Background: The high levels of sickness absence and disability pensioning experienced during the 1990's and 2000's have become both socially as well as financially burdensome for society. Sickness absence implies a costly loss of production for society and large groups of individuals are risking to become marginalised on the labour market. Sickness absence is both a public health and an economic problem. Thus from both a human approach as well as from an economic perspective it is urgent to increase knowledge about what influences individual behaviour when it comes to sickness absence and return to work. Objectives: The overall aim of the thesis is to elucidate the decisive factors for explaining sickness absence. Three different aspects of sickness absence were considered, i.e. factors leading to sickness absence, factors preventing sickness absence and factors leading back to work ability and work when being sickness absent. This is done using a frame of reference involving broadly defined areas of work, health and social insurance related factors. Material and methods: Study I analyzes the outcome of unemployed sick-listed individuals. A total of 280 individuals from the county of Värmland were followed through register data between the years 2000 to 2001. Linear and logistic regression models were used to analyze the occurrence of short and long term economic incentives. Study II has a longitudinal design and explores determinants of return to work. Sick-listed individuals with a stress-related psychiatric diagnosis from the county of Värmland were analyzed over a period of three years (2000-2003) using logistic regression. The data comprised 911 individuals. Study III is a cross-sectional study using questionnaire data from the county of Värmland from year 2004. A total of 3123 persons either working or being self employed were analyzed on determinants of work presence through logistic regression. Study IV had a cross-sectional design and used questionnaire data from five counties in central Sweden. The data, from 2004, comprised 10536 individuals being employed, i.e. not self-employed, and with self reported physical and mental medical conditions. Logistic regression was mainly used in the analysis and the focus was on risk factors for long term sickness absence. Study V comprises cross-sectional data retrieved at three separate occasions between 1991 and 1994. It includes 8839 individuals from five counties in western Sweden with sickness absence spells over 60 days. The data was analysed through bi-variate probit regression with a focus on effects of vocational rehabilitation on return to work. Results: The results from study I were interpreted as that both short and long term economic incentives matter for the outcome of sickness absence through the interaction of different insurance systems. The principal findings from study II was that age, gender and factors implying less favourable health characteristics and thereby lower work capacity, reduce probabilities of returning to work after long term sickness absence. Considering study III determinants of work presence were found to vary between sexes and whether the determinants were counteracting long or short term sickness absence. Factors interpreted as job control counteracted short term absence. Sense of coherence was found to be an important determinant of work presence for women. In study IV long term sickness absence was found to be related to the level of ill-health. Moreover it was concluded that work environment factors as job strain, job satisfaction, physical work environment were important factors for explaining sickness absence in a population with impaired health. The results from study V indicated that vocational rehabilitation is a potentially effective instrument for improving the individual's work ability and chances of return to work. That no signs of prioritizing selection of rehabilitation participants to those likely to return to work with or without rehabilitation measures, i.e. "managerial creaming", were found was also considered as important results. Conclusions: This thesis shows that we need different models and approaches to improve knowledge about the various aspects of sickness absence as entry into absence, return to work or into disability retirement. It also has the implications that sickness absence behaviour can be influenced. Largely depending on what long term path is chosen for welfare policy at the political level it should be acknowledged that other means, improving working conditions and promoting rehabilitation rather than reducing benefit levels and narrowing the eligibility criteria for the insurance benefits are at hand.

The purpose of this study was to identify and determine the risk factors for malnutrition among children under the age of 5 years in Kweneng West District of Botswana. A case control study was conducted. The cases consisted of 37 underweight children under the age of 5 (n=37), and the controls consisted of 76 children less than 5 years of age (n=76) recruited concurrently among the under-five children attending Letlhakeng Child Welfare Clinic on a monthly basis. The controls were of good nutritional status. Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were small number of daily meals taken by the child (Adjusted OR=19.04, 95% CI 3.24-112.13), lack of knowledge of methods of prevention of child malnutrition by the parent (Adjusted OR=4.71, 95% CI 1.41-15.82), parent’s unemployment (Adjusted OR=50.3, 95% CI 4.86-52.1), low birth weight (Adjusted OR=12.34, 95% CI 2.76-55.02), inadequate Vitamin A supplementation (Adjusted OR=13.27, 95% CI 1.94-90.46), child illness (OR=20.95, 95% CI 7.55-58.10), and child raised by a guardian (Adjusted OR=5.67, 95% CI 1.30-24.73). The findings from this study suggest that Socio-economic factors such as unemployment, a lack of knowledge about recommended infant and child feeding practices, the child raised by a guardian, and health-related factors such as low birth weight, inadequate Vitamin A supplementation, and child illness are predictors of malnutrition in under five. Therefore, increasing household food security and reinforcing educational interventions could contribute to a reduction in the prevalence of child malnutrition in the district / Health Studies / M.A. (Public Health)

Individers upplevelse av den psykosociala arbetsmiljön har visat sig hänga samman med trivsel, hälsa och välbefinnande. I ett långsiktigt perspektiv kan en god psykosocial arbetsmiljö främja kvalitet och produktivitet i organisationer, medan en sämre arbetsmiljö kan resultera i det motsatta. Arbetsgivare, som i Sverige har ett yttersta arbetsmiljöansvar, strävar efter att arbeta förebyggande och systematiskt med fokus på psykosociala arbetsmiljöinsatser. Samtidigt utgör individerna en del av den psykosociala arbetsmiljön och i samband med att de utför sitt arbete bidrar de även till formandet av arbetsmiljön. Med detta som utgångspunkt syftar avhandlingen till att studera psykosociala och personliga faktorer i form av krav och resurser, hälsa och välbefinnande samt ett organisatoriskt förebyggande program för anställda i välfärdssektorn. Detta har gjorts genom att undersöka hur olika krav och resurser i arbetet samt personliga resurser relaterar till olika hälsorelaterade utfall. Vidare har två varianter av ett nyutvecklat interventionsprogram med fokus på psykosociala faktorer och personliga resurser undersökts och utvärderats. En variant av programmet var riktad till både chefer och medarbetare, medan den andra varianten riktades enbart till chefer. Interventionsprogrammen undersöktes utifrån genomförbarhet och utifrån effektutvärdering. Resultaten visar att resurser i arbetet verkar ha mer hälsofrämjande potential än personliga resurser. Vidare visar resultaten att det program som inkluderade medarbetare och chefer accepterades av deltagarna och gick att genomföra praktiskt. Resultaten visar också att effekterna av båda programmen var oklara. Sammantaget visar avhandlingen på vikten av att såväl reducera krav i arbetet som att främja olika resurser, men även på de utmaningar som finns i att utforma, genomföra och utvärdera förebyggande organisatoriska interventioner. / Individuals’ experiences of the psychosocial work environment have been linked to their satisfaction, health, and well-being. In the long run, a favorable psychosocial work environment seems related to organizational quality and productivity, while a poorer psychosocial work environment may relate to the opposite. Employers, who in Sweden have the ultimate responsibility for the work environment, aim for systematic preventive efforts focusing particularly on factors of the psychosocial work environment. Additionally, individuals also form part of the psychosocial work environment, and may, through their own daily work practices contribute to creating the work environment. Based on this, the aim of this thesis is to study how psychosocial factors, in terms of demands and resources, and personal resources at work relate to health and well-being but also to investigate the effects of an organizational preventive intervention program. Specifically, job demands, job resources, and personal resources and their relations with health-related outcomes among employees of the Swedish welfare sector were investigated. Also, two versions of a newly developed intervention program focusing on psychosocial factors and personal resources were examined. This included a feasibility study of one program version offered to both employees and managers and an effect evaluation of another version offered to managers only. The results show that job resources seem to have a stronger health-promoting potential than personal resources. Moreover, the results show that while the program offered to both employees and managers was accepted by participants and found possible to implement practically, its effect were small. Similarly, effects of the program including managers only were also small. Overall, the thesis shows the importance of reducing job demands along with promoting different resources, but emphasizes the challenges in developing, implementing, and evaluating preventive organizational interventions. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Manuscript. Paper 3: Manuscript.</p>

The purpose of this study was to identify and determine the risk factors for malnutrition among children under the age of 5 years in Kweneng West District of Botswana. A case control study was conducted. The cases consisted of 37 underweight children under the age of 5 (n=37), and the controls consisted of 76 children less than 5 years of age (n=76) recruited concurrently among the under-five children attending Letlhakeng Child Welfare Clinic on a monthly basis. The controls were of good nutritional status. Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were small number of daily meals taken by the child (Adjusted OR=19.04, 95% CI 3.24-112.13), lack of knowledge of methods of prevention of child malnutrition by the parent (Adjusted OR=4.71, 95% CI 1.41-15.82), parent’s unemployment (Adjusted OR=50.3, 95% CI 4.86-52.1), low birth weight (Adjusted OR=12.34, 95% CI 2.76-55.02), inadequate Vitamin A supplementation (Adjusted OR=13.27, 95% CI 1.94-90.46), child illness (OR=20.95, 95% CI 7.55-58.10), and child raised by a guardian (Adjusted OR=5.67, 95% CI 1.30-24.73). The findings from this study suggest that Socio-economic factors such as unemployment, a lack of knowledge about recommended infant and child feeding practices, the child raised by a guardian, and health-related factors such as low birth weight, inadequate Vitamin A supplementation, and child illness are predictors of malnutrition in under five. Therefore, increasing household food security and reinforcing educational interventions could contribute to a reduction in the prevalence of child malnutrition in the district / Health Studies / M.A. (Public Health)