A consecutive series of 149 subjects with complete or partial vocational disability due to somatic ill-health were investigated at admission for vocational rehabilitation and two years later. Subjects filled in checklists which encompassed 5 socio-demographic, 5 psycho-social and 9 life satisfaction items. Moreover, 5 dimensions of "handicap" were assessed. At admission subjects were physically examined. In this diagnostically mixed sample 80 of them had non-specific locomotor dysfunction with pain ("algia"). In this sub-sample 23 symptoms (yes/no alternatives) and 24 signs (present/not present) were registered. At the two-year follow-up actual source and level of income were registered and 126 subjects reported their levels of life satisfaction. A reference population including 163 employed subjects was used for comparisons of levels of life satisfaction.At admission satisfaction with life as a whole (level of happiness) and with 6/8 domain specific life satisfaction items were significantly lower for the vocational rehabilitation clients than for the references. Psycho-socio-demographic items formed 5 factors, two were socio-demographic and three psycho-social characteristics. Only few were "handicapped" concerning orientation, mobility and self-care, while the majority were financially and/or occupationally "handicapped". At the two-year follow-up 91% of the partly and 67% of those who at admission were completely vocationally disabled were undergoing education or were gainfully employed, giving a success rate of 77%. Moreover, return to work from unemployment resulted in significantly increased income. Successful rehabilitation resulted in normalization of the majority of life satisfaction domains. This was particularly true for overall vocational satisfaction. Level of happiness was increased but not up to the level of the references. At follow-up the level of or change in (admission/follow-up computations) vocational satisfaction were major predictors for level of or change in happiness. Hence, successful vocational rehabilitation led to increased social well-being. For the total sample major predictors of outcome were: Level of experienced health and belief in vocational return. It is suggested that these two variables arc useful instruments for vocational rehabilitation decision making. In the algic sub-sample signs and symptoms were - statistically - combined into 8 meaningful entities, characterizing regional, postural and relational syndromes. Whereas these may not necessarily be generalizable they may be of clinical descriptory value. However, only one of them contributed to outcome prediction; the major predictors for those algic subjects being belief in vocational return and sex. / <p>S. 1-48: sammanfattning, s. 49-125: 5 uppsatser</p> / digitalisering@umu

Bakgrund: Sverige är ett av de länder som har högst sjukfrånvaro och för att minska den, med dess konskekvenser för individen och samhället, inrättades Sjukskrivningsmiljarden. Det gav hälso- och sjukvården ökade möjligheter att med sjukskrivningskoordinatorer effektivisera rehabiliteringen av de sjukskrivna. Den sjukskrivne upplever konsekvenser ur flera aspekter, inte minst avseende livskvaliteten. Sjukskrivningslängden står i direkt samband med den sjukskrivnes självförmåga till rehabilitering och desto längre sjukperioden är desto svårare är det att återgå till arbetet. Studier, såsom den av Noordik et al. (2011), menar att om den sjukskrivne upplever ett stöd från omgivningen stärks självförmågan och därmed ökar möjligheten till rehabilitering och återgång till arbetet. Syfte: Studiens syfte var att beskriva sjukskrivningskoordinerande sjuksköterskors erfarenheter av arbetet med att stärka sjukskrivnas självförmåga. Metod: Genom en kvalitativ design genomfördes semistrukturerade intervjuer med åtta sjukskrivningskoordinerande sjuksköterskor. Intervjuerna analyserades med hjälp av manifest innehållsanalys. Resultat: Tre kategorier framkom i resultatet. Kategorin Koordinatorns behov och förutsättningar för att kunna stärka den sjukskrivnes självförmåga belyser de kunskaper och faktorer som möjliggör ett stärkande av den sjukskrivnes självförmåga. Det är bland annat av värde att koordinatorn besitter kunskap om Försäkringskassans regler och att den egna yrkeserfarenheten som sjuksköterska används i mötet med den sjukskrivne. Förhållandet mellan koordinatorn och den sjukskrivne beskriver vikten av en helhetssyn, att vara tillgänglig för den sjukskrivne och risken med att göra för mycket. Den tredje kategorin Genomförande av arbetet som koordinator handlar om erfarenheter kring hur koordinatorn utför sitt arbete. Faktorer som beskrivs är att motivera den sjukskrivne, hjälpa denne finna en begriplighet och koordinatorns samarbete med andra aktörer. Slutsats: Koordinatorer betonar vikten av den sjukskrivnes självförmåga och för att kunna stärka denne behövs en relation som grundar sig på tillit. Helhetsperspektivet gör att koordinatorn kan anpassa insatserna vilket möjliggör en individanpassad rehabilitering och återgång till arbete. / Background: Sweden is one of the countries with the highest sick leave and in order to reduce it, with it´s consequences för the individual and the society, the Swedish government did a financial investment called Sjukskrivningsmiljarden. This increased the ability to, due to the coordinators function, increase the efficiency of patients’ rehabilitation process. Being on sick leave has consequences for patients in many areas, not least the quality of life. The length of sick leave is dependent upon patients´ self-efficacy concerning rehabilitation and returning to work. Research, such as Noordik et al. (2011), also indicates how patients´ self-efficacy can be strengthen by the support from the coordinator and thereby increase the capability to rehabilitation and return to work. Aim: The aim of the study was to describe the sick leave-coordinating nurses’ experiences of strengthening self-efficacy in patients on sick leave. Method: A qualitative approach was used and data was collected by semi-structured interwievs. Eight sick leave-coordinating nurses participated and interviews were analysed with manifest content analysis. Results: Three categories resulted. The category Needs and conditions of the coordinator in order to strengthen the self-efficacy of the patient on sick leave describes the knowledge and factors needed to increase the patients self-efficacy. It is, among other things, important that the coordinator has knowledge in how the social insurance system works and that the coordinator uses her professional experiences as a nurse in contact with patients on sick leave. The relationship between the coordinator and the patient on sick leave describes the value of adopting a holistic perspective, to be available for the patient and the immanent risk of doing too much for the patient. The last category, Conducting the tasks of the coordinator, illustrates perceptions of how the coordinator conducts her work. Coordinators described how to motivate patients; how to support the patient to find comprehensibility; and how coordinators cooperate with other stakeholders. Conclusion: Sick leave-coordinators emphasizes the importance of the self-efficacy of the patient on sick leave. A relationship based in thrust is needed to strengthen the patients self-efficacy. The holistic perspective proposed by the coordinators opens opportunitites to individually adapt each patient´s the process of rehabilitation and return to work.

Idag är psykisk ohälsa den vanligaste orsaken till långtidssjukskrivning i Sverige. Denna studie syftade till att undersöka vad det innebär för kvinnor att vara långtidssjukskrivna för psykisk ohälsa och återvända till arbetet. Datainsamlingen bestod av semistrukturerade intervjuer. Totalt intervjuades åtta kvinnor som varit sjukskrivna i minst två månader. Kvinnorna var bosatta i Uppsala län, Västmanlands län och Västra Götalands län. Dataanalysen genomfördes i linje med de riktlinjer IPA-metoden förespråkar. Resultatet påvisar att det förekommer en del svårigheter med att vara långtidssjukskriven för psykisk ohälsa. Mest framträdande var en känsla av orkeslöshet och isolering. Arbetsåtergången var utformad på olika sätt, den vanligaste rehabiliteringsåtgärden var arbetsanpassning. Studiens resultat tyder på att arbetsplatser saknar tydliga rutiner för arbetsåtergång vid långtidssjukskrivning för psykisk ohälsa. Vidare framgick det att delaktighet och inflytande, lyhörda chefer och den egna viljan var viktiga utgångspunkter för en god arbetsåtergång. Socialt stöd betraktades som en viktig förutsättning under hela sjukskrivningsförloppet.

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No. of bitstreams: 1 TeseECS.pdf: 16227842 bytes, checksum: f7f0fbf30ae14210803e8b976c3e6266 (MD5) Previous issue date: 2016-06-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Manifestations Work-Related Musculoskeletal Disorders (WRMSDs) in the workplace have been of concern, as its growth has forced the society to deal with this problem high economic impact due to the significant increase in the number of absences related to work. After diagnosis and removal, the INSS medical expert, according to conditions / worker capabilities, forwards it to the Vocational Rehabilitation Program INSS, which should provide the means of professional and social rehabilitation, according to the Federal Constitution. However, the difficulties of the Ministry of Social Security in return method of workers away by WRMSDs has been the subject of discussion. This study aimed to understand of the process of return to the employee's work away for WRMSDs, through the activity of ergonomics, focusing on the need for interaction between business, labor and INSS. The methodology was designed / led by a return to work flow chart created by the researcher from the model of inclusion of people with disabilities of Simonelli (2009). The methodology consisted initially of approval of UFSCar's Ethics Committee for the collection and analysis of data in the four companies that agreed to participate, and Term of Consent of workers. For data collection, the workers were interviewed, underwent evaluation capacity for work, from protocols and core set of ICF and were followed in jobs for systematic observation and understanding of the activity, as a presupposition of ergonomics activity. In the study of different cases it was found that the activities analyzed show that the removal station for reintegration post significant changes. Some study companies have a program for approaching the worker in the period of clearance. The professional courses offered by the INSS, mostly do not meet the requirements of the tasks of the companies, therefore, do not help the worker in the process of returning to work. The worker who returns clearance, is generally placed in the position that the company chooses, since it seeks to meet the restrictions that the Vocational Rehabilitation Program prescribes. However, this does not help you during the process of reintegration and skilled professionals of the company did not accompany him regularly. With the observed situations, it is concluded that the actual return depends on the joint work of these three social actors (company, employee and Vocational Rehabilitation), which complement each other, including analysis of activity in the stations selection process for inclusion, aiming discussions generate fruits that benefit workers and, consequently, companies and the INSS. / As manifestações das LER/DORT no mundo do trabalho têm sido motivo de preocupação, visto que seu crescimento tem constrangido a sociedade a lidar com esse problema de elevado impacto econômico, devido ao aumento significativo no número de afastamentos relacionados ao trabalho. Após o diagnóstico e afastamento, o médico perito do INSS, de acordo com condições/capacidades do trabalhador, o encaminha para o Programa de Reabilitação Profissional do INSS, que deve proporcionar os meios de readaptação profissional e social, segundo a Constituição Federal. No entanto, as dificuldades por parte do Ministério da Previdência Social no método de retorno dos trabalhadores afastados por LER/DORT tem sido motivo de discussão. Esse estudo teve por objetivo compreender o processo de retorno ao trabalho do trabalhador afastado por LER/DOR, por meio da ergonomia da atividade, enfocando a necessidade de interação entre empresa, trabalhador e INSS. A trajetória metodológica foi delineada/conduzida por um fluxograma de retorno ao trabalho criado pela pesquisadora a partir do modelo de inclusão da pessoa com deficiência de Simonelli (2009). A metodologia constituiu-se, inicialmente, da aprovação do Comitê de Ética da UFSCar para a coleta e análise dos dados nas quatro empresas que aceitaram participar do estudo e Termo de Consentimento Livre e Esclarecido dos trabalhadores. Para a coleta de dados, os trabalhadores foram entrevistados, passaram por avaliação de capacidade para o trabalho a partir de protocolos e core set da CIF e foram acompanhados nos postos de trabalho para a observação sistematizada e compreensão da atividade, como um pressuposto da ergonomia da atividade. No estudo dos diferentes casos foi possível constatar que as atividades analisadas demonstram que do posto de afastamento para o posto de reinserção houve mudanças significativas. Algumas empresas do estudo não apresentam um programa para reaproximação do trabalhador no período de afastamento. Os cursos profissionalizantes oferecidos pelo INSS, em sua maioria não pactua com as exigências das tarefas das empresas, portanto, não ajudam o trabalhador no processo de retorno ao trabalho. O trabalhador que retorna do afastamento geralmente é colocado no posto que a empresa escolhe, pois, esta procura atender as restrições que o Programa de Reabilitação Profissional prescreve. No entanto, este não o acompanha durante o processo de reinserção e os profissionais habilitados da empresa também não o acompanham regularmente. Com as situações observadas, conclui-se que o efetivo retorno depende do trabalho conjunto desses três atores sociais (empresa, trabalhador e Reabilitação Profissional), que se complementam, incluindo análise da atividade no processo de seleção dos postos para a inclusão, visando discussões que gerem frutos que beneficiem os trabalhadores e, consequentemente, as empresas e o INSS.

Introdução: O trabalhador de enfermagem que passa por afastamento de trabalho por transtorno mental enfrenta preconceitos e dificuldades, desde seu adoecimento e afastamento até o momento que retorna ao trabalho. As dificuldades e limitações sentidas para realizar as atividades e se reinserir na equipe de trabalho, ainda, são pouco estudadas, evidenciando a necessidade de uma maior compreensão sobre a problemática. Objetivo: O presente estudo teve por objetivo analisar a percepção dos trabalhadores de enfermagem oncológica afastados por transtornos mentais, sobre o retorno ao trabalho e elaborar propostas de intervenção que facilitem este retorno. Metodologia: O estudo foi desenvolvido na linha compreensiva e na abordagem qualitativa. A população foi de 564 trabalhadores de enfermagem de um hospital especializado em oncologia no Estado de São Paulo. A amostra intencional foi constituída por oito trabalhadores de enfermagem, sendo seis mulheres e dois homens, incluindo as categorias profissionais de técnicos de enfermagem e enfermeiros, que atenderam ao critério de inclusão, ou seja, que retornaram de afastamento por transtorno mental há, no máximo, seis meses. Após aprovação do projeto pelo Comitê de Ética, a coleta dos dados foi realizada através de questionário de caracterização dos sujeitos e entrevista individual, no período de junho a outubro de 2013. Para tratamento dos dados qualitativos foi utilizada a técnica da Análise Temática. Resultados: As categorias que emergiram dos relatos dos trabalhadores evidenciaram as relações entre o trabalho e o adoecimento psíquico: condições de trabalho, situações que os trabalhadores viviam na época do afastamento, situações enfrentadas ao retornar ao trabalho, estigma da doença mental e as propostas de intervenção. Com relação às condições de trabalho, observou-se que um dimensionamento inadequado e características inerentes ao trabalho em oncologia são percebidos pelos trabalhadores como fatores que levam ao degaste pelo trabalho. Quanto às situações que os trabalhadores viviam na época do afastamento, os relatos mostram que mesmo havendo uma sobreposição de problemas pessoais aos de trabalho, o trabalho foi fator decisivo para o adoecimento. Sobre as situações enfrentadas ao retornar ao trabalho, evidenciou-se as dificuldades em voltar atuar na assistência direta ao paciente e trabalhar em equipe. O estigma da doença mental se mostrou tanto antes quanto depois do afastamento, denotando dificuldades de compreensão dos sintomas e da cronicidade dos transtornos mentais. Os trabalhadores só tiveram acesso à assistência à saúde dentro da instituição, quando se tronou necessário entrar em afastamento de trabalho. As sugestões de propostas de intervenção de melhorias: na rotina de trabalho; no trabalho em equipe; no suporte à saúde do trabalhador. Conclusões: Os resultados apontam as seguintes necessidades: redimensionamento da equipe, levando em consideração as particularidades do trabalho de enfermagem em oncologia; minimizar o estigma da doença mental dentro da instituição, através esclarecimento das equipes; elaborar propostas de atendimento à saúde do trabalhador portador de transtorno mental. / Introduction: The nursing workers who live the sick leave by mental disorder face prejudices and difficulties, since the illness until the moment which returns to work. The restrictions for work in consequence of illness and reinsertion of worker in the daily life of work and in the team after this sick leave are still little studied, evidencing the need to a greater understanding about the theme. Objective: This study aimed to analyze the perception of oncology nursing workers after sick leave by mental disorders, about the return to work and elaborate proposals of intervention to facilitate this return. Methodology: This is a comprehensive study with qualitative approach developed with the nursing staff of an oncology hospital in São Paulo state. The sample consisted of 8 nursing workers, being 6 women and 2 men, which returned to sick leave by mental disorders in a maximum of six months. After project approval by the ethics committee, data collection began with a socio demographic questionnaire and after, an individual interview. The data collection was performed from June to October of 2013. The quantitative data were analyzed using descriptive statistics and the qualitative data analysis was conducted by Thematic Analysis technique. Results: The categories that emerged from reports of workers showed the relations between work and the psychic illness. With respect to the working conditions, was observed that the nursing staffing is inappropriate and inherent characteristics to work in oncology are perceived by workers as factors of strain processes by the work. About the situations that workers lived at the time of the sick leave, the reports show that although there an overlay of personal problems and work problems, the work was the deciding factor for the illness. About the situations faced to returning to work, was evident that the difficulties for back to act on patient assistance and for back to work in a team. The stigma of mental disorders, both before and after of the sick leave, showed the difficulties of understanding the symptoms of mental disorders and the chronicity of these diseases. The workers only had access to occupational health in the institution, when it was necessary to request the sick leave. Intervention proposals suggestions for improvements: in the routine of work; teamwork; in supporting workers \' health. Conclusion: The results show the following needs: changes in the nursing staffing considering the particularities about the oncology nursing work; minimize the stigma of mental disorders in the institution, through the clarification of the teams; elaborate proposals for occupational health, for workers with mental disorders.

Introduction : Le diagnostic de cancer du sein, les symptômes et les effets secondaires des traitements, entraînent de multiples déficits physiques et psychologiques qui peuvent avoir des effets sur la vie professionnelle. En effet, avec un âge médian de 63 ans au moment du diagnostic de cancer du sein, la moitié des femmes sont encore en âge de travailler. Pourtant, après le diagnostic, toutes les femmes ne retournent pas au travail. Afin d’expliquer ce phénomène, de nombreuses études se sont intéressées aux déterminants sociodémographiques, professionnels et médicaux impactant le retour à l’emploi des patientes ; or ces seuls facteurs ne suffisent pas à expliquer le non-retour à l’emploi des femmes. Il semble qu’un certain nombre de facteurs psychosociaux puissent également rendre compte du retour à l’emploi.Objectifs : L’objectif principal de cette étude est d’identifier les principaux déterminants psychosociaux du retour à l’emploi des femmes ayant un cancer du sein durant l’année suivant le début de leurs traitements adjuvants. Un objectif secondaire consiste à appréhender l’impact des variations de ces déterminants psychosociaux sur le retour à l’emploi des patientes.Méthode : Nous avons réalisé une étude longitudinale et prospective auprès de 68 patientes d’âge moyen 46,97 (ET = 6,92), en emploi au moment du diagnostic de cancer du sein, recrutées au Montpellier Institut du Sein (MIS). Les femmes ont été rencontrées lors d’un premier temps de mesure, par entretien interindividuel, en début de traitements adjuvants (T0). Par la suite, elles ont été suivies par voie téléphonique à 3, 6 et 12 mois après T0 (T1, T2 et T3, respectivement). Les données sociodémographiques, professionnelles, médicales, la précarité (score EPICES), le névrosisme (Néo-PI r), la qualité de vie (QLQ-C30), la fatigue (MFI 20), le développement post traumatique (PTGI), la détresse sociale (SDI) et le soutien social perçu (QSSSC) ont été évalués à T0. À T1, T2 et T3 nous avons relevé : le fait d’être en couple, de subvenir ou non aux études des enfants, le recueil de toxicités liées au traitement médical et le retour à l’emploi. À T2 et T3 nous avons également évalué : la qualité de vie, le développement post-traumatique, la fatigue, la détresse sociale et le soutien social perçu.Résultats : À T1, 50,0% des patientes sont de retour à l’emploi ; à T2, 60,7% sont de retour à l’emploi ; à T3, 74,5% d’entre elles sont de retour à l’emploi. Les résultats des analyses de régression logistique indiquent qu’une forte perception de soutien négatif à T0, OR = 0,74 [0,56 – 0,97] et à T3, OR = 0,59 [0,39 – 0,90], une forte sensation de fatigue physique à T3, OR = 0,55 [0,36 – 0,80] et une précarité élevée, OR = 0,94 [0,89 – 0,99], sont des freins au retour à l’emploi à T3. En revanche, un bon état physique à T0, OR = 1,17 [1,02 – 1,33] et un bon état cognitif à T2, OR = 1,06 [1,01 – 1,11] sont des leviers du retour à l’emploi à T3. Par ailleurs, nous observons qu’une bonne santé globale, OR = 1,10 [1,001 – 1,20] ainsi qu’un bon état cognitif, OR = 1,08 [1,02 – 1,15], à T2, sont des leviers du retour à l’emploi à ce même moment, alors qu’une augmentation de la fatigue mentale, entre T0 et T2, diminue les chances de retour à l’emploi à T2, OR = 0,13 [0,02 – 0,80]. Enfin, les résultats de notre étude montrent qu’une bonne santé globale à T0 est un levier du retour à l’emploi à T1, OR = 1,05 [1,01 – 1,10].Conclusion : Les déterminants psychosociaux, notamment le soutien social, la précarité, la qualité de vie et la fatigue, peuvent jouer un rôle important pour prédire le retour à l’emploi des femmes ayant un cancer du sein. Cela justifie l’intérêt d’une prise en charge pluridisciplinaire du cancer et encourage l’émergence d’un modèle théorique du maintien en emploi, tenant compte à la fois des caractéristiques sociodémographiques, professionnelles, médicales, sociales, physiques et psychologiques des patientes. / Introduction : The breast cancer diagnosis, the symptoms and the side effects of the treatments, lead to multiple physical and psychological deficits that can have effects on the professional life. Indeed, with a median age of 63 years at the time of diagnosis, half of the women are still of working age. However, after the diagnosis, all women do not return to work. In order to explain this phenomenon, numerous studies have addressed the sociodemographic, occupational and medical determinants that impact the patients’ return to work ; but these factors alone are not sufficient to explain women's non-return to work. It appears that a number of psychosocial factors may also account for the return to work.Aims : The main objective of this study is to identify the main psychosocial determinants of the return to work of women with breast cancer during the year following the start of their adjuvant treatments. A secondary objective is to understand the impact of changes in these psychosocial determinants on the return to work.Method : We performed a longitudinal and prospective study of 68 patients with a mean age of 46.97 (SD = 6.92), employed at the time of diagnosis of breast cancer, recruited at the Montpellier Institut du Sein (MIS). The women were encountered during an initial measurement, by interindividual maintenance, at the beginning of adjuvant treatments (T0). Subsequently, they were followed by telephone at 3, 6 and 12 months after T0 (T1, T2 and T3, respectively). Socio-demographic, occupational and medical data, precariousness (EPICES score), neuroticism (Neo-PI r), quality of life (QLQ-C30), fatigue (MFI 20), post traumatic development social distress (SDI) and perceived social support (SSHSC) were assessed at T0. At T1, T2 and T3 we observed : being in a couple, providing or not supporting children's studies, collecting toxicities related to medical treatment and returning to work. At T2 and T3 we also assessed : quality of life, post-traumatic development, fatigue, social distress and perceived social support.Results : At T1, 50.0% of patients returned to work ; at T2, 60.7% were back to work ; at T3, 74.5% of them were back to work. Results of logistic regression analyzes indicate that a strong perception of negative support at T0, OR = 0.74 [0.56 - 0.97] and at T3, OR = 0.59 [0.39-0.90], a high sensation of physical fatigue at T3, OR = 0.55 [0.36 - 0.80] and high precariousness, OR = 0.94 [0.89 - 0.99] brake the return to work at T3. On the other hand, a good physical state at T0, OR = 1.17 [1.02 - 1.33] and a good cognitive state at T2, OR = 1.06 [1.01 - 1.11] are levers for returning to work at T3. Otherwise, we observed that overall good health, OR = 1.10 [1.001 - 1.20] and good cognitive status, OR = 1.08 [1.02 - 1.15] at T2, are levers for returning to work at the same time, while an increase in mental fatigue between T0 and T2 decreases the chances of returning to work at T2, OR = 0.13 [0.02 - 0.80]. Finally, the results of our study show that good overall health at T0 is a return to employment lever at T1, OR = 1.05 [1.01 - 1.10].Conclusion : Psychosocial determinants, including social support, precariousness, quality of life and fatigue, can play an important role in predicting the return to work of women with breast cancer. This confirms the interest of a multidisciplinary care of cancer and encourages the emergence of a theoretical model of the job retention, taking into account the socio-demographic, professional, medical, social, physical and psychological characteristics of the patients.

Cette étude exploratoire a pour objectifs de cerner les modalités de réaction des personnes atteintes de cancer face à la reprise du travail et de repérer les ressources ou les facteurs de vulnérabilité face à cette reprise. Quatre-vingts sujets sont répartis en trois groupes : 33 sujets qui ne bénéficient d’aucun accompagnement spécifique, 44 sujets reçus à la consultation d’aide à la reprise du travail après un cancer du CHU de Rouen et 3 sujets qui ne souhaitent plus reprendre le travail. Les caractéristiques psychologiques, médicales et socioprofessionnelles des sujets non consultants et des sujets consultants sont comparées. Les données relatives aux sujets qui ont abandonné leur projet de reprise du travail sont analysées sur un plan qualitatif. Nous nous attendions à ce que les sujets consultants soient plus vulnérables que les sujets non consultants. Nos résultats soulignent que les sujets des deux groupes ne sont pas si différents. Les facteurs de vulnérabilité présentés par les sujets consultants n’ont pas eu d’incidence sur la reprise du travail. L’aide de la consultation a pu favoriser une forme de résilience et l’autonomie psychique chez ces sujets. Les situations des sujets qui ne souhaitent plus reprendre un travail ont amené des éléments de compréhension face à la sortie de l’emploi après le diagnostic de cancer. Ce travail confirme la singularité de chaque situation de cancer et souligne un besoin spécifique à cette population, celui d’un accompagnement individualisé. Celui-ci doit être envisagé tout au long du processus de reprise du travail pour prévenir des difficultés susceptibles d’apparaître bien au-delà de cette reprise. / This exploratory study aims to identify the modalities of reaction of people with cancer who face the resumption of work and identify the resources or the vulnerabilities facing return to work. Eighty persons divided into three groups: 33 persons who return to work without accompaniment, 44 persons who solicit the department of ‘return to work after a cancer’ (University Hospital of Rouen) and 3 persons who no longer wish to return to work. The psychological, medical, social and professional characteristics of non consultants and consultants are compared. A qualitative analysis (case studies) is performed for the results concerning the three persons that have abandoned their plans to return to work. We expected that consultants are more vulnerable than non consultants. Our results emphasize that both groups are not so different. The vulnerability factors presented by consultants did not have any impact on return to work. The help provided by the department had probably promoted a form of resilience and psychological autonomy for these patients. The situations of persons that have no intention to return to work have highlighted elements of understanding of the reasons which encourage them to quit their job after cancer diagnosis. This study confirms the uniqueness of each situation of cancer. Our results highlight a specific need for this population that of an individualized support. The possibility of being supported throughout the return to work process should be considered in order to prevent issues that may appear beyond this resumption.

Background: For indeterminate reasons, there have been major variations in sick leave in Sweden, and many physicians have perceived sick leave assignments as burdensome. Aim: To gain more knowledge and understanding, from a perspective of primary health care, about factors in health care and patients that affect sick leave. Thereby help patients in the best way, facilitate the work of physicians and other health professionals involved in the rehabilitation process, and use the health care resources optimally. Methods: This thesis is based on a randomised controlled trial (RCT) in a primary health care centre with participants on short-term sick leave, due to pain and/or mental illness, who received a multidisciplinary assessment. Qualitative focus-group discussions with physicians in primary health care centres. A cohort of women on very long-term sick leave due to pain and/or mental illness, who lost sickness benefits due to a new time limit on sickness insurance, were randomised to multidisciplinary assessment and multimodal intervention (TEAM), or to Acceptance and Commitment Therapy (ACT). In an extended cohort, including some men on very long-term sick leave due to pain and/or mental illness, the importance of the motivation for return to work (RTW) was investigated. Results. Very early multidisciplinary assessment increased days on sick leave in the first three month period. Physicians at primary health care centres perceived sick leave assignments as burdensome, but clearer rules and cooperation with other professionals have made sick leave assignments less burdensome. TEAM intervention resulted in an increase in working hours per week as well as an increase in work-related engagements, compared to control in the RCT. Motivation for RTW was associated with RTW or increased employability in the rehabilitation of patients Conclusions: Continued studies are needed to find those who are at risk of long-term sick leave, the time when rehabilitation efforts should be started, and the content of rehabilitation. Collaboration in teams facilitates sick leave assignments for physicians at primary care health centres. Motivation for RTW might be a factor of importance for the effect of rehabilitation and needs to be studied further.

Problemformulering: En av de vanligaste orsakerna till sjukskrivning i Sverige är psykiatriska diagnoser såsom depressioner och stressreaktioner. Sjukfrånvaro innebär stora kostnader både för arbetsgivare och för samhället, och är på olika sätt drabbande även för den som är sjukskriven. Det finns därmed goda skäl att undersöka olika sätt på vilka rehabiliteringsprocessen kan förbättras och göra återgången i arbete enklare. Tidigare forskning har visat att det finns ett flertal faktorer som går att förändra för att förbättra möjligheterna till återgång i arbete, såsom bättre kommunikation och bättre samordning av rehabiliteringsinsatserna. Få studier har dock undersökt hur tidigare sjukskrivna upplevt rehabiliteringsprocessen i sin helhet, från första sjukskrivningsdag till och med återgång i arbete. Syfte: Syftet med denna studie var att undersöka upplevelsen av rehabiliteringsprocessen, bland offentligt anställda i Sverige som tidigare varit sjukskrivna i psykiatriska diagnoser. Metod: Studien hade en kvalitativ design, och för att samla in data användes semistrukturerade intervjuer, vilka analyserades med hjälp av kvalitativ innehållsanalys. Deltagarna bestod av tio kvinnor som arbetade inom offentlig sektor i Sverige, hade varit sjukskrivna på 100 procent i en psykiatrisk diagnos i minst en månad samt återgått fullt i arbete. Resultat: Resultatet visade att upplevelsen av rehabiliteringsprocessen var att den förändrar en som person, att den innebär sårbarhet och att därför är viktigt med bra bemötande, tillräckliga anpassningar och en fungerande struktur kring rehabiliteringsprocessen där den sjukskrivne själv involveras utan att behöva vara ansvarig. Slutsats: Utifrån studiedeltagarnas upplevelser verkar det finnas behov av ett tydligare ramverk kring rehabiliteringsprocessen, tydligare ansvarsfördelning och vägledning till individen. Med kunskap om hur rehabiliteringsprocessen upplevs och vilka delar av processen som exempelvis anses bristfälliga, kan också förbättringar göras vilket i sin tur kan göra återgången i arbete mer hälsosam och hållbar. / Aim: The aim of this study was to examine the experience of the rehabilitation process, among Swedish public employees, who had returned to work after sick leave due to common mental disorders. Method: To examine this, qualitative method was used. To collect data, semi-structured interviews was carried out and then analyzed with qualitative content analysis. Ten women participated in the study. They were employed in the public sector in Sweden and had returned to work after being on full time sick leave. Result: The analysis resulted in six categories. Summarized, the experience of the rehabilitation process was being changed as a person, feeling vulnerable, and consequently, the importance of good treatment, appropriate work adaptations, and a functioning structure around the rehabilitation process, where the person going through rehabilitation is involved without having to be responsible. Conclusion: Based on the experiences of the study participants, there seems to be a need for a clearer framework for the rehabilitation process, clearer division of responsibilities and guidance for the individual. With knowledge of how the rehabilitation process is experienced, and of facilitating and hindering factors, improvements can be made.

復職支援プログラムにおけるマインドフルネス・トレーニングの有効性を評価するための効果指標について検討した。まず、マインレスネス尺度の因子的および構成概念妥当性の検討を行い、「自己不承認」、「表現の抑制」、「不注意」の3因子構造であることを確認した。次に、マインドレスネス尺度は既存のマインドフルネス尺度よりも気分障害患者を対象に行うマインドフルネス・トレーニングの効果をより適切に反映するかを検討した。その結果、本調査のみではマインドレスネス尺度は既存の尺度よりも妥当性が高いと結論づけるに至らなかったため、さらなる検討が求められる。 / The purpose of this paper is to test the reliability and validity of the Mindlessness Scale. The first survey was conducted to examine the factorial and construct validity of the Mindlessness scale. Results suggested that the Mindlessness Scale consists of the three-factor structure: self-judgment, suppression of describing, and non-awareness. The second survey was conducted to test whether the Mindlessness scale obtain more sensitive measurements of therapeutic effects for patients having mood disorders by mindfulness trainings than the Mindfulness scales. Results suggested that the validity could not be determined for the Mindlessness Scale more than the Mindfulness scales, and that additional research is needed. / 博士(政策科学) / Doctor of Philosophy in Policy and Management / 同志社大学 / Doshisha University