Thesis focuses on social security system at Czech Republic, mainly on health insurance area. The aim of the thesis is to analyze healt insurance development, which projects itself into calculations of healt insurance allowances (sickness compensation, motherhood financial support and nursing compensation) and to evaluate influence of legislative changes during observed period of time (2005 {--} 2010) at these calculations. Thesis is divided into two parts, theoretical one, which describes all social security system areas as they were at year 2005 from the employee point of view and from the accounting viewpoint as well. Second part consists from five chaptures, where is gradually described choosen company {--} Southbohemian regional veterinary administration {--} profile, it´s social security obligations as an employer, calculations of healt insurance allowances and in conclusion results evaluation and legislative changes influence assesment.

After the elections in 2006 there was a change of government in Sweden, when the Moderate Party with the right block took over the power from the Social democrats. The politics of the new government is more liberal than the politics of the Social democrats, which implied several changes of the Swedish social security system, in particular some important changes of the sickness benefit. The objective of this essay has been to examinate the changes of the system, as well as the reasons for the changes, and also to compare the system in Sweden to the one in France, who has another structure. The methods used are archive and corpus crossings in terms of collecting information from literature and websites of the social insurance offices in Sweden and in France. Further a qualitative method has been carried out in shape of an interview with the administrative official responsible of the sickness benefit at the social insurance office in Växjö. The result has shown that there are several reasons for the changes in the Swedish system. It seems as if the most important reason is the big number of individuals on the sick-list which causes economical problems, since the employment rate is too low compared to the retired quotient of the population. The economical crises might have an influence on the changes of the systems, but not the present recession. Despite the rather big changes from a social system towards a more liberal one, the Swedish scheme has still kept its basic characteristics. / En 2006, la Suède a eu un changement de gouvernement. Les sociaux-démocrates ont été remplacés par l'alliance entre les partis à droite. Le nouveau gouvernement mène une politique plus libérale que les sociaux-démocrates, et ils ont introduit plusieurs changements dans le système de santé et particulièrement dans le règlement de l'indemnité journalière. Ce mémoire a pour but d'examiner les changements dans le système, ainsi que les raisons de ces changements. Les méthodes appliquées sont l'archive et le corpus, puisque j'ai étudié les ouvrages relatifs à la santé ainsi que les sites Internet des institutions responsables de l'indemnité journalière en Suède et en France. J'ai aussi eu un entretien avec un employé de la Caisse de Sécurité sociale à Växjö qui s'occupe particulièrement de l'indemnité journalière. Les résultats de cette étude montrent qu'il y a plusieurs raisons à l'origine des changements dans le système suédois. Il semble que la raison la plus importante soit le nombre croissant de personnes en arrêt maladie ce qui génère des difficultés économiques, de même la proportion de la population active par rapport aux retraités est au cœur de la problématique. Enfin, les crises économiques peuvent influencer le système, mais la crise actuelle ne semble pas avoir eu une influence importante sur les changements. Malgré les changements assez bouleversants vers un système plus libéral en Suède, qui tend à se rapprocher légèrement du système français, le système suédois reste plus social que le système français.

A presente pesquisa visa analisar a dinâmica dos benefícios assistenciais do governo federal, buscando entender se a mesma se coaduna com a teoria dos ciclos eleitorais. Nesse sentido, foi avaliado se o número de concessões destes benefícios tenderia a crescer com a aproximação da eleições. Para atingir tal objetivo, foram utilizados dados mensais do número de concessões de três dos principais benefícios assistenciais brasileiros: o Benefício de Prestação Continuada, o Bolsa Família e o Auxílio Doença. Com base na análise das séries de tempo e dos dados em painel associados a estes últimos, foi possível detectar que a proximidade das eleições tende a afetar o número de concessões de benefícios assistenciais na maior parte dos casos analisados. Entretanto, a discussão dos resultados atingidos parece apontar no sentido de que os efeitos eleitorais encontrados não são tão somente resultados de manipulações eleitorais de políticos que visam à reeleição, mas frutos de uma dinâmica mais ampla, que seria característica de períodos eleitorais. / This research aims to analyze the dynamics of the welfare benefits of the federal government, seeking to understand whether it is consistent with the theory of electoral cycles. Accordingly, we assessed whether the number of concessions to these benefits tend to increase with the approaching elections. To achieve this, we used monthly data on the number of leases of three major Brazilian welfare benefits: the Benefício de Prestação Continuada, the Bolsa Família and Auxílio Doença. Based on the analysis of time series and panel data associated with the latter, it was possible to detect that the proximity of elections tends to affect the number of grants of welfare benefits in most cases analyzed. However, the discussion of the results indicate that the effects of elections are not solely the results of manipulations of politicians who seek reelection, but fruits of a wider dynamic that would be characteristic of elections.

Introdução: O tratamento do câncer retal melhorou ao longo das décadas com aprimoramento e surgimento de novas terapêuticas resultando em maior sobrevida. Assim, os resultados e o impacto pós-tratamento sobre a QVRS são cada vez mais considerados e não só a ausência da doença. Objetivo: Avaliar a qualidade de vida imediata e tardia relacionada à saúde em pacientes tratados de câncer retal com intenção curativa. Método: Estudo descritivo-exploratório, com delineamento de coorte prospectivo, de caráter observacional para geração de hipóteses acerca da qualidade de vida de pacientes com câncer de reto. Conduzimos com aplicação de entrevista por questionário específico para dados demográficos; questionário estruturado EORTC QLQ-C30 e EORTC-CR38 para avaliação da QVRS aplicados no início do tratamento, três meses após a cirurgia e 12 meses após. A casuística foi composta de 58 pessoas, totalizando 29 pacientes puderam participar conforme critérios de inclusão e 12 que puderam responder os questionários após 12 meses. Os escores de cada paciente foram comparados - início, após 3 meses de intervenção e 12 meses com ou sem estoma. Os dados foram organizados em planilha Excel e análise dos dados realizada utilizando o software R (R-project) versão 3.1.2. Resultados: Após três meses houve piora da satisfação sexual, Problemas sexuais femininos e Perspectiva futura. Melhoram os Sintomas Gastrointestinais, problemas esfincterianos e perda de peso. Após 12 meses a Perspectiva futura deteriorou, porém houve melhora dos Problemas relacionados ao estoma, Problemas esfincterianos e Imagem Corporal. Conclusão: Apesar de toda complexidade do tratamento multidisciplinar do câncer de reto dentro de um serviço especializado, a qualidade de vida ficou preservada e foi satisfatória na maioria dos quesitos estudados / Introduction: The treatment of rectal cancer has improved over the decades with improvement and emergence of new therapies resulting in greater survival. Thus, the results and post-treatment impact on HRQoL are increasingly considered and not just the absence of the disease. Objective: To evaluate the immediate and late health-related quality of life in patients treated for rectal cancer with curative intent. Method: A descriptive-exploratory study, with a prospective cohort design, with an observational character to generate hypotheses about the quality of life of patients with rectal cancer. We conducted with questionnaire interview application specific to demographic data; structured questionnaire EORTC QLQ-C30 and EORTC-CR38 for the evaluation of HRQoL applied at the beginning of treatment, three months after surgery and 12 months after. The sample consisted of 58 people, totaling 29 patients who could participate according to inclusion criteria and 12 who could answer the questionnaires after 12 months. The scores of each patient were compared - beginning, after 3 months of intervention and 12 months with or without stoma. The data were organized in Excel spreadsheet and data analysis performed using software R (R-project) version 3.1.2. Results: After three months there was worsening of sexual satisfaction, Female sexual problems and Future perspective. Improve Gastrointestinal Symptoms, Sphincter Problems and Weight Loss. After 12 months, the future Perspective deteriorated, but there was improvement of the problems related to the stoma, Sphincter problems and Body Image. Conclusion: Despite the complexity of the multidisciplinary treatment of rectal cancer within a specialized service, the quality of life was preserved and was satisfactory in most of the studied questions

INTRODUÇÃO: A Miastenia gravis (MG) é uma desordem imunológica com antígenos alvos conhecidos, com produção de anticorpos contra o receptor nicotínico de acetilcolina, AAChR e Musk, na junção neuromuscular, dificultando a transmissão do impulso nervoso e provocando fadiga e fraqueza flutuantes na musculatura ocular, facial, dos membros e respiratória. A terapêutica sintomática com inibidores de acetilcolinesterase e a etiopatogênica como a timectomia, corticosteróides, agentes citostásticos e imunoglobulinas são utilizadas e indicadas em acordo com a incapacidade e gravidade clínicas. A qualidade de vida (QV) é uma ferramenta utilizada para quantificar a eficácia e a resposta às terapêuticas adotadas, avaliar a efetividade e custos econômicos de novas estratégias terapêuticas, contribuir para planejar e aplicar os recursos para a saúde na comunidade. OBJETIVO: Avaliar a influência da terapêutica na QV e evolução clínica dos pacientes com MG. CASUÍSTICA: Foram avaliados 51 pacientes com MG, 38 submetidos a tratamento conservador e 13 timectomizados. MÉTODOS: Os instrumentos genéricos quantitativos de QV como WHOQOL, qualidade de vida relacionada à saúde (QVRS) SF-36, e depressão (BDI) foram utilizados. ESTATÍSTICA: Empregou-se análise univariada com os testes de Wilcoxon, U-Mann-Whitney, Fisher e razão de chance para avaliar a evolução clínica, a QV e QVRS e depressão; análise multivariada para a caracterização dos dois grupos de terapêutica considerando a interação de múltiplos fatores. RESULTADOS: O grupo submetido à terapêutica conservadora foi constituído por 16 pacientes do sexo masculino e 22 do feminino, com média de idade de 33,71±2,76 anos; o grupo timectomizado foi constituído por 6 homens e 7 mulheres, média de idade de 32,23±4,16 anos. Os pacientes do grupo conservador apresentaram melhora clínica estatisticamente significante (p <0,05) dos aspectos clínicos, da QV, da QVRS e depressão. Os timectomizados apresentaram melhora estatisticamente significante dos aspectos físicos e psicológicos da QV e QVRS e depressão, e melhora clínica evidente e não significante (p = 0,06). A análise multivariável mostrou r=0,65 para comparação das áreas; Wilks? Lambda para analisar as distâncias, X2 = 22,67; gl = 7; p = 0,05; as medidas centrais mostraram média = -0,42 dp = 1,0 para o grupo conservador; e média = 1,22, dp = 1,0 para o grupo timectomizado. CONCLUSÕES: Nesta amostra e no período avaliado constatamos que: 1) Os pacientes submetidos ao tratamento conservador apresentaram diferenças significantes com melhora clínica acentuada, de QV, de QVRS e depressão; 2) os timectomizados apresentaram melhora clínica, da QV e QVRS em seus aspectos físicos e psicológicos, e efetiva e significante melhora dos índices de depressão; 3) a análise multivariada revelou que a timectomia produziu efeito benéfico e significativo na recuperação da saúde e bem estar nos pacientes. / INTRODUCTION: Myasthenia gravis (MG) is an immune mediated disease with production of antibodies against post-synaptic acetylcholine receptor of neuromuscular junctions (AAChR,Musk) and orders in nervous impulse transmission. The disease´s clinical characteristics include fatigability and fluctuating weakness of voluntary muscles. Acetylcholinesterase inhibitors, thymectomy, corticosteroids, cytostatic agents and immunoglobulin are widely used and are indicated according to the patient´s disability and severity. Clinical manifestations, Quality of life (Qol), health-related (HRQol) analysis are used to evaluate response to therapy. Nowadays, Qol index is an important tool to evaluate the medical outcome, treatment efficacy, cost effectiveness and net benefit of new therapeutic strategies to determine whether their cost can be justified in the planning and application of health policies. OBJECTIVE: To evaluate the influence of conservative treatment and thymectomy on Qol and clinical response of myasthenic patients. SUBJECTS: Fifty-one myasthenic patients were chosen; 38 were submitted to conservative therapy and 13 to thymectomy. METHODS: Quantitative Qol tools such as WHOQOL, SF-36 and BDI were employed to evaluate Qol, HRQol and depression. STATISTICS: Univariate analysis by means of the Wilcoxon, U-Mann Whitney and Fisher tests, Chi-Square, odd ratio were used to follow the patient?s clinical status, evolution of Qol, HRQol and depression. Discriminant analysis was used to analyze the interation of multiple factors in the characterization of conservative and thymectomized groups. RESULTS: The conservative group of patients was constituted of 16 males and 22 females average age 33.71±2.76 years; the thymectomized group was composed of 6 males, 7 females, average age 32.23±4.16 years. Patients submitted to conservative therapy improved significantly in clinical progress, Qol, HRQol and depression. The follow-up of thymectomized patients showed a strong trend for clinical progress and significant improvement in physical and psychological Qol domains as well as in depression index. Discriminant analysis showed r = 0.65, p <0.05; Wilk?s Lambda X2 = 22.67, gl = 7; mean = -0.42, SD = 1.0 for conservative group; and mean = 1.22, SD = 1.0 for timectomized group. CONCLUSIONS: A prospective evaluation of a myasthenic patients sample revealed: 1) conservative treatment was found to have a strong and significant impact on clinical progress, Qol, HRQol and depression; 2) Thymectomy partly influenced Qol, specially physical and psychological aspects. There was also improvement in depression and clinical progress; 3) the evaluation of multiple parameters pointed to a strong and positive influence of thymectomy in the recovery of the patients.

INTRODUÇÃO: O impacto do diagnóstico do câncer de cabeça e pescoço e as consequências de seu tratamento podem alterar profundamente a qualidade de vida de um indivíduo. OBJETIVOS: Realizar a validação psicométrica do Patients Concerns Inventory - PCI-HeN para o Português-Brasil, caracterizar nos momentos pré-tratamento e após o diagnóstico, os graus de ansiedade e depressão, a qualidade de vida, a intensidade dos sintomas, suas necessidades, preferências e atitudes em relação às informações, suas preocupações, expectativas, o grau de preenchimento de suas expectativas (pós-tratamento). MÉTODOS - Parte I: Estudo transversal. Após as etapas de tradução e adaptação transcultural, a validade de construto foi realizada pela comparação do PCI com o Questionário de Qualidade de Vida da Universidade de Washington (UW-QOL). Parte II: Estudo prospectivo longitudinal. Os participantes completaram a Escala de Ansiedade e Depressão (HADS), o Questionário de Qualidade de Vida da Universidade de Washington (UW-QOL), o Inventário de Sintomas do M.D. Anderson (MDASI- HeN), o Questionário de Informação dos Pacientes (QIP), a versão em Português validada do Inventário de Preocupações dos Pacientes (IPP), o Protocolo de Avaliação das Expectativas (PAE) e o Protocolo de Preenchimento das Expectativas (PPE). Na primeira etapa, os testes não paramétricos de Mann-Whitney ou Kruskal-Wallis foram utilizados para avaliar a associação do número de itens/profissionais selecionados com as características dos pacientes. O teste de Mann-Whitney também foi utilizado para associar os escores dos domínios do UW-QOL com os itens/profissionais específicos selecionados pelos pacientes. Associações entre os itens/profissionais específicos selecionados com as características dos pacientes foram avaliadas por meio do teste Qui-Quadrado ou o teste Exato de Fisher. RESULTADOS - Parte I: Oitenta e quatro pacientes participaram do processo de validação. Os itens mais selecionados pelos pacientes no IPP foram: medo do câncer voltar, boca seca, mastigar/comer, e fala/voz/ser entendido. Os profissionais mais assinalados pelos pacientes foram o fonoaudiólogo, dentista e psicólogo. Os domínios físico e sócio-emocional do UW-QOL apresentaram correlações significantes com o número de preocupações e de profissionais selecionados. Resultados - Parte II: As amostras foram constituídas respectivamente por 104 pacientes (pré-tratamento), 80 pacientes (aos 6 meses) e 62 pacientes (aos 12 meses). Em todos os momentos do estudo, a maioria dos pacientes apresentou escores de ansiedade e de depressão dentro dos limites de normalidade. A qualidade de vida apresentou um declínio nos primeiros meses, seguida por uma melhora geral ao longo do primeiro ano. Os sintomas mais assinalados no MDASIH& N foram dor, preocupações, problemas de sono e dificuldade para engolir/mastigar (pré-tratamento), dificuldades para engolir/mastigar, boca seca e catarro (aos 6 meses) e boca seca, dificuldades para engolir/mastigar e preocupações (aos 12 meses). Em todas as épocas, a maioria dos pacientes desejava receber toda a informação possível. As principais preocupações dos pacientes e os principais profissionais por eles assinalados, foram: mastigar/comer, tratamento do câncer, fala/voz/ser entendido e engolir; fonoaudiólogo, nutricionista e oncologista/radioterapeuta. Em geral, as expectativas dos pacientes no momento prétratamento, eram boas. As expectativas dos pacientes em relação aos itens ligados à alimentação: mastigar/comer, boca seca, engolir, paladar e perda de peso foram as menos preenchidas após o tratamento. Foram encontradas diversas associações significativas entre a qualidade de vida global dos pacientes e o grau de preenchimento de várias expectativas após o tratamento. CONCLUSÕES: O Inventário de Preocupações dos Pacientes-IPP pode ser considerado apropriado e psicométricamente válido para uso em pacientes brasileiros portadores de câncer de cabeça e pescoço. Ao longo de um ano após o diagnóstico os pacientes com neoplasias de cabeça e pescoço tendem a apresentar diminuição de comorbidades (ansiedade e depressão), boa qualidade de vida (com declínio aos 6 meses), predomínio de sintomatologia física/funcional associada à preocupações, desejam todas as informações possíveis, têm preocupações eminentemente físicas/funcionais, associadas ao medo de recidiva da doença e priorizam o contato com os clínicos responsáveis pelo tratamento e reabilitação, têm suas expectativas gerais preenchidas e o nível de satisfação de suas expectativas impacta a qualidade de vida global / INTRODUCTION: The impact of cancer diagnosis and consequence of its treatment have a major effect on quality of life on these patients. OBJECTIVES: To perform a psychometric validation of the Patients Concerns Inventory - PCI-HeN in Portuguese-Brazil and characterize, at pre-treatment, and after diagnosis, the degree of anxiety and depression of patients, their quality of life, severity of symptoms, their preferences regarding information, their concerns, expectations, extent to which expectations were met (post-treatment). METHODS - Part I: Cross-sectional study. After the translation and transcultural adaptation stages, construct validity was determined by comparing the PCI against the University of Washington Quality of Life Questionnaire (UW-QOL). Part II: Prospective, longitudinal study. Participants completed the Anxiety and Depression Scale (HADS), the University of Washington Quality of Life Questionnaire (UW-QOL), the MD Anderson Symptom Inventory (MDASI-HeN), the Information Styles Questionnaire (ISQ), the validated Portuguese version of the Patient Concerns Inventory (PCI), the Expectations Assessment Protocol (EAP), and the Meeting Expectations Protocol (MEP). In stage one, non-parametric Mann-Whitney or Kruskal-Wallis tests were employed to assess the association of number of items/professionals selected with patient characteristics. The Mann-Whitney test was also used to associate scores on the UW-QOL domains with specific items/professionals selected by patients Associations of specific items/professionals selected with patient characteristics were assessed using the Chisquare or Fisher Exact tests. RESULTS - Part I: Eighty-four patients took part in the validation process. The items most frequently selected by patients on the PCI were: fear of cancer coming back, dry mouth, chewing/eating and speech/voice/being understood. The professionals most indicated by patients were speech/language therapist, dentist and psychologist. The physical and social-emotional domains of the UW-QOL were significantly correlated with number of concerns and of professionals selected. Results - Part II: The samples comprised 104 patients (pretreatment), 80 patients (at 6 months) and 62 patients (at 12 months), respectively. At all study timepoints, anxiety and depression scores of most patients were within normal limits. A decline in quality of life was evident in the first few months, followed by a general improvement during the course of the first year. The most frequently reported symptoms on the MDASI-H&N were pain, concerns, disturbed sleep and difficulty swallowing/chewing (pre-treatment), difficulties swallowing/chewing, dry mouth and catarrh (at 6 months), and dry mouth, difficulties swallowing/chewing and concerns (at 12 months). At all timepoints, most patients wished to receive all possible information. The main patient concerns and professionals selected were: chewing/eating, cancer treatment, speech/voice/being understood, swallowing; speech-therapist, nutritionist and oncologist/radiotherapist. In general, patient expectations at pre-treatment were good. Patient expectations for food-related items: chewing/eating, dry mouth, swallowing, taste and weight loss were the least met after treatment. A number of significant associations were found between global quality of life of patients and extent to which various expectations were met after treatment. CONCLUSIONS: The Patient Concerns Inventory-PCI was shown to be appropriate and psychometrically valid for use in Brazilian head and neck cancer patients. During the course of one year after diagnosis, the head and neck cancer patients tended to exhibit a decrease in comorbidities (anxiety and depression), good quality of life (with decline at 6 months), predominance of physical/functional symptoms associated with concerns, desire for all possible information, predominantly physical/functional concerns, associated with fear of disease recurrence and prioritized contact with the physicians responsible for treatment and rehabilitation, had general expectations met and the extent to which expectations were met impacted global quality of life

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-04-20T13:34:30Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Ana_Luiza_Bacelo_Correa.pdf: 1846985 bytes, checksum: ea2e1aefb251e3049dcd032a5529e3f6 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-04-20T14:22:01Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Ana_Luiza_Bacelo_Correa.pdf: 1846985 bytes, checksum: ea2e1aefb251e3049dcd032a5529e3f6 (MD5) / Made available in DSpace on 2018-04-20T14:22:16Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Ana_Luiza_Bacelo_Correa.pdf: 1846985 bytes, checksum: ea2e1aefb251e3049dcd032a5529e3f6 (MD5) Previous issue date: 2017-06-01 / Sem bolsa / O fumo em folha é o quinto produto mais exportado pelo país. O tabaco é cultivado principalmente em pequenas propriedades com mão de obra familiar. No sul do Brasil, aproximadamente 186 mil famílias obtém sua principal renda através da produção de tabaco. Devido ao seu método de produção pouco mecanizado e de intensivo trabalho, doenças ocupacionais são associadas a esse cultivo. Entre elas o risco de intoxicação pela nicotina presente nas folhas do tabaco, denominada doença da folha verde do tabaco (DFVT). Esta doença é provocada pela exposição à nicotina que ocorre através da absorção dérmica proveniente do contato das folhas de tabaco com a pele. Para prevenir a DFVT o uso do equipamento de proteção individual (EPI) na colheita do tabaco se faz necessário. Dessa forma, o objetivo da presente pesquisa foi analisar o entendimento do agricultor sobre a utilização do equipamento de proteção individual (EPI) na colheita do tabaco e como o produtor o relaciona com a doença da folha verde do tabaco (DFVT). Metodologicamente, trata-se de um estudo qualitativo, sendo a produção dos dados realizada em duas etapas. Para a realização da pesquisa utilizou-se um banco de dados baseado em entrevistas primárias realizadas pela equipe de extensão rural de Assistência Técnica e Extensão Rural(ATER) na região Centro Sul do Rio Grande do Sul. Foram selecionados os produtores para a realização das entrevistas semiestruturadas em quinze famílias. Os resultados confirmaram que a maioria dos produtores não utiliza a vestimenta de colheita, tendo como principal queixa, o desconforto térmico. Eles conhecem os riscos provenientes das folhas de tabaco e, por isso, utilizam-se de estratégias para evita-los através de adaptações em roupas/vestimentas existentes ou produzidas por eles. Outra estratégia utilizada é ir mais tarde para a lavoura, evitando assim o contato com as folhas úmidas pelo orvalho da manhã. Este fato mostra que os agricultores têm conhecimento sobre a vulnerabilidade de colher a folha do tabaco úmida. Todos estão conscientes sobre a existência da DFVT e muitos afirmaram que já se sentiram mal, com sintomas e sinais desta enfermidade. Nem todos acreditam que o EPI de colheita seja eficiente para a prevenção da DFVT. / Leaf tobacco is the fifth most exported product in the country. Tobacco is mainly cultivated in small properties with family based labor. In the south of Brazil, approximately 186 thousand families obtain their main income through tobacco production. Due to its poorly mechanized and intensive work, occupational diseases are associated with this cultivation. Among them is the risk of nicotine intoxication from tobacco leaves, called green tobacco sickness (GTS). The disease is caused by exposure to nicotine, which happens through dermal absorption when the skin gets in touch with the leaves. To prevent GTS it is necessary to wear personal protection equipment (PPE) during the tobacco harvest. Therefore, this research aims to analyze the farmer’s understanding over the use of the personal protection equipment (PPE) e how the farmer relates its use to the green tobacco sickness (GTS). Methodologically, this is a qualitative study, with a research strategies happening in two stages. For the research, an analysis was carried out over a database built on primary interviews performed by Technical Assistency and Rural Extension team from the South Central region of Rio Grande do Sul. Based on the database, fifteen families were enrolled in semi-structured interviews. The results confirmed that most farmers do not wear the harvesting garment, as a result ofthe thermal discomfort caused by the PPE. They know the risks coming from the tobacco leaves and, because of it, they use strategies to avoid them, like the use of adaptations instead of the recommended PPE. Furthermore they delay the harvest during the morning to avoid contact with moist leaves due to dew. This fact shows that the farmers know about the vulnerability of harvesting moist leaves. They are all aware of the existence of GTS and many affirm to have felt sick, showing symptoms and signs of the disease. Not all of them believe that the PPE is efficient on preventing GTS.

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

Les maladies émergentes à transmission vectorielle sont une préoccupation croissante et particulièrement lorsqu’elles affectent les chevaux, une population spécifiquement à risque vis-à-vis de la propagation de maladies. En effet, les chevaux voyagent fréquemment et, malgré l’impact sanitaire et économique des maladies équines, les règlementations sanitaires et les principes de biosécurité et de traçabilité censés assurer la sécurité des mouvements d'équidés ne sont pas toujours en place. Notre travail propose d'améliorer la surveillance des maladies à transmission vectorielle chez les chevaux en utilisant différentes méthodes pour estimer la probabilité d'émergence d'une maladie. Tout d'abord, nous avons développé un modèle quantitatif et spatio-temporel combinant différentes probabilités pour estimer les risques d'introduction de la peste équine et de l’encéphalose équine. Ces combinaisons permettent d’obtenir une image plus détaillée du risque posé par ces agents pathogènes. Nous avons ensuite évalué des systèmes de surveillance syndromique par deux approches méthodologiques: l'approche classique avec un seuil d'alarme basé sur un multiple de l'erreur standard de prédiction, et l'approche bayésienne basée sur le rapport de vraisemblance. Nous avons travaillé ici principalement sur la détection précoce du virus West Nile en utilisant les symptômes nerveux des chevaux. Les deux approches ont fourni des résultats prometteurs, mais l’approche bayésienne était particulièrement intéressante pour obtenir un résultat quantitatif et pour combiner différentes informations épidémiologiques. Pour finir, l'approche bayésienne a été utilisée pour combiner quantitativement différentes sources d'estimation du risque : surveillance syndromique multivariée, et combinaison de la surveillance syndromique avec les résultats d’analyses de risques. Ces combinaisons ont données des résultats prometteurs. Ce travail, basé sur des estimations de risque, contribue à améliorer la surveillance des maladies à transmission vectorielle chez les chevaux et facilite la prise de décision. Les principales perspectives de ce travail sont d'améliorer la collecte et le partage de données, de mettre en oeuvre une évaluation complète des performances des systèmes de surveillance multivariés, et de favoriser l'adoption de ce genre d’approche par les décideurs en utilisant une interface conviviale et en mettant en place un transfert de connaissance. / Emerging vector-borne diseases are a growing concern, especially for horse populations, which are at particular risk for disease spread. In general, horses travel widely and frequently and, despite the health and economic impacts of equine diseases, effective health regulations and biosecurity systems to ensure safe equine movements are not always in place. The present work proposes to improve the surveillance of vector-borne diseases in horses through the use of different approaches that assess the probability of occurrence of a newly introduced epidemic. First, we developed a spatiotemporal quantitative model which combined various probabilities in order to estimate the risk of introduction of African horse sickness and equine encephalosis. Such combinations of risk provided more a detailed picture of the true risk posed by these pathogens. Second, we assessed syndromic surveillance systems using two approaches: a classical approach with the alarm threshold based on the standard error of prediction, and a Bayesian approach based on a likelihood ratio. We focused particularly on the early detection of West Nile virus using reports of nervous symptoms in horses. Both approaches provided interesting results but Bayes’ rule was especially useful as it provided a quantitative output and was able to combine different epidemiological information. Finally, a Bayesian approach was also used to quantitatively combine various sources of risk estimation in a multivariate syndromic surveillance system, as well as a combination of quantitative risk assessment with syndromic surveillance (applied to West Nile virus and equine encephalosis, respectively). Combining evidence provided promising results. This work, based on risk estimations, strengthens the surveillance of VBDs in horses and can support public health decision making. It also, however, highlights the need to improve data collection and data sharing, to implement full performance assessments of complex surveillance systems, and to use effective communication and training to promote the adoption of these approaches.

Sjukfrånvaron inom de svenska kommunala vård- och omsorgsorganisationerna ökar. Samtidigt har en organiserings- och styrningsförändring skett inom dessa organisationer de senaste decennierna i form av införandet av New Public Management (NPM) och dess reformer. Studien syftade till att genom en kvalitativ fallstudie få en ökad förståelse för hur psykosociala och organisatoriska faktorer tillsammans kunde ha inverkan på en kommunal vård- och omsorgsorganisations sjukfrånvaro för organisationens medarbetare inom kontaktyrken och dess chefer. Detta utifrån att identifiera vad organisationens sjukfrånvaro orsakades av samt för att föreslå åtgärder för att förebygga framtida sjukfrånvaro. För att uppfylla syftet och studiens frågeställningar genomfördes semistrukturerade intervjuer med totalt 19 intervjupersoner som representerade de arbetsgrupper med organisationens högsta och lägsta sjuktal under 2019 samt de chefsgrupper med organisationens högsta och lägsta sjuktal under 2019. Empirin analyserades utifrån den teoretiska referensramen. Denna innefattade tidigare forskning samt teorier gällande NPM, struktureringsteori, psykosociala sjukfrånvarofaktorer, organisatoriska sjukfrånvarofaktorer, psykosociala friskfaktorer, organisatoriska friskfaktorer samt organisationshälsa. Studiens resultat visade på tre framträdande psykosociala sjukfrånvarofaktorer för medarbetare respektive chefer, fyra organisatoriska sjukfrånvarofaktorer för medarbetare respektive chefer, fyra psykosociala friskfaktorer för medarbetare respektive chefer samt fyra organisatoriska friskfaktorer för medarbetare och fem organisatoriska friskfaktorer för chefer. Resultaten visade att de psykosociala och organisatoriska sjukfrånvaro- och friskfaktorerna påverkade varandra, att det fanns ett samband mellan chefers och medarbetares upplevda arbetsmiljö samt att sjukfrånvaron framförallt kunde härledas till strukturer medan frisknärvaron istället kunde härledas till individers handlingar. Tio åtgärder för att minska sjukfrånvaron inom kommunala vård- och omsorgsorganisationer presenterades utifrån studiens resultat och potentiell vidare forskning har föreslagits. / Sickness absence within the Swedish municipal healthcare organizations is increasing. At the same time, there has been a change in organization and governance within these organizations in recent decades in the form of the introduction of New Public Management (NPM) and its reforms. The study aimed to gain a better understanding of how psychosocial and organizational factors together could have an impact on a municipal healthcare organization's sickness absence, regarding employees in the human service profession and its managers, through a qualitative case study. This to identify what was causing the organization's sickness absence and on proposing measures to prevent future sickness absence. To fulfill the purpose and study questions, semi-structured interviews were conducted with a total of 19 informants representing the working groups with the organization's highest and lowest sickness numbers in 2019 and the management groups with the highest and lowest sickness numbers in 2019. The empirical data was analyzed based on the theoretical frame of reference. This included previous research as well as theories of NPM, structuring theory, psychosocial sickness absence factors, organizational sickness absence factors, psychosocial health factors, organizational health factors and organizational health. The study's results showed three prominent psychosocial sickness absence factors for employees and managers, four organizational sickness absence factors for employees and managers, four psychosocial health factors for employees and managers, four organizational health factors for employees and five organizational health factors for managers. The results showed that the psychosocial and organizational sickness absence and health factors affected each other, that there was a connection between managers and employees perceived work environment and that the sickness absence could primarily be attributed to structures, while work attendance instead could be attributed to individuals' actions. Ten measures to reduce sickness absence within municipal healthcare organizations has been presented based on the results of the study, as well as suggestions for further research.