Syftet med denna studie är att undersöka faktorer kring hög korttidssjukfrånvaro (sjukfrånvaro dag 1-14) på Ekgårdens äldreboende i Vingåkers kommun. Metoderna som använts är granskning av frånvarostatistik, intervjuer med tre chefer och enkätundersökning bland de anställda (n=26). Den undersökta gruppen består nästan uteslutande av kvinnor med relativt låg inkomst och utbildning, faktorer som enligt tidigare forskning sammanfaller med hög sjukfrånvaro. Studien visar även att de anställda i den undersökta gruppen fått erfara täta omorganisationer och chefsbyten samt att de upplever vissa brister i den fysiska arbetsmiljön i form av tunga lyft, fysiskt ansträngande arbete och dålig luft samt i den psykosociala arbetsmiljön i form av höga krav och låg egenkontroll. Dessa faktorer kan vara bidragande orsaker till den höga korttidssjukfrånvaron. / The aim of this study is to investigate factors concerning high levels of short term sick leave (absence day 1-14) at the old people’s home of Ekgården in Vingåker. Methods used include statistics revision, interviews with three managers and questionnaire among employees (n=26). The group of employees consists almost exclusively of women with relatively low salaries and low level of educational attainment, which, according to previous research, coincide with high levels of sickness absence. The study shows that the group of employees during the last couple of years has had to endure quite a few reorganizations and changes in management. They also experience some shortages in their physical work environment like heavy lifting, physical demanding work and poor air ventilation and in their psychosocial work environment with high demands and low self control. These factors might be contributing to high levels of short term sick leave.

The importance of organizations for understanding differences in the working conditions and health of employees is often emphasized but rarely explored empirically. The general aim of this thesis is to describe organizational characteristics of workplaces, and to assess their impact on the psychosocial working conditions and health of employees. In modern working life, it is assumed that employees' working conditions and health are affected by a general transformation of workplaces from bureaucracy to post-bureaucracy.  The organizational data used are based on structured interviews with managers at workplaces in different types of operations in mid-Sweden, whereas the individual data consist of a questionnaire to all employees working in the participating workplaces, resulting in a dataset of 90 workplaces and 4306 individuals. Descriptive analysis was carried out for comparison of organizational characteristics in different types of operations, while multilevel analysis was applied to investigate the magnitude of the organizational impact on psychosocial working conditions, and to analyze associations between organizational characteristics, psychosocial working conditions and health. The results showed that the workplaces were mainly displayed by a combination of bureaucratic and post-bureaucratic characteristics, and these were unequally distributed between types of operations. A systematic variation in the psychosocial working conditions and health of employees was found between workplaces, and the variation in psychosocial working conditions was attributed to several organizational levels. The variation between workplaces was explained by both organizational characteristics of the workplaces and individual characteristics of the employees. Formalization, centralization, job enrichment, individual responsibility, soft control systems, and performance control were associated with psychosocial working conditions when controlled for occupational class, gender and age of employees, and a high degree of customer adaptation was associated with increased sickness absence of employees.   It is concluded that bureaucracy and post-bureaucracy should not be regarded as dichotomies. Organizational characteristics of workplaces have an impact on the psychosocial working conditions and health of employees beyond occupational class. This has implications for both the theory and the practice of occupational health research. / The Healthy Workplace Study

Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness. Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III). Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis is 27% respective 22%. The relative risk increase for headache is 63% after granisetron, and 44% for difficulty with accommodation after droperidol. Less PONV was seen after P6-acupressure, 33% (44/135) compared to reference group 46% (63/136) (p = 0.019), number needed to treat (NNT) was 7 [95% confidence interval (CI) 4- 6]. When comparing laparoscopic and vaginal surgery (subgroup analysis) the main effect was in the vaginal group (day-case surgery), 36% (27/75) in the reference group to 27% (23/86) in the placebo group and to 20% (17/84) in the P6-acupressure group, (P = 0.017), NNT for the vaginal group was 6 [95% CI 3-18]. P6-acupressure increased time to nausea after a laboratory motion challenge and reduced the total number of symptoms reported (p <0.009). Conclusions: There is no clinical efficacy in the form of reduced postoperative symptoms after prophylactic antiemetics (droperidol and granisetron) in females with a high risk (>30%) for PONV undergoing gynaecological surgery. P6-acupressure reduces the incidence of PONV after gynaecological surgery in females with a high (>30%) risk for PONV. The effect seems to be most prominent after vaginal surgery. P6-acupressure increased tolerance to experimental nausogenic stimuli and reduced the total number of symptoms reported in females with a history of motion sickness. / On the day of the public defence the status of article IV was: Submitted.

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

No abstract available. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 4 uppsatser.

The principal aim of the thesis is to chart the development of social insurance in the Czech Republic and the sub-goal is to evaluate the influence of changes in the social insurance on social incomes of the Czechs. The practical part is at first focused on the development and changes of the social insurance in a social security insurance, sickness and retirement insurance from 2005 till now. Then there is a description of the development of social incomes in the Czech Republic from 2005 till 2009 followed by a comparison of social incomes with full incomes of the Czech inhabitants. Subsequently, a comparison of the social benefits with the disposable income in the Czech Republic and the European Union is done. In conclusion, there is an evaluation of the effectiveness of the changes in the social insurance system connected with the social incomes of the Czech inhabitants.

A neuroinflamação vem sendo estudada através da administração aguda, central ou periférica, de lipopolissacarídeos bacterianos (LPS) em roedores. A administração de LPS causa uma mudança na resposta imune do animal, aumentando os níveis de citocinas e outras quimiocinas inflamatórias. Essas alterações levam a um estado comportamental do tipo doente, que tende a ser extinto 24 h depois da administração de LPS, momento no qual se pode visualizar o desenvolvimento de um comportamento do tipo deprimido no animal. O hiperosídeo (HYP) é um flavonoide glicosilado, encontrado em diversas espécies vegetais e apresenta efeito do tipo antidepressivo, atividade citoprotetora, antioxidante e anti-inflamatória em roedores. O objetivo desse trabalho foi avaliar o efeito do flavonoide hiperosídeo (HYP) no modelo do comportamento de doente e do tipo deprimido induzidos pela administração de LPS em camundongos e sobre os níveis hipocampais de citocinas (IL-6, TNF, IFN-γ, IL-12 e IL-10) e quimiocina MCP-1. O modelo consistiu na exposição dos animais a uma sessão de 5 min de natação forçada (estímulo estressor) com posterior administração de LPS (600 μg/kg, i.p.) ou solução salina (10 mL/kg, i.p., SAL, animais controle do modelo). O comportamento de doente foi avaliado em campo aberto, através da medida do número de cruzamentos e score de sintomas, 06 e 24 h após a administração de LPS. O comportamento do tipo deprimido foi avaliado pela medida da imobilidade no teste de suspensão pela cauda (TSC) 24 h após a administração de LPS. Os tratamentos imipramina (IMI, 20 mg/kg), HYP (20 mg/kg) ou solução salina 10 mL/kg (grupo controle do tratamento) foram administrados (i.p.) 30 min antes (protocolo profilático) ou 5 h e 30 min depois (protocolo terapêutico) da administração de LPS ou SAL. Os níveis hipocampais de citocinas foram medidas por citometria de fluxo nos animais eutanasiados uma hora após o TSC. A administração profilática de HYP aumentou 12 os níveis de todas as citocinas tanto no grupo LPS quanto no grupo SAL. A análise da correlação citocinas pró-/anti-inflamatórias demonstrou que o tratamento profilático HYP resultou em uma correlação positiva IL-6/IL10 e TNF/IL-10 tanto nos animais SAL quanto LPS. A administração terapêutica de HYP aumentou somente os níveis de IL-10 e resultou em uma correlação IL-6/IL-10 positiva apenas no grupo SAL. Nos animais do grupo LPS, o tratamento terapêutico HYP aumentou os níveis de MCP-1 e resultou numa correlação positiva TNF/IL-10. O tratamento profilático HYP preveniu parcialmente o desenvolvimento do comportamento de doente, diminuindo o score de sintomas e o comportamento do tipo deprimido no grupo LPS. O tratamento terapêutico HYP preveniu o desenvolvimento do comportamento do tipo deprimido apenas no grupo SAL. A administração profilática de IMI nos animais SAL não alterou os níveis de IL-6, IL-10 e TNF, mas resultou em correlações IL-6/IL-10 e TNF/IL-10 positivas. Nos animais que receberam LPS, a administração profilática de IMI somente diminuiu os níveis de IL-6 e TNF, sem apresentar nenhuma correlação entre os níveis de citocinas. A administração terapêutica de IMI não alterou os níveis de nenhuma citocina, porém resultou em uma correlação TNF/IL-10 positiva. O tratamento profilático IMI preveniu tanto o desenvolvimento do comportamento de doente como do tipo deprimido. O tratamento terapêutico com IMI não reverteu os prejuízos induzidos pela administração de LPS, nem no comportamento de doente nem no do tipo deprimido. Em conclusão, os dados deste trabalho confirmam o efeito do tipo antidepressivo de hiperosídeo em camundongos e demonstram que o tratamento profilático com HYP tem efeito protetor parcial contra a manifestação dos sintomas de doente e comportamento do tipo deprimido induzidos pela natação forçada e administração de LPS. A ação do HYP pode estar relacionada ao aumento dos níveis hipocampais da citocina antiinflamatória IL-10. / The neuroinflammation has been studied through acute, central or peripheral administration of bacterial lipopolysaccharides (LPS) in rodents. LPS alters the animal immune response increasing the cytokines and others inflammatory chemokines levels. These alterations generate a group of symptoms and behavioral changes known as sickness behavior, which tends to be extinct 24 h after LPS administration when the animals develop a depressive-like behavior. Hyperoside (HYP) is a glycosylated flavonoid that present antidepressant, cytoprotective, antioxidant and anti-inflammatory properties in rodents. The aim of this study was to evaluate the HYP effects on sickness and depressive-like behaviors induced by LPS administration in mice as well as to investigate its effect on hippocampal cytokines (IL-6, TNF, IFN-γ, IL-12 e IL-10) and chemokine MCP-1 levels. The model consisted of a 5 min forced swimming session (stressor stimuli) with posterior LPS (600 μg/kg, i.p.) or saline (10 ml/kg, i.p., SAL) administration. The sickness behavior was assessed in the open field test by measuring the number of crossings and by scoring symptoms, 06 and 24 h after LPS administration. The depressive-like behavior was evaluated by measuring the immobility time in the tail suspension test (TST) 24 h after LPS administration. The treatments imipramine (IMI, 20 mg/kg), HYP (20 mg/kg) or saline 10 mL/kg (treatment control group) were administered (i.p.) 30 min before (prophylactic protocol) or 5 h and 30 min after (therapeutic protocol) LPS or saline (SAL - experiment control) administration. The cytokines levels were measured by flow cytometry in animals euthanized by decapitation 1 h after TST. The prophylactic administration of HYP increased all cytokines in both LPS and SAL groups, and resulted in an IL-6/IL-10 and a TNF/IL-10 positive correlation in both SAL and LPS animals. The therapeutic administration of HYP increased IL-10 levels, with an IL-6/IL10 positive correlation in SAL group only. In LPS animal group, the therapeutic 14 administration of HYP increased the MCP-1 levels and resulted in a TNF/IL-10 positive correlation. The prophylactic HYP did not prevent the reduction on spontaneous locomotion induced by LPS but decreased the symptoms score in LPS group and the depressive-like behavior in both LPS and SAL groups. The therapeutic HYP did not revert the sickness behavior and prevented the depressive-like behavior only in SAL group. The prophylactic IMI decreased IL-6 and TNF without any correlation between cytokines levels in animals that received LPS. In SAL animals, the prophylactic administration of IMI did not alter the cytokines levels but resulted in an IL-6/IL-10 and TNF/IL-10 positive correlations. The therapeutic IMI did not alter any cytokine levels, but resulted in a positive TNF/IL-10 correlation. The prophylactic IMI prevented both sickness and depressive-like behavior in LPS and SAL groups. The therapeutic IMI did not revert any LPS impairment. In conclusion, this study confirmed the antidepressant–like effect of hyperoside in mice and demonstrated that prophylactic treatment with this flavonoid partially protect the animals against sickness and depressive-like behaviors induced by LPS combined with forced swimming stress. Ability of HYP to increase the anti-inflammatory cytokine IL-10 hippocampal levels may underlies its effects on this model.

Submitted by Felipe Guimaraes Uchoa (felipe.g.uchoa@gmail.com) on 2015-02-19T15:38:56Z No. of bitstreams: 1 Dissertação_FelipeUchoa_MPFE_19.02.2014.docx: 155271 bytes, checksum: 623619d1f24dfa627add019a29b984e7 (MD5) / Rejected by Renata de Souza Nascimento (renata.souza@fgv.br), reason: Felipe, O trabalho não está de acordo com as normas da ABNT. Segue abaixo, o que deverá ser alterado: - O arquivo deve estar em PDF e não em Word (conforme a postagem). - Nas páginas onde constam SÃO PAULO 2014, deverá alterar o ano para 2015 (pois a apresentação ocorreu em 2015). - Nas páginas dos Agradecimentos/ Resumo/ Abstract, o texto deve estar alinhado, sem os espaços dos parágrafos. Aguardo as alterações e nova submissão. 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No. of bitstreams: 1 Dissertação_FelipeUchoa_MPFE_19 02 2014.pdf: 445771 bytes, checksum: 7d62e511d073b5de4cf00c2a38d2db77 (MD5) Previous issue date: 2015-01-20 / Per year, more than R$ 15 billion reais are spent with the statutory sickness benefits issued by the Brazilian National Insurance Institute (Instituto Nacional do Seguro Social, INSS) and the costs related with the whole process. In addition, around 7 million medical examinations are held by the INSS medical examiners in order to grant the benefit, from which 2 million are denied by them. The main objective of this work is to assess the whole process of issuing statutory sickness benefits held by the INSS with a Game Theory approach. Analyzing the game structure of the process and the interactions of both, claimants and examiners, with the INSS and the unwanted incentives generated by the current structure. The claimant has an incentive for requiring the benefit even though he does not fit all the requirements for the benefit to be granted. As a result, the number of exams rise, lowering their quality and eventually making the INSS to issue unnecessary benefits. The examiner faces a high complex task without necessary time to perform it with all the caution required. Besides, once it is mandatory to inform the exam result immediately to the claimant, the examiner may have an incentive for conceiving the benefit even when the claimant does not fit all the requirements needed, given that the time provided to the examiner to analyze the case is too short to take a full evaluation.. Once made the parallel with the Game Theory and the Common Pool Resources (CPR) issue, it is possible to research the literature about mitigating this kind of problems. It is also interesting to perform a research on the Market Design literature. Both have showed positive results in mitigating similar issues and may have successful results with the sickness benefit process. / Por ano são gastos mais de R$ 15 bilhões de reais entre os benefícios de auxílio-saúde emitidos pelo INSS e os custos para viabilizar o processo. São realizadas, em torno de 7 milhões de pericias, das quais mais de 2 milhões tem resultado contrário por parte do médico perito. O objetivo deste trabalho é realizar uma leitura do processo de concessão de benefícios de auxílio-saúde pelo INSS sob a ótica da Teoria dos Jogos, com a análise da estrutura das interações entre segurado e perito com o INSS e os incentivos indesejados resultantes desta estrutura. Sendo que o segurado é incentivado a buscar o benefício mesmo sem ter, de fato, a necessidade. Resultando num aumento na quantidade de perícias realizadas por ano, diminuindo sua qualidade e eventualmente concedendo benefícios desnecessários. O perito, por sua vez, se defronta com uma atividade de alta complexidade e não dispõe do tempo necessário para uma análise cautelosa. Além disso, tem o incentivo a, em momentos de incerteza, conceder o benefício mesmo que o segurado não se enquadre corretamente nos requisitos necessários. Isto pode ocorrer, dentre outros fatores, devido ao tempo disponibilizado ao perito para analisar o caso com a atenção necessária não ser suficiente. Uma vez traçado o paralelo com a Teoria dos Jogos e os problemas de Common Pool Resources (CPR), é feita uma pesquisa nessa literatura em busca de maneiras de mitigar problemas similares ao pesquisado. Este paralelo também traz a possibilidade de pesquisar a literatura de Market Design acerca do redesenho da estrutura de mercados, com intuito de corrigir e desenvolver estes mercados. Estudos recentes apresentaram resultados positivos, sendo indicado, portanto, para trabalhos futuros, a implementação desta metodologia para o processo de concessão de benefícios de auxílio-saúde.

In today’s working life both the physical and the psychosocial aspects has to be considered when examining the work environment. The psychosocial working environment is of great relevance because it illuminates the individual's perception and experience of relationships and phenomena at work. This essay aims to investigate, describe and analyze the obligation an employer has to pursue in order to tackle high short- term sickness absence and at the same time manage the psychosocial work environment at the workplace. Furthermore, the purpose of this study is to acknowledge the European legislation on this subject matter in order to broaden the understanding of the comprehensiveness of the term psychosocial work environment and how applicable laws and guidelines apply in working life. The legal methodology has been used in order to answer the questions of this essay. The social perspective worked as a complement to the legal method in order to observe new problems and conduct more information in how to confront this issue at small scale enterprises. In conclusion this study deals with a complex situation where every case is unique. It is not possible to prevent all short-term sickness absence, but with the right preconditions and external assistance, employers can handle it without neglecting the psychosocial work environment. By securing a good psychosocial work environment even the smallest enterprises might be able to handle short- term sickness absence.