Avhandlingen består av två studier som utgår från projektet ”Det goda arbetet”. Det överordnade syftet med projektet Det Goda Arbetet var att använda tandvård som ett exempel på ett arbete där relationerna med patienterna utgör arbetets kärna. Denna typ av arbete (även kallat människovårdande arbete) har speciella psykosociala arbetsmiljövillkor och känslomässiga krav som måste tas hänsyn till vid organisering av arbetet. Syftet med den första studien var att beskriva bakgrunden och utvecklingen av frågeformuläret ’Svenska och Danska tandläkares uppfattning av ’Det Goda Arbetet’ och att skapa ett mått för generell arbetstillfredsställelse, applicerat på fyra organisatoriska miljöer. Syftet med den andra studien var att introducera konceptet emotionellt arbete i tandvård genom att ge en teoretisk överblick av de emotionella aspekterna av arbetet, villkoren under vilka arbetet utförs och de potentiella effekterna på tandläkarnas välbefinnande. I kappan har kompletterande resultat från projektet Det Goda Arbetet inkluderats i syfte att ge en empirisk illustration av hur tandläkare upplever de emotionella faktorer som relaterar till patient-interaktionen och deras arbetsglädje. Data från 1226 danska och svenska verksamma tandläkare samlades in i November 2008 med en svarsprocent på 68 %. Ett additivt index skapades för att mäta generell arbetstillfredsställelse, och resultaten visade statistiska skillnader i tandläkarnas uppfattning mellan de olika organisatoriska miljöerna (Svenska offentliga/privata och Danska offentliga/privata). De danska offentliga tandläkarna hade den högsta graden av generell arbetstillfredsställelse medan de svenska offentliga hade den lägsta graden. En möjlig förklaring till detta kan vara att danska offentliga tandläkare skiljer sig från de andra tre grupperna i karakteristika vad gäller både tandläkare och patienter. Den låga graden av generell arbetstillfredsställelse hos de offentliga svenska tandläkarna kan möjligtvis vara en effekt av New Public Management-tänkande i sättet att organisera tandvård. Tilläggsresultaten visade att de svenska offentliga tandläkarna hade mycket mindre energi till sina privatliv i jämförelse med de andra tre grupperna och bara hälften av dem förväntade sig att fortsätta arbeta som nu fram till pensionen. Att arbeta med eller på människor handlar mycket om att skapa goda interaktioner och relationer mellan vårdgivaren och patienten. Goda patientrelationer kan vara ett primärt- och/eller sekundärt mål för att göra andra saker, som t.ex. den kliniska behandlingen, lättare. För många vårdgivare är relationerna med patienterna en arena där de kan leva ut sin potential som människor och kan upplevas som en bestående inre glädje av arbetet, kallat eudaimonia. I patientrelationen utför tandläkaren emotionellt arbete som ett sätt att intervenera med patienten för att vägleda denne i en bestämd riktning. Tandläkare har uttalade emotionella arbetsuppgifter i sina interaktioner med patienterna, emellertid har dessa emotionella aspekter av arbetet hitintills varit ett försummat forskningsområde inom odontologin. De emotionella arbetsuppgifterna är betingade eftersom att tandläkarens incitament inte är endimensionella och därför kräver de en hel del emotionell flexibilitet, uppmärksamhet och reflektion av tandläkaren. Påverkan från marknadskrafter och managerialism på de professionella värdena inom tandvård kan av tandläkaren uppfattas som motstridande och utmana villkoren för emotionellt arbete och tandläkarnas välbefinnande. Denna forskning syftar till att starka och uppmuntra olika nivåer av tandvård till att ytterligare undersöka, förstå och stötta dynamiken i de emotionella aspekterna av arbetet för att skapa en hållbar arbetsmiljö där värden och logik kan uppfattas som kompatibla med tandvårdens professionella värden. / The thesis consists of two papers which are based on a research project called ‘Good Work’. The overall aim of the Good Work project was to use dentistry as an example of work which has close relations with patients at its core. This kind of work (also called human service work) has special psycho-social work environment considerations and emotional requirements, which need to be considered when organizing work. The aims of the first study were to describe the background and development of the questionnaire ‘Swedish and Danish Dentists’ Perceptions of Good Work’ and to create a measure of overall job satisfaction, applying the measure in four organizational settings. The aim of the second study was to introduce the concept of emotion work in dentistry by giving a theoretical overview of the emotional aspects of work, the conditions under which it is performed and the potential effects on the dentist’s wellbeing. Additional results from the Good Work project have been included in the thesis with the purpose of giving an empirical illustration of how dentists experience the emotional factors related to patient interaction and their job satisfaction. Data from 1226 Danish and Swedish practising dentists was collected in November 2008, with a 68% response rate. An additive index was created to measure overall job satisfaction showing statistical difference in the dentists’ experience according to affiliation (Swedish public/private, Danish public/private). The Danish public dentists had the highest degree of overall job satisfaction and the Swedish public dentists had the lowest. A reason for this difference might be that Danish public dentistry differs from the other three groups in the characteristics of both dentists and patients. However, the lower job satisfaction for the Swedish public dentists could be an effect of New Public Management thinking in organizing dentistry. The additional results showed that Swedish public dentists had substantially less energy left for their private lives compared with the other three groups and only half of them expected to continue working as they do now until retirement. Working directly with or on people is very much about creating good interactions and relations between the health professional and the patient. Good patient relations can be a primary aim and/or a secondary aim, to make other things, e.g. the clinical treatment, easier. To many health professionals their relations with the patients is an arena in which to activate their human potentials and can be experienced as a lasting intrinsic joy from work, called eudaimonia. In the relation with the patient the dentist performs emotion work as an intervention toolkit to direct the patient in a specific direction. Dentists have extensive emotional work tasks in their patient interactions, however this emotional part of dentists’ work is, so far, a neglected research area of odontology. The emotion work tasks are conditioned because the dentists’ incentives are not one-dimensional and require a great deal of emotional flexibility, attentiveness and reflection by the dentist. The influence of the market and managerialism on the professional values of dentistry may challenge the conditions for these tasks in the patient interaction and the wellbeing of the dentist if they are experienced as contradictory. This research aims to encourage and empower different levels of dentistry to further investigate, understand and support the dynamics of the emotional aspects of work with the aim to constitute a sustainable work environment where values and logics can be experienced as compatible with professional values.

No description available.

This thesis studies how scientists and science were put to use in the passing of the 1962 Water Fluoridation Act. The law was created for a specific purpose: that of facilitating the continuation of the water fluoridation trials that had been under way in Norrköping until January 1962, when they were forced to cease, having been deemed illegal by the Supreme Administrative Court.  By studying the network of scientists who were either directly involved in or explicitly supportive of the Norrköping trials, and their actions as members of the two expert committees formed in the 1950’s by the Royal Board of Medicine, and which would come to greatly influence the legislative process, the thesis examines how personal and research interests transferred from Norrköping into the issue of nationwide fluoridation.  Using analytical tools gathered from Roger Pielke Jr. and Daniel Sarewitz, the thesis utilizes the concept of uncertainty to describe how scientists, in the political process, assumed different roles in order to further the cause of fluoridation on the one hand, but also to maintain an ideal image of the relationship between science and politics. Furthermore, the tension within the concept of scientization is examined, illuminating how the political end result - the law - is made possible by means of a balancing act between science’s claims to objective truth and the value-driven, often ethically charged discourse of politics.   Fianlly, the case of fluoridation is placed in the context of the welfare state and the public health project, where it emerges as a part of a broader political and societal renegotiation of the relationship between the individual and the state, which I argue was taking place in Sweden during ”the long fifties”. / Uppsatsen studerar hur forskare och vetenskap kom till användning i skapandet av 1962 års Lag om tillsättande av fluor till vattenledningsvatten. Lagen kom till med ett specifikt syfte, nämligen att möjliggöra för en fortsättning av de försök med fluoridering av dricksvatten som hade pågått i Norrköping fram till januari 1962, då de tvingats att upphöra efter att ha bedömts som olagliga av Regeringsrätten.  Genom att studera det nätverk av forskare som knöts till Norrköpingsförsöken, antingen som direkt involverade eller som förespråkare, och hur dessa agerade som medlemmar av de två expertkommittéer som tillsattes av Medicinalstyrelsen för att utreda frågan om fluoranvändning i kariesförebyggande syfte, vilka kom att utöva ett betydande inflytande på lagstiftningsprocessen, undersöker uppsatsen hur forsknings- och personliga intressen överfördes från Norrköping till frågan om rikstäckande vattenfluoridering.  Med hjälp av analytiska verktyg hämtade från Roger Pielke Jr. och Daniel Sarewitz, tar uppsatsen fasta på begreppet osäkerhet för att beskriva hur forskarna i den politiska processen antog olika roller, i syfte att dels främja fluorideringen som sådan, men också att upprätthålla rådande ideal om relationen mellan vetenskap och politik. Vidare undersöks spänningen i den process som Roger Pielke kallar scientization, och hur det politiska slutresultatet - lagen - blev verklighet till följd av en balansgång mellan vetenskapens anspråk på objektiv sanning och politikens värderingsdrivna och ofta etiskt färgade diskurs.  Slutligen placeras fallet med vattenfluorideringen i välfärdsstatens och folkhälsoprojektets kontext, där det framträder som en del av en bredare politisk och samhällelig omförhandling av relationen mellan individ och samhälle, som jag menar ägde rum i Sverige under ”det långa femtiotalet”.

Les études mettent en évidence des problèmes de santé psychologique chez les professionnels de la santé. Par contre, les facteurs permettant d’expliquer ces difficultés sont peu connus (p. ex., Cohen & Patten, 2005). Le but de cette thèse est d’étudier les déterminants de la santé psychologique des professionnels de la santé en se basant sur une théorie validée empiriquement. À cette fin, la théorie de l’autodétermination (Deci & Ryan, 1985, 2000) est utilisée comme cadre conceptuel et le soutien à l’autonomie (Black & Deci, 2000; Grolnick & Ryan, 1989) est proposé comme déterminant principal de la santé psychologique. Le premier article consiste en une recension des conséquences et corrélats associés au soutien à l’autonomie dans divers domaines de vie. Le deuxième article a pour objectif de tester un modèle prédictif de la santé psychologique auprès de médecins résidents. Le modèle propose que la concordance des tâches (Sheldon & Elliot, 1999) et la conscience de soi (Goldman & Kernis, 2002) sont deux sources distinctes d’autonomie qui prédisent de façon indépendante la santé psychologique. De plus, le soutien à l’autonomie de la part des superviseurs est suggéré comme étant un déterminant important de la concordance des tâches et de la conscience de soi. Au total, 333 médecins résidents de la province de Québec (Canada) ont rempli un questionnaire comportant différentes mesures. Des analyses par équations structurelles révèlent une excellente adéquation du modèle. Le troisième article examine l’influence du soutien à l’autonomie des collègues sur la satisfaction au travail ainsi que sur la santé psychologique des professionnels de la santé. Au total, 597 jeunes professionnels de la santé ont rempli un questionnaire incluant diverses mesures. Les résultats confirment que le soutien à l’autonomie perçu de la part des collègues prédit la santé psychologique et la satisfaction au travail. De plus, des régressions hiérarchiques démontrent que le soutien à l’autonomie des collègues contribue à la prédiction de la satisfaction au travail, du bien-être subjectif et des idéations suicidaires au-delà de ce qui est prédit par le soutien à l’autonomie des superviseurs. Les implications théoriques et pratiques de ces recherches sont discutées. / Past studies have revealed psychological health problems among health professionals, but less is known about the factors that may explain these difficulties (e.g., Cohen & Patten, 2005). The goal of this dissertation is to examine the antecedents of health professionals’ psychological health based on an empirically validated theory. To this end, self-determination theory (Deci & Ryan, 1985, 2000) is used as a conceptual framework and autonomy support (Black & Deci, 2000; Grolnick & Ryan, 1989) is proposed as a principal predictor of psychological health. The first article is a literature review of the consequences and correlates of autonomy support in various life domains. The second article aims at testing a predictive model of medical residents’ psychological health. Tasks self-concordance (Sheldon & Elliot, 1999) and self-awareness (Goldman & Kernis, 2002) are hypothesized to be two different pathways toward autonomy that should independently predict psychological health. The model further posits that perceived supervisors’ autonomy support should be an important determinant of both tasks self-concordance and self-awareness. A total of 333 medical residents from the province of Quebec (Canada) completed a questionnaire, which included various measures. Structural equation modeling analyses revealed an excellent model fit. The third article explores the contribution of colleagues’ autonomy support in the prediction of health professionals’ work satisfaction and psychological health. A total of 597 young health professionals from the province of Quebec (Canada) completed a questionnaire, which included different measures. Results confirmed that colleagues’ autonomy support predicts work satisfaction and psychological health. Furthermore, hierarchical regression analyses showed that colleagues’ autonomy support adds to the prediction of health professionals’ work satisfaction, subjective well-being, and suicidal ideation above and beyond supervisors’ autonomy support. The theoretical and practical implications of this research are discussed.

No description available.

Esta tese é composta por três estudos ecológicos que incluíram as 27 capitais brasileiras. Esses três estudos foram os seguintes: 1- A associação entre a disponibilidade de cirurgiões-dentistas e a quantidade de procedimentos odontológicos nos serviços públicos de odontologia; 2- A associação entre a disponibilidade de cirurgiões-dentistas e a proporção de dentes restaurados (em relação ao total de dentes atacados pela cárie) em indivíduos de 15 a 19 anos ; 3- A associação da disponibilidade de cirurgiões-dentistas com a prevalência e severidade da cárie em indivíduos de 15 a 19 anos. As três investigações são apresentadas sob forma de artigos. Foram utilizados diversos bancos de dados secundários, disponíveis gratuitamente na internet. No primeiro estudo foi identificada associação do número de Equipes de Saúde Bucal do programa Saúde da Família (ESB) e de cirurgiões-dentistas no SUS de uma forma geral com o número de procedimentos odontológicos no serviço público; quanto mais ESB e cirurgiões-dentistas mais procedimentos odontológicos, tanto preventivos quanto restauradores. Mais dentistas no serviço público de odontologia significaram mais procedimentos preventivos e coletivos, porém um número relativamente pequeno a mais de restaurações. É preocupante a quantidade relativamente pequena de restaurações realizadas pelos dentistas do serviço público no Brasil diante do grande número de dentes com cárie não tratada, identificado pela pesquisa nacional de saúde bucal. O segundo estudo revelou que a quantidade de dentistas nas capitais brasileiras é muito grande e que, portanto, há capacidade instalada para atender todas as necessidades de tratamentos restauradores. Entretanto, o índice de cuidado odontológico em jovens de 15 a 19 anos revelou que menos da metade dos dentes atacados pela cárie tinham recebido o cuidado adequado, i.e., estavam restaurados. Este estudo concluiu que, o grande investimento da sociedade brasileira em odontologia, seja no setor público ou privado, não está tendo o retorno esperado, pelo menos para jovens de 15 a 19 anos. O terceiro estudo concluiu que fatores socioeconômicos amplos e flúor na água foram os principais determinantes da variação na prevalência e severidade da cárie em jovens de 15 a 19 anos e que a contribuição do dentista foi relativamente pequena. Diante do papel relativamente pequeno do dentista na prevenção da cárie, o esforço clínico do mesmo deveria, portanto, enfatizar tratamentos de maior complexidade, visando a restauração e reabilitação de danos relevantes para a função e bem estar (Serviço Pessoal de Saúde). Esforços efetivos para evitar a cárie dentária ocorrem principalmente no âmbito de estratégias preventivas populacionais (Serviço não Pessoal de Saúde), com uma contribuição relativamente pequena do trabalho clínico. / This thesis comprises three ecological studies including the 27 state capitals. These three studies were as follows: 1- The association between the availability of dentists and the amount of dental procedures in public dental services; 2- The association between the availability of dentists and the proportion of filled teeth (in relation to total teeth attacked by caries) in subjects 15-19 years; 3- The combination of the availability of dentists with the prevalence and severity of dental caries in individuals 15-19 years. The three investigations are presented in the form of articles. Many banks side, available freely on the internet data were used. In the first study association was found in the number of oral health teams of the Family Health Program (ESB) and dentists in the NHS in general with the number of dental procedures in the public service; ESB as more and more dentists dental procedures, both preventive as restorers. "Most dentists" in public dental services meant more collective and preventive procedures, but a relatively small number of the most restorations. Worryingly the relatively small amount of restorations performed by dentists of the public service in Brazil on the number of teeth with untreated caries, identified by a national survey of oral health. The second study revealed that the number of dentists in the Brazilian capital is very large and, therefore, there is capacity to meet all the needs of restorative treatments. However, the rate of dental care for young people aged 15 to 19 years revealed that less than half of the teeth attacked by caries had received proper care, for example, were restored. This study concluded that the large investment in Brazilian society in dentistry, whether in the public or private sector, is not having the expected return, at least for young people 15-19 years. The third study found that larger socioeconomic factors and fluoride in the water was the major determinant of variation in the prevalence and severity of dental caries in young people 15-19 years and that the contribution of the dentist was relatively small. Given the relatively small role of dental caries prevention, clinical effort it should therefore emphasize more complex treatments, aimed at the restoration and rehabilitation of significant damage to the function and well-being ("Personal Health Service"). Effective efforts to prevent tooth decay occur primarily in population-based prevention strategies ("no Personal Health Service"), with a relatively small contribution of clinical work.

Esta tese é composta por três estudos ecológicos que incluíram as 27 capitais brasileiras. Esses três estudos foram os seguintes: 1- A associação entre a disponibilidade de cirurgiões-dentistas e a quantidade de procedimentos odontológicos nos serviços públicos de odontologia; 2- A associação entre a disponibilidade de cirurgiões-dentistas e a proporção de dentes restaurados (em relação ao total de dentes atacados pela cárie) em indivíduos de 15 a 19 anos ; 3- A associação da disponibilidade de cirurgiões-dentistas com a prevalência e severidade da cárie em indivíduos de 15 a 19 anos. As três investigações são apresentadas sob forma de artigos. Foram utilizados diversos bancos de dados secundários, disponíveis gratuitamente na internet. No primeiro estudo foi identificada associação do número de Equipes de Saúde Bucal do programa Saúde da Família (ESB) e de cirurgiões-dentistas no SUS de uma forma geral com o número de procedimentos odontológicos no serviço público; quanto mais ESB e cirurgiões-dentistas mais procedimentos odontológicos, tanto preventivos quanto restauradores. Mais dentistas no serviço público de odontologia significaram mais procedimentos preventivos e coletivos, porém um número relativamente pequeno a mais de restaurações. É preocupante a quantidade relativamente pequena de restaurações realizadas pelos dentistas do serviço público no Brasil diante do grande número de dentes com cárie não tratada, identificado pela pesquisa nacional de saúde bucal. O segundo estudo revelou que a quantidade de dentistas nas capitais brasileiras é muito grande e que, portanto, há capacidade instalada para atender todas as necessidades de tratamentos restauradores. Entretanto, o índice de cuidado odontológico em jovens de 15 a 19 anos revelou que menos da metade dos dentes atacados pela cárie tinham recebido o cuidado adequado, i.e., estavam restaurados. Este estudo concluiu que, o grande investimento da sociedade brasileira em odontologia, seja no setor público ou privado, não está tendo o retorno esperado, pelo menos para jovens de 15 a 19 anos. O terceiro estudo concluiu que fatores socioeconômicos amplos e flúor na água foram os principais determinantes da variação na prevalência e severidade da cárie em jovens de 15 a 19 anos e que a contribuição do dentista foi relativamente pequena. Diante do papel relativamente pequeno do dentista na prevenção da cárie, o esforço clínico do mesmo deveria, portanto, enfatizar tratamentos de maior complexidade, visando a restauração e reabilitação de danos relevantes para a função e bem estar (Serviço Pessoal de Saúde). Esforços efetivos para evitar a cárie dentária ocorrem principalmente no âmbito de estratégias preventivas populacionais (Serviço não Pessoal de Saúde), com uma contribuição relativamente pequena do trabalho clínico. / This thesis comprises three ecological studies including the 27 state capitals. These three studies were as follows: 1- The association between the availability of dentists and the amount of dental procedures in public dental services; 2- The association between the availability of dentists and the proportion of filled teeth (in relation to total teeth attacked by caries) in subjects 15-19 years; 3- The combination of the availability of dentists with the prevalence and severity of dental caries in individuals 15-19 years. The three investigations are presented in the form of articles. Many banks side, available freely on the internet data were used. In the first study association was found in the number of oral health teams of the Family Health Program (ESB) and dentists in the NHS in general with the number of dental procedures in the public service; ESB as more and more dentists dental procedures, both preventive as restorers. "Most dentists" in public dental services meant more collective and preventive procedures, but a relatively small number of the most restorations. Worryingly the relatively small amount of restorations performed by dentists of the public service in Brazil on the number of teeth with untreated caries, identified by a national survey of oral health. The second study revealed that the number of dentists in the Brazilian capital is very large and, therefore, there is capacity to meet all the needs of restorative treatments. However, the rate of dental care for young people aged 15 to 19 years revealed that less than half of the teeth attacked by caries had received proper care, for example, were restored. This study concluded that the large investment in Brazilian society in dentistry, whether in the public or private sector, is not having the expected return, at least for young people 15-19 years. The third study found that larger socioeconomic factors and fluoride in the water was the major determinant of variation in the prevalence and severity of dental caries in young people 15-19 years and that the contribution of the dentist was relatively small. Given the relatively small role of dental caries prevention, clinical effort it should therefore emphasize more complex treatments, aimed at the restoration and rehabilitation of significant damage to the function and well-being ("Personal Health Service"). Effective efforts to prevent tooth decay occur primarily in population-based prevention strategies ("no Personal Health Service"), with a relatively small contribution of clinical work.