SWEPPE is a mobile application for employees returning to work after sick leave and a web application for their employer. Employees can update the application with data regarding their return-to-work process and choose what to share with their employers. When SWEPPE was tested in real contexts, the researchers developing the application found that employers were not using the application to its full potential, and there was a need for further development. This master's thesis identified requirements for employers in their web application to support their employee's return-to-work process caused by chronic pain. Additionally, prototypes were designed in an iterative human-centered design process, focusing on usability in terms of satisfaction. In each iteration, prototypes were first designed and modified, and afterward, evaluations with stakeholders participating took place. The study revealed that contributing further knowledge to the employers, showing employees data efficiently, designing in line with the employer's workflow, and considering the integrity aspect were essential for usability. The design process resulted in a high-fidelity prototype, and the last evaluation showed that the designed prototype was usable in terms of satisfaction.

Background Compared with other malignancies, head and neck cancer (HNC) increases the risk of not returning to work (RTW). Methods Within a cross-sectional study, patients with HNC filled out the OncoFunction questionnaire, a version of the International Classification of Functioning Core Sets for HNC. In 231 patients below 65 years of age, associations of sociodemographic, clinical, functional, and psychological factors with employment and participation in rehabilitation program were explored. Results Unemployed patients reported more swallowing difficulties and speaking problems. Being unemployed was associated with higher levels of depressive and anxiety symptoms, fatigue, and lower global health. Rehabilitation participation was not significantly associated with any of the assessed factors except for smoking. Conclusions Unemployed patients with HNC are more burdened than employed patients with HNC regarding clinical, psychological, and functional factors. These differences are more evident later in recovery. Rehabilitation participation was not associated with psychological and functional burden which indicates the need for tailored HNC rehabilitation programs.

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.

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with mean age of 59 years. SAH accounts for 5% of all stroke and more than one quarter of potential life years lost through stroke. With the advanced neurosurgical methods of today two thirds of the patients survive. We know, however, that various cognitive, psychiatric and physical impairments are common that affect quality of life, social life, and the ability to work in the aftermath of SAH. The overall aim constituting this PhD dissertation is to better understand some of the challenges often faced by those surviving SAH. Two SAH patient cohorts have been studied. The first followed 96 consecutively included patients during the first year after ictus. Spasticity and cognitive impairment was assessed after 6 months and the Swedish stroke register follow-up form was used to investigate family support and the use of medical and social services. Return to work was assessed at 12 months. The second cohort assessed attention deficits using the test of variables of attention (T.O.V.A.) at 7 months after ictus in 19 patients with moderate to good recovery. Spasticity was just as common in our SAH patients as after other stroke, though it was rarely treated pharmacologically. By assessing cognitive impairment at 6 months after ictus using the Montreal cognitive assessment, 68% of the patients could be correctly predicted as having returned/not returned to work at 12 months. Seventeen percent of the patients had not had a follow-up appointment 6 months after ictus. These patients were older, more often living alone, had a lower quality of life, more depressive symptoms and more cognitive impairment compared to those having had a follow-up appointment. Twenty percent had had a follow-up in primary care. Seventy-eight percent of those with moderate to severe disability were living in their own accommodations. Fifty-eight percent of the patients had attention deficits. Challenges after SAH were common and often dealt with in the home environment of the patients. The results of this thesis highlight the importance of assisting the patients and their relatives in their struggle back to life after SAH.

Thesis (Ph.D. (Physiotherapy))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Stroke impacts on a survivor’s ability to participate in community activities such as return to work (RTW) and affects people who are still within the working age. Return to work contributes to life satisfaction and social identity at least partly through independence gained from income-generation. The impact of RTW programmes for stroke survivors is limited and not generalisable to South Africa. This study aimed to bridge this gap in South Africa, and was conducted within the Gauteng province as it comprises the largest share of the South African population. Objectives and Methodology: The aim of the study was to determine the current practice in RTW intervention programmes for stroke survivors in the Gauteng Province of South Africa and to establish the effect of a workplace intervention programme on the rate of RTW of previously employed stroke survivors. This study had two stages: Stage one: A cross sectional survey was performed using a self administered questionnaire to establish current practice in RTW intervention programmes and the therapists’ perceived barriers and enablers of RTW after stroke. Stage two study included: a) a randomised controlled trial (RCT) to evaluate a six week RTW intervention, with follow-up at three and six months. The workplace intervention programme was tailored according to the functional ability and workplace challenges of each stroke survivor and was as follows: Week one: Assessment for work skill. The assessment included work modules which identified potential problems such as: visual discrimination; eye hand coordination; form and spatial perception; manual dexterity; colour discrimination; cognitive problems, and job specific physical demand factors. Week two: The therapist interviewed the stroke survivor and employer separately to establish perceived barriers and enablers of RTW. This was followed by a meeting between the therapist, stroke survivor and employer/supervisor to discuss and develop a plan to overcome identified barriers and to strengthen identified enablers based on consensus between stroke survivor and employer. Week three: A work visit for the stroke survivor to demonstrate what they did at work and identify what they could still do safely and what they could not do. This included vocational counselling and coaching; emotional support; adaptation of the working environment; advice on coping strategies to compensate for mobility and upper limb functional limitations; and fatigue management. Weeks four, five and six: continuation of the work visits, while monitoring progress, and making necessary adjustments as per stroke survivor and employer’s needs. This was done at the workplace while the participants continued with their usual therapy at the hospital. The control group received usual care. The primary outcome was RTW rate. The secondary outcomes included activities of daily living (measured with the Barthel Index); mobility (measured with the Modified Rivermead Mobility Index); basic cognitive function (measured with the Montreal Cognitive Assessment) and perceived quality of life (measured with the Stroke Specific Quality of life Scale). Another aim of stage two study was to: b) establish the stroke survivors’ and employers’ perceived barriers and enablers of RTW (this was done with the experimental group only); and to: c) identify predictors of RTW. Stage one study results: Thirty six (68%) of the 53 questionnaires sent to stroke rehabilitation facilities were returned. Seventeen (47%) of the 36 clinical settings referred stroke survivors to facilities offering RTW services; 12 (33%) facilities did not refer stroke survivors for RTW and did not offer RTW services; and seven (20%) facilities offered RTW services. Of the seven facilities that rendered RTW services for stroke survivors, five (71%) communicated with the employer to discuss reasonable accommodation and four (57%) did assessments for potential to RTW. The most common reason given by the 29 facilities for not offering RTW services was that they referred stroke survivors to other therapists who offered these services. The second most common reason was the unemployment status of the stroke survivor at the time of having stroke. The therapists’ most commonly perceived barriers of RTW were the severity of the stroke survivors’ physical impairments (n = 3) (36%) and their employment status (n = 11) (31%) at the time of having stroke. The most commonly perceived enablers were willingness of the employer to reasonably accommodate the stroke survivor at work (n = 12) (33%), family support (n = 8) (22%) and increased length of hospital stay to allow for intensive rehabilitation (n = 7) (19%). Stigma in the workplace was the only variable which had a statistically significant relationship with the type of clinical facility therapists worked at (p = 0.02). Stage two study results: The average age for the study group was 45 (SD: 8.7) years and the average stroke duration was 4.6 (SD: 1.8) weeks. There were 41 (51%) male stroke survivors and 39 (49%) female stroke survivors. Majority (55%) of the stroke survivors were breadwinners (63%), had a grade 11 to 12 educational level (64%), an income above R5000 (46%) and had a helper (74%) whom they did not have to pay (81%). Stroke survivors who returned to work had better quality of life at six months after stroke than those who did not RTW (p = 0.05). Results from the qualitative study indicated that the perceived enablers of RTW included: ability of the employer to provide reasonable accommodation and good interpersonal working relationships between stroke survivor, employer and co-workers. The perceived barriers of RTW included: unaffordable reasonable accommodation costs; inaccessible transport; having cognitive (memory and attention) and speech impairments and high unemployment rates. The overall RTW rate was 20% at three months follow-up and 40% at six months follow-up. Twenty seven percent of the stroke survivors in the intervention group returned to work at three months compared to 12% in the control group (p = 0.13). At six months, the majority of stroke survivors (60%) in the intervention group returned to work compared to 20% in the control group (p <0.001). The following factors were predictive of RTW: male gender (p = 0.03); fewer speech problems (p = 0.02); increased time off work post stroke (p = 0.001); ability to perform activities of daily living (p = 0.02); good mobility (p = 0.01) and good cognitive ability (p = 0.02). The stroke survivors in the intervention group were 5.2 times more likely to RTW than those in the control group at six months following stroke, and for every unit increase in the activities of the Barthel Index and Montreal Cognitive assessment score, the likelihood of RTW increased by 1.7 and 1.3 respectively. Conclusion: A RTW intervention consisting of workability assessments and workplace visits was effective in facilitating RTW for stroke survivors in Gauteng province, South Africa. Key predictors of RTW included male gender; increased time off work post stroke; ability to perform activities of daily living; good mobility and good cognitive ability and were identified as facilitating RTW; speech problems were identified as barriers to RTW. Overall, these results suggest the need to direct resources towards increasing work place intervention strategies after stroke.

Syftet med studien är att skapa en djupare förståelse för vilka faktorer som upplevs främja återgången till arbete efter en långtidssjukskrivning vid psykisk ohälsa, utifrån den sjukskrivnes perspektiv. Studien baseras på Karaseks och Theorells modell som består av krav och kontroll samt en teoriutveckling av socialt stöd i förhållande till krav och kontroll av Jeffery Johnson. Studien baseras även på teorin ”Känsla av sammanhang”, förkortat KASAM, som utvecklats av Aaron Antonovsky. För att få en djupare förståelse för vilka faktorer som upplevs främja återgången till arbete efter en långtidssjukskrivning vid psykisk ohälsa genomfördes samtalsintervjuer med fem personer. Resultatet i studien visar att stöd och kommunikation med arbetsgivare och kollegor är en framgångsfaktor vid återgången till arbetet. Det framkommer även i studien att arbetsträning är en framgångsfaktor men kan hämma återgången om den inte är verklighetsförankrad. Deltagare i studien menar att lägre krav och högre egenkontroll är främjande i återgångsprocessen. Slutligen framkommer det även att återgången underlättas när individen känner tillhörighet till arbetsplatsen och arbetsgruppen. / The aim of the study is to create a deeper understanding of which factors perceived to promote the return to work after a long-term sickness in mental health, based on the perspective of the sick-listed. The study is based on Karaseks and Theorells model consisting of demand, control and a theory development of social support in relation to demand and control by Jeffery Johnson. The study is also based on the theory ”a Sense of Coherence”, abbreviated KASAM, developed by Aaron Antonovsky. In order to gain a deeper understanding of which factors perceived to promote the return to work after a long-term sickness in mental ill-health, five interviews were conducted. The results in this study shows that support and communication with employers and colleagues is a success factor when returning to work. It also appears in the study that job training is a success factor but can inhibit the return if it is not reality-based. Participants in this study argues that lower demands and higher self-control are promotions in the return process. Finally, it also emerges that the return is facilitated when the individual feel a sense of coherence to the workplace and the working group.

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.

Introdução - Os trabalhadores no Brasil geralmente retornam ao trabalho nas mesmas condições que geraram seus afastamentos. No ano de 2012 os professores foram o terceiro grupo profissional que mais se afastou e retornou ao trabalho (RT) em readaptação funcional, entre os servidores públicos da rede municipal de São Paulo. Transtornos mentais e comportamentais (TMC) foram um dos diagnósticos mais frequentes. Objetivos - Conhecer e analisar os processos de afastamentos por TMC e RT entre os professores da rede pública municipal de SP. Métodos - Estudo qualitativo, de caráter exploratório, realizado por meio de entrevistas individuais centradas no problema, em linha de narrativa oral e grupos focais. Participaram 20 professores ativos e readaptados, com histórico de licenças médicas por TMC e RT. A análise dos dados envolveu transcrição, codificação aberta, axial e seletiva. Resultados - As categorias temáticas discutidas foram: a) afastamentos do trabalho por TMC; b) RT; c) estratégias para o cuidado da saúde e permanência no trabalho; d) período de afastamento até o retorno ao trabalho; e) preconceitos no trabalho; f) perícia médica; g) autonomia dos professores em modificações das condições e organização do trabalho. Os participantes foram na maioria mulheres, principais responsáveis pela renda familiar e com longa jornada de trabalho. Foram relatadas situações caracterizadas pela falta de autonomia. As negociações no âmbito do RT ocorreram preferencialmente com os professores readaptados, de maneira dependente da equipe gestora da escola e sem direcionamento às modificações dos fatores que colaboraram com os afastamentos. Professores ativos e readaptados significaram de modo distinto afastamento e RT. O contexto de trabalho na educação foi causa referida para o adoecimento. Aspectos de gestão do trabalho na escola foram associados tanto ao afastamento quanto ao RT, que ocorreram na sua maioria, em condições desfavoráveis ao trabalho e à saúde. Conclusões - São complexas as relações entre os aspectos envolvidos nos processos de afastamento por TMC e RT entre os professores participantes. Discutir retorno ao trabalho exige abordar os motivos dos afastamentos. Tanto politicas públicas e macroestruturas, quanto as micropolíticas foram determinantes do adoecimento, afastamento e processo de RT entre os participantes. Ações de prevenção do adoecimento mental e dos afastamentos e promoção da saúde devem integrar um projeto multi-institucional que garanta vigilância em saúde do trabalhador, capacitações voltadas ao processo de afastamento e RT e participação dos professores / Introduction - Workers in Brazil usually return to work under the same conditions that led to their sick leave. In 2012 teachers were the third professional group with more sick leave and return to work (RT) in functional readaptation, among public servants of the city of São Paulo. One of the most frequent diagnoses was mental and behavioral disorders (MBD). Objectives - To investigate and analyze the processes of sick leave by MBD and RT among teachers from São Paulo public municipal system. Methods - Qualitative study, of exploratory approach, conducted through individual interviews focused on the issue in oral narrative line and focus groups. Twenty active and readaptation functional teachers participated, with a history of sick leave due MBD and RT. The data analysis involved transcription, encoding open, axial and selective. Results - The themes discussed were: a) sick leave due MBD; b) RT c) strategies for health care and remain in work; d) period off work on sick leave; e) prejudices at work; f) medical expertise; g) autonomy of teachers in changing the conditions and organization at work. Participants were mostly women, sole breadwinner and long working hours. Situations characterized by lack of autonomy were reported. Negotiations within the RT preferentially occurred with readaptation functional teachers, in dependant way of the management team of the school and without targeting alteration of the factors that collaborated with the sick leave. Active and readaptation functional teachers meant sick leave and RT differently. The work context in education was concerned referred to the illness. Work management aspects at school were both associated with the sick leave on the RT, which occurred mostly in unfavorable working and health conditions. Conclusions - Relationships among aspects are complex when involved in the process of sick leave due TMC and RT among participants. Discussing return to work requires addressing the reasons for the sick leave. Both public policy and macro structures as the micro were determinants of illness, sick leave and RT process 8 among participants. Actions to prevent MBD and sick leave, and health promotion should integrate a multi-institutional project to ensure worker health surveillance, qualification aimed at the sick leave and RT process and participation of teachers

Introdução:Os transtornos mentais (TM) são a terceira princip al causa de incapacidade laborativa de longa duração no Brasil. Existem dive rsos fatores que influenciam o tempo para o retorno ao trabalho (RT) e a efetividade da reint egração laboral após um episódio de afastamento por TM. É considerado um retorno ao tra balho eficaz (RTE) quando o trabalhador se mantém no exercício das suas ativida des profissionais por prazo superior a trinta dias após a volta ao trabalho. No Brasil não há estudos que descrevam fatores associados ao RT de trabalhadores afastados por TM incapacitante. Objetivo: Analisar os fatores que influenciam o tempo para o retorno ao t rabalho após afastamento de longa duração por TM e a efetividade da reintegração do trabalhad or após o período de afastamento. Métodos:Um estudo longitudinal realizado na cidade de São Paulo entre 2014-2016 que incluiu trabalhadores do mercado formal que requeri am benefício por incapacidade. Foram conduzidas quatro fases: a) adaptação transcultural de um instrumento holandês que avalia a expectativa para o RT entre afastados por TM (N=411 ); b) coleta de informações sociodemográficas, comportamento de risco para a sa úde, características do trabalho, condições de saúde e histórico previdenciário (N=20 4); c) entrevista sobre o processo de RT na empresa (N=128); d) verificação da situação do t rabalhador no mercado de trabalho após 365 dias do afastamento. Foram realizadas análise d e sobrevida para verificar os fatores que influenciavam o tempo para o RT e regressão logísti ca para analisar os fatores que contribuíam para o RTE. Resultados: O grupo da fase longitudinal era composto na sua maioria por mulheres (71 por cento ), pessoas com idade infer ior a 40 anos (68 por cento ), alta escolaridade (78 por cento ), trabalhadores em atividade de atendimento (4 4,1 por cento ) e diagnóstico de quadro depressivo (52 por cento ). O tempo médio para o RT foi de qu ase seis meses entre os 63 por cento que tentaram voltar ao trabalho no período do estudo. O s fatores que influenciaram um retorno mais precoce foram: faixa etária entre 30-39 anos, escolaridade de mais de 12 anos de estudo, baixo consumo de álcool e ausência de sintomas ansi osos. A taxa de efetividade entre os que tentaram o retorno foi de 74 por cento . Os fatores que influ enciaram o retorno ao trabalho eficaz foram: maior tempo de trabalho na função, menor exp ectativa sobre o retorno ao trabalho durante o afastamento e a realização de exame médic o de retorno ao trabalho. A avaliação psicométrica da versão para o português brasileiro do questionário de autoeficácia sobre o trabalho após afastamento por TM demonstrou substan cial (0,64) a quase perfeita (0,86) estabilidade temporal ajustada por prevalência, boa confiabilidade interna (0,76) e estrutura bidimensional. Conclusão: Fatores relacionados a características sociodemogr áficas, ao comportamento de risco para a saúde e à condição cl ínica no afastamento influenciaram o tempo para o RT. Fatores relacionados a aspectos ps icológicos, características da história ocupacional e o processo de acolhimento do trabalha dor na empresa influenciam a efetividade do retorno. A versão para o português brasileiro do questionário de expectativa sobre o trabalho demonstrou ser adequada para o uso em popu lações similares à da pesquisa. Desejamos que o estudo possa contribuir para a disc ussão e formatação de ações públicas e privadas voltadas tanto para a prevenção terciária, quanto para intervenções em nível primário e secundário da atenção integral à saúde mental dos trabalhadores / Introduction: Mental disorders (MD) are the third leading cause of long-term disability in Brazil. There are several factors that influence th e time to return to work (RTW) and the effectiveness of labor reintegration after an episo de of sick leave due to MD. When workers remain working more than 30 days after back to work is known as sustained return-to-work (S-RTW). In Brazil, there are no studies describing factors associated with the RTW of workers in sick leave due to MD. Objectives: To analyze factors associated to time to RTW after an episode of long-term sickness absence due to MD and the effectiveness of those RTW. Methods: A longitudinal study conducted in the city of São Paulo, Brazil, from 2014- 2016 included formal workers requiring disability b enefit. We had four phases: a) the cross- cultural adaptation of a Dutch instrument that asse sses the RTW-SE among absentees due to MD (N = 411); b) collecting demographic information , health risk behaviors, work characteristics, health conditions and social secur ity history (N = 204); c) interview on the employer s RTW process (N = 128); check worker\'s si tuation in the labor market after 365 days of absence. Survival analysis was performed to identify factors influencing the time for the RTW and multiple logistic regression to analyze the factors that contributed to the S- RTW. Results: The group of longitudinal study was composed mostl y by women (71 per cent ), people aged under 40 (68 per cent ), 12 or more years of edu cation (78 per cent ), customer service jobs (44,1 per cent ) and diagnosed as depressed (52 per cent ). The avera ge time for the RTW was almost six months among the 63 per cent who tried the resumption of wo rk activities. Factors that influence an earlier return were: aged between 30-39 years, 12 o r more years of education, low alcohol intake and lack of anxiety symptoms. The effectiven ess rate among those who tried to return was 74 per cent . Factors influencing the sustained RTW were job working time, return-to-work self- efficacy (RTW-SE) in baseline, and to be evaluated by a physician before RTW. The psychometric evaluation for Brazilian Portuguese ve rsion of RTW-SE questionnaire showed substantial (0.64) to almost perfect (0.86) tempora l stability adjusted by prevalence, good reliability (0.76) and a two dimensions structure. Conclusion: Factors related to sociodemographic characteristics, risk health behav iors and medical condition influenced the time for RTW. Factors related to psychological and occupational aspects, and also the RTW process influence the effectiveness of the return. The Brazilian Portuguese version for RTW- SE showed to be suitable for use in similar populat ions of our research. We hope to contribute to the discussion and to stimulate public and priva te intervention policies on tertiary prevention, focused in early RTW, and also in prima ry and secondary level of integral attention to the workers mental health

Introdução - Os trabalhadores no Brasil geralmente retornam ao trabalho nas mesmas condições que geraram seus afastamentos. No ano de 2012 os professores foram o terceiro grupo profissional que mais se afastou e retornou ao trabalho (RT) em readaptação funcional, entre os servidores públicos da rede municipal de São Paulo. Transtornos mentais e comportamentais (TMC) foram um dos diagnósticos mais frequentes. Objetivos - Conhecer e analisar os processos de afastamentos por TMC e RT entre os professores da rede pública municipal de SP. Métodos - Estudo qualitativo, de caráter exploratório, realizado por meio de entrevistas individuais centradas no problema, em linha de narrativa oral e grupos focais. Participaram 20 professores ativos e readaptados, com histórico de licenças médicas por TMC e RT. A análise dos dados envolveu transcrição, codificação aberta, axial e seletiva. Resultados - As categorias temáticas discutidas foram: a) afastamentos do trabalho por TMC; b) RT; c) estratégias para o cuidado da saúde e permanência no trabalho; d) período de afastamento até o retorno ao trabalho; e) preconceitos no trabalho; f) perícia médica; g) autonomia dos professores em modificações das condições e organização do trabalho. Os participantes foram na maioria mulheres, principais responsáveis pela renda familiar e com longa jornada de trabalho. Foram relatadas situações caracterizadas pela falta de autonomia. As negociações no âmbito do RT ocorreram preferencialmente com os professores readaptados, de maneira dependente da equipe gestora da escola e sem direcionamento às modificações dos fatores que colaboraram com os afastamentos. Professores ativos e readaptados significaram de modo distinto afastamento e RT. O contexto de trabalho na educação foi causa referida para o adoecimento. Aspectos de gestão do trabalho na escola foram associados tanto ao afastamento quanto ao RT, que ocorreram na sua maioria, em condições desfavoráveis ao trabalho e à saúde. Conclusões - São complexas as relações entre os aspectos envolvidos nos processos de afastamento por TMC e RT entre os professores participantes. Discutir retorno ao trabalho exige abordar os motivos dos afastamentos. Tanto politicas públicas e macroestruturas, quanto as micropolíticas foram determinantes do adoecimento, afastamento e processo de RT entre os participantes. Ações de prevenção do adoecimento mental e dos afastamentos e promoção da saúde devem integrar um projeto multi-institucional que garanta vigilância em saúde do trabalhador, capacitações voltadas ao processo de afastamento e RT e participação dos professores / Introduction - Workers in Brazil usually return to work under the same conditions that led to their sick leave. In 2012 teachers were the third professional group with more sick leave and return to work (RT) in functional readaptation, among public servants of the city of São Paulo. One of the most frequent diagnoses was mental and behavioral disorders (MBD). Objectives - To investigate and analyze the processes of sick leave by MBD and RT among teachers from São Paulo public municipal system. Methods - Qualitative study, of exploratory approach, conducted through individual interviews focused on the issue in oral narrative line and focus groups. Twenty active and readaptation functional teachers participated, with a history of sick leave due MBD and RT. The data analysis involved transcription, encoding open, axial and selective. Results - The themes discussed were: a) sick leave due MBD; b) RT c) strategies for health care and remain in work; d) period off work on sick leave; e) prejudices at work; f) medical expertise; g) autonomy of teachers in changing the conditions and organization at work. Participants were mostly women, sole breadwinner and long working hours. Situations characterized by lack of autonomy were reported. Negotiations within the RT preferentially occurred with readaptation functional teachers, in dependant way of the management team of the school and without targeting alteration of the factors that collaborated with the sick leave. Active and readaptation functional teachers meant sick leave and RT differently. The work context in education was concerned referred to the illness. Work management aspects at school were both associated with the sick leave on the RT, which occurred mostly in unfavorable working and health conditions. Conclusions - Relationships among aspects are complex when involved in the process of sick leave due TMC and RT among participants. Discussing return to work requires addressing the reasons for the sick leave. Both public policy and macro structures as the micro were determinants of illness, sick leave and RT process 8 among participants. Actions to prevent MBD and sick leave, and health promotion should integrate a multi-institutional project to ensure worker health surveillance, qualification aimed at the sick leave and RT process and participation of teachers