The aim of this thesis was to investigate in a (RCT) the effect of support group intervention in women with primary breast cancer in the short term, and with a long-term follow-up. Women with primary breast cancer were randomized between April 2002 and November 2007 and stratified according to adjuvant treatment with chemotherapy. Of 382 eligible patients, 191+191 patients were randomized to intervention and control groups respectively. Control patients were subjected to standard follow-up procedures. Patients in the intervention group received support intervention at the Foundation of Lustgården Mälardalen during one week followed by four days of follow-up two months later. Patients in intervention and control groups filled in questionnaires at baseline, after 2, 6 and 12 months and in the long-term follow-up after a mean of 6.5 years. In paper I, we studied the effect of the intervention on anxiety and depression measured by the HAD scale and we could show that a significantly lower proportion of women in the intervention group had high anxiety scores compared with women in the control group after 12 months; however, the proportion of women with high depression scores were unaffected. In paper II, we studied the effect of the intervention on fatigue and health-related quality of life (HRQoL) measured by the Norwegian version of the fatigue questionnaire (FQ) and EORTC-QLQ 30 and BR 23.We could not demonstrate any significant effect of the intervention. In paper III, we studied the effect of the intervention on sick-leave, healthcare utilization and the effect of the intervention in economic terms. We used a specially formulated questionnaire. There was a trend towards longer sick leave and more health-care utilization in the intervention group. The difference in total costs was statistically significantly higher in the intervention group after 12 months (p= 0.0036). In paper IV, we studied the long-term effects of the support intervention on anxiety, depression, fatigue and HRQoL. We could show a significant effect of the intervention on cognitive function, body image, future perspective and fatigue, the largest effect was seen among women who received chemotherapy; however, no effects on anxiety and depression were demonstrated.

Nurses report high rates of back pain with consequent disability, work absenteeism and attrition from the profession. In the current climate of an international nursing shortage, efficacious interventions to reduce the impact of back pain must be developed. It is uncertain what components a back pain preventive intervention should comprise. Appropriate and reliable means to assess back pain and disability in nurses is also undetermined. The first aim of this thesis was to undertake a mixed methods program of research to inform the development of an intervention to prevent back pain in nurses. The second aim of the thesis was to examine the psychometric and measurement properties of back pain and disability outcome instruments frequently applied in nursing samples. Epidemiological studies were undertaken to examine factors associated with back pain in nursing cohorts. In student nurses, a history of manual handling work was found to be significantly associated with neck and back pain outcomes. In a large population cohort study of nurses and midwives, pain characteristics (pain severity and radiation), pain-related cognitive and behavioural factors (kinesiophobia and passive pain coping), job characteristics (job classification and manual handling task frequency) as well as demographic interactions explained sick leave due to back pain. A systematic review was undertaken to determine the efficacy of interventions aiming to prevent back pain and back injury in nurses. Due to methodological heterogeneity, a qualitative synthesis of evidence was undertaken on the 16 studies that met inclusion criteria. The review identified moderate level evidence from multiple trials that manual handling training in isolation is not effective and multidimensional interventions are effective in preventing back pain and injury in nurses. Single trials provided moderate evidence that stress management programs do not prevent back pain and limited evidence that lumbar supports are effective in preventing back injury in nurses. There was conflicting evidence regarding the efficacy of exercise interventions and the provision of manual handling equipment and training. A qualitative description study was employed to explore the beliefs and perceptions of nursing stakeholders regarding risk factors for back pain and strategies to prevent back pain in nurses. Stakeholders identified individual, intrapersonal, organisational and environmental risk factors that were consistent with the social ecological view of health. They believed that interventions targeting the individual would be ineffective in the absence of workplace and other reforms. At the individual level, they recommended strategies that address physical, psychological and occupational preparedness for nursing work. In addition, they suggested ecological intervention strategies to induce change at the intrapersonal, organisational, community and policy levels. A mixed method synthesis of evidence was performed to develop an evidence-based and stakeholder-relevant intervention that aims to reduce the impact of back pain in nurses. The proposed intervention incorporates evidence-based multidimensional strategies that address individual and organisational level factors, and proposes ecological factors that may warrant inclusion once evidence of their causal association with back pain is established. Methodological studies examined the psychometric and measurement properties of key instruments used to assess back pain and disability in nursing populations. An extended version of the Nordic Musculoskeletal Questionnaire – that is frequently modified when applied in nursing cohorts - was developed and deemed to have acceptable test-retest reliability. The Oswestry Disability Index was found to have unacceptable measurement properties for application in nursing samples, and is therefore not recommended for future studies of back pain related disability in the nursing population. In summary, this program of research contributes novel insights that can meaningfully inform understanding of back pain prevention in nurses. Factors not previously assessed in nursing populations have been examined and shown to be significantly related to back pain outcomes. The strength of existing evidence for the prevention of back pain and injury in nurses has been established, and methodological advances regarding appropriate and reliable measurement of back pain and disability have been made. The views and perceptions of stakeholders from multiple levels and vantage points have been considered and integrated within the interpretation of evidence from multiple mixed method studies. In fact, stakeholders have played a crucial role in the identification of an appropriate theoretical framework – the social ecological paradigm - to conceptualise back pain causality in nurses and identify relevant solutions. A future research agenda of expanded scope is implicated to adequately address back pain prevention in nurses.

Diss. (sammanfattning) Stockholm : Stockholms universitet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 4 uppsatser.

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

In Brazil, much has been published on the nature of sickness absence of civil servants employed in federal institutions of higher education, but so far, there are few researches that used for such purposes the data base of the Integrated Administration System of Human resources-SIAPE. This study aimed to identify possible diferences between sickness absence of civil servants employed in the health sector and those working in other sectors of a federal institution of higher education located in Minas Gerais, with a corresponding population to 4011 servers.This cross-sectional study, with data collected from the webpage Siapnet health module, includes 1.860 sickness absence for treatment of the server and for sick family care; 1.318 of these sickness absence referred to servants of the health sector (group I) and 542 to servants of other sectors (group II), all of both sexes and holding positions compatible with 2nd and 3rd degree education. These sickness absence were granted between January and June 2012.We classified the diagnosis of the cause of morbidity in accordance with ICD 10. The statistical evaluation included descriptive analysis of the sample. We used the Kolmogorov-Smirnov test to ensure the normality of data. We employed the Mann-Whitney U-test to evaluate the difference between medians, and to verify the associations between variables statistical Pearson s chi-square test or the Binomial test were used. We adopted a significance level of 5% (p ≤ 0,05) for the analyses. In the two groups we investigated, the highest sickness absence rates occured in Group I, among females, and in the 40 to 50 age group. In both groups, were characterized days away with short duration (1 to 14 days). Musculoskeletal and connective tissue disorders are the most frequent causes of sickness absence in the Group I; the factors that are determinants of health, the contact with health services and the respiratory diseases were the main causes of sickness absence in Grupo II. The results presented in this study confirm the health sector, female, aged between 40 and 50 years as predictors of risk of sickness absenteeism factors, as well as increased frequency of musculoskeletal and connective tissue diseases on servers in the health area, tendency corroborated in other studies. / No Brasil, muito tem sido publicado sobre o perfil dos afastamentos de servidores públicos lotados em instituições federais de ensino superior entretanto, até o momento, são escassos as pesquisas que utilizaram para tais fins a base de dados do Sistema Integrado de Administração de Recursos Humanos-SIAPE. Este estudo teve como objetivo conhecer possíveis diferenças entre as licenças médicas para tratamento de saúde de servidores lotadas na área saúde e outras áreas em uma instituição federal de ensino superior em Minas Gerais com uma população correspondente a 4011 servidores. Trata-se de um estudo de corte transversal sendo os dados colhidos através da página Siapnet módulo saúde, referentes à 1860 licenças médicas para tratamento do servidor e para o acompanhamento de familiar doente; destas, 1318 licenças médicas foram referentes a servidores lotados na área saúde (grupo I) e 542 licenças referentes a servidores de outras áreas (grupo II), de ambos os sexos, cargo compatível ao 2º e 3º grau de escolaridade, durante o período de janeiro a junho de 2012. O diagnóstico da causa mórbida foi classificado segundo a CID 10. A avaliação estatística compreendeu a realização da análise descritiva da amostra. Para avaliar a normalidade dos dados utilizou-se o teste de Kolmogorov-Smirnov. As diferenças entre as medianas foram avaliadas por meio dos testes não paramétricos de Mann-Whitney; para verificar as associações entre as variáveis foram utilizados os testes estatísticos do Qui-quadrado de Pearson ou o teste Binomial. O nível de significância nas análises foi de 5% (p ≤ 0,05). A maior frequências das licenças médicas ocorreu no Grupo I, bem como entre as mulheres, e na faixa etária de 40 a 50 anos, para os dois grupos estudados. Os dias afastados para ambos os grupos, correspondeu a curta duração (entre 1 a 14 dias). As doenças osteomuscular e do tecido conjuntivo foram às causas motivadoras mais frequentes das licenças no Grupo I; os fatores que influenciam o estado de saúde e o contato com serviços de saúde e as doenças respiratórias foram as principais causas das licenças entre os servidores do Grupo II. Os resultados apresentados neste estudo confirmam a área da saúde, sexo feminino e idade entre 40 e 50 anos, como fatores de risco preditores de absenteísmo por doença, bem como a maior frequência das doenças osteomuscular e do tecido conjuntivo em servidores lotados na área saúde, tendência corroborada por outros estudos. / Mestre em Ciências da Saúde

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

M.A. (Psychology) / Please refer to full text to view abstract

Sjukfrånvaro innebär en kostnad för både arbetsgivare och arbetstagare. För en anonym fullgrossist är detta ett problem på en av deras lagerlokaler, där sjukfrånvaron är hög. Uppsatsen syftar till att identifiera intressanta mönster över tid som leder till sjukfrånvaro genom att analysera data från företagets lönesystem och tidssystem. Datamaterialet är longitudinellt och för att upptäcka mönster som leder till sjukfrånvaro används sekvensanalys. För att generera de sekventiella mönstren används algoritmen cSPADE då den möjliggör att tidsbegränsningar kan anges för sekvenserna. Relevansen hos de genererade sekvenserna utvärderas med tre intressemått: support, konfidens och lift. Tre separata analyser genomförs där olika antal variabler används, beroende på om de förändras över tid eller har ett konstant värde, och för dessa analyser aggregeras data veckovis. De vanligaste händelserna som leder till sjukfrånvaro hos expeditörer är olika anställningstider, kön och födelseår. Några dagars sjukfrånvaro under en vecka, det vill säga mellan 8 och 40 timmar, är mer förekommande bland expeditörerna jämfört med kortare respektive längre sjukfrånvaro. Det går att konstatera att mönster med tidigare sjukfrånvaro ofta leder till fortsatt sjukfrånvaro. Uppsatsen belyser även de problem som uppstår inom sekvensanalys, till exempel att konstanta variabler överskuggar de icke-konstanta variablerna i de genererade sekvenserna. Detta händer när variabler som förändras över tiden används i kombination med variabler som har konstanta värden, något som kan förekomma i longitudinella datamaterial. / Absence due to sickness results in a cost to both employers and employees. For an unnamed wholesaler this is a problem at one of their warehouses, where the rate of sick leave is high. The aim of this thesis is to identify interesting patterns over time that lead to sick leave by analyzing data from the company's payroll system and their attendance system. The data is longitudinal and to detect the patterns that lead to sick leave, sequence analysis is used. To generate the sequential patterns the algorithm cSPADE is used since it allows time constraints to be specified for the sequences. The relevance of the generated sequences is evaluated with three interest measures: support, confidence and lift. Three separate analyses are performed where different variables are used, depending on whether they change over time or have a constant value, and for these analyses the data is aggregated weekly. The most common events that lead to sick leave for the employees are different duration of employment, gender and birth year. A few days sick leave during a week, namely between 8 and 40 hours, is more common among the employees compared to shorter and longer sick leave. It can be noted that the pattern of previous sick leave usually leads to continued sick leave. The thesis also highlights the problems that arise in sequence analysis, for example that the constant variables overshadow the non-constant variables in the resulting sequences. This happens when variables that change over time are used in combination with variables that have a constant value, which may occur in longitudinal data.