Försäkringskassan (FK) har fått i uppdrag av regeringen att vidareutveckla bedömningsförfarandet för sjukskrivna i Sverige. Som en del i detta har bland annat ett nytt bedömningsinstrument tagits fram för att användas vid arbetsterapeutisk kompletterande bedömning av medicinska förutsättningar för arbete. Instrumentet bygger på det redan befintliga bedömningsinstrumentet Assessment of Work Performance (AWP), med tre utvalda arbetsuppgifter och kallas för AWP-FK. Syftet med den här studien var att göra en initial prövning av AWP-FK med fokus på innehållsvaliditet och användbarhet. Som metod användes kvalitativa telefonintervjuer med nio arbetsterapeuter som ingick i Försäkringskassans pilotstudie. Resultatet indikerar att AWP-FK har en god innehållsvaliditet och användbarhet. Arbetsterapeuterna i studien ansåg att instrumentet var relevant för både målgruppen och bedömning i förhållande till den reguljära arbetsmarknaden. Några förslag på förändringar föreslogs, t.ex. att förtydliga vissa instruktioner i manualen till AWP-FK. I diskussionen tas vikten av att klienterna förstår syftet med bedömningen och får återkoppling på sitt utförande upp. Även bedömningsmiljöns påverkan på bedömningen har diskuterats. Vidare studier kring AWP-FK behövs för att säkerställa en god validitet, användbarhet och reliabilitet. / The Swedish Social Insurance Agency (Försäkringskassan, FK) has been commissioned by the Government to further develop the assessment procedure for those on sick leave in Sweden.  As part of this, a new assessment instrument has been developed for occupational therapy assessment of the medical ability to work. The instrument is based on the Assessment of Work Performance (AWP), using three selected tasks, and is called AWP-FK. The purpose of this study was to do an initial assessment of AWP-FK with a focus on content validity and utility. The method chosen was qualitative telephone interviews with nine occupational therapists who participated in the Agency's pilot study. The results indicate that AWP-FK has good content validity and utility. The occupational therapists in the study believed that the instrument was relevant, both for the target group and assessment in relationship to the regular labour market. Some suggestions for change have been included, for example that certain instructions in the AWP-FK manual be clarified. The importance of clients understanding the purpose of the assessment and receiving feedback on their performance, and the influence of the assessment environment is discussed. Further studies on AWP-FK are needed to ensure high validity, utility and reliability.

<p>I denna uppsats behandlas ohälsans regionala utveckling och syftet är att analysera vad som påverkar den svenska ohälsan. Teori angående hushållens val mellan fritid och arbete används för att analysera resultaten från den empiriska undersökningen. Bakgrunden till denna uppsats bottnar i utvecklingen av ohälsotalen som har ökat med 5,1 dagar mellan åren 2000 och 2004. De empiriska resultaten påvisar att arbetslösheten har ett positivt samband med ohälsa och att kvinnor tenderar att vara mer sjuka än män. Vidare bekräftar resultaten att inkomsten har ett negativt samband med ohälsa och detta är även sant för stora företag. Följaktligen har små företag en positiv inverkan på ohälsotalen och en analys av kommuner belägna i den norra delen av Sverige påvisar ett högre ohälsotal än övriga kommuner. Vidare är individernas ålder en faktor som kan förklara utvecklingen av öhälsotalen. Dessa resultat bekräftar att arbetslöshet, kön, inkomst, företagsstorlek, ålder och kommuner belägna i den norra delen är faktorer som kan förklara ohälsotalens utveckling, men även andra faktorer är av betydelse.</p> / <p>This thesis examines the regional development of ill-health and the purpose is to analyse factors that tend to influence the Swedish ill-health. Theory of household choice between work and leisure is used when analysing the results of the empirical study. The background for this thesis is derived from the development of ill-health that has increased with 5.1 days between the years 2000 and 2004. The empirical findings show that unemployment has a positive relationship with ill-health and that women tend to be more ill than men. Furthermore, the results confirm that income has a negative relationship with ill-health and this is also true for large companies. Consequently, small companies have positive influence on ill-health and an analysis of the municipalities in the northern part of Sweden points out a higher number of ill-health than the other municipalities. Moreover, the individuals’ age is also a factor that can explain the development of ill-health. These findings confirm that unemployment, gender, income, size of company, age, and the municipalities in the north-ern part are factors that can explain the development of ill-health. However, other factors are important in the process as well.</p>

Rheumatoid arthritis (RA) is a progressive disease, often leading to disability. Because the disease course develops rapidly during the first years after diagnosis, more knowledge is needed about the early disease course to minimize later disability. This thesis describes the course of disability in early RA such as hand function, pain intensity, activity limitation and sick leave. In addition, this thesis compares disability between women and men and compares disability between RA patients and referents. This thesis is primarily based on data from the 320 patients that were included in the multi-centre project in Sweden called ‘Early interventions in rheumatoid arthritis’ (TIRA). A wide range of outcome variables was registered between 1996 and 2006 during regular follow-ups from time for diagnosis through the eight-year follow-up. Outcome regarding disease activity and disability of RA patients still remaining in TIRA at the three and five year follow-up respectively are used in this thesis. Data concerning sick leave were obtained for the patients during six years (1993-2001) – three years before and three years after diagnosis. Referents were included in two of the studies. Data regarding disability in referents were obtained according to hand function and activity limitation using the Health Assessment Questionnaire (HAQ). Data for sick leave were obtained for six years in referents, for the same period as the RA patients. For most variables, disability in RA was most pronounced at time of diagnosis but before intervention started. Disability was then reduced already at the 3-month follow-up and thereafter affected but stable during the following five years. The exception was participation, reflected by sick leave, a variable that was stable from inclusion to three years from diagnosis. Activity limitation, pain intensity and sick leave in RA that represents different aspects of disability were explained by other aspects of disability and contextual factors rather than by disease activity. RA affects women and men differently in some aspects. Women had more severe course of activity limitations than men according to HAQ. Men were more affected than women in range of motion, although the differences were small in a clinical perspective. However, pain intensity and frequency of sick leave did not differ between women and men. Patients with RA have pronounced disability in relation to referents although several variables improve soon after diagnosis. This discrepancy refers to hand function as well as activity limitations and sick leave. The frequency of sick leave increased during the year before diagnosis in relation to referents and was thereafter high compared to sick leave in referents.

Syftet: Syftet med denna uppsats är att studera och kartlägga i vilken utsträckning användandet av formella styrmedel, i ambitionen att minska sjukfrånvaron, skiljer sig mellan stora och små företag. Metod: Vi har i denna studie tillämpat en kvantitativ forskningsmetod för att besvara uppsatsens forskningsfråga och syfte. Detta sker med hjälp av en explorativ studie, baserad på 60 slumpmässigt utvalda konsultföretag inom ekonomisk och juridisk verksamhet. Vi har utifrån befintliga teorier skapat hypoteser som testats på verkligheten och vi följer därför en deduktiv ansats. Det empiriska materialet har samlats in via telefonintervjuer och svaren har sedan sammanställts i olika tester i SPSS. Slutsats: Vi kan utifrån vår studie konstatera att användandet av formella styrmedel skiljer sig mellan stora och små företag i tre av fyra avseenden, nämligen användandet av nyckeltal, kalkyler som beslutsunderlag och användandet av förebyggande åtgärder. Detta trots att sjukfrånvaron inte skiljer sig åt mellan stora och små företag. / Purpose: The purpose of this paper is to study and map out to what extent the use of management control systems vary between small and large companies in their ambition to decrease sick leave. Method: To fulfill the purpose of this study, we have used a deductive approach. We have conducted telephone interviews with 60 randomly selected consultancy companies within the accounting and legal field. The data has been analyzed using the computer software SPSS. Conclusion: We have come to the conclusion that the use of management control systems vary between small and large companies in three of four aspects, namely, the use of KPI’s, costs accounting and preventive measures.

Syftet med denna studie var att analysera anmälda arbetsolyckor inom sjöfarten utefter frekvens och konsekvens och således kunna dra slutsatser om vilka arbetsolyckor som är allvarligast. Studiens syfte var också att finna eventuella samband mellan dessa olyckor. Efter kontakt med Sjöfartens arbetsmiljönämnd beställdes statistik från Arbetsmiljöverket. Denna statistik bearbetades på olika vis, bland annat genom att stora avgränsningar gjordes gällande typ av befattning ombord. Efter att ha studerat hur förutsättningarna för anmälan av arbetsskada förändrats valdes relevanta år. Resultatet av studien visar att när en person snubblar, halkar, trampar snett eller går tungt leder det i många fall till lång sjukfrånvaro. Det är också denna typ av olyckor som sker oftast. Att en person förlorar kontroll över föremål eller utrustning för förflyttning av material är också något som sker ofta och leder till lång sjukfrånvaro. Det enda riktiga samband som hittats är att den yttre faktorn tross (förtöjningslina/grovt tågvirke) förekommer i flera arbetsolyckor med olika konsekvens och orsak. / The purpose of this thesis was to analyse the reported work-related accidents in shipping by using frequency combined with consequence. Thereafter the purpose was to reach conclusions regarding which work-related accident was the most serious. The thesis also aimed to find if there were any connections between these accidents. Statistics were ordered from the Swedish Work Environment Authority. These statistics were processed in several ways, for instance demarcations regarding position onboard was made. Since the conditions of reporting workrelated accidents had changed during time, relevant years was chosen after consideration. The result of the study shows that when a person experiences an accident where he or she stumbles, trips, slips or treads heavily, the person is more likely to have a long sick-leave. These types of accidents are also the most common ones. To lose control of equipment or to lose control of equipment used to move material is also a common accident leading to a long sickleave. The only connection found is that the external factor hawser is present at several accidents with different consequences and cause.

The aim of the study was to explore the methods used in horticultural therapy gardens in rehabilitating people suffering from fatigue syndrome. Nine horticultural therapy gardens were contacted of wich three chose to participate. Using case study as method e-mail interviews was carried out with the participants about their establishment and what kind of theories they based their methods upon. The material collected from the interviews was complemented with additional data from the establishments web pages and information pamphlets. Collected data was processed trough content analysis and then formed as background for the development of a program theory for horticultural therapy. The results show some variations in how the different establishments practice horticultural therapy and how they assess and follow up their work. The program theory of horticultural therapy contains gardening and residing in the garden, conversational therapy, autogenic exercise and stress managment. These activities are expected to lead to a higher degree of self perception, a reevaluation of one´s conceptions and higher self esteem. Through these activities the participants are given an increased ability to handle their lives, which in turn is thought to make it possible for them to return to work or studies. The abcense of clearly defined goals with the rehabilitation makes it difficult to determine how effective it is in bringing people with fatigue syndrome back to work. / Syftet med studien var att undersöka hur trädgårdsrehabilitering tillämpas av några verksamheter för att göra en jämförelse i syfte att påvisa likheter och skillnader. Nio verksamheter kontaktades varav tre valde att delta. En fallstudie utfördes där de tre verksamhetsansvariga intervjuades via e-post om sina verksamheters organisation och grundfilosofi samt hur verksamheten utväderades och följdes upp. Som komplement till intervjuerna granskades även verksamheternas presentationer av sig själva på hemsidor och i broschyrer. Resultatet ger en bild av hur tre verksamheter som bedriver trädgårdsrehabilitering för utmattningsdrabbade är utformade, samt i vilken utsträckning de gör utvärderinga och uppföljningar. Gemensamma inslag i rehabiliteringen var trädgårdsvistelse/aktiviteter, hantverksaktiviteter, samtal, stresshantering och avslappningsövningar. Utvärderingar och uppföljningar skedde i varierande grad och med olika mätinstrument. Som en del i att försöka tydliggöra de tänkta verkningsmekanismerna i trädgårdsrehabiliteringen och ge en översiktlig bild av metoden, utformades även en programteori. Den utgår från verksamheternas metoder samt vetenskaplig evidens inom området. Programteorin visar hur de tänkta aktiviteterna förväntas leda fram till slutresultatet. Den, för trädgårdsrehabilitering, utformade programteorin innehåller vistelse i trädgård och trädgårdsarbete, samtalsterapi, avslappningsövningar och stresshantering. Aktiviteterna förväntas leda till en ökad självinsikt, ett ändrat förhållningssätt och en bättre självkänsla, och genom det en ökad förmåga att hantera sin livssituation. Detta antas ge de förutsättningar som behövs för att kunna återgå till arbetsliv eller studier, alternativt fortsätta rehabiliteringen med arbetsträning. Avsaknaden av tydliga, mätbara mål med rehabiliteringen gör det svårt att värdera hur effektiv rehabiliteringsformen egentligen är på att återinföra utmattningsdrabbade i arbetslivet.

Hensikt. Mange kommuner har over år hatt svært stram økonomi.  Mange av kommunene har som endel av tiltakene for å få økonomien i balanse foretatt omfattende omorganiseringer.  Generelt sett har det vært lite fokus på hva omorganiseringene koster i form av tidstap, frustrasjoner og stress, økt sykefravær og rene utgifter i form av konsulenter etc. Metode 14 ansatte på alle nivå i organisasjonen ble intervjuet om deres opplevelser i forbindelse med omorganisering.  Dette ble satt sammen med vurderinger av sykefravær statistikk og omkostninger som skulle komme frem i regnskapene. Resultat De ansatte som ble intervjuet var meget opptatt av ikke å stipulere for stor bruk av tid.  Da lot de heller være å angi tid.  Likevel ble resultatene av brukt tid til samtaler, møter og frustrasjoner formidable.  Det var i denne kommunens sykefraværs statistikk ikke mulig å kunne si noe om økt sykefravær på grunn av omorganisering.  Derimot fortalte de ansatte selv om at de hade blitt syke på grunn av prosessene. Kostnadene til omorganisering var ført i  ordinært driftsregnskap. Mye av de faktiske kostnadene var derfor ikke mulig å finne tilbake til i etterkant. Konklusjon:  Omorganiseringer koster svært mye i medgått tid.  Ansatte blir syke av økt stress  og mangel på kontroll, økt arbeisbyrde, press og usikkerhet.  Kostnader i form av for eksempel konsulenter, flyttinger og innkjøp av nytt utstyr må tas med i en helhet.  For å vurdere innsparingene ved en omorganisering må man se det opp mot omkostningen med omorganisering.  Det har til nå ikke blitt tatt tilstrekkelig hensynt til. Det anbefales å gjøre videre forskning på omorganiseringer og de totale omkostningene. / Aim  The municipalities in Norway have for the last decades been given a lot of new tasks and the economy has been poor.  In order to reduce costs many municipalities  has chosen to restructure the organisation.  There has been little attention given to what a reorganisation really costs in terms of loss of time, frustrations, stress, increased sick leave and actual expenditures. Method 14 employees from all over the organisation were interviewed on their experiences with reorganisations.  These results were put together with the results of the sick leave statistics and the numbers from the accounts.  Result  The employees were very concerned not to exaggerate the use of time.  They would rather not estimate any time used.  All the same, the time used was of incredible dimensions.  This municipality’s statistics on sick leave did not give any evidence that the reorganisations caused more sickness in the organisation.  But the employees told about being sick from the processes. The expenses for the reorganisation process were accounted for in the ordinary accounting system.  It was not possible to identify and extract the actual expenses 3 – 4 years later. The exception was the expenses connected to the consultants. Conclusions  The expenses in terms of time used are huge.  The employees get sick from stress and lack of control, increased workload, pressure and uncertainty. Expenses as the costs of consultants, expenditures of new outfits and moving expenditures must also be considered.   In an evaluation of the savings made through a reorganisation, the all expenses must be considered in full in order to have a true evaluation.  Until today such evaluation do not seem to have been done.   It is a recommended to do further research on this subject / <p>ISBN 978-91-85721-31-3</p>

Aim: The overall aim of this thesis was to study health-related quality of life (HRQoL) and return to work in the first 3 years following a breast cancer diagnosis, and to identify clinical and contextual factors associated with these outcomes. Method: The four studies were part of a population-based cohort study including women identified in the Breast Cancer Quality Register in central Sweden. Of 1,573 women asked to participate, 69% (n=1,093) responded to a baseline questionnaire, 62% (n=977) responded at the 1st follow-up and 54% (n=856) participated at the 2nd follow-up (mean time 4, 16 and 38 months post-diagnosis, respectively). Studies II and IV only included women aged &lt;63 years at diagnosis. In Study IV, each woman was individually matched to five breast-cancer-free controls. Questionnaire data on HRQoL, socio-demographics and work-related variables were combined with clinical register, normative and social insurance data. Main findings: Study I: Women with breast cancer, particularly women aged &lt;50 years, experienced poorer HRQoL at baseline than normative data. Chemotherapy, lack of social support, sick leave and a poor financial situation were associated with poorer HRQoL. Study II: Compared with pre-diagnosis working time, 72% of participating women reported no change, 2% had increased their working time, 15% reported a decrease in working time and 11% did not work at the 1st follow-up. Chemotherapy, cancer-related work limitations and less value attached to work increased the odds of job discontinuation/decreased working time. Study III: During the 3 years post-diagnosis, HRQoL generally improved. Less consistent improvements were found among women on sick leave/disability pension pre-diagnosis and women reporting job discontinuation/decreased working time post-diagnosis. Study IV: The proportion of women with breast cancer on sick leave steadily decreased during the 3 years post-diagnosis, but they were more likely to be on sick leave than the controls. Chemotherapy, fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd and 3rd year post-diagnosis. Conclusions: Most women with breast cancer gradually recover, but there are subgroups of women who may be particularly vulnerable. In a clinical setting, increased attention should be directed towards women undergoing chemotherapy, young women, women on sick leave/disability pension pre-diagnosis and women who do not return to work to the same extent as pre-diagnosis.

Background: Chronic pain, defined as non-malignant pain emanating from the musculoskeletal system, may limit everyday activities, social functioning and the quality of social and working life for individuals, creating disability as well as incurring high economic and public costs for society. Controlled studies show that cognitive-behavioural interdisciplinary rehabilitation has a positive effect on functioning in patients who have been disabled by chronic non-malignant pain conditions. Positive outcomes described include lower pain intensity, less preoccupation with pain, greater independence and lower consumption of healthcare. On the other hand, the return to work rate varies. To facilitate comparisons on the national level and to enable audit spirals for single programmes as part of the ongoing quality assurance in healthcare the Swedish Quality Registry for Pain Rehabilitation (SQRP) has aggregated data since 1998 on all patients referred to the majority of Swedish rehabilitation units. The aim of this dissertation was to improve the knowledge base of pain rehabilitation in Sweden using the validated self-reported instruments of pain and its consequences included in the SQRP. Methods: The SQRP data were collected before, at the end and 1 year after the intervention for all individuals included, and concerns self-reported demographic variables, pain intensity, activities, thought patterns, impact of pain on daily life and life satisfaction. Individual sick leave data were collected from the Swedish Social Insurance after 1 year. Data collected from 19833 patients (6002 men and 13831 women) of which 7289 participate in work ability improving programmes, were used. Results: The results of four studies included in this thesis showed that the SQRP provided a basis for scientific works since it use the validated self-report instruments of pain and its consequences and contain a large amount of patient’s data. However, a lack of follow-up data from some units influenced the opportunity of to analyse long-term outcomes. Nevertheless, the SQRP was a useful tool to audit and evaluate as well as to propose optimising of pain rehabilitation. It seemed that contextual factors such as patients’ own beliefs and expectations, education, gender, actual sick leave and employment situation had more importance for the effect of rehabilitation programme than pain characteristics, depression or activity limitation. The Multidimensional Pain Inventory (MPI) scale scores and MPI coping profiles might be used for assessing the outcomes of treatment interventions. A reduction of MPI scale scores for Pain severity and Interference decreased the risk of being on full-time sick leave. On the other hand, the MPI coping profiles Dysfunctional, among both men and women, and Interpersonally distressed, among women, were associated with higher odds of being on full-time sick leave. Conclusions: Attending cognitive-behavioural interdisciplinary pain rehabilitation programmes in Sweden resulted in improvements of the MPI scales after completing a pain rehabilitation programme and this improvement was sustained after 1 year. Moreover, these programmes decreased the levels of full-time sick leave 1 year after completed programme. The findings suggest also the need to tailor rehabilitative strategies differently for men and women as well as for different pain coping profiles.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser. NB: Spikblad saknas.