Det finns många aktörer på marknaden som säljer hälsofrämjande tjänster till företag, föreningar och organisationer. Två bolag inom Sandvik AB köper en sjuk- och friskanmälningstjänst med telefonrådgivning av Unimed Care AB. Syftet med uppsatsen var att utföra en utvärdering åt de två bolag som köper tjänsten, samt se effekten av den. Tre olika enkäter delades ut till totalt 861 medarbetare. Bortfallet i undersökningen är betydande, 21 % av undersökningspopulationen deltog i utvärderingen. En enkät riktar sig till medarbetare, en till flödeschefer och en till Human Resource (personalavdelningen). För att komplettera insamlat material har information sökts via telefon och mail. Resultatet visar att medarbetares och flödeschefers uppfattningar om tjänsten varierar. För att öka samtligas tillfredställelse med tjänsten behövs mer information och kunskap om tjänsten, samt dess syfte. Det är många som inte vet hur tjänsten kan användas. Flödescheferna kan behöva förslag på hur statistiken kan användas i arbetet med personalfrågor. Sjukfrånvaron har minskat nationellt och även inom Sandvik koncernen under 2006-2008. Att sjukfrånvaron minskat under de år bolagen köpt tjänsten från Unimed kan förklaras som en kombination av samtliga insatser som bolagen genomfört, förändringar i nationella regler för sjukskrivning, samt att sjukskrivningarna minskat i hela landet.

När en person söker en första kontakt med hälso- och sjukvården sker det oftast via ett telefonsamtal till vårdcentralen. Vid telefonsamtalet, som tas emot av en sjuksköterska, bedöms och åtgärdas vårdsökarens ärende. Sjukskrivningar är ett av många ärenden som hanteras. De senaste åren har hanteringen av sjukskrivningar i Svensk hälso- och sjukvård förändrats vilket har orsakat en minskning av antalet sjukskrivningar. Sjuksköterskor har i varierande grad deltagit i denna utveckling och denna studie vill synliggöra sjuksköterskans deltagande i vården av sjukskrivna på vårdcentralen. Syftet var att beskriva sjuksköterskors erfarenheter av telefonrådgivning på vårdcentralen och speciellt hantering av sjukskrivningar. Studien är kvalitativ med induktiv ansats. Datainsamling har skett genom fokusgruppssamtal med 14 stycken sjuksköterskor som arbetar med telefonrådgivning på tre vårdcentraler. Insamlat material analyserades med kvalitativ innehållsanalys. Gruppsamtalen visade att sjuksköterskors erfarenheter av telefonrådgivning är att arbetet är kvalificerat och stimulerande. Hanteringen av sjukskrivningar innefattar att göra bedömning, ge patienten information och bevaka patientens rättigheter. Hindrande och möjliggörande omständigheter påverkar sjuksköterskornas arbete och deras hantering. De hindrande omständigheterna kan ibland leda till att sjuksköterskan vill frånsäga sig ansvar. Studien har identifierat ett behov av att tydliggöra omvårdnadsansvaret för verksamma sjuksköterskor i telefonrådgivning på vårdcentral så att sjuksköterskans bedömningar i telefonrådgivningssituationen i högre grad baseras på omvårdnadens mål. / When a person seeks contact with community health services in Sweden it’s usually via a phone call to the primary health care centre. By the phone call, received by a nurse, the health seeker’s case is assessed and addressed. Sick leave is one of many cases being managed. In recent years, management of sick leave in Swedish primary health care has changed and decreased the number of sick leaves. However, nurses have in varying degrees, participated in this change. This study will visualize the nurse's participation in the care of patients on sick leave at the primary health care centre. The aim was to describe nurses' experiences of telephone advisory services at the primary health care centre and especially the management of sick leaves. The study is qualitative with an inductive approach. Data collection was done through focus group discussions with 14 nurses working with telephone advisory services at three primary health care centres. Collected material was analyzed by qualitative content analysis. The group discussions demonstrated nurses' experiences of telephone advisory services as qualified and stimulating. The specific management of sick leave was described as a combination of making assessment, providing patient information and monitoring the patient's rights. Obstructing and enabling circumstances affect nurses telephone advisory services and their management of sick leaves. The obstucitive cirumstances sometimes causes nurses wanting to abdicate responsibility. The study has identified a need to clarify the caring responsibility for nurses in telephone advice services so that nurse's assessments increasingly are based on caring goales.

Syftet med studien är att undersöka hur samverkan ser ut mellan kommun och landsting vad avser personer som vårdas enligt lag (1991:1129) om rättspsykiatrisk vård (LRV) och skall permitteras till hemkommunen. Studiens frågeställningar är: (1) Hur sker samverkan mellan kommun och landsting innan permissionen verkställs? (2) Hur sker samverkan mellan kommun och landsting under tiden en person är permitterad? (3) Vilka möjligheter och hinder finns vad avser samverkan mellan kommun och landsting gällande personer som permitterats? Metodvalet är kvalitativt och författarna har genomfört fem intervjuer med nyckelpersoner inom landsting och samverkande kommuner. Den teoretiska utgångspunkten är Danermarks tre primära samverkansbegrepp: organisation, kunskap och regelverk. Resultatet visar att landstinget har ansvar för vård och behandling och att kommunen har ansvar för boende och sysselsättning. Respondenterna inom landstinget upplever att deras samverkan fungerar bra och uttrycker att det är vikigt med en god kommunikation samt att personkännedom underlättar samverkan. I dagsläget saknas det skriftliga samverkansavtal som är förankrade i verksamheterna, det saknas även en klar målsättning för samverkan. Detta är något som studiens tidigare forskning rekommenderar för en förbättrad samverkan. Respondenterna i en av kommunerna upplever att de får för lite bakgrundshistorik om brukarna och anser att viss rädsla kan finnas på grund av detta. De anser även att den handledning de idag får ifrån landstingets personal inte är tillräcklig. En respondent ifrån landstinget tycker dock att de ger lagom mycket information och att rädslan skulle kunna öka bland kommunens personal om de gav mer information. / The aim of this study is to research how the collaboration between municipality and county council works, about persons who are in forensic psychiatric care and are going on community leave. The studied issues are: (1) How does the collaboration work, between the municipality and county council, before the community leave is carried out? (2) How does the collaboration work, between the municipality and county council, during the community leave? (3) Witch possibilities and obstacles can be found in the collaboration between the municipality and county council, about persons who are on community leave? The method in the study is qualitative and the authors have accomplished five interviews with key figures within county council and collaborating municipalities. The theoretical starting point is Danermarks three collaboration concepts: organization, knowledge and rules. The result shows that the county council has the responsibility of medical care and treatment and that the municipality has the responsibility of the housing and occupation. The county council respondents experience that the collaboration is good and they also express that it is important to have an open communication, and that good knowledge of the persons involved facilitates the collaboration. Today there is a lack of written collaboration agreements that have gained approval within the organizations. Also, there is no common aim with the collaboration. A written agreement with a clear aim for the collaboration is something that is recommended by earlier research to improve the collaboration. The respondents in one municipality would like to get more background history about the persons who are on community leave, the lack of information could cause fear among the employees. They would also like some more guidance from the county council staff. One county council employee thinks that more information would cause more fear amongst the municipality staff.

The aim of this study is to evaluate the outcome of adoptions and to study the gene-environment influences on psychiatric illness as well as sick-leave patterns. The material consists of 2 966 adopted persons born between 1917 and 1949, their 5 932 adoptive parents and 5 438 identified biological parents.Adopted persons had a higher incidence of personality disorders and substance abuse than non-adopted controls. Adopted men also had an increased incidence of neuroses. Adopted women had an increased sick-leave because of somatic complaints, especially upper respiratory tract infections and abdominal complaints of short duration. Somatization i.e. more than 2 sick-leaves/year because of somatic complaint together with nervous complaints was more frequent among adopted women. Women with somatization could be separated into 2 types according to the pattern of sick-leave. Type 1 ("high frequency") had frequent sick-leaves for psychiatric, abdominal and back complaints. They also had a high frequency of alcohol abuse. Type 2 ("diversiform") had more diverse complaints and had fewer sick-leaves because of nervous complaints.High frequency somatizers had biological fathers with teenage onset of criminality and frequent registrations for alcohol abuse. Diversiform somatizers had the same genetic background as adopted men with petty criminality or male limited alcoholism.No specific genetic influences on treated depression or substance abuse were found in this study. However, a non-specific vulnerability of the biological mother influenced on the risk of depression and substance abuse among adopted women.There were some indications that placement in the adoptive home between 6 and 12 months of age was associated with reactive neurotic depression in adult life. Otherwise early negative experiences in term of unstable placements before adoption did not significantly influence on psychiatric illness in adulthood.Affective disorders in the adoptive father were associated with treatment for depressions or substance abuse in the adoptee. Low social status in the part of the adoptive father increased the risk of somatization of both types in the adoptee. / <p>S. 1-80: sammanfattning, s. 81-236: 6 uppsatser</p> / digitalisering@umu

Canadian statistics on patient safety in acute care hospitals are alarming. Hospital safety concerns are not isolated to patient safety. Occupational safety is also important. With increasing shortages of nurses, stress in the work place is growing. Nurses report high levels of absenteeism of 14.5 days per year. The importance of a just and fair culture and the role of nurse leaders have been emphasized in safety literature. Although deemed important, studies of nurse leaders and patient outcomes are limited. The influence of interactional justice in the workplace on nurse and patient safety has not been studied. The purpose of this study was to test and refine a model developed from the literature which explains the impact of perceived interactional justice, relational leadership, and quality of nurse manager – clinical nurse relationships on the nursing work environment and ultimately patient and nurse safety outcomes. The model was tested on a random sample of 266 Ontario acute care registered nurses. Findings indicated the model reasonably fit the observed data, however could benefit from further refinement. The addition of 2 pathways (span of control to nurses’ intent to leave and number of medication errors to nurse emotional exhaustion) and trimming of the insignificant paths improved the overall model fit. The resulting model indicates that resonant leadership style and interactional justice improves the quality of nurse leader-nurse relationships which in turn improves quality of the nurses’ work environment and safety climate. A positive safety climate led to a decrease in the number medication errors and nurses’ intentions to leave their unit. A higher quality work environment predicted lower nurse emotional exhaustion. Additionally, higher numbers of medication errors led to an increase in nurse emotional exhaustion. This suggests that distress may be associated with making a medication error or fear of consequences. As well, larger manager spans were associated with less nurse intent to leave. As the span increased, the number of support personnel also increased. Contrary to other research findings, this result suggests that supportive personnel may mitigate the effect of large manager spans of control on nurses’ intent to leave their units.

Canadian statistics on patient safety in acute care hospitals are alarming. Hospital safety concerns are not isolated to patient safety. Occupational safety is also important. With increasing shortages of nurses, stress in the work place is growing. Nurses report high levels of absenteeism of 14.5 days per year. The importance of a just and fair culture and the role of nurse leaders have been emphasized in safety literature. Although deemed important, studies of nurse leaders and patient outcomes are limited. The influence of interactional justice in the workplace on nurse and patient safety has not been studied. The purpose of this study was to test and refine a model developed from the literature which explains the impact of perceived interactional justice, relational leadership, and quality of nurse manager – clinical nurse relationships on the nursing work environment and ultimately patient and nurse safety outcomes. The model was tested on a random sample of 266 Ontario acute care registered nurses. Findings indicated the model reasonably fit the observed data, however could benefit from further refinement. The addition of 2 pathways (span of control to nurses’ intent to leave and number of medication errors to nurse emotional exhaustion) and trimming of the insignificant paths improved the overall model fit. The resulting model indicates that resonant leadership style and interactional justice improves the quality of nurse leader-nurse relationships which in turn improves quality of the nurses’ work environment and safety climate. A positive safety climate led to a decrease in the number medication errors and nurses’ intentions to leave their unit. A higher quality work environment predicted lower nurse emotional exhaustion. Additionally, higher numbers of medication errors led to an increase in nurse emotional exhaustion. This suggests that distress may be associated with making a medication error or fear of consequences. As well, larger manager spans were associated with less nurse intent to leave. As the span increased, the number of support personnel also increased. Contrary to other research findings, this result suggests that supportive personnel may mitigate the effect of large manager spans of control on nurses’ intent to leave their units.

Eriksson, Simon &amp; Ögren, Andreas. (2011). Vart tar fotbollsungdomarna vägen? En studie om varför 15-16 åringar i Västerbotten väljer att lämna fotbollen. (Where do the football youths go? A study of why 15-16 year olds in Västerbotten choose to leave football) Bachelor Essay in Swedish. Umeå: Umeå University, Department of Education. Abstract: This study was made on request from Västerbottens Football Association and treats the problem with youth players who drop out from football in Västerbotten, Sweden. Västerbottens Football Association has noticed that more and more players are leaving football at the age of 15-16. The purpose of the study was to examine the perceptions that youths in Västerbotten had about why they decided to leave football. Questions of why the youth players are leaving football and causes that could have made them stay was examined in this study. Also possible differences between genders were examined. The data was collected through a web-based survey where 40 youths answered. The results showed that the most common reasons of leaving football were lack of motivation and that they choosed another sport instead. There were a significant difference between the genders in some questions, for example more girls than boys meant that bad coaches had affected their decision of leaving football.

The issue of sick leave and an increase of ill health in the workplace is a social problem inSwedenthat is currently an important topic. Public human service organisations are one of the sectors where this is a major problem. The aim of this study is to examine what significance the leadership in public human service organisations has on the health and sense of well being among the staff within the organisation. We have chosen to look at this issue from a health promoting perspective where we focused on health factors and to what extent the management can influence and promote the possibilities for a healthy workplace with healthy staff. The results of the study are based on interviews with three leaders within the public human service sector. Results shows that having staff that are content and healthy is a key ingredient in the organisations goal to provide the best possible care and service to their clients. The results also identify leadership qualities and tools that are important such as being present in the workplace and available for the staff and also setting a good example. Other leadership qualities such as being clear in their role as to what they expect from their staff, being goal orientated, and being strong and secure in their leadership proved to be important in relation to health in the workplace. Making sure that the staff feel that they have the possibility to influence their working conditions and given the opportunity to participate in changes were also identified as important health promoting factors. The study also shows that showing trust in the staff and allowing them to take responsibility as well as seeing them as individuals is also important health promoting factors. It became evident that achieving a healthy workplace is a process where all the factors are equally important.

The aim of the study was to examine the knowledge and experience women, who participants in the project Steget vidare, have to health, quality of life and empowerment and how long-term sickness absence has affected these components. A further aim of this study was to examine whether and if so, how the project's rehabilitative efforts targeted to health may be related to increased opportunities to return to work. The methods for generating data were qualitative interviews based on seven long-term sick individuals who participated in the project Steget vidares health group. The result indicates that the interviewees have a clear picture of what health and quality of life are, while the concept of empowerment is not as obvious. Further, long-term sickness seemed to affect the individual’s health, quality of life and empowerment in various ways, usually in a negative sense. Before their participation in the project, several of the interviewees experienced being caught in an area of nowhere between different social agencies. However, the result indicates that since they started in the project they have received a more individual approach tailored to their specific situation. Due to the result, the social interaction between the health group participators has contributed to an improved life situation for several of them which have strengthened their potential to become competitive on the labor market. Finally, we can conclude that despite of the interviewees’ positive experiences of the project and the process which it includes it is difficult to locate and explain how and to what extent health interventions contribute to participants’ ability to return to work.

Error estimation must be used to find the accuracy of a designed classifier, an issue that is critical in biomarker discovery for disease diagnosis and prognosis in genomics and proteomics. This dissertation is concerned with the analytical formulation of the joint distribution of the true error of misclassification and two of its commonly used estimators, resubstitution and leave-one-out, as well as their marginal and mixed moments, in the context of the Linear Discriminant Analysis (LDA) classification rule. In the first part of this dissertation, we obtain the joint sampling distribution of the actual and estimated errors under a general parametric Gaussian assumption. Exact results are provided in the univariate case and an accurate approximation is obtained in the multivariate case. We show how these results can be applied in the computation of conditional bounds and the regression of the actual error, given the observed error estimate. In practice the unknown parameters of the Gaussian distributions, which figure in the expressions, are not known and need to be estimated. Using the usual maximum-likelihood estimates for such parameters and plugging them into the theoretical exact expressions provides a sample-based approximation to the joint distribution, and also sample-based methods to estimate upper conditional bounds. In the second part of this dissertation, exact analytical expressions for the bias, variance, and Root Mean Square (RMS) for the resubstitution and leave-one-out error estimators in the univariate Gaussian model are derived. All probabilistic characteristics of an error estimator are given by the knowledge of its joint distribution with the true error. Partial information is contained in their mixed moments, in particular, their second mixed moment. Marginal information regarding an error estimator is contained in its marginal moments, in particular, its mean and variance. Since we are interested in estimator accuracy and wish to use the RMS to measure that accuracy, we desire knowledge of the second-order moments, marginal and mixed, with the true error. In the multivariate case, using the double asymptotic approach with the assumption of knowing the common covariance matrix of the Gaussian model, analytical expressions for the first moments, second moments, and mixed moment with the actual error for the resubstitution and leave-one-out error estimators are derived. The results provide accurate small sample approximations and this is demonstrated in the present situation via numerical comparisons. Application of the results is discussed in the context of genomics.