Made available in DSpace on 2016-06-02T20:18:18Z (GMT). No. of bitstreams: 1 TeseIAPW.pdf: 1512962 bytes, checksum: fa65d9db2288861ce39f29eb99b3533c (MD5) Previous issue date: 2004-12-02 / Work-related musculoskeletal disorders (WRMDs) are diseases that result in persistent pain, loss of functional capacity and associated work disability. This diagnostic is important because it is used to guide clinical and legal decisions. Their initial diagnosis is difficult because such diagnoses are based on complaints of pain and they often involve conflicting social and economic interests. Because of the complexity of such diagnoses, further studies are needed in order to analyze the association between subjective descriptions and objective findings. Therefore was made two research. The objective of the first research was to evaluate the impact of personal, clinical and occupational aspects on work ability of workers with and without WRMDs using an approved version of the Work Ability Index (WAI) and pain scale. This evaluated 127 workers of industrial production lines. A descriptive analysis was carried out using the Chi-square test and it was also performed a logistic regression analysis. A significant association was identified between the WAI and all personal, clinical and occupational aspects. Regression analysis showed that pain and sick leave together accounted for 59% of poor work ability. The objective of the second research was to evaluate the clinical and functional aspects of WRMDs, in relation to physical evaluation, perception of pain, self-reporting of symptoms and functional ability, among active workers at a single company with and without symptoms or evidence of this disorders. 134 female workers were physically evaluated by two trained physiotherapists. They filled out a questionnaire on discomfort due to pain, a pain scale, the Oswestry Disability Questionnaire (ODQ) and the Work Ability Index (WAI). The results were correlated and logistic regressions were run. According to the results symptom reports were explained by the results from the pain scale and the clinical findings and clinical findings by symptom reports and WAI. In two research the relationship between pain, symptom reports and clinical findings demonstrates that the patient s current state can be assessed not only by means of objective examinations, but also by means of instruments that take into account the patient s perception of his or her state. / Os distúrbios ostemusculares relacionados ao trabalho (DORT) podem resultar em dor crônica, diminuição da capacidade funcional e associada incapacidade para o trabalho.Seu diagnóstico é importante pois direciona as decisões clínicas e legais. No entanto, essas lesões apresentam desafios para seu diagnóstico e prognóstico, uma vez que envolvem indicadores subjetivos, porque há fatores de interesses sociais e econômicos envolvidos. Em função desta complexidade, mais estudos são necessários para analisar a associação entre relatos subjetivos e achados objetivos. Desta forma foram realizados dois estudos. O objetivo do primeiro foi avaliar o impacto de fatores pessoais, do trabalho e da lesão na capacidade funcional dos trabalhadores com e sem história de acometimento de lesões músculo-esqueléticas relacionadas ao trabalho, utilizando a aplicação autorizada do Índice de Capacidade para o Trabalho (WAI) e escala de dor. Este avaliou 127 trabalhadores de linhas de produção industrial. Os resultados foram analisados descritivamente, por meio do teste Qui-quadrado e pela análise de regressão logística. Todos os fatores pessoais, ocupacionais e clínicos analisados apresentaram relação significativa com a capacidade para o trabalho. A análise de regressão mostrou que dor e afastamento do trabalho explicaram juntas 59% da baixa capacidade para o trabalho. O objetivo do segundo estudo foi avaliar os aspectos clínicos e funcionais dos DORT, em relação a avaliação clínica, percepção da dor, auto-relato de sintomas e capacidade funcional através da avaliação de trabalhadores de uma mesma empresa, com sem sintomas de DORT. 134 mulheres foram fisicamente avaliadas por dois fisioterapeutas treinados e responderam a um questionário relacionado a sensação de dor ou desconforto, escala de dor, questionário de incapacidade de Oswestry (ODQ) e índice de capacidade para o trabalho (WAI). Os resultados foram correlacionados e a análise de logística foi aplicada. Os resultados indicaram que relatos de sintomas foram explicados pela escala de dor e exame clínico e o exame clínico foi explicado pelos relatos de sintomas e WAI. As associações entre dor, relatos de sintomas e exame clínico, demonstraram que o estado atual do paciente pode ser avaliado não somente por exames objetivos mas também por meio de instrumentos que levem em conta a percepção do próprio paciente sobre seu estado.

The thesis "Effects of surgery treatment of epilepsy on psychosocial condition of the patients" deals with the disease which causes many social effects on the patients. The most frequent ones are limitations in the working life and mental problems. I am interested in the epilepsy issue and therefore I have selected this topic which continues the bachelor thesis written in 2008. The objective of my work was to determine effects of epileptosurgery on the work life and on the mental area. Two hypotheses were established which assumed that the surgical treatment improved the patient´s life both in the working and in the mental spheres. The hypotheses were tested by means of quantitative research; questionnaires were used for the collection of data and the respondents were adult patients, who underwent surgical treatment of epilepsy and have been in the care of the Center of Epilepsy Na Homolce in Prague, and patients in the care of neurology departments in České Budějovice and in Strakonice. The results have shown that the epileptosurgery failed to improve the lives of the patients in the working sphere and thus the first hypothesis was not confirmed. Many of the patients are still unemployed and they still find it difficult to find jobs. The offer of vacancies has not increased much after the surgery. Those who work often feel stress and anxiety as a result. Some patients even lost jobs after the surgery or their working positions do not correspond to the achieved qualification level, experience and potential. The improvement in the mental area has been confirmed and many of the patients no more suffer from mental problems they had before the surgery. In some of the respondents mental disorders diminished or disappeared entirely. They are more self-confident, more even-tempered and they need less professional help. In this area I see the effects of surgical treatment as very beneficial. The results of my thesis might be used in publications for the general public, as well as for professionals specializing in the field.

Introdução – A capacidade para o trabalho é influenciada por vários fatores, incluindo a condição de saúde, características sócio-demográficas, estilo de vida e fatores relacionados ao trabalho. Objetivo – Analisar os fatores associados à capacidade para o trabalho em uma população de eletricitários. Métodos – Estudo transversal onde foram analisados 475 trabalhadores, voluntários, de uma empresa privada no setor eletricitário do Estado de São Paulo, Brasil. Os dados foram coletados por meio de questionários auto-preenchidos (Índice de Capacidade para o Trabalho - ICT, Escala Estresse no Trabalho - EET, Medical Outcomes Study 36 – Item short form health survey – SF-36, Questionário de Baecke, Questionário de tolerância de Fagerström e Questionário AUDIT). A relação entre as variáveis foi analisada por meio do coeficiente de correlação de Spearman, e para comparação das médias foram utilizados os testes Mann-Whitney e Kruskal-Wallis. A análise conjunta das variáveis foi feita por meio de regressão linear múltipla. Resultados – Foi identificada uma diminuição progressiva do valor do ICT significativamente associada aos aumentos da idade (r=-0,16, p<0,001), do índice de massa corporal (r=-0,17, p<0,001), do consumo de álcool (r=-0,11, p=0,019), do tempo na empresa (r=-0,17, p<0,001) e da intensidade do estresse no trabalho (r=-0,37, p<0,001). O valor do ICT apresentou elevação associada ao incremento da prática de atividade física (r=0,19, p<0,001). A média do valor do ICT esteve associada à unidade de trabalho (p=0,043). O ICT esteve associado significativamente com as diversas dimensões do estado de saúde físico e mental (p<0,001 em todas as dimensões). A análise múltipla, ajustada por sexo e tempo na empresa, evidenciou que os fatores que melhor explicaram a variação do ICT foram o estresse no trabalho e as dimensões da saúde física. Uma segunda análise, excluídas as dimensões da saúde, mostrou que o estresse no trabalho, a unidade de trabalho e características do estilo de vida foram os fatores que melhor explicaram a variação do ICT. Conclusões – A pesquisa evidenciou que o estresse decorrente de fatores psicossociais do trabalho, a elevação do índice de massa corporal, o consumo de bebida alcoólica e o local de trabalho podem contribuir para a diminuição da capacidade para o trabalho, e que uma boa qualidade do estado da saúde física e a prática de atividade física podem contribuir para a manutenção da capacidade para o trabalho dos eletricitários. / Introduction – The work ability receives influence of several factors, including the health state, social and demographic characteristics, the lifestyle, and factors related to work. Aim – To analyze the factors associated with work ability in a population of electric sector workers. Methods – This is a cross-sectional study. There have been analyzed 475 volunteers workers of a private company of the electric sector of São Paulo, Brazil. They answered the questionnaires: Work Ability Index - WAI, Work Stress Scale – WSS, Medical Outcomes Study 36 – Item short form health survey – SF-36, Baecke Questionnaire, Fagerström Tolerance Questionnaire and AUDIT test. These questionnaires got information regarding work ability, stress related to psychosocial factors at work, health state, smoking, alcohol intake and practice of physical activities. The statistical analyses were done using Spearman correlation coefficient, Mann-Whitney test, Kruskal-Wallis test, and multiple linear regression models. Results – There was a significant progressive decrease of the WAI value associated to the increase of the age (r=-0,16, p<0,001), body mass index (r=-0,17, p<0,001), alcohol intake (r=-0,11, p=0,019), time at company (r=-0,17, p<0,001) and intensity of work stress (r=-0,37, p<0,001). The WAI value presented elevation associated to the increment of the practice of physical activities (r=0,19, p<0,001). The mean of WAI was associated to workplace (p=0,043). The WAI had significant association with the several dimensions of the physical and mental health state (p<0,001 in all dimensions). The multiple analyses, adjusted for sex and time at company, showed that the factors that better explained the variability of WAI were work stress and the physical health dimensions. Another analysis, excluded the health dimensions, showed that work stress, local of work and lifestyle characteristics were those that better explained the variability of WAI. Conclusions – The stress related to psychosocial factors of the work, the body mass increase, the alcohol intake and the workplace can contribute to the decrease of work ability, and a good physical health state and the practice of physical activity can contribute to the maintenance of the work ability of the electric sector workers.

Denna studie har undersökt vilka förutsättningar en chef upplever sig ha för att tillämpa ett stödjande ledarskap inom den offentliga förvaltningen Vård och omsorg. Bakgrunden till denna studie bygger på att det finns ett behov av att personal som arbetar inom den offentliga förvaltningen Vård och Omsorg att utveckla sin kompetens. Detta behöver ske på grund av att personalens kunskapsbrister inom dessa verksamheter har medfört att brukare utsätts för risker om missförhållanden på grund av personalens kunskapsbrister. Studien har belyst vilka behov av stöd som de anställda inom Vård och omsorg kan tänkas behöva ha för att kunna utveckla sin kompetens. Det framkom att det kan finnas ett behov av stöd för eventuella kognitiva nedsättningar som kan beskrivas vara ett dolt funktionshinder. Efter detta har chefer som arbetar inom Vård och omsorg blivit intervjuade för att beskriva sin upplevelse av sina förutsättningar för att kunna ge sina medarbetare de stöd som kan tänkas behövas. Resultatet visade att det kunde ske om cheferna upplevde sig ha rätt förutsättningar för att arbeta med syfte, metod och ledarskap i relation med att det tydligt att det var brukarfokus som var syftet. Syftet förtydligade vad som skulle göras och varför det var viktigt med brukarfokus. Det gav också metodiska förutsättningar inför att kunna planera och utvärdera arbetet i verksamheten samt för medarbetarens utvecklings. Om brukarfokus var ett tydligt syfte kunde deras ledarskap liknas vid ett verktyg för att ge ett individanpassat stöd till medarbetaren. / The study has examined the conditions a manager feels he or she has for applying supportive leadership within the public administration Health and care. The background tells that there is a need for the employers in the public administration Health and Care to develop their skills. This is happened because the employers insufficient knowledge has affected the residents who need their support being exposed to risks of misconduct due to the staff's lack of knowledge. The study has highlighted the need for support that employees in Health and Care may need to be able to develop their skills. It emerged that there may be a need for support for any cognitive impairments that can be described as a hidden disability. After this, managers who work in Health and Care have been interviewed to describe their experience of their conditions to be able to give their employees the support that may be needed. The results showed that it could happen if the managers felt they had the right conditions to work with purpose, method, and leadership in relation to the fact that it was clear that it was the user focus that was the purpose. The purpose clarified what was to be done and why user focus was important. It also provided methodical conditions for being able to plan and evaluate the work in the business and for the employee's development. If user focus was a clear purpose, their leadership could be likened to a tool to provide individualized support to the employee.

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.

Abstract Coping at work and job retention have been on the list of priorities of European countries for some decades. Vocational rehabilitation is a key measure for preventing work disability, but its possibilities have remained unused in many respects. Moreover, rehabilitation tasks are defined differently depending on the perspective taken. The purpose of this thesis is to determine the possibilities that arise from defining work-related rehabilitation tasks in a way that combines different perspectives and interests. The research questions are: 1) What were the impacts on working career and psychosocial factors of an intervention for long-term unemployed people with disabilities? 2) What kind of processes and mechanisms promoted the working careers and other outcomes of the employed people during the interventions? 3) What forms of collaboration took place between the rehabilitees and different stakeholders, and to what extent did the rehabilitees have opportunities to choose and act during the process? The empirical data for the study were collected from two vocational rehabilitation research projects. The research design was a multiple case study from multiple perspectives combined with mixed methods. The materials were collected through surveys, individual and group interviews, documents, and register follow-up. We found the contextual mechanism through which the outcomes of the work-related rehabilitation emerged. The process was promoted or hindered by actions taken by all stakeholders. The promoting or hindering mechanisms were born through the actions taken by the supervisor in particular, the occupational health service and rehabilitation service provider, and the individual’s life situation factors. Similar factors promoted and hindered the re-employment and staying or returning to work outcomes. Enhancing the rehabilitees’ own agency is also important, regardless of how weak it is at the beginning. I also present a new way of assigning rehabilitation tasks, which structures the complexity of the field of work-related rehabilitation and helps manage it. Work-related rehabilitation is a combination of societal and individual actions. The results of this study will help all actors involved in rehabilitation to improve the outcomes of work-related rehabilitation by developing opportunities for the rehabilitees’ own agency and collaboration / Tiivistelmä Työurien jatkaminen on keskeinen eurooppalaisten yhteiskuntien selviämisen haaste. Kuntoutus on riittämättömästi hyödynnetty resurssi työurien pidentämiseksi. Lisäksi kuntoutuksen tehtävät määrittyvät eri näkökulmista eri tavalla. Tutkimuksen tavoitteena on tarkastella, miten työikäisten kuntoutuksen tehtävää voitaisiin määritellä eri toimijoiden intressejä ja päämääriä yhdistäen. Tutkimuskysymyksiä oli kolme: 1) Mitkä olivat monimuotoisen ammatillisen kuntoutuksen vaikutukset pitkäaikaistyöttömien työuraan ja muihin psykososiaalisiin tekijöihin? 2) Millaiset prosessit ja mekanismit edistivät työuria työllisten monimuotoisen ammatillisen kuntoutuksen interventiossa? 3) Minkälaisia yhteistyömuotoja työhön kytkeytyvässä kuntoutuksessa kuntoutujan ja eri toimijoiden välillä toteutui, ja missä määrin kuntoutujat pystyivät vaikuttamaan omiin valinta- ja toimintamahdollisuuksiinsa prosessin aikana? Aineisto koostui kahden ammatillisen kuntoutuksen kehittämishankkeen arviointitutkimusaineistoista. Tutkimusasetelma oli monitapaustutkimus, joka oli toteutettu moninäkökulmaisena mixed method –tutkimuksena. Aineistot oli koottu kyselyiden, yksilö- ja ryhmähaastatteluiden, dokumenttien ja rekisteriseurannan avulla. Aineistojen analyysejä oli tehty aineistokokonaisuuksittain analysoiden kvantitatiiviset ja kvalitatiiviset aineistot erikseen sekä yhdistämällä aineistoja tapaustutkimuksen keinoin. Tutkimuksessa löytyi mekanismi, jonka kautta kuntoutuksen tulokset syntyivät tai jäivät syntymättä. Edistävät ja estävät mekanismit liittyivät erityisesti esimiehen, työterveyshuollon ja kuntoutuksen palvelutuottajan toimintaan ja kuntoutujan elämäntilanteeseen. Samanlaiset tekijät edistivät ja estivät työttömillä ja työllisillä kuntoutumista. Lisäksi työhön kytkeytyvässä kuntoutuksessa kuntoutujan oman toimijuuden tukeminen on tärkeää, vaikka se alkuvaiheessa olisi vähäinen. Tutkimuksessa kuvataan työikäisten kuntoutuksen tehtävät uuden mallin avulla. Tämä jäsentää ammatillisen kuntoutuksen kentän kompleksisuutta ja auttaa hallitsemaan sitä. Työhön kytkeytyvä kuntoutus muodostuu yhteiskuntaan ja yksilöön kohdistuvista toimista, joilla mahdollistetaan työelämään paluu ja osallistuminen. Tulosten avulla kuntoutuksen toteuttajat, tutkijat ja viranomaiset voivat parantaa kuntoutuksen työuravaikutuksia kehittämällä kuntoutujan osallistumismahdollisuuksia ja yhteistoimintaa.

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.

Made available in DSpace on 2011-05-04T12:36:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / Dentre os instrumentos existentes para mensurar a capacidade para trabalho destaca-se o Índice de Capacidade para o Trabalho (ICT). Ele foi desenvolvido para mensurar o quão bem está, ou estará, um (a) trabalhador (a) neste momento ou num futuro próximo, equão bem ele ou ela pode executar seu trabalho, em função das exigências, de seu estado de saúde e capacidades físicas e mentais. O objetivo desta dissertação é avaliar algumas das propriedades psicométricas do ICT em trabalhadores de enfermagem. Os capítulos iniciais apresentam a revisão bibliográfica sobre estudos abordando qualidades psicométricas do ICT e conceitos referentes a alguns aspectos da qualidade psicométrica de instrumentos. Também apresenta os objetivos e justificava desse estudo. Os métodos e resultados são apresentados em dois artigos. O primeiro artigo investigou a confiabilidade teste reteste do ICT em uma amostra composta de 80 enfermeiros através dos coeficientes de correlação intraclasse (CCI), estatística Kappa e gráfico de Bland e Altman. No segundo artigo apresenta-se a validade de construto e a confiabilidade doICT em uma amostra de 1436 profissionais de enfermagem. Na validade de construto investigou-se a estrutura dimensional por meio da análise fatorial exploratória a partirda matriz de correlação policórica e análise paralela para retenção dos fatores a serem extraídos. Na validade de construto também investigou-se a correlação do ICT com alguns conceitos teoricamente relevantes na literatura sobre o tema através do cálculo da correlação de Spearman. Para avaliação da confiabilidade, medida através da consistência interna, foi utilizado os estimadores alfa de Cronbach e omega de McDonald. Os resultados evidenciaram confiabilidade teste reteste adequada para o índice; os valores do CCI e do Kappa ponderado mostraram concordância substancial (0,79 e 0,69, respectivamente). O gráfico de Bland e Altman mostrou que 95 por cento dasdiferenças entre a 1° e 2° medidas apresentam-se entre -6 e + 6 pontos, não mostrando um padrão sistemático entre ambas as medidas. O resultado do alfa de Cronbach e do omega de McDonald foi, respectivamente 0,80 e 0,87 indicando confiabilidade satisfatória. E a exclusão de qualquer questão não alterou substancialmente o resultado dos mesmos. Na validade de construto identificou-se estrutura bidimensional explicando 52,8 por cento da variância acumulada para os componentes principais e 42,0 por cento para os eixos principais. As hipóteses teóricas da validade de construto foram confirmadas com correlação direta e significativa do ICT com os escores de recompensa, controle e autoavaliação do estado de saúde; correlação inversa e significativa com a escala derecuperação após o trabalho, distúrbios psíquicos menores, esforço, excesso de comprometimento e demanda. Concluiu-se que o ICT, traduzido e adaptado para o português, apresentou propriedades psicométricas adequadas e que o mesmo dá suporte adicional para pesquisas na área de saúde ocupacional. / Among the existing instruments for measurement the work ability stands out the Work Abilty Index (WAI). It was developed to measure how well a worker is or will be in the present or near future, and how capable this worker is of performing work given the demands of the job and the health status and mental and physical capabilities of the worker. The purpose of this study is evaluate some of psychometric properties of the Work Ability Index (WAI) in nursing. The initial chapters present the revision bibliographic about studies focusing psychometric qualities of the WAI and some concepts referents the some aspects of the psychometric qualities instruments. It also presents the objectives of this study and justified. The methods and results of the present study are presented in two papers. The first paper investigated the test-retest reliability of the WAI in one sample composed of 80 nurses through the intra-class correlation coefficient (ICC), Kappa statistic and Bland and Altman graphic. In the second paper presents the construct validity and the reliability of the WAI in the sample of 1436 nurses. In the construct validity was assessed dimensional structure through for the exploratory factorial analyses from the polychoric correlate matrix and the parallel analysis for the retention of the factors. In the construct validity also investigated the correlate of WAI with the same theoretically relevant concepts in the literature about the theme thought of the calculus of the Spearman correlate. To assess the reliability, measure thought of internal consistence, we used Cronbach’s alpha and McDonald’s omega. The results showed appropriate test-retest reliability for the WAI; the value of the ICC and the weighted Kappa showed substantial agreement (0,79 e 0,69, respectively). The Bland and Altman graphic showed that 95% of the differences between 1° and 2° measurement present among -6 and + 6 points, not show a systematic pattern between the two measures. The results of the Cronbach’s alpha and McDonald omega was, respectively 0,80 e 0,87. And the exclusion of any issue did not substantially affect the outcome of these. We identified two-dimensional structure explaining 52,8% of the accumulated variance for the principal components and 42,0% for the principal axis. The theoretical hypothesis assumptions of the construct validity were confirmed with significant and direct correlate of the WAI with scores of the reward, control and Self-evaluation of the health state; correlated inversely and significantly with the Need for Recovery Scale, psychiatric disturbance, effort, overcommitment and demand. It was concluded that the WAI, adapted and translated for the Portuguese, showed appropriates psychometric properties and it give the supports additional research in occupational health.

Am Beispiel von Projektarbeit in der IT-Branche werden die Auswirkungen neuer Managementkonzepte auf die Zeitsouveränität von Projektbeschäftigten anhand qualitativer Interviews untersucht. Flexible Formen der Arbeitsorganisation zielen auf eine Veränderung des Arbeitskraftvermögens hin zu größerer Autonomie und Übernahme betrieblicher Verantwortung durch die Beschäftigten. Mit den veränderten Kontrollformen des Managements modifizieren sich die betrieblichen Machtverhältnisse. Im Konzept des Zeithandelns werden die aktiven Gestaltungsleistungen der Beschäftigten bei der Arbeitszeitgestaltung hervorgehoben, gleichzeitig können verschiedene zeitsoziologische Theorien integriert werden. Wesentliches Ergebnis der empirischen Untersuchung verschiedener Arbeitszeitkulturen in IT-Betrieben ist eine Machtverschiebung zugunsten des Managements. Auf Seiten der abhängig Beschäftigten ist positiv zu verbuchen: eine größere Autonomie in der Arbeit, die Ausdifferenzierung eigenständiger Zeitstile sowie eine hohe Wertschätzung und Anerkennung durch Vorgesetzte. Dagegen stehen restriktive Rahmenbedingungen wie Zeitdruck, ungünstige Bedingungen für die Work-Life-Balance und starke zeitliche und gedankliche Vereinnahmung der Beschäftigten durch den Betrieb. Durch das Fehlen kollektiver Formen der Interessenvertretung und einen defensiven Konfliktumgangsstil sind die betrieblichen Beziehungen durch individuelle Aushandlungsprozesse geprägt.

Am Beispiel von Projektarbeit in der IT-Branche werden die Auswirkungen neuer Managementkonzepte auf die Zeitsouveränität von Projektbeschäftigten anhand qualitativer Interviews untersucht. Flexible Formen der Arbeitsorganisation zielen auf eine Veränderung des Arbeitskraftvermögens hin zu größerer Autonomie und Übernahme betrieblicher Verantwortung durch die Beschäftigten. Mit den veränderten Kontrollformen des Managements modifizieren sich die betrieblichen Machtverhältnisse. Im Konzept des Zeithandelns werden die aktiven Gestaltungsleistungen der Beschäftigten bei der Arbeitszeitgestaltung hervorgehoben, gleichzeitig können verschiedene zeitsoziologische Theorien integriert werden. Wesentliches Ergebnis der empirischen Untersuchung verschiedener Arbeitszeitkulturen in IT-Betrieben ist eine Machtverschiebung zugunsten des Managements. Auf Seiten der abhängig Beschäftigten ist positiv zu verbuchen: eine größere Autonomie in der Arbeit, die Ausdifferenzierung eigenständiger Zeitstile sowie eine hohe Wertschätzung und Anerkennung durch Vorgesetzte. Dagegen stehen restriktive Rahmenbedingungen wie Zeitdruck, ungünstige Bedingungen für die Work-Life-Balance und starke zeitliche und gedankliche Vereinnahmung der Beschäftigten durch den Betrieb. Durch das Fehlen kollektiver Formen der Interessenvertretung und einen defensiven Konfliktumgangsstil sind die betrieblichen Beziehungen durch individuelle Aushandlungsprozesse geprägt.