and 7) development of evaluation recommendations. Results from an exploratory study of the guideline’s implementation by occupational therapists in their daily practices revealed that clinicians used the guideline to identify practice gaps, systematize their evaluation processes, enhance inter-professional and inter-stakeholder communication, and re-conceptualize their vocational evaluations across disability groups. Statistically significant improvements were also noted in clients’ participation scores on the Mayo-Portland Adaptability Inventory–4 following guideline use. This guideline may be applicable to individuals with TBI, clinicians, health and vocational professionals, employers, professional organizations, administrators, policy makers and insurers.

Due to physical, cognitive and emotional impairments, many individuals are unemployed or under-employed following a traumatic brain injury. The research evidence links the rigour of a vocational evaluation to future employment outcomes. Despite this link, no specific guidelines exist for vocational evaluations. Using the research evidence and a diverse panel of clinical and academic experts, the primary objective of this doctoral research was to develop an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. The objective of the guideline is to make explicit the processes and factors relevant to vocational evaluation, to assist evaluators (i.e. clients, health and vocational professionals, and employers) in collaboratively determining clients’ work abilities and developing recommendations for work entry, re-entry or vocational planning. The steps outlined in the Canadian Medical Association's Handbook on Clinical Practice Guidelines were utilized to develop the guideline and include the following: 1) identifying the guideline’s objective/questions; 2) performing a systematic literature review; 3) gathering a panel; 4) developing recommendations; 4) guideline writing; 5) pilot testing. The resulting guideline includes 17 key recommendations within the following seven domains: 1) evaluation purpose and rationale; 2) initial intake process; 3) assessment of the personal domain; 4) assessment of the environment; 5) assessment of occupational/job requirements; 6) analysis and synthesis of assessment results; and 7) development of evaluation recommendations. Results from an exploratory study of the guideline’s implementation by occupational therapists in their daily practices revealed that clinicians used the guideline to identify practice gaps, systematize their evaluation processes, enhance inter-professional and inter-stakeholder communication, and re-conceptualize their vocational evaluations across disability groups. Statistically significant improvements were also noted in clients’ participation scores on the Mayo-Portland Adaptability Inventory–4 following guideline use. This guideline may be applicable to individuals with TBI, clinicians, health and vocational professionals, employers, professional organizations, administrators, policy makers and insurers.