Introduction : Cette thèse est constituée de trois articles liés les uns aux autres. Le premier s’attache à clarifier les perspectives théoriques et problèmes conceptuels entourant la notion de capacité/incapacité au travail, sa définition et son évolution au fil du temps. Les deuxième et troisième articles visent à évaluer les effets différentiels selon le genre de déterminants du retour au travail (RAT) et de la durée d’indemnisation ainsi que les coûts associés, dans une population de travailleurs indemnisés à long terme pour troubles musculosquelettiques (TMS). Méthodes : Dans le premier article, une revue systématique des définitions de l’(in)capacité au travail et une analyse comparative basée sur la théorisation ancrée débouchent sur une carte conceptuelle intégrative. Dans le second article, une cohorte de 455 adultes en incapacité à long terme pour TMS au dos/cou/membres supérieurs est suivie cinq ans au travers d’entretiens structurés et de données d’indemnisation. Des modèles de Cox stratifiés par genre ont été utilisés pour évaluer la durée jusqu’au premier RAT. Dans le troisième article, une cohorte populationnelle de 13,073 hommes et 9032 femmes en incapacité prolongée pour TMS au dos/cou/membres supérieurs a été suivie pendant trois ans à l’aide de données administratives. Des modèles de Cox stratifiés par genre ont été utilisés pour étudier la durée d’indemnisation et détecter les effets dépendants du temps. Les coûts ont également été examinés. Résultats : Les définitions analysées dans la première étude ne reflètent pas une vision intégrée et partagée de l’(in)capacité au travail. Cependant, un consensus relatif semble émerger qu’il s’agit d’un concept relationnel, résultant de l’interaction de multiples dimensions aux niveaux individuel, organisationnel et sociétal. La seconde étude montre que malgré des courbes de survie jusqu’au RAT similaires entre hommes et femmes (p =0.920), plusieurs déterminants diffèrent selon le genre. Les femmes plus âgées (HR=0.734, par tranches de 10 ans), d’un statut économique perçu comme pauvre (HR=0.625), travaillant ≥40 heures/semaine en ayant des personnes à charge (HR=0.508) et ne connaissant pas l’existence d’un programme de santé et sécurité sur leur lieu de travail (HR=0.598) retournent moins vite au travail, tandis qu’un revenu brut annuel plus élevé (par $10,000) est un facteur facilitant (HR=1.225). Les hommes de plus de 55 ans (HR=0.458), au statut économique perçu comme pauvre (HR=0.653), travaillant ≥40 heures/semaine avec une charge de travail physique perçue élevée (HR=0.720) et une plus grande précarité d’emploi (HR=0.825) retournent moins rapidement au travail. La troisième étude a révélé que trois ans après la lésion, 12.3% des hommes et 7.3% des femmes étaient encore indemnisés, avec un ratio de coûts homme-femme pour l’ensemble des réclamations de 2.1 :1. L’effet de certain prédicteurs (e.g. revenu, siège de lésion, industrie) varie selon le genre. De plus, l’effet de l’âge chez les hommes et l’effet de l’historique d’indemnisation chez les femmes varient dans le temps. Conclusion : La façon de définir l’(in)capacité au travail a des implications importantes pour la recherche, l’indemnisation et la réadaptation. Les résultats confirment également la pertinence d’investiguer les déterminants du RAT et de l’indemnisation selon le genre. / Introduction: This thesis consists of three interrelated papers. The first one set out to clarify conceptual issues surrounding the notion of work ability/disability, its definition and its evolution over time. The aims of the second and third paper are to assess the differential effect of the determinants of time to return-to-work (RTW) and compensation duration by gender, as well as the related costs, in workers receiving long-term compensation benefits for musculoskeletal injuries (MSIs). Methods: The first study consists of developing an integrative concept map of work (dis)ability through the systematic scoping review of its definitions and a comparative analysis based on the grounded theory approach. In the second study, a cohort of 455 adults on long-term disability due to work-related MSIs of the back/neck/upper limb was followed for five years through structured interviews and administrative databases. Cox regression modeling stratified by gender was used to assess time to a first RTW of at least three days. In the third study, a register-based cohort of 13,073 men and 9032 women with long-term claims related to neck/back/upper-limb MSIs was followed for three years. Main outcomes were compensation duration and costs. Gender stratified extended Cox models were used to study the compensation duration and detect time-varying effects. Results: The definitions analyzed in the first study do not reflect a shared, integrated vision of the exact nature and attributes of work (dis)ability. However, there seems to be a relative consensus that work (dis)ability is a relational concept resulting from the interaction of multiple dimensions at different ecological levels (individual, organizational and societal). The second study showed that despite similar survival curves of time to RTW between men and women on long-term disability (p=0.920), several factors influencing RTW differed by gender. Women’s risk factors included older age (HR=0.734 - in 10 years unit), poor perceived economic status (HR=0.625), working ≥40 hours/week and having dependents (HR=0.508) and awareness of workplace-based occupational health and safety program (HR=0.598); higher gross annual income (in $10,000s) was a facilitator (HR=1.225). In men, being over 55 years old (HR=0.458), poor perceived economic status (HR=0.653), working ≥40 hours/week and high perceived physical workload (HR=0.720) and higher job insecurity (HR=0.825) negatively influenced time to RTW. The third study revealed that three years post-injury, 12.3% of men and 7.3% of women were still receiving compensation benefits, with a male-female cost ratio of 2.1:1 for all compensation claims. Effects of certain predictors (e.g. income, injury site or industry) differed markedly between men and women. Age and claim history had time-varying effects in men and women’s models respectively. Conclusion: The way work (dis)ability is defined has important implications for research, compensation and rehabilitation. Results also confirm the importance of gender-sensitive studies to investigate the determinants of RTW and time on compensation benefits.

This practicum focuses on developing a deeper knowledge about stress and our external environments. It is directed towards the profession of Landscape Architecture, and healthcare facilities including professionals. It outlines critical information about stress: how stress affects people’s physical, emotional, mental health and well-being, and how landscape architects are able to mitigate different types of stress through the design and use of our exterior environments, offering respite and healing in times of great need. Stress reveals and manifests itself in numerous ways. It has become a major problem within our society, much bigger than people care to acknowledge or believe. Landscape Architects have the ability to help people reflect upon the stress that they are under by creating spaces that inevitably sooth their ‘selves’. Through the profession and subsequent work of Landscape Architects the awareness of stress can be addressed, helping bring respite and relieve tension and stress, whether large or small, which is extremely critical in today’s society. Through the use of gardens and exterior spaces designed with stress-relief in mind, we will be able to decrease hospital stays, drug use and the overall amount of money used by medical institutions and governments, while decreasing the progression and succession of illness and diseases related to and accentuated or propagated by, or due to stress. Through this document I will discuss ideas and theories that influence and/or are pertinent to Landscape Architecture and stress, as well as natural elements that should be taken into consideration when starting to design or when planning a design that will be situated within medical institutions and healthcare facilities, but not limited to, and including any other exterior environment (such as a backyard). It will also outline design elements which emphasize appropriate ways to design these spaces and places responsibly and sensitively. By understanding how people respond to stress, Landscape Architects may be able to design appropriate, beautiful spaces. Initially this practicum was directed towards designing beautiful, meaningful gardens for the sick and/or dying, as well as for the families, visitors, and employees within healthcare settings. It has evolved, to include how our brains and bodies are physiologically affected by spaces and places that we encounter, and how these spaces either reduce or increase stress responses within us, therefore, increasing or decreasing our ability to heal, be healthy, and feel well. Stress is a major condition that is often “down-played”, ignored, or not understood within society. It is in fact a very serious condition / illness that has the ability to dictate the outcome of our physical and mental performances, and especially our health and well-being. Landscape Architects have the ability and responsibility to contribute positively to people’s bodily reactions to spaces: exterior and interior.

Das Klinoskop ist die Firmenzeitschrift des Klinikums Chemnitz für Mitarbeiter, Patienten, Angehörige und für unsere Partner. Es erscheint in vier bis fünf Ausgaben pro Jahr in einem Umfang von 40 bis 92 Seiten im Vollfarbdruck. Unsere Firmenzeitschrift wurde seit 2006 von einer qualitativen Mitarbeiterinformation kontinuierlich zu einem relevanten Informationsmedium für unsere Partner wie niedergelassene Ärzte weiterentwickelt. Parallel soll das Klinoskop eine Publikation sein, mit der Patienten und Angehörige einen informativen Zugang zu Ihrem Klinkum Chemnitz erhalten. Damit möchten wir auch unseren Anspruch einer offenen Kommunikation unterlegen. / The Klinoskop is the corporate magazine of the Klinikum Chemnitz for our staff, patients and their family members as well as for our cooperating partners. It is published in full colour, with four or five issues per year, and each issue contains between 40 and 92 pages. Since 2006, our corporate magazine has been continuously refined from a high-quality publication for our staff to the relevant information medium for our partners, in particular physicians in private practice. At the same time, the Klinoskop is intended to be a publication that provides patients and their relatives with more detailed information about their Hospital in Chemnitz. This also helps us to emphasize our intentions of fostering open communication.

Das Klinoskop ist die Firmenzeitschrift des Klinikums Chemnitz für Mitarbeiter, Patienten, Angehörige und für unsere Partner. Es erscheint in vier bis fünf Ausgaben pro Jahr in einem Umfang von 40 bis 92 Seiten im Vollfarbdruck. Unsere Firmenzeitschrift wurde seit 2006 von einer qualitativen Mitarbeiterinformation kontinuierlich zu einem relevanten Informationsmedium für unsere Partner wie niedergelassene Ärzte weiterentwickelt. Parallel soll das Klinoskop eine Publikation sein, mit der Patienten und Angehörige einen informativen Zugang zu Ihrem Klinikum Chemnitz erhalten. Damit möchten wir auch unseren Anspruch einer offenen Kommunikation unterlegen. / The Klinoskop is the corporate magazine of the Klinikum Chemnitz for our staff, patients and their family members as well as for our cooperating partners. It is published in full colour, with four or five issues per year, and each issue contains between 40 and 92 pages. Since 2006, our corporate magazine has been continuously refined from a high-quality publication for our staff to the relevant information medium for our partners, in particular physicians in private practice. At the same time, the Klinoskop is intended to be a publication that provides patients and their relatives with more detailed information about their Hospital in Chemnitz. This also helps us to emphasize our intentions of fostering open communication.

Das Klinoskop ist die Firmenzeitschrift des Klinikums Chemnitz für Mitarbeiter, Patienten, Angehörige und für unsere Partner. Es erscheint in vier bis fünf Ausgaben pro Jahr in einem Umfang von 40 bis 92 Seiten im Vollfarbdruck. Unsere Firmenzeitschrift wurde seit 2006 von einer qualitativen Mitarbeiterinformation kontinuierlich zu einem relevanten Informationsmedium für unsere Partner wie niedergelassene Ärzte weiterentwickelt. Parallel soll das Klinoskop eine Publikation sein, mit der Patienten und Angehörige einen informativen Zugang zu Ihrem Klinikum Chemnitz erhalten. Damit möchten wir auch unseren Anspruch einer offenen Kommunikation unterlegen. / The Klinoskop is the corporate magazine of the Klinikum Chemnitz for our staff, patients and their family members as well as for our cooperating partners. It is published in full colour, with four or five issues per year, and each issue contains between 40 and 92 pages. Since 2006, our corporate magazine has been continuously refined from a high-quality publication for our staff to the relevant information medium for our partners, in particular physicians in private practice. At the same time, the Klinoskop is intended to be a publication that provides patients and their relatives with more detailed information about their Hospital in Chemnitz. This also helps us to emphasize our intentions of fostering open communication.

Das Klinoskop ist die Firmenzeitschrift des Klinikums Chemnitz für Mitarbeiter, Patienten, Angehörige und für unsere Partner. Es erscheint in vier bis fünf Ausgaben pro Jahr in einem Umfang von 40 bis 92 Seiten im Vollfarbdruck. Unsere Firmenzeitschrift wurde seit 2006 von einer qualitativen Mitarbeiterinformation kontinuierlich zu einem relevanten Informationsmedium für unsere Partner wie niedergelassene Ärzte weiterentwickelt. Parallel soll das Klinoskop eine Publikation sein, mit der Patienten und Angehörige einen informativen Zugang zu Ihrem Klinikum Chemnitz erhalten. Damit möchten wir auch unseren Anspruch einer offenen Kommunikation unterlegen. / The Klinoskop is the corporate magazine of the Klinikum Chemnitz for our staff, patients and their family members as well as for our cooperating partners. It is published in full colour, with four or five issues per year, and each issue contains between 40 and 92 pages. Since 2006, our corporate magazine has been continuously refined from a high-quality publication for our staff to the relevant information medium for our partners, in particular physicians in private practice. At the same time, the Klinoskop is intended to be a publication that provides patients and their relatives with more detailed information about their Hospital in Chemnitz. This also helps us to emphasize our intentions of fostering open communication.

Das Klinoskop ist die Firmenzeitschrift des Klinikums Chemnitz für Mitarbeiter, Patienten, Angehörige und für unsere Partner. Es erscheint in vier bis fünf Ausgaben pro Jahr in einem Umfang von 40 bis 92 Seiten im Vollfarbdruck. Unsere Firmenzeitschrift wurde seit 2006 von einer qualitativen Mitarbeiterinformation kontinuierlich zu einem relevanten Informationsmedium für unsere Partner wie niedergelassene Ärzte weiterentwickelt. Parallel soll das Klinoskop eine Publikation sein, mit der Patienten und Angehörige einen informativen Zugang zu Ihrem Klinikum Chemnitz erhalten. Damit möchten wir auch unseren Anspruch einer offenen Kommunikation unterlegen. / The Klinoskop is the corporate magazine of the Klinikum Chemnitz for our staff, patients and their family members as well as for our cooperating partners. It is published in full colour, with four or five issues per year, and each issue contains between 40 and 92 pages. Since 2006, our corporate magazine has been continuously refined from a high-quality publication for our staff to the relevant information medium for our partners, in particular physicians in private practice. At the same time, the Klinoskop is intended to be a publication that provides patients and their relatives with more detailed information about their Hospital in Chemnitz. This also helps us to emphasize our intentions of fostering open communication.

Das Klinoskop ist die Firmenzeitschrift des Klinikums Chemnitz für Mitarbeiter, Patienten, Angehörige und für unsere Partner. Es erscheint in vier bis fünf Ausgaben pro Jahr in einem Umfang von 40 bis 92 Seiten im Vollfarbdruck. Unsere Firmenzeitschrift wurde seit 2006 von einer qualitativen Mitarbeiterinformation kontinuierlich zu einem relevanten Informationsmedium für unsere Partner wie niedergelassene Ärzte weiterentwickelt. Parallel soll das Klinoskop eine Publikation sein, mit der Patienten und Angehörige einen informativen Zugang zu Ihrem Klinikum Chemnitz erhalten. Damit möchten wir auch unseren Anspruch einer offenen Kommunikation unterlegen. / The Klinoskop is the corporate magazine of the Klinikum Chemnitz for our staff, patients and their family members as well as for our cooperating partners. It is published in full colour, with four or five issues per year, and each issue contains between 40 and 92 pages. Since 2006, our corporate magazine has been continuously refined from a high-quality publication for our staff to the relevant information medium for our partners, in particular physicians in private practice. At the same time, the Klinoskop is intended to be a publication that provides patients and their relatives with more detailed information about their Hospital in Chemnitz. This also helps us to emphasize our intentions of fostering open communication.

Das Klinoskop ist die Firmenzeitschrift des Klinikums Chemnitz für Mitarbeiter, Patienten, Angehörige und für unsere Partner. Es erscheint in vier bis fünf Ausgaben pro Jahr in einem Umfang von 40 bis 92 Seiten im Vollfarbdruck. Unsere Firmenzeitschrift wurde seit 2006 von einer qualitativen Mitarbeiterinformation kontinuierlich zu einem relevanten Informationsmedium für unsere Partner wie niedergelassene Ärzte weiterentwickelt. Parallel soll das Klinoskop eine Publikation sein, mit der Patienten und Angehörige einen informativen Zugang zu Ihrem Klinikum Chemnitz erhalten. Damit möchten wir auch unseren Anspruch einer offenen Kommunikation unterlegen. / The Klinoskop is the corporate magazine of the Klinikum Chemnitz for our staff, patients and their family members as well as for our cooperating partners. It is published in full colour, with four or five issues per year, and each issue contains between 40 and 92 pages. Since 2006, our corporate magazine has been continuously refined from a high-quality publication for our staff to the relevant information medium for our partners, in particular physicians in private practice. At the same time, the Klinoskop is intended to be a publication that provides patients and their relatives with more detailed information about their Hospital in Chemnitz. This also helps us to emphasize our intentions of fostering open communication.

Das Klinoskop ist die Firmenzeitschrift des Klinikums Chemnitz für Mitarbeiter, Patienten, Angehörige und für unsere Partner. Es erscheint in vier bis fünf Ausgaben pro Jahr in einem Umfang von 40 bis 92 Seiten im Vollfarbdruck. Unsere Firmenzeitschrift wurde seit 2006 von einer qualitativen Mitarbeiterinformation kontinuierlich zu einem relevanten Informationsmedium für unsere Partner wie niedergelassene Ärzte weiterentwickelt. Parallel soll das Klinoskop eine Publikation sein, mit der Patienten und Angehörige einen informativen Zugang zu Ihrem Klinikum Chemnitz erhalten. Damit möchten wir auch unseren Anspruch einer offenen Kommunikation unterlegen. / The Klinoskop is the corporate magazine of the Klinikum Chemnitz for our staff, patients and their family members as well as for our cooperating partners. It is published in full colour, with four or five issues per year, and each issue contains between 40 and 92 pages. Since 2006, our corporate magazine has been continuously refined from a high-quality publication for our staff to the relevant information medium for our partners, in particular physicians in private practice. At the same time, the Klinoskop is intended to be a publication that provides patients and their relatives with more detailed information about their Hospital in Chemnitz. This also helps us to emphasize our intentions of fostering open communication.