The primary aim of this investigation was to evaluate a seven-week multidisciplinary rehabilitation programme, with emphasis on musculoskeletal disorders, for working-age people, by assessments at the start and end of the rehabilitation programme, and at follow-up examinations 6, 12 and 24 months after completion of the programme. A further aim was to explore the experiences of people not returning to work during a period of six years after participation in an extensive multidisciplinary rehabilitation programme. Sixty participants, 40 women and 20 men (mean age 46.8 ± SD 7.9), with musculoskeletal disorders, mainly neck and back pain, participated in a 7- week rehabilitation programme which was based on a combination of theoretical and practical education, physical activities, relaxation and individual guidance. Before and after the programme and at the follow-up occasions all participants were evaluated with the Global Self-Efficacy Index (GSI), Hospital Anxiety and Depression Scale (HAD), and Stress test (Study I). A group of participants who were still full-time sick-listed (Group I) at the end of the study period were compared with participants who were part-time or not sick-listed (Group II) at the end of the study period (II, III, IV). They were evaluated with the Disability Rating Index (DRI), with the Pain Intensity Rating Index on a visual analogue scale (VAS) (II, III)), mobility tests (III), GSI (III), HAD, and a stress test (IV). Seven women (median age 48 years) and three men (53 years) (Group I) were interviewed and the interviews were analysed by manifest content analysis (V). At the 2-year follow-up full-time sick leave, anxiety, depression and selfexperienced stress had decreased in both sexes. They also showed increased quality of life (QoL) (I). In participants with full-time sick leave (Group I), self-experienced physical disability and pain ratings were high and showed no decrease up until the 2-year follow-up. In participants with part-time or no sick leave (Group II), physical disability and pain ratings decreased gradually throughout the 2-year follow-up period (II). Cervical and thoracolumbar spine range of motion (ROM) was lower in Group I than in Group II from the start of rehabilitation to a 2-year follow-up. Only Group II showed a temporal improvement in ROM. No changes in DRI, VAS or GSI were found in parallel with corresponding temporal changes in any of the ROM (III). Group I experienced no change in anxiety or depression during the study period, in contrast to Group II, in which this decreased. Decreased stress was found in both groups (IV). Group I described perceived barriers to and possibilities of returning to work, and also gave information on what strategies they used, to cope with everyday life (V). The majority of the participants improved and they continued to be physically active, their QoL improved, and most participants returned to work. Ten of the participants, however, were on full-time sick leave throughout the whole study period, with high self-experienced physical disability, high pain rating and no improvement in anxiety and depression. They experienced barriers to re-entering the labour market as consequences of physical symptoms and fatigue. But they also believed in possibilities of returning to work if they could get a modified job adapted to their own capacity. Thus, persons with severe disability and pain did not improve by rehabilitation in this project. New methods of treatment have to be developed for improvement of symptoms resulting in reduction of functional impairment and a consequent need for sick leave. / Huvudsyftet med undersökningen var att utvärdera ett 7-veckors multidisciplinärt rehabiliteringsprogram inriktat på muskuloskeletala besvär, för arbetsföra kvinnor och män, vid start och efter rehabiliteringsprogrammets slut samt vid 6, 12 och 24 månader. Vidare var syftet att undersöka deltagares upplevelse av att inte återgå i någon form av arbete sex år efter deltagande i rehabiliteringsprogrammet. Sextio deltagare, 40 kvinnor och 20 män (medelålder 46.8 ±7.9), med muskuloskeletala besvär, framför allt nack- och ryggbesvär, deltog i ett 7- veckors rehabiliteringsprogram som innehöll en kombination av teoretisk och praktisk undervisning, fysisk aktivitet, avslappning och individuell vägledning. Deltagarna testades före och efter rehabiliteringsprogrammet samt vid uppföljningstillfällena med Globalt Självskattnings Index (GSI), Hospital Anxitey and Depression Scale (HAD) och stress test (Studie I). En grupp deltagare som fortfarande var helt sjukskriven (Grupp I) i slutet av studieperioden, jämfördes med deltagare som var delvis eller inte alls sjukskriven (Grupp II) vid studieperiodens slut (II, III, IV). De utvärderades med Disability Rating Index (DRI), smärtskattning med visuell analog skala (VAS) (II,III), rörlighetsmätning (III), GSI (III), HAD, och stress test (IV). Sju kvinnor (median ålder 48 år) och tre män (53 år) (Grupp I) intervjuades och intervjuerna analyserades med manifest innehållsanalys (V). Vid två års uppföljning hade heltidssjukskrivning, ångest/oro, depression och självupplevd stress minskat hos båda könen. De visade också ökad livskvalitet (I). Deltagarna som var helt sjukskrivna (Grupp I) hade hög självskattad funktionsnedsättning samt smärtskattning och visade ingen förändring vid två års uppföljning. Deltagarna som var delvis eller inte alls sjukskrivna (Grupp II) visade en gradvis förbättring av fysisk funktion och smärtskattning under studieperioden (II). Cervical och thoracolumbar rörlighet var mindre i Grupp I jämfört med i Grupp II från start till två års uppföljning. Endast Grupp II visade en temporär förbättring av den aktiva rörligheten. DRI, VAS och GSI förändrades inte parallellt med förändringarna i den aktiva rörligheten (III). Grupp I upplevde ingen förändring i ångest/oro eller depression under studie perioden jämfört med Grupp II, som minskade ångest/oro och depression. Båda grupperna skattade mindre stress (IV). I studie V beskrevs deltagarnas upplevelser av hinder och möjligheter för att återgå i arbete. De beskrev vidare vilka strategier som användes för att hantera vardagslivet. Majoriteten av deltagarna förbättrades och de fortsatte att vara fysiskt aktiva, livskvaliteten förbättrades och de flesta deltagarna återgick i arbete. Tio av deltagarna var helt sjukskrivna under hela studieperioden, med hög självskattad fysisk funktionsnedsättning, hög smärtskattning och ingen förbättring i ångest/oro eller depression. De upplevde hinder för återgång i arbete, en konsekvens av de fysiska symtomen och trötthet. De trodde också på möjlighet till återgång i arbete om de kunde få ett arbete anpassat till deras egen arbetsförmåga. Alltså, personer med stor funktionsnedsättning och hög smärta förbättrades inte av rehabilitering i det här projektet. Nya metoder av behandling behöver utvecklas för att förbättra symtomen och därmed minska funktionell försämring och behovet av sjukskrivning.

The aim of this study was to examine how individuals with disability pension reason about a return to work. Action theory, as presented by Berglind, was used as theoretical approach. Qualitative interviews were conducted with five individuals who have disability pension due to mental illness. The respondents describe how they weigh benefits and disadvantages against each other. The main reason for a return to work is economical. The greatest disadvan-tage is the risk of losing their right to disability pension, which seems to limit their motivation to return to work. All respondents stress benefits associated with work but they do not all wish to return to work. Work is not described as equal to paid work but as an essential part of life. All respondents’ express a belief in their ability to work but are doubtful concerning their chances of getting employment, which seems to have a negative impact on their motivation as well. Furthermore, the respondents criticize the public authorities in the field of rehabilitation for not contributing to a return to work process. However, they give an example of how a non-governmental organisation has been important for increasing their possibilities of a return to work.

Studiens övergripande syfte är att belysa och gestalta det sociala stöd respektive sociala tryck personer sjukskrivna för utmattningsdepression anser sig uppleva från omgivningen, vad gäller både att vara sjukskriven och att återgå till arbete. Undersökningen genomfördes med hjälp av kvalitativ metod, och sex personer som var sjukskrivna för utmattningsdepression intervjuades individuellt. Resultatet visar att de sjukskrivna upplever en komplex blandning av både press och stöd i processen att ta sig tillbaka till arbetslivet. Stödet, oftast i form av förståelse och undvikande av press, upplevs främst från personer i individens nära omgivning, medan pressen att återgå till arbete oftast relateras till personer och grupper på längre avstånd. Störst press att återgå till arbetet upplevdes från den "samhälleliga" normen "att göra rätt för sig", men även omgivningens okunskap och brist på förståelse upplevdes som en press. / The overall aim in this essay is to highlight and describe the social support and social pressure, people on sick leave for burnout feel they experience by their environment, both in terms of being on sick leave and in terms of return to work. The survey was conducted using qualitative methodology, and six people being sick for burnout were interviexed individually. The result shows that people on sick leave for burnout are experiencing a complex mixture of both social pressure and social support in the process of returning to work. Social support, often in the form of understanding for the disease and avoidance of pressure, are mostly experienced by people in the individual's near environment, while the pressure usually is related to individuals and groups at longer distances. The strongest pressure to return to work was experienced from the "societal" norm "to do the right thing", but also lack of krowledge and lack of understanding were experienced as a pressure to return to work.

Made available in DSpace on 2016-06-02T20:44:16Z (GMT). No. of bitstreams: 1 6603.pdf: 1107602 bytes, checksum: f1fd43079c8ff9036b6e8cde5701d313 (MD5) Previous issue date: 2015-02-06 / Currently, in Brazil, the assistance geared to workers who were affected by disease or accident, who find themselves unable to return to their original function, but have the potential to exercise other labor activities, is provided by the National Institute of Social Security (INSS) to taxpayers, through the Vocational Rehabilitation Program (PRP). Vocational rehabilitation aims to provide the necessary means for the worker s re-entry into the labor market. This research aimed to understand the INSS PRP s contribution to the employee s reintegration in the market and, as specific objectives, identify the profile of the population served by the program of the Social Security Agency (APS) of the Southeast, between 2007-2012; we investigated the means used within the program to reintegrate workers into the labor market; trace the professional profile of users who visited the PRP; and characterize, in the view of the rehabilitated workers, how the program interfered with their reintegration into the market. This is a case study because it was focused on a single APS among a vast universe, transversal and descriptive, which had as data collection 592 records of people referred to the PRP on the above period; besides having been performed eight in-depth interviews with workers considered rehabilitated. The results showed that the profile of the people served corresponds to 76.5% male, 61.15% of those aged between 30-44 years, the most natural of the host city of the Program or the same state, about 62 % are married or living in a stable relationship, 15% have some form of disability, 42% had not finished elementary school, 74.5% are affiliated to the INSS as employees, 99.5% receive social security benefits, and of these, 77,2% receive common sickness assistance. About 48.5% of people referred were eligible to join the program. As for the resources used in the rehabilitation process, in 5.33% of cases was fitting, 23.33% in the provision of courses, and 25% training in the bond company; no resource were used with the remainder. Workers considered rehabilitated by the organization totaled 34%; currently, according to information from corporate systems of the institution, of these, 49.02% are employed or are self-employed, Social Security contributors, and 26.5% are without bond. The in-depth interviews allowed us observe that the rehabilitated workers do not show a direct relationship between the program and their reintegration into the labor market, but they claim that the resources used in the rehabilitation process are important means to win, if not a job, at least recognition personal and The study points to the need for coordination between the INSS and companies to be forwarded to the rehabilitated internship or a job vacancy by the Institute; this, while federal agency, would have, in their view, the power to promote this articulation and guarantee them a job. The PRP requires changes, a more active attitude of the body at the end of the rehabilitation process, and fundamentally have not ceased their responsibility at the time the rehabilitation of the certificate is sent out. / Atualmente, no Brasil, a assistência voltada aos trabalhadores que foram acometidos por alguma doença ou acidente, que se encontram incapazes para retornar à sua função de origem, mas possuem potencial laborativo para exercer outras atividades laborativas, é prestada pelo Instituto Nacional do Seguro Social (INSS) aos contribuintes, por meio do Programa de Reabilitação Profissional (PRP). A reabilitação profissional visa proporcionar os meios necessários para o reingresso do trabalhador no mercado de trabalho. Esta pesquisa teve como objetivo geral compreender a contribuição do PRP do INSS para a reinserção do trabalhador no mercado e, como objetivos específicos, identificar o perfil da população atendida pelo Programa de uma Agência da Previdência Social (APS) da região Sudeste, entre os anos de 2007 e 2012; investigar os meios utilizados dentro do Programa para reinserir o trabalhador no mercado de trabalho; traçar o perfil profissional dos usuários elegíveis para o PRP; caracterizar, na visão dos trabalhadores reabilitados, como o Programa interferiu na sua reinserção no mercado. Trata-se de um estudo de caso, pois foi enfocada uma única APS entre um vasto universo, transversal e descritivo, que teve como fonte de coleta de dados 592 prontuários das pessoas encaminhadas ao PRP no período exposto, além de terem sido realizadas oito entrevistas em profundidade com trabalhadores considerados reabilitados. Os resultados mostraram que o perfil das pessoas atendidas corresponde a 76,5% do sexo masculino, 61,15% na faixa etária entre 30 e 44 anos, a maioria natural da cidade-sede do Programa ou do mesmo estado deste, cerca de 62% são casados ou vivem em união estável; 15% apresentam algum tipo de deficiência; 42% não concluíram o Ensino Fundamental; 74,5% estão filiados ao INSS como empregados; 99,5% recebem benefício previdenciário, destes, 77,2% recebem auxílio-doença comum. Cerca de 48,5% das pessoas encaminhadas foram consideradas elegíveis para integrarem o Programa. Quanto aos recursos utilizados no processo de reabilitação, em 5,33% dos casos foi a protetização, em 23,33% a oferta de cursos e, em 25%, o treinamento na empresa de vínculo; com o restante não chegou ser utilizado nenhum recurso. Os trabalhadores considerados reabilitados pelo órgão somaram 34%; atualmente, de acordo com informações dos sistemas corporativos da instituição, destes, 49,02% estão empregados ou são autônomos, contribuintes da Previdência, e 26,5% estão sem vínculo. As entrevistas em profundidade permitiram observar que os trabalhadores reabilitados não apontam uma relação direta entre o Programa e sua reinserção no mercado de trabalho, mas afirmam que os recursos utilizados no processo de reabilitação são meios importantes para conquistarem, senão um emprego, ao menos reconhecimento pessoal e profissional. O treinamento na empresa de vínculo se mostrou um recurso ineficaz para os dois entrevistados nesta categoria, desviados de função e demitidos após seu retorno, já os cursos, técnicos ou de qualificação, são vistos como uma oportunidade de aprendizado e satisfação, porém não garantem um emprego; as próteses foram consideradas de ótima qualidade e imprescindíveis ao exercício de uma atividade laborativa. Foi apontada a necessidade de articulação entre o INSS e as empresas para que os reabilitados sejam encaminhados para estágio ou a uma vaga de emprego pelo Instituto. Este, como órgão federal, teria, na visão deles, o poder de promover essa articulação e garantir-lhes um emprego. O PRP requer mudanças, uma postura mais ativa do órgão ao término do processo de reabilitação, e, fundamentalmente, não ter cessada sua responsabilidade no momento em que o certificado da reabilitação é emitido.

Introdução: Câncer de mama é o mais comum em mulheres. Embora sua incidência ainda esteja em ascensão, as taxas de recorrência e mortalidade têm diminuído, em especial nos países desenvolvidos. Assim o câncer pode ser considerado um choque transitório que não impede que os sobreviventes retomem a normalidade em suas vidas, incluindo atividades laborais. Na América do Norte e Europa, as taxas de RT entre as pacientes com câncer de mama variam de 24-66% após 6 meses e 53-82% após 36 meses de diagnóstico. Os fatores mais associados ao RT são: idade, quimioterapia, sequelas da terapia do câncer e apoio do empregador e colegas de trabalho. Esses achados, no entanto, variam sugerindo que outros fatores e até aspectos de diferentes legislações podem interferir no RT. Na América Latina há escassez de dados sobre RT após o diagnóstico de câncer de mama. Objetivos: Avaliar as taxas de retorno ao trabalho nos meses 12 e 24 após o diagnóstico de câncer de mama e verificar a correlação de fatores à retomada ao trabalho aos 24 meses. Métodos: Estudo prospectivo observacional avaliando taxas de RT em mulheres com câncer de mama tratadas no Instituto do Câncer do estado de São Paulo, com idade > 18 e < 57 anos e que trabalhavam de forma remunerada por pelo menos 03 meses ao diagnóstico. Pacientes com doença inoperável ou metastática foram excluídas. Nos meses 06, 12 e 24 do seguimento responderam à questionários do estudo e de qualidade de vida (FACT-B), por telefone. Resultados: Entre julho/2012 e setembro/2014, 125 pacientes assinaram o TCLE. Quatro foram excluídas da análise (02 óbitos e 02 sem contato por telefone). A idade média foi de 45.1 anos (± 8,1). A maioria (94%) gostava do trabalho, 73% receberam apoio do empregador, mas apenas 29% relataram ter recebido oferta de ajuste no trabalho. Metade apresentava doença no estádio II e 93% fizeram quimioterapia como parte de seu tratamento. As taxas de RT foram 21,5%, 30,3% e 60,4% aos 06, 12 e 24 meses, após o diagnóstico de câncer de mama. Na análise multivariada os fatores que afetaram de forma positiva as taxas de RT foram: renda familiar mensal >= 02 salários mínimos (OR 17,76, IC95% 3,33-94,75, p 0,001), cirurgia conservadora da mama (OR 9,77, IC 95% 2,03-47,05, p 0,004) e oferta de ajuste no trabalho pelo empregador (OR 37,62, IC95% 2,03-47,05, p 0,004). Fatores que se associaram de forma negativa ao RT foram: terapia endócrina (OR 0,11, IC95%0,02-0,74, p 0,023) e diagnóstico de depressão após o câncer (OR 0,07, IC95% 0,01-0,63, p 0,017). Conclusões: As taxas de RT aos 12 e 24 meses após diagnóstico de câncer de mama são inferiores a maioria dos estudos conduzidos na América do Norte e Europa. Oferta de ajuste no trabalho, maior renda familiar, cirurgia conservadora da mama, terapia endócrina adjuvante e diagnóstico de depressão após o câncer de mama desempenharam importante papel no RT / Background: Breast cancer is the most common cancer in women. While its incidence has been increasing, recurrence and mortality rates have been decreasing, mainly because of better treatment options. Because of that cancer can be regarded as a transient shock that does not prevent survivors resume normality in their lives including return to their workplace. In North America and Europe return to work (RTW) rates vary among breast cancer patients from 24- 66% after 06 months and 53-82% after 36 months of diagnosis. Factors most associated with the decision to return to work are: age, chemotherapy, sequelae related to cancer therapy and support from the employer and coworkers. However, these findings vary among the different populations evaluated, suggesting that other factors and even variations in countries laws may interfere with the decision to return to work. So far there is a lack of data on RTW after breast cancer diagnosis in Latin America. Endpoints: To evaluate return to work rates on months 12 and 24 after breast cancer diagnosis, and check the correlation of some factors with the decision to return to work at 24 months. Methods: A prospective, observational study evaluating RTW rates in patients with breast cancer diagnosis, > 18 and < 57 years old and a paid work for at least 03 months at the time of dianosis. Patients with inoperable or metastatic disease were excluded. On months 6, 12 and 24 they answered a telephone interview and the quality of life questionnaire (FACT-B). Results: Between july/2012 and september/2014, 125 patients were enrolled. Two of them died and two other could not be reached by telephone, and were excluded from the analysis. Mean age was 45,1 years (± 8,1). Most of them reported that they liked their job (94%) and received support from employer (73%), but only 29,1% reported having been offered work adjustment. Half of patients had stage II disease and 93% received chemotherapy as part of their treatment. Overall, 21,5%, 30,3% and 60,4% of patients returned to work 06, 12 and 24 months after breast cancer diagnosis, respectively. In the multivariate analysis, factors associated with positive RTW outcomes included higher income (OR: 17,76, CI95% 3,33-94,75; p = 0,001), breast conserving surgery (OR: 9,77, CI95% 2,03-47,05; p = 0,004) and work adjustment (OR: 37,62, CI95% 2,03-47,05; p= 0,004). Factors associated with negative RTW outcomes included adjuvant endocrine therapy (OR: 0,11, IC95% 0,02-0,74; p = 0,023) and depression diagnosis after breast cancer diagnosis (OR: 0,07, IC95% 0,01-0,63; p = 0,017). Conclusion: RTW rates after 12 and 24 months of breast cancer diagnosis are lower than reported in North America (with exception for low income americans) and Europe. Workplace adjustments, higher income, breast conserving surgery, endocrine therapy and depression after breast cancer played an important role in the RTW decision

The overall aim of this study was to illustrate the organizations importance to female staff within education, health and social care on return to work after long term sick leave due to mental illness. The aim of this study was also to identify improvement opportunities. A qualitative study was made with seven interviewees that had return to work after long term sick leave for mental illness. The material was analyzed with an inducitve thematic method. The main themes that emerged was: Information and consulting, Social support from managers and colleagues, Changed attitude and participation in the rehabilitation process and Improvement opportunities. The main result showed that the social support from managers and colleagues and the changed attitude towards the illness mattered the most to the interviewees for a successful return to work. The result also showed that the interviewees had a great need of information about the sick leave process. According to the interviewees the understanding and knowledge about mental illness has to increase.

Bakgrund: Sjukfrånvaron i Sverige är hög i jämförelse med andra EU-länder.Långtidssjukskrivning till följd av stressrelaterade sjukdomar domineras av kvinnor.Det finns ett stort behov av en effektivare återgångsprocess till arbetslivet efter ensjukskrivning där olika insatser bör prövas och utvärderas. I vissa fall kan en neutralpart i form av en oberoende samordnare vara till hjälp för den sjukskrivne iåtergångsprocessen. Syfte: Syftet med studien var att beskriva kvinnors erfarenheter avmöten med arbetsgivarringens representant i återgångsprocessen till arbete, efter enstressrelaterad långtidssjukskrivning. Metod: Data insamlades genom kvalitativaintervjuer med tio kvinnor. Inklusionskriterer var att ha varit långtidssjukskriven förstressrelaterade sjukdomar, att ha varit i kontakt med en arbetsgivarring, samt att underåren 2007-2008 återgått till tidigare arbete eller annat lönearbete i en omfattning avminst 25 procent och ha arbetat under minst sex månader. Med arbetsgivarringens hjälpgjordes ett strategiskt urval, där hänsyn togs till ålder, sjukskrivningens längd, yrke ocharbetsplats. Data analyserades med manifest- och latent innehållsanalys. Resultat:Resultatet visar på fyra kategorier som representerar det manifesta innehållet: att blibemött med respekt och engagemang, att arbeta med att finna lösningar, egen utvecklingmed ökat självförtroende, organisatoriska aspekter. Det latenta innehållet beskriverkvinnans utvecklingsprocess, arbetsgivarringens handledningsprocess och det mellanmänskligasamspel som sker mellan dessa parter. Intervjuerna genomsyras av uttryckdär kvinnan beskriver att hon befinner sig i centrum. Allt handlar om henne och det ärarbetsgivarringen som får henne att känna sig betydelsefull. Slutsats: Genom en djupareförståelse för vad som bidrar till återgång till arbetslivet för personer medlångtidssjukskrivning, kan grunden läggas till ökad satsning och adekvata insatser förökad återgång till arbetet för fler personer.Nyckelord: återgång till arbete (RTW), stressrelaterad långtidssjukskrivning / Background: Sickness absenteeism is high in Sweden compared to other countries inthe European Union. Long-term-sick-absenteeism which depends on stress-relatedsickness is dominated by women. There is a great need to make the return-to-work(RTW) process more effective after an absenteeism where different contributions mustbe tested and evaluated. In some cases may neutral parties in form of an independentRTW-coordinator support sick-listed persons in their RTW-process. Purpose: Thepurpose of the study was to describe women’s experiences of meetings with a personfrom an “arbetsgivarring” in the RTW-process, after a period of stress-related sickness.Methods: Data was collected by qualitative interviews with ten women. Criteria thatincluded participation: to have been long-term-sick-listed because of stress-relatedsickness,to have been in touch with an “arbetsgivarring”, and during 2007-2008returned to earlier occupation or other form of paid work in an extend of 25 percent andhave been working for at least six month. Data was analysed using both manifest andlatent content analysis. Results: The result shows four categories representing themanifest content: to be treated with respect and engagement, to work with findingsolutions, own development with increased self-confidence, organisational aspects. Thelatent content describes the development process of the woman, the guidance process ofthe “arbetsgivarring” and the inter-mediate humanity that occurs between these twoparts in the meeting. All narratives are permeated by expressions where the womandescribes herself being in the centre of attention. Everything is about her and the“arbetsgivarring” makes her feel important. Conclusions: Through deeperunderstanding regarding what promotes RTW for persons on long-term-sick-list thebasis for an increased investment and adequate contributions to reach an improvingRTW can be laid for numerous persons.

No description available.

Après les traitements pour un cancer du sein, plusieurs survivantes désirent réintégrer une vie sociale active qui inclut le retour au travail. Bien que cette étape semble bénéfique, elle comporte plusieurs défis à surmonter tels que la gestion des effets secondaires des traitements au travail ou un soutien variable de la part des collègues et des professionnels de la santé. Toutefois, des facettes de cette expérience demeurent à être exploré au regard des survivantes, qui sont le plus susceptibles de réintégrer leur emploi. Il est même permis de croire que cette expérience peut être semblable à celle d’une transition. À notre connaissance, peu d’études abordent cette expérience sous l’angle de la transition et au regard des survivantes âgées de moins de 50 ans. Le but de cette étude était d’explorer l’expérience de transition vers le retour au travail de survivantes du cancer du sein. Une étude qualitative exploratoire a été effectuée. Des entrevues narratives (n=8) ont été menées auprès de survivantes qui étaient retournées au travail depuis au moins six mois et âgées de moins de 50 ans. Une analyse de contenu thématique a été réalisée. Les résultats ont été regroupés selon quatre thèmes : 1) une vie changée par le cancer, 2) le travail est un signe de normalité, 3) les facteurs influençant la transition et 4) les stratégies mobilisées pour réussir la transition vers le retour au travail. Les résultats suggèrent que les survivantes du cancer du sein veulent délaisser leur vie teintée par la maladie et réintégrer une vie « normale » qui inclut le retour au travail. L’expérience de transition vers le retour au travail est aussi influencée par plusieurs facteurs qui peuvent la faciliter ou l’entraver. Cette étude a permis de mettre en lumière l’expérience de transition vers le retour au travail de femmes de moins de 50 ans qui semblent comporter des défis distincts par rapport à celles des femmes plus âgées. À la lumière des résultats, de nombreuses recommandations ont été élaborées afin de mieux accompagner les survivantes de moins de 50 ans durant leur transition vers le retour au travail. / After breast cancer treatments, many survivors wish to return to an active social life that includes return to work. Although this step seems beneficial, it has several challenges to overcome, such as managing the side effects of treatment at work or varying support from colleagues and health professionals. However, aspects of this experience remain to be explored for survivors, who are most likely to return to their jobs. It is even possible that this experience may be similar to that of a transition. To our knowledge, few studies have addressed this experience from a transition perspective and from the perspective of survivors under the age of 50. The purpose of this study was to explore the experience of transitioning breast cancer survivors back to work. An exploratory qualitative study was conducted. Narrative interviews (n=8) were conducted with youth survivors who had returned to work for at least six months and were under the age of 50. An analysis of the thematic content was carried out. The results were grouped into four themes: 1) a life changed by cancer, 2) work is a sign of normality, 3) factors influencing the transition and 4) strategies mobilized to successfully transition back to work. The results suggest that breast cancer survivors want to leave their illness-tinged lives and return to a “normal” life that includes returning to work. The experience of transitioning back to work is also influenced by several factors that may facilitate or hinder it. This study highlighted the transition experience of women under the age of 50 who appear to have distinct challenges to return to work. Based on the results, many recommendations were developed to better support survivors during their transition back to work.

Problem finns inom hälso- och sjukvårdens hantering av sjukskrivningsärenden och har visat sig vara extra stora inom primärvården. Många sjukskrivningar löper risk att bli långvariga, rehabiliteringsärenden drar ut på tiden och missförstånd uppstår mellan patienter och myndigheter samt myndigheter emellan. Mellan 1 september 2009 och 31 maj 2011 har man på Gotland bedrivit ett projekt med syfte att effektivisera sjukskrivningsprocessen med hjälp av Rehabkoordinator i primärvården. Denna studie utgör den kvalitativa utvärderingen utav projektet. Syftet med denna studie var att utvärdera om sjukskrivningsprocessen har underlättats för de samverkande aktörerna och för patienter efter inrättandet av Rehabkoordinator. Detta har genomförts genom en explorativ metod genom intervjuer och enkät.   I studien beskrivs och analyseras införandet av Rehabkoordinator som ett förbindelseorgan mellan primärvården, Försäkringskassan, Arbetsförmedlingen och socialtjänsten för bättre samordning kring patienter. Resultatet av studien visar att merparten av aktörerna upplever arbetsformen som positiv och gynnar samarbete och samordning vid arbetslivsinriktad rehabilitering. Aktörerna upplever att processen, effektiviteten och kvalitén i arbetet runt patienten har förbättrats. Kommunikationen och samordningen mellan berörda aktörer har underlättats och den psykosociala arbetsmiljön har förbättrats även om det framgår att det är för lite resurser för rehabiliteringssamverkan.   Patienterna upplever det positivt med Rehabkoordinatorns stödjande, förmedlande och koordinerande insatser vilket ses vara en framgångsfaktor för patienten. Majoriteten känner att de blivit respektfullt bemötta, känt sig delaktiga i sin rehabilitering samt fått det stöd och den information som de behövde av Rehabkoordinatorn.   Studien visar också att merparten av aktörerna har funnit fungerande rutiner för sin arbetsform och samverkan. Kvarstående hinder tycks bero på framförallt organisatoriska faktorer som till exempel förankring av verksamheten i de samverkande organisationerna, kunskap och kommunikation om och mellan olika professioner och organisationer, samt incitament och legitimitet för deltagande i rehabiliteringssamverkan. / The identified problems within the health care management concerning cases of sickness have proven to be particularly severe in the area of primary care. A large number of sick leaves are at risk of being long term, cases of rehabilitation drags on, and misunderstandings occur both between authorities and patients, and authorities. Between 1 September 2009 and 31 May 2011 Gotland has pursued a project with the intention to streamline the process of sick leave with the help of a Rehab coordinator in primary care. This study is the qualitative evaluation of the project. The aim of this study was to evaluate whether the process of sick leave have been facilitated both for the interacting actors and for the patients, after the establishment of the Rehab coordinator. This has been implemented through an exploratory approach through interviews and questionnaires.   This study describes and analyzes the introduction of a Rehab coordinator as a liaison body between primary care, social insurance, employment service and social services for a better coordination concerning the patients. The results of this study show that the majority of actors experience that the method is positive and benefits cooperation and coordination of vocational rehabilitation. The actors feel that the process, the efficiency and the quality of work around the patient has improved. The communication and coordination between actors have been facilitated and the psychosocial work environment has improved, although it is clear the there are not enough resources for the rehabilitation agreement.   The patients finds the support, the mediating and coordinating actions of the rehab coordinator positive, which is considered a factor of success to the patient. The majority feel they have been met with respect, felt involved in their rehabilitation and received the support and information they needed by the Rehab coordinator.    The study also shows that majority of the actors have found successful routines to support their method of work and collaboration. The remaining obstacle appeared to be particular organizational factors for example the anchoring of activities for the collaborating organizations, knowledge and communication about and between different professions and organizations, as well as incentives and legitimacy for participation in the rehabilitation agreement.