Background: The recent increase in long-term sickness absence both in Sweden and many other countries has been met with various attempts to intensify the use of rehabilitation measures in order to prevent people from remaining long-term sickness absent. Several actors, among them professionals in healthcare, occupational health services, and social insurance are involved in handling issues related to the sick leave of an individual, and in providing measures to promote return to work (RTW). Identification of the factors that are related to RTW of the individual is a multifaceted task; therefore to meet the individual in this process is an essential challenge for many actors involved. Knowledge is needed about factors that might promote RTW in order to facilitate future research aimed at designing effective rehabilitation programs. Such information is of great importance to improve the work situations of the professionals, to decrease the cost for society, and to improve the situations for people on sick leave by facilitating RTW. Objectives: The overall aim of the work underlying this thesis was to ascertain whether contacts between professionals and sickness absentees might a factor that can promote RTW, and also to identify different aspects of how such positive encounters are experienced by those who are sick listed. Material and methods: Five investigations were conducted using different study designs, data, and methods of data analyses. The first two (papers I and II) concerned interviews with people on sick leave about positive experiences of their encounters with professionals. The third study (paper III) was based on four questions about encounters, which were included in a questionnaire that was administrated to people who were on sick leave. The fourth study (paper IV) used a broad questionnaire to examine experiences of positive encounters, and the final study (paper V) proposed a model of possible effects of the encounters on RTW. Results: In paper I and II different aspects of sick-listed person’s experiences of positive encounters were identified. For example, it seemed that important qualities included being treated with respect, feeling supported, establishing a personal relationship, and participating in decisions regarding RTW measures. Several of the interviewees stated that RTW might be promoted by positive encounters. Paper III showed that perceptions of interactions varied with the type of professionals, as well as with demographics. The respondents perceived their encounters with professionals within healthcare as most positive, followed by social insurance, and lastly occupational health services. In general, females, people born in Sweden, and those who were older, or had a higher education rated their encounters with professionals as more positive. The main finding reported in paper IV was that the majority of the participants had experienced being positive encountered by professionals. Three aspects of such encounters were stressed, namely being treated with ”competence”, ”personal attention”, and ”competence and trust”. The results related in paper V indicated that theories about empowerment and on social emotions could be successfully applied in this area, after they were specifically adapted to some unique features of the contacts between sickness absentees and rehabilitation professionals. Conclusions: This thesis emphasizes that being positively encountered by professionals can have a beneficial impact on RTW after a period of sickness absence. More research is required to elucidate the interaction between sick-listed persons and professionals who are involved in their cases. Further studies should focus on how methods for professionals can be provided to increase sick-listed persons’ own ability to mobilize and develop their resources. Moreover, additional knowledge is needed to extend professional treatment strategies that enhance self-confidence and empowerment of individuals during sickness absence.

No description available.

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.

Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work. Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work. Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p<0.05 and p<0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p<0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ2=4.56). Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.

Made available in DSpace on 2016-06-02T20:44:13Z (GMT). No. of bitstreams: 1 5800.pdf: 1456116 bytes, checksum: 8a6c1cec1a8b571063a72a9e4e046c95 (MD5) Previous issue date: 2014-02-25 / Financiadora de Estudos e Projetos / In Brazil, the Mental and Behavioral Disorder ranks third in number of sickness benefits provided by the National Institute of Social Security (INSS) and thus illustrate the importance of further research on the topic. The aim of this study was to know the process of return to work of municipal workers who were turned away by mental and behavioral disorders, received sickness benefit (for incapacity) and returned to work activities. Participants were seven employees of a Municipality in the State of Sao Paulo, who managed to return to work activities after being away from work for 30 days or more with a primary diagnosis of Mental and Behavioral Disorders (CID F from CID-10) in the period January 2008 to December 2012. Data collection happened in the period December 2012 to March 2013 and it accomplished through filling out a personal information and professional protocol related to the removal process and return to work and the application of a semi-structured interview which addressed questions about the process of removal and return to work. For data analysis, the technique used was Thematic Analysis. The results showed that the participants were unanimous in considering their families as the main source of support in the process of return to work activities. Regarding the reasons that led to the illness and consequent removal from work, some participants reported poor relationship with superiors and coworkers. Nevertheless, a good relationship with management and co-workers appeared to aid in the process of returning to work. The physical environment, inadequate and precarious working conditions were identified as facilitators for mental illness in workers. Participants signaled suggestions about changes in their work environments, which could make them less sick prone, and more appropriate and favorable for good employee performance. For most of the study participants there is no difference in the meaning of work in their lives prior to removal and after returning to work. The work takes on different meanings in the lives of the participants related to personal fulfillment and enjoyment, social function, means of support and space for socializing. Although all participants had undergone expert care of the INSS, none received any information or indication on the Vocational Rehabilitation Program of the INSS. It is expected that this research will contribute to the strengthening of the local network of health care worker and bring enlightenment about reinsertion of these people into the labor market and the assurance of their rights. / No Brasil, os Transtornos Mentais e do Comportamento ocupam o terceiro lugar em número de auxílios-doença concedidos pelo Instituto Nacional do Seguro Social (INSS) e, assim, ilustram a importância do desenvolvimento de pesquisas sobre o tema. O objetivo do presente estudo foi conhecer o processo de retorno ao trabalho de trabalhadores municipais que foram afastados por Transtornos Mentais e do Comportamento, receberam benefício auxílio-doença (por incapacidade) e retornaram às atividades de trabalho. Participaram do estudo sete trabalhadores de uma Prefeitura Municipal do interior do estado de São Paulo, que conseguiram retornar às atividades de trabalho após serem afastados do trabalho por 30 dias ou mais com diagnóstico primário de Transtornos Mentais e do Comportamento (CID F do CID-10), no período de janeiro de 2008 a dezembro de 2012. A coleta de dados aconteceu no período de dezembro de 2012 a março de 2013 e se deu por meio do preenchimento de um protocolo de informações pessoais, profissionais e referentes ao processo de afastamento e retorno ao trabalho e da aplicação de uma entrevista semiestruturada que abordou questões sobre o processo de afastamento e retorno ao trabalho. Para análise dos dados, foi utilizada a técnica de Análise Temática. Os resultados mostraram que os participantes foram unânimes em considerar suas famílias como principal fonte de suporte no processo de retorno às atividades de trabalho. Quanto aos motivos que levaram ao adoecimento e consequente afastamento do trabalho, alguns participantes relataram o mau relacionamento com chefia e colegas de trabalho. No entanto, o bom relacionamento com a chefia e com os colegas de trabalho apareceu também como auxílio no processo de retorno ao trabalho. O ambiente físico inadequado e as condições de trabalho precárias foram apontados como facilitadores de adoecimento mental nos trabalhadores. Os participantes sinalizaram sugestões sobre mudanças em seus ambientes de trabalho que poderiam torná-los menos adoecedores e mais adequados e favoráveis ao bom desempenho dos funcionários. Para a maioria dos participantes do estudo não existe diferença no sentido do trabalho em suas vidas antes do afastamento e após o retorno ao trabalho. O trabalho assume significados diversos na vida dos participantes relacionados à realização pessoal e prazer, função social, forma de sustento e espaço de socialização. Apesar de todos os participantes terem passado por atendimento pericial do INSS, nenhum recebeu qualquer informação ou indicação sobre o Programa de Reabilitação Profissional do INSS. Espera-se que esta pesquisa contribua para o fortalecimento da rede local de atenção à saúde do trabalhador e traga esclarecimento sobre a reinserção dessas pessoas no mercado de trabalho e a garantia de seus direitos.

Under de sista decennierna har den psykiska ohälsan i Sverige ökat dramatiskt och orsakat en omfattande sjukfrånvaro med en hög belastning på samhällets socialförsäkringssystem som följd. Utmattningssyndrom är en av de vanligaste diagnoserna som leder till sjukfrånvaro, som följd av både psykiska och fysiska symtom. Chefen har stort ansvar och en viktig roll i rehabiliteringsprocessen, där det sociala stödet från hens sida tycks vara betydelsefullt. Emellertid är det mindre känt vad personer som är sjukskrivna för utmattningssyndrom förväntar sig att få för socialt stöd av chefen inför arbetsåtergång, vilket undersöks och beskrivs närmare i den här studien. En kvalitativ tvärsnittsdesign tillämpades och fem individer som alla var sjukskrivna till följd av utmattningssyndrom inkluderades. De genomgick en semistrukturerad intervjuprocess, där innehållet transkriberades och analyserades genom kvalitativ innehållsanalys. Resultatet visar att personer som är sjukskrivna för utmattningssyndrom förväntar sig att få socialt stöd av chefen inför arbetsåtergång. Det är framförallt ansvar och trygghet som utgör det sociala stödet, vilket yttrar sig genom olika variationer av känslomässig inlevelse, praktiska åtaganden och kommunikation. Ett strukturerat, lyhört och engagerat ledarskap där relativt långtgående, individfokuserade arbetsmiljöanpassningar erbjuds i samverkan med andra aktörer beskrivs av informanterna som viktigt inför arbetsåtergång. Studien förstärker inte bara den tidigare bilden av det sociala stödets betydelse i sammanhanget, utan diskuterar även mer ingående vilka förväntningar av socialt stöd som upplevs väsentliga. / In this research study, the role of social support from the supervisor in a return to work context was examined and analysed. Five individuals on sick leave due to burnout were asked to participate in the study. Informed consent was obtained from each individual and they were then subjected to a standardised interview, which was evaluated using qualitative content analysis. The result shows that individuals with burnout have expectations of social support from the supervisor, in particular with regard to taking responsibility and established a sense safety. The supervisor is expected to structure the rehabilitation and return to work, but also display emotional commitment such as trust, sensitivity and empathy. The communication between the supervisor and the individual during sick leave and the experience of social support from the supervisor may indeed be crucial to mediate a successful recovery. This study emphasized the importance of social support from the supervisor during sick leave from burnout to optimize return to work.

p. 1-243 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-25T21:13:52Z No. of bitstreams: 1 222222.pdf: 3297140 bytes, checksum: 1291faff859d1a2fa3e097cac0f5f252 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:22:07Z (GMT) No. of bitstreams: 1 222222.pdf: 3297140 bytes, checksum: 1291faff859d1a2fa3e097cac0f5f252 (MD5) / Made available in DSpace on 2013-05-04T17:22:07Z (GMT). No. of bitstreams: 1 222222.pdf: 3297140 bytes, checksum: 1291faff859d1a2fa3e097cac0f5f252 (MD5) Previous issue date: 2010 / Esta tese apresenta o resultado da investigação sobre a funcionalidade de pacientes com traumatismo craniencefálico (TCE) que foram admitidos na unidade de referência estadual para este tipo de trauma na Região Metropolitana de Salvador, Bahia, Brasil no período de 1º de agosto de 2007 a 31 de julho de 2008. Inicialmente investigou-se o perfil epidemiológico dos pacientes e verificou-se que a distribuição por sexo foi uniforme de acordo com as faixas etárias, com exceção da faixa etária de 25 a 34 anos, cuja concentração de casos foi maior para homens e mulheres diferiram significativamente em relação à idade, local de ocorrência, atenção pré-hospitalar, etiologia do trauma, acidentes de transporte e quedas. A maior proporção dos traumas ocorreu em via pública, por atropelamento, espancamento e acidentes motociclísticos. Em seguida, analisou-se a distribuição espacial dos locais de ocorrência dos eventos e residência dos pacientes e constatou-se que muitos eventos ocorrem em locais distantes do hospital de referência dificultando o acesso e o socorro em tempo reduzido. Em função da magnitude do agravo observada para homens, um estudo de coorte foi conduzido para observar os fatores prognósticos da capacidade funcional e os relacionados com o retorno às atividades produtivas. Observou-se que idade, gravidade do trauma, fadiga, distúrbios da atenção e concentração, alteração no equilíbrio, presença de plegias ou fraturas estiveram significativamente associados com a incapacidade funcional global, assim como ter sido submetido a tratamentos multiprofissionais de reabilitação. Com relação às atividades produtivas prévias, observou-se que 91 (37,7%) indivíduos reassumiram antigas funções e que a média do tempo decorrido para o retorno às atividades produtivas foi de 225 dias, com 25% dos pacientes retornando em até 103 dias e 75% deles em até 390 dias. Os mais jovens que sofreram traumas mais graves, e concomitantes distúrbios motores, que evoluíram com sintomas somáticos ou cognitivo-comportamentais, além de incapacidade funcional global, apresentaram dificuldade para retomar suas atividades prévias ou não retornaram. Todavia, história pregressa de trabalho remunerado mostrou-se significativamente associado com mais rápido retorno à produtividade. / Salvador

The purpose of this hermeneutic phenomenology study was to explore and describe the meaning employees attribute to the lived experiences of returning to work after cancer treatment. Semi-structured interviews were held with eight participants and a thematic data analysis method was used. The results indicate that cancer survivors experience various challenges that make it difficult to function as they did before the diagnosis when they return to work. A critical hermeneutical reflection against the literature followed the structural analysis and resulted in a contextual framework that incorporated the individual and organisational perspective on the various influences involved in supporting cancer survivors to maintain their wellbeing when they return to work. Four phases, repression, comprehension, activation and reintegration, were identified when they tried to cope/adjust on their return to work. The corresponding forms of organisational support they expected through these phases were labelled motivation, information, navigation and stabilisation. / Industrial and Organisational Psychology / M. Com. (Industrial and Organisational Psychology)

No Brasil, a Lei de Cotas determina uma reserva de vagas para as pessoas com deficiência nas iniciativas pública e privada. A inclusão das pessoas com deficiência opera-se em um universo de trabalho precarizado, no qual se impõe uma nova morfologia em que coexistem o modelo tayloriano-fordista e a flexibilidade toyotizada. Consoante o exposto, buscou-se compreender as vivências de trabalho da pessoa com deficiência e as repercussões à saúde. Para tanto, foi delineada uma pesquisa qualitativa de cunho exploratório, na forma de estudo de caso. Foram realizados grupos focais e entrevistas com pessoas com deficiência físicas e surdas. As deficiências físicas foram adquiridas, em alguns casos, em decorrência de acidentes de trabalho, fruto do trabalho inseguro e da perversidade do sistema que projeta o trabalhador à condição de pessoa com deficiência. Prevalece o discurso do trabalhador com deficiência não qualificado e busca-se incluir aquele que depende de poucas adaptações no ambiente e em suas atitudes. As exigências de qualificação profissional estão baseadas na ideologia da normalização que se efetiva em programas disciplinadores das condutas, organizadores da vida social. São exigências relativas à subjetividade, aos modos de existir, com ênfase na persistência e superação individuais. O controle sutil se opera por meio do discurso da inclusão e o trabalhador adquire a condição de reificado. Hoje o surdo fica limitado ao uso de seu principal modo de comunicação, as mãos, sob o discurso do surdo produtivo reproduzindo o isolamento cultural do povo surdo nas empresas. Os excluídos, disfarçados de incluídos, vivenciam o sofrimento relativo às injustiças sociais e às violências psicológicas. A sociedade precisa intervir na produção da dupla discriminação e no discurso da naturalização da desqualificação profissional da pessoa com deficiência. Os avanços em relação às políticas públicas brasileiras refletem a tentativa de reparação diante da dívida histórica da sociedade em relação à exclusão das pessoas com deficiência, no entanto, é necessário radicalizar-se na defesa dos direitos sociais, protetivos e inclusivos. / In Brazil, the Quota Law requires a reserve places for people with disabilities in the public and private sector. The inclusion of people with disabilities operates in a precarious working universe in which it imposes a new morphology that coexist the Taylorian - Fordista and toyotizada flexibility. Depending on the above, we sought to understand the person\'s work experiences with disability and the impact to health. For this, it was outlined a qualitative research of exploratory nature, in the form of case study. Focus groups and interviews with people with physical disabilities and deaf were performed. Physical impairments were acquired in some cases, due to accidents, the result of unsafe work and system perversity that projects the employee to the person\'s condition with disabilities. Prevails worker speech with unqualified disability and seeks to include one that depends on a few adjustments in the environment and attitudinal. The qualification requirements are based on the ideology of standardization that is effective in disciplining programs of pipelines and organizers of social life. Are requirements of subjectivity, the modes of existence, emphasizing the persistence and overcoming individual. The subtle control operates through discourse of inclusion and the employee acquires the reified condition. Today the deaf is limited to use their primary mode of communication, their hands, under the discourse of productive deaf reproducing the \"cultural isolation of deaf people\" in companies. The excluded, disguised as included, experience suffering on the social injustices and psychological violence Society needs to intervene in the production of double discrimination and the discourse of naturalization of skilling of people with disabilities. Advances in relation to the Brazilian public policies reflect the attempt to repair the front historic debt of the society in relation to the exclusion of people with disabilities, however it is necessary to radicalize the defense of social, protective and inclusive rights.

Syftet med denna studie var att förstå hur arbetstagare upplever sin återgång i arbete efter en utmattningsdiagnos och hur upplevelser, erfarenheter, tankar och känslor upplevs främja återgång i arbete. Studien var kvalitativ och datainsamlingen bestod av fenomenologiska intervjuer med en person i taget med totalt åtta deltagare. I studien konstaterades huvudsakligen en kongruens mellan det som tidigare forskning visat och det som framkommit i införskaffad empiri. En del upplevelser som visat sig vara effektiva för återgång i arbete i tidigare forskning har också av deltagarna i denna studie visat sig upplevas som särskilt effektiva och värdefulla. De interna resurserna i form av bekräftelse, insikt och coping var av stor betydelse för tillfrisknande och återgång i arbete i kombination med ett upplevt praktiskt och emotionellt stöd av framförallt vården, chef och familj. En skillnad från tidigare studier var att det upplevda stödet från familjen uttrycktes och påtalades i högre utsträckning i denna studie än i tidigare studier. Den viktigaste slutsatsen som kan dras av studien är att ett upplevt praktiskt som emotionellt stöd, såväl under sjukskrivning som vid återgången i arbete är av oerhörd vikt för både tillfrisknande och återgång i arbete. / The purpose of this study was to understand how workers experience their return to work after a job burn out and how experiences, thoughts and feelings are perceived to promote return to work. The study was qualitative and the data collection consisted of phenomenological interviews with one person at a time with a total of eight participants. The study found mainly a congruence between what has been shown in previous research and what emerged from acquired empirical evidence. Some experiences that have proven to be effective for returning to work in previous research have also been shown by participants in this study to be particularly effective and valuable. The internal resources in terms of confirmation, insight and coping were of great importance for recovery and return in work combined with experienced practical and emotional support, especially by the care, manager and family. A difference from previous studies was that the perceived support from the family was expressed and addressed to a greater extent in this study than in previous studies. The main conclusion that can be drawn from the study is that experienced support, both practical and emotional, both during sick leave and at return to work, is of crucial importance both for recovery and return to work.