| 1. |
- Eberhard, Jakob, et al.
(author)
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Sexual Function in Men Treated for Testicular Cancer.
- 2009
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In: Journal of Sexual Medicine. - : Oxford University Press (OUP). - 1743-6109 .- 1743-6095. ; 6, s. 1979-1989
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Journal article (peer-reviewed)abstract
- ABSTRACT Introduction. Testicular germ cell cancer (TGCC) patients may be at risk of developing sexual dysfunction after treatment. Aim. The aim of this study was to assess the prevalence of sexual dysfunctions in TGCC patients 3 to 5 years after treatment, and relate findings to biochemical hypogonadism, treatment intensity, and the expected prevalence in the Swedish male population. Methods. A questionnaire study on 129 consecutive TGCC patients 3 to 5 years post-treatment was performed. Comparators were an age-matched nationally representative group of men (N = 916) included in a study on sexual life in Sweden. Main Outcome Measures. Sexual functions (including erectile dysfunctional distress), time since last intercourse, sexual satisfaction, and experience of sexological treatment seeking were assessed using the same questions used in the epidemiological study on sexual life in Sweden. The findings in TGCC patients were correlated to biochemical signs of hypogonadism and type of oncological treatment: Surveillance, adjuvant chemotherapy, adjuvant radiotherapy, or standard doses of chemotherapy. Results. A higher proportion of TGCC patients than comparators were likely to report low sexual desire (odds ratio [OR] 6.7 [95% confidence interval {CI} 2.1-21]) as well as erectile dysfunction (OR 3.8 [95% CI 1.4-10]). No significant differences were observed regarding erectile dysfunctional distress, change of desire over time, interest in sex, premature or delayed ejaculation, time since last intercourse, need for or receiving sexual advice, or sexual satisfaction. Hypogonadism did not predict erectile dysfunction (OR 1.1 [95% CI 0.26-4.5]) or low sexual desire (OR 1.2 [95% CI 0.11-14]). Treatment modality had no obvious impact on sexual function. Conclusion. Men treated for testicular cancer had higher risk of having low sexual desire and erectile dysfunction 3 to 5 years after completion of therapy than comparators. These sexual dysfunctions were not significantly associated with treatment intensity or hypogonadism. Eberhard J, Ståhl O, Cohn-Cedermark G, Cavallin-Ståhl E, Giwercman Y, Rylander L, Eberhard-Gran M, Kvist U, Fugl-Meyer KS, and Giwercman A. Sexual function in men treated for testicular cancer. J Sex Med **;**:**-**.
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| 2. |
- Romerius, Patrik, et al.
(author)
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Sperm DNA Integrity in Men Treated for Childhood Cancer.
- 2010
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In: Clinical Cancer Research. - 1078-0432. ; Jul 1, s. 3843-3850
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Journal article (peer-reviewed)abstract
- PURPOSE: It is unknown whether childhood cancer and its treatment are associated with sperm DNA damage, which subsequently affects fertility and might be transmitted to the offspring. The aim of this study was to assess DNA fragmentation index (DFI) as an indicator of sperm DNA integrity in childhood cancer survivors (CCS), treatment regimen taken into account.EXPERIMENTAL DESIGN: In 99 CCS and 193 age-matched healthy controls, the DFI was assessed by the use of Sperm Chromatin Structure Assay.RESULTS: In the whole group of CCS DFI was increased as compared to the controls with borderline statistical significance (mean difference=0.94%; 95%CI: -0.0088; 3.7%). Those treated with radiotherapy only (mean difference=6.0%; 95%CI: 1.6; 10%) or surgery only (mean difference=2.9%; 95%CI: 0.083; 3.7%) had statistically significantly higher DFI than the controls. The odds ratio (OR) for having DFI >20%, which is associated with reduced fertility, was significantly increased in CCS as compared to the control group (OR=2.2, 95%CI: 1.1; 4.4). For the radiotherapy only group the OR was even higher (OR=4.9, 95%CI 1.3; 18). The DFI was not associated to the dose of scattered testicular irradiation or the type of chemotherapy given.CONCLUSIONS: The DFI is increased in CCS, those treated with chemotherapy being the only exception. This sperm DNA impairment may be associated with the disease per se rather than due to the treatment and may have negative consequences in terms of fertility and risk of transmission to the offspring.
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| 3. |
- Behboudi, Afrouz, 1967, et al.
(author)
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Detailed chromosomal and radiation hybrid mapping in the proximal part of rat Chromosome 10 and gene order comparison with mouse and human.
- 2002
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In: Mammalian genome : official journal of the International Mammalian Genome Society. - : Springer Science and Business Media LLC. - 0938-8990 .- 1432-1777. ; 13:6, s. 302-9
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Journal article (peer-reviewed)abstract
- The rat provides valuable and sometimes unique models of human complex diseases. To fully exploit the rat models in biomedical research, it is important to have access to detailed knowledge of the rat genome organization as well as its relation to the human genome. Rat Chromosome 10 (RNO10) harbors several important cancer-related genes. Deletions in the proximal part of RNO10 were repeatedly found in a rat model for endometrial cancer. To identify functional and positional candidate genes in the affected region, we used radiation hybrid (RH) mapping and single- and dual-color fluorescence in situ hybridization (FISH) techniques to construct a detailed chromosomal map of the proximal part of RNO10. The regional localization of 14 genes, most of them cancer-related ( Grin2a, Gspt1, Crebbp, Gfer, Tsc2, Tpsb1, Il9r, Il4, Irf1, Csf2, Sparc, Tp53, Thra1, Gh1), and of five microsatellite markers ( D10Mit10, D10Rat42, D10Rat50, D10Rat72, and D10Rat165) was determined on RNO10. For a fifteenth gene, Ppm1b, which had previously been assigned to RNO10, the map position was corrected to RNO6q12-q13.
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| 4. |
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| 5. |
- Fagerlind Ståhl, Anna-Carin, et al.
(author)
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Associations between organisation of work, work conditions, work-relatedf low and performance: a multilevel analysis
- 2015
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Other publication (other academic/artistic)abstract
- The aim of this study is to investigate how organisation of work in terms of sociotechnical characteristics and use of tools inspired by lean production, and psychosocial conditions at the workplace, are associated with work-related flow and performance.A questionnaire including questions concerning work organisation, psychosocial work conditions, work-related flow and self-rated performance was sent to employees in ten Swedish organisations; 4442 people (56%) responded. Multilevel logistic regression analyses were used in order to investigate organisation of work and work conditions in relation to work-related flow and performance. In addition, the association between work-related flow and performance was investigated.Our results show that a high degree of lean tool use in combination with a low degree of sociotechnical characteristics was negatively associated with work-related flow but positively associated with performance. When decision latitude, social capital, and innovative learning climate were included in the model, the association was no longer significant in relation to work-related flow, but remained and was strengthen in relation to performance. Work-related flow had a positive association with performance.The conclusion is that work-related flow and work conditions that enable individual and collective skill use are important for increased performance. When lean tools are used to a high degree, good decision latitude, social capital and innovative learning climate buffer negative effects on health, and increase performance.
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| 6. |
- Fagerlind Ståhl, Anna-Carin, et al.
(author)
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Lean production tools and decision latitude enable conditions for innovative learning in organizations : a multilevel analysis
- 2015
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In: Applied Ergonomics. - : Elsevier. - 0003-6870 .- 1872-9126. ; 47, s. 285-291
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Journal article (peer-reviewed)abstract
- The effect of lean production on conditions for learning is debated. This study aimed to investigate how tools inspired by lean production (standardization, resource reduction, visual monitoring, housekeeping, value flow analysis) were associated with an innovative learning climate and with collective dispersion of ideas in organizations, and whether decision latitude contributed to these associations. A questionnaire was sent out to employees in public, private, production and service organizations (n = 4442). Multilevel linear regression analyses were used. Use of lean tools and decision latitude were positively associated with an innovative learning climate and collective dispersion of ideas. A low degree of decision latitude was a modifier in the association to collective dispersion of ideas. Lean tools can enable shared understanding and collective spreading of ideas, needed for the development of work processes, especially when decision latitude is low. Value flow analysis played a pivotal role in the associations.
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| 7. |
- Fagerlind Ståhl, Anna-Carin, 1982-
(author)
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Live long and prosper : Health-promoting conditions at work
- 2015
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis is to contribute with knowledge concerning health-promoting conditions at work, and to investigate how individual, workplace and organisational conditions are interrelated. In the thesis, work-related flow, i.e. an experience of motivation, absorption and work enjoyment, is used as a holistic notion of occupational health. In Paper I, work-related flow is investigated in relation to decision latitude, social capital and an innovative learning climate at work. Paper II investigates whether the use of tools inspired by lean production, such as standardisation and value stream mapping, is positively associated with conditions for innovative learning in organisations. The aim of Paper III is to identify conditions for health and performance in organisation and at work; further, to investigate the association between work-related flow and performance. Paper IV reports on a longitudinal investigation of workrelated flow in relation to lean tool use and conditions at the workplace. The empirical material is based on data from 10 organisations, including 4442 employees. Papers I-III are cross-sectional, whereas Paper IV is longitudinal. Papers II-IV utilise multilevel analyses.The results show that decision latitude, social capital and an innovative learning climate are associated with an increase in work-related flow (Papers I, III & IV), and with performance (Paper III). Individuals’ decision latitude enables an increased benefit from the social capital and innovative learning climate at work (Paper I). The effect of tools inspired by lean production on work-related flow (Papers III & IV), and on conditions for innovative learning (Paper II) differs, depending on which tools are used, and on workplace conditions. These tools enable innovative learning mainly where decision latitude is low (Paper II), and it is primarily the lean tool value stream mapping which has the potential to create an arena for innovative learning (Paper II) and work-related flow (Paper IV).It is concluded that the individual is embedded in a social work context that has the potential to strengthen the ability to act with motivation, absorption and enjoyment. In order to utilise collective healthpromoting conditions at work, individuals need to have authority to make their own decisions and use their skills. The effect of tools inspired by lean production depends on the specific tools that are used, and on individuals’ decision latitude at work. Their potential to enable innovative learning is most evident for employees who have few opportunities for autonomous decision-making and skill use in their work. For those with a high degree of decision latitude, the use of lean tools has a smaller effect. Work-related flow may in itself serve as a resource that improves performance and increases engagement in health-promoting work conditions. In order to promote health as well as performance, work needsto be organised so that employees have opportunities to decide over their own work, and utilise their skills, individually and collectively within the workgroup.
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| 8. |
- Fagerlind Ståhl, Anna-Carin, et al.
(author)
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The effect of lean tool use and work conditions on employee health : a longitudinal multilevel study
- 2015
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Other publication (other academic/artistic)abstract
- Objectives: Although lean production is an increasingly common approach to increase the efficiency of organisations, its effect on employee health is not clear. This longitudinal study investigates the effect of lean tool use and work conditions on work-related flow. Flow is a measure of health that reflects the experience of intrinsic motivation, absorption and work enjoyment.Methods: A questionnaire was sent to employees in seven organisations on two occasions with an interval of two years (n =1722). Multilevel linear regression analyses were used in order to investigate the association between the use of lean tools (i.e. standardisation, value stream mapping, visual monitoring, housekeeping and resource reduction), decision latitude, social capital, and innovative learning climate at baseline, and work-related flow at follow-up.Results: In multivariate analyses, adjusted for flow at baseline, use of lean tools was positively associated with work-related flow at follow-up. When the tools were investigated separately, only value stream mapping remained significant after adjustment for work conditions and flow at baseline. Social capital and decision latitude were positively associated with flow at follow-up. Flow at baseline and follow-up were strongly associated.Conclusions: The extent to which lean tool use has an effect on employee health depends on which tools are used. Work conditions that support learning, such as decision latitude and social capital, are associated with a longitudinal increase in the experience of work-related flow, and are important for gaining health-promoting benefits from the use of lean tools.
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| 9. |
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| 10. |
- Kreibich, Heidi, et al.
(author)
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The challenge of unprecedented floods and droughts in risk management
- 2022
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In: Nature. - : Springer Nature. - 0028-0836 .- 1476-4687. ; 608:7921, s. 80-86
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Journal article (peer-reviewed)abstract
- Risk management has reduced vulnerability to floods and droughts globally, yet their impacts are still increasing. An improved understanding of the causes of changing impacts is therefore needed, but has been hampered by a lack of empirical data4,5. On the basis of a global dataset of 45 pairs of events that occurred within the same area, we show that risk management generally reduces the impacts of floods and droughts but faces difficulties in reducing the impacts of unprecedented events of a magnitude not previously experienced. If the second event was much more hazardous than the first, its impact was almost always higher. This is because management was not designed to deal with such extreme events: for example, they exceeded the design levels of levees and reservoirs. In two success stories, the impact of the second, more hazardous, event was lower, as a result of improved risk management governance and high investment in integrated management. The observed difficulty of managing unprecedented events is alarming, given that more extreme hydrological events are projected owing to climate change.
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| 11. |
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| 12. |
- Nilsen, Per, et al.
(author)
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Never the twain shall meet? - a comparison of implementation science and policy implementation research
- 2013
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In: Implementation Science. - : BioMed Central. - 1748-5908. ; 8
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Journal article (peer-reviewed)abstract
- BackgroundMany of society’s health problems require research-based knowledge acted on by healthcare practitioners together with implementation of political measures from governmental agencies. However, there has been limited knowledge exchange between implementation science and policy implementation research, which has been conducted since the early 1970s. Based on a narrative review of selective literature on implementation science and policy implementation research, the aim of this paper is to describe the characteristics of policy implementation research, analyze key similarities and differences between this field and implementation science, and discuss how knowledge assembled in policy implementation research could inform implementation science.DiscussionFollowing a brief overview of policy implementation research, several aspects of the two fields were described and compared: the purpose and origins of the research; the characteristics of the research; the development and use of theory; determinants of change (independent variables); and the impact of implementation (dependent variables). The comparative analysis showed that there are many similarities between the two fields, yet there are also profound differences. Still, important learning may be derived from several aspects of policy implementation research, including issues related to the influence of the context of implementation and the values and norms of the implementers (the healthcare practitioners) on implementation processes. Relevant research on various associated policy topics, including The Advocacy Coalition Framework, Governance Theory, and Institutional Theory, may also contribute to improved understanding of the difficulties of implementing evidence in healthcare. Implementation science is at a relatively early stage of development, and advancement of the field would benefit from accounting for knowledge beyond the parameters of the immediate implementation science literature.SummaryThere are many common issues in policy implementation research and implementation science. Research in both fields deals with the challenges of translating intentions into desired changes. Important learning may be derived from several aspects of policy implementation research.
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| 13. |
- Perski, Kerstin, 1960-
(author)
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Levandegörandets poetik : På spaning efter musikdramat Gränsland och transformationen av dramat via text, vokalt och instrumentalt agerande
- 2020
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Artistic work (other academic/artistic)abstract
- From the librettist’s perspective, the traditional working methods which tend to dominate in the creation of new music drama, often result in a situation where the initial intentions are lost along the way. How can we get away from a rigid methodology, where the different professionals involved in the creation of new music drama have to succumb to a procedure which can be likened to a whispering game? A procedure, where the dramatic content, rather than undergoing an emotional enrichment in its transformation into music, often loses the crucial connections to the initial intentions. This doctoral project aims to reach beyond the whispering game by seeking alternative working methods in the creation of a new music drama with the working title "Borderlands", circling around the subject matter of flight and borders - inner as well as outer. The research identified cross–border methods which, borrowing from the terminology of Martin Buber, can be seen as an attempt to counteract the “I–It” relationship that often results from the genre’s focus on virtuosity. The results might inspire further attempts to find alternative working methods which could ultimately create a stronger “I–Thou” relationship between the performance and the audience.
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| 14. |
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| 15. |
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| 16. |
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| 17. |
- Sartz, Lisa, et al.
(author)
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A novel C3 mutation causing increased formation of the C3 convertase in familial atypical hemolytic uremic syndrome.
- 2012
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In: Journal of Immunology. - : The American Association of Immunologists. - 0022-1767 .- 1550-6606. ; 188:4, s. 2030-2037
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Research review (peer-reviewed)abstract
- Atypical hemolytic uremic syndrome has been associated with dysregulation of the alternative complement pathway. In this study, a novel heterozygous C3 mutation was identified in a factor B-binding region in exon 41, V1636A (4973 T > C). The mutation was found in three family members affected with late-onset atypical hemolytic uremic syndrome and symptoms of glomerulonephritis. All three patients exhibited increased complement activation detected by decreased C3 levels and glomerular C3 deposits. Platelets from two of the patients had C3 and C9 deposits on the cell surface. Patient sera exhibited more C3 cleavage and higher levels of C3a. The C3 mutation resulted in increased C3 binding to factor B and increased net formation of the C3 convertase, even after decay induced by decay-accelerating factor and factor H, as assayed by surface plasmon resonance. Patient sera incubated with washed human platelets induced more C3 and C9 deposition on the cell surface in comparison with normal sera. More C3a was released into serum over time when washed platelets were exposed to patient sera. Results regarding C3 and C9 deposition on washed platelets were confirmed using purified patient C3 in C3-depleted serum. The results indicated enhanced convertase formation leading to increased complement activation on cell surfaces. Previously described C3 mutations showed loss of function with regard to C3 binding to complement regulators. To our knowledge, this study presents the first known C3 mutation inducing increased formation of the C3 convertase, thus explaining enhanced activation of the alternative pathway of complement.
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| 18. |
- Seing, Ida, 1982-
(author)
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Activating the Sick-Listed : Policy and Practice of Return to Work in Swedish Sickness Insurance and Working Life
- 2014
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Doctoral thesis (other academic/artistic)abstract
- A critical task of social policy in most Western welfare states during recent decades has consisted of reducing the economic burden on society due to sick leave, by stimulating participation in the labour market. Many jurisdictions have introduced activation policies, based on the premise that work “per se” has a therapeutic effect on sick-listed workers. People are expected to be “active”, rather than “passive”, recipients of financial benefits. However, there is limited knowledge of how activation policies focusing on return to work (RTW) are carried out in local practice. Against this background, the overall aim of this thesis is to study the local practice of activation policies by analysing how they are received, implemented and experienced by welfare state organizations, employers and sick-listed workers. The analysis has been influenced by theories concerning organization fields, individualization, street-level bureaucracy and organizational governance.In this thesis, the overall aim is investigated in four interrelated papers. In Paper I, the aim is to analyse the perspectives of stakeholders (i.e. welfare state actors and employers) on work ability by studying multistakeholder meetings. Paper II sheds light on activation policy, focusing on early RTW in the context of modern working conditions; the aim is to analyse RTW practice in local workplace contexts, in relation to Swedish early-RTW policy. The third paper focuses on employers, with the aim of analysing their role and activities regarding RTW, in local workplace practice. In Paper IV, the aim is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the Swedish Social Insurance Agency (SSIA) and their front-line staff.The empirical material comprises two empirical studies: 1) audio-recorded multi-stakeholder meetings from regular practice (n=9) and 2) semi-structured interviews with sick-listed workers and their supervisors in 18 workplaces (n=36). The analyses of the material have been performed in accordance with the principles of qualitative content analysis.Main findings of the papers reflect strong organizational boundaries in the implementation process of activation policies. Welfare state actors and employers appear to be governed by their own organizational logics and interests, so the actors involved fail to take a holistic view of sick-listed workers and do not share a common social responsibility for individuals’ RTW. This thesis illustrates how current activation policies focusing on RTW are based on a rather idealized image of the standard workplace. There is an explicit or implicit assumption that employers and work organizations are able to welcome sick-listed workers back to work in a healthy way. However, the intensity of modern working life leaves limited room for accommodating people with reduced work ability, who are not considered to have a business value to the workplace. In several cases, findings indicate that the SSIA’s focus on activation and early RTW clashes with the financially oriented perspective of employers. Economic considerations regarding their business take precedence over legal and ethical considerations, and employers have difficulty taking social responsibility for RTW. Sick-listed workers are encouraged to adjust to new workplace settings and environments to meet the demands of the workplace, and, if RTW is not possible, to the demands of the labour market. The findings also show that sick-listed workers experience that contacts with the SSIA are ‘standardized’; i.e., they perceive that the officials are loyal to demands in their organizations rather than being involved actors who support workers’ individual needs. Sick-listed workers clearly experience that measures in Swedish activation policies have a strong focus on demanding aspects (financial work incentives) and less on enabling aspects (investments in skills).Overall, this thesis illustrates an emerging social climate where sick-listed workers are positioned as active agents who must take responsibility for their sick leave and their RTW process. In a Swedish context, RTW is a matter of activating the sick-listed rather than activating the workplace.
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| 19. |
- Seing, Ida, et al.
(author)
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Activation Policies and Sick-Listed Workers’ Experiences and Trust in the Sickness Insurance System in Local Practice
- 2014
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Other publication (other academic/artistic)abstract
- In recent welfare and labour market reforms in Europe and North America, there is a general trend towards activation, in that people (e.g. those who are sick-listed, unemployed and recipients of social welfare) are expected to be “active”, rather than “passive”, recipients of financial benefits. Meanwhile, street-level bureaucracy in many welfare state organizations has been fundamentally reformed in recent years with the implementation of New Public Management Principles which have come to influence the day-to-day work of front-line staff. The aim of this paper is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the SSIA and their front-line staff. The data consists of semistructured interviews with 18 sick-listed workers in Sweden. The material was analysed using qualitative content analysis. The findings illustrate that sick-listed workers experienced contacts with the Social Insurance Agency (SSIA) as “standardized”; that is, they perceived that the officials were loyal to demands in their organizations rather than involved actors that supported workers’ individual needs. The SSIA was described as having a mainly administrative and controlling function during their sick leave, resulting in a distant relationship. It was also clear that sick-listed individuals experienced the activation policy as demanding, and their sick leave was characterized by insecurity and uncertainty. Overall, this paper suggests that activation policies with regulations emphasizing time limits, and enforcement of standardized work processes at the SSIA, challenge sick-listed workers’ trust in the sickness insurance system.
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| 20. |
- Seing, Ida, et al.
(author)
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Avstämningsmötet som arena för förhandling om arbetsförmåga
- 2011
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In: Socialmedicinsk Tidskrift. - 0037-833X. ; 88:5, s. 408-417
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Journal article (peer-reviewed)abstract
- I studien analyseras på vilka grunder individers arbetsförmåga bedöms, med utgångspunkt i nio avstämningsmöten mellan sjukskrivna, Försäkringskassan, sjukvården och arbetsgivare. Fokus riktas mot hur parterna diskuterar och resonerar om arbetsförmåga och hur aktörerna ser på sin och övriga parters roll i rehabiliteringsprocessen. Avstämningsmötena utmärktes av en förhandling om arbetsförmåga och vilka aktörer som hade rehabiliteringsansvaret för den sjukskrivne. Studien visar att sjukskrivnas arbetsförmåga i hög grad bestämdes av arbetsgivarens anpassningsmöjligheter. Bedömningen av arbetsförmåga grundades således i praktiken på relationen mellan individens förmåga och arbetets förutsättningar. Studien visar också hur läkares arbetsförmågebedömningar, trots att de ibland bygger på osäkra uppskattningar, används som objektiva expertutlåtanden i diskussioner om sjukpenning och återgång i arbete.
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| 21. |
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| 22. |
- Seing, Ida, et al.
(author)
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Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships
- 2015
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In: Journal of occupational rehabilitation. - : Springer. - 1053-0487 .- 1573-3688. ; 25:1, s. 74-85
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Journal article (peer-reviewed)abstract
- Purpose Many Western welfare states have introduced early-return-to-work policies, in which getting sick-listed people back to work before they have fully recovered is presented as a rather unproblematic approach. This reflects a belief in the ability of employers and the labour market to solve sickness absence. Against this background, the aim of this study was to analyse return-to-work practice in local workplace contexts, in relation to Swedish early-return-to-work policy.Methods Semi-structured interviews were conducted with 18 matched pairs of workers and managers. The material, comprising a total of 36 interviews, was analysed using qualitative content analysis.Results Three main themes were identified: (1) intensive workplaces and work conditions (2) employer support—a function of worker value and (3) work attachment and resistance to job transition. The results reflected the intensity of modern working life, which challenged return-to-work processes. Managers had different approaches to workers’ return-to-work, depending on how they valued the worker. While managers used the discourse of ‘new opportunities’ and ‘healthy change’ to describe the transition process (e.g. relocation, unemployment and retirement), workers regularly experienced transitions as difficult and unjust.Conclusions In the context of early-return-to-work policy and the intensity of modern working life, a great deal of responsibility was placed on workers to be adaptable to workplace demands in order to be able to return and stay at work. Overall, this study illustrates an emerging social climate where sick-listed workers are positioned as active agents who must take responsibility for sick leave and return-to-work process.
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| 23. |
- Seing, Ida, 1982-, et al.
(author)
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Policy and Practice of Work Ability : A Negotiation of Responsibility in Organizing Return to Work
- 2012
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In: Journal of occupational rehabilitation. - : Springer. - 1053-0487 .- 1573-3688. ; 22:4, s. 553-564
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Journal article (peer-reviewed)abstract
- Purpose In welfare policy and practical work it is unclear what the concept of work ability involves and assessments may be different among involved actors, partly due to a lack of theoretical research in relation to regulations and practice. Based on theoretical and legal aspects of work ability the aim of the study is to analyze stakeholders’ perspectives on work ability in local practice by studying multi-stakeholder meetings.Methods The material comprises nine digitally recorded multi-stakeholder meetings. Apart from the sick-listed individual, representatives from the public Social Insurance Agency, health care, employers, public employment service and the union participated in the meeting. The material was analyzed using qualitative content analysis.Results Three perspectives on work ability were identified: a medical perspective, a workplace perspective and a regulatory perspective. The meetings developed into negotiations of responsibility concerning workplace adjustments, rehabilitation efforts and financial support. Medical assessments served as objective expert statements to legitimize stakeholders’ perspectives on work ability and return to work.Conclusions Although the formal goal of the status meeting was to facilitate stakeholder collaboration, the results demonstrates an unequal distribution of power among cooperating actors where the employers had the “trump card” due to their possibilities to offer workplace adjustments. The employer perspective often determined whether or not persons could return to work and if they had work ability.
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| 24. |
- Seing, Ida, et al.
(author)
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Return to work or job transition? : Employer dilemmas in taking social responsibility for return to work in local workplace practice
- 2015
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In: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 37:18-19, s. 1760-1769
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Journal article (peer-reviewed)abstract
- Purpose: The aim was to analyze the role and activities of employers with regard to return to work (RTW), in local workplace practice.Method: Semi-structured interviews were conducted with sick-listed workers and their supervisors in 18 workplaces (n = 36). The analytical approach to study the role of employers in RTW was based on the three-domain model of social corporate responsibility. The model illustrates the linkage between corporations and their social environment, and consists of three areas of corporate responsibility: economic, legal and ethical.Results: Employers had difficulties in taking social responsibility for RTW, in that economic considerations regarding their business took precedence over legal and ethical considerations. Employers engaged in either “RTW activities” or “transition activities” that were applied differently depending on how valued sick-listed workers were considered to be to their business, and on the nature of the job (e.g. availability of suitable work adjustments).Conclusions: This study suggests that Swedish legislation and policies does not always adequately prompt employers to engage in RTW. There is a need for further attention to the organizational conditions for employers to take social responsibility for RTW in the context of business pressure and work intensification.Implications for RehabilitationEmployers may have difficulties in taking social responsibility for RTW when economic considerations regarding their business take precedence over legal and ethical considerations.Rehabilitation professionals should be aware of that outcomes of an RTW process can be influenced by the worker’s value to the employer and the nature of the job (e.g. availability of suitable work adjustments). “Low-value” workers at workplaces with limited possibilities to offer workplace adjustments may run a high risk of dismissal.Swedish legislation and policies may need reforms to put more pressure on employers to promote RTW.
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| 25. |
- Sellstedt, Anita, 1953-, et al.
(author)
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Can the 15N Dilution Technique be used to Study N2 Fixation in Tropical Tree Symbioses as Affected by Water Deficit?
- 1993
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In: Journal of Experimental Botany. - : Oxford University Press (OUP). - 0022-0957 .- 1460-2431. ; 44:12, s. 1749-1755
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Journal article (peer-reviewed)abstract
- Three methods were used to study N2 fixation and effects of water deficit on N2 fixation: C2H2 reduction assay (ARA), 15N dilution technique and accumulated N content. In addition, 15N dilution was calculated both in a traditional way and in a modified way, which takes into consideration N and 15N content for the plants before the experiment started. The three methods were applied on the following Rhizobium-symbioses: Acacia albida Del (Faidherbia albida (Del) A. Chev.) and Leucaena leucocephala (Lam) de Wit., and the Frankia-symbiosis Casuarina equisetifolia L. The plants wereabout 4-months-old when they were harvested.Nitrogen derived from N2 fixation in control plants of Acacia albida was 54·2 mg as measured with ARA, while it was 28·5 mg as measured with the 15N dilution technique, compared to 30·7 mg calculated as accumulated N. In comparison, L. leucocephala fixed 41·6 mg N (ARA), 53·5 mg N(15N dilution technique) and 56·3 mg N (accumulated N). The Frankia-symbiosis had fixed 27·4 mg N as measured by ARA, 8·1 mg N as measured by 15N dilution technique and 12·3 mg N as accumulated N. There were no differences between the estimates based ontraditional and modified ways of calculating 15N dilution.The immediate effect of water deficit treatment on N2 fixation was continuously measured inall species with ARA, which started to decrease approximately 10 d after the initiation of the treatment, and declined to less than 5% of the initial level after 21–28 d.The decrease in the amount of N derived from N2 fixation was studied in L. leucocephala during the period of treatment. There was a 26% decrease in amount of N derived from N2 fixation as result of water deficit (as measured with ARA), while the decrease was 23% when measured withboth the 15N dilution method and as accumulated N.The three different methods for measuring N2 fixation and effects of water deficit on N2 fixation are discussed.
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| 26. |
- Ståhl, Christian, 1980-, et al.
(author)
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A Matter of Trust? : A Study of Coordination of Swedish Stakeholders in Return-to-Work
- 2010
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In: Journal of occupational rehabilitation. - : SpringerLink. - 1053-0487 .- 1573-3688. ; 20, s. 299-310
-
Journal article (peer-reviewed)abstract
- Introduction Stakeholder cooperation in return-to-work has been increasingly emphasized over the last years. However, there is a lack of empirical studies on the subject. This study explores different public stakeholders' experiences of participating in Coordination Associations (CAs), a Swedish form of structured cooperation in return-to-work. The aim of the study is to determine the impact of stakeholder interests on the prerequisites for cooperation. Methods Thirty-five representatives from two CAs in eastern Sweden were interviewed regarding the aim, structure and strategies for their common work. Results Stakeholders' actions are to a high degree determined by their institutional preferences and self-interest. In the CAs, the motives for cooperation differ, and although these differences supposedly could be overcome, they are in fact not. One of the stakeholders, the Public Employment Service, limit its interest to coordinating resources, while the other three wishes to engage in elaborated cooperative work forms, implying the crossing of organizational borders. This discrepancy can largely be attributed to the difficulties for representatives from state authorities in changing their priorities in order to make cooperation work. Conclusions Stakeholders' interests have a high impact on the prerequisites for cooperation in return-to-work. By referring to organizational goals, stakeholders engage in non-cooperative behaviour, which threatens to spoil cooperative initiatives and to develop distrust in cooperative work forms. The results of this study expose the complexity of and threats to cooperation, and its conclusions may be used by return-to-work stakeholders in different jurisdictions to improve the possibilities for the development of cooperative structures.
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| 27. |
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| 28. |
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| 29. |
- Ståhl, Christian, 1980-, et al.
(author)
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Discretion, governance and cooperative learning : Swedish rehabilitation professionals’ experiences of financial cooperation
-
Other publication (other academic/artistic)abstract
- Purpose: This article analyses the experiences of Swedish rehabilitation professionals in interorganizational cooperation in return-to-work and labour marker reintegration. Method: Two groups (n=15) from different organizations met recurrently to discuss their practice from a cooperation perspective. The participants had experience of cooperation in the organizational setting of Coordination Associations (CAs). The groups worked with a tutor according to a problem-based methodology to discuss how their practice is influenced by new structures for cooperation. The material was analysed inductively using qualitative content analysis. Results: The results show that CAs were successful in creating cooperative work forms at a local level by ensuring financial support for interorganizational work. This experience was considered positive by the participants. However, the different developments in the two CAs (one attained a sustainable cooperation, the other did not) show the importance of local strategies for maintaining the positive effects of cooperation. Conclusions: Work forms initiated by Coordination Associations have been perceived and used as learning environments in which the participants use the learning opportunities provided by the formal cooperation structures. However, the level of trust between managers and officials is low, implying that officials have limited support to learn from their cooperation.
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| 30. |
- Ståhl, Christian, 1980-, et al.
(author)
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From Cooperation to Conflict? Swedish Rehabilitation Professionals' Experiences of Interorganizational Cooperation.
- 2011
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In: Journal of occupational rehabilitation. - : Springer. - 1053-0487 .- 1573-3688. ; 21:3, s. 441-448
-
Journal article (peer-reviewed)abstract
- Purpose This article analyses Swedish rehabilitation professionals' experiences of interorganizational cooperation in return-to-work and labour market reintegration. Method Two groups (n = 15) from different organizations met on a regular basis to discuss their practice from a cooperation perspective. The participants had experience of cooperation in the organizational setting of Coordination Associations. The groups worked with a tutor according to a problem-based methodology, to discuss how their practice is influenced by new structures for cooperation. The material was analysed inductively using qualitative content analysis. Results Interorganizational cooperation in rehabilitation is generally perceived as promoting coherence and communication. Nevertheless, there are several contradictory factors in the implementation of such work forms, primarily inflexible sickness insurance regulations and inability of managers to implement cooperation in regular practice. Conclusions While interorganizational cooperation promotes professional discretion and tailored solutions, the insurance system contradicts such ambitions through increased governance. Ultimately, the contradictory tendencies of cooperative initiatives and the stricter governance of sickness insurance regulations are political matters. If political attempts to promote interorganizational cooperation are to succeed, the increasing sectorization that results from strict governance of sickness insurance regulations needs to be targeted on a system level.
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| 31. |
- Ståhl, Christian, et al.
(author)
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Förutsättningar för implementering och användning av motiverande samtal (MI) inom Försäkringskassan : Slutrapport
- 2015
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Reports (other academic/artistic)abstract
- Detta är slutrapporten från det utvärderingsprojekt som studerat implementering och användning av motiverande samtal (MI) inom Försäkringskassan. Satsningen på MI har genomförts för att utveckla och förstärka metoder inom sjukförsäkrings- och samordningsprocessen, med syftet att skapa bättre förutsättningar för personliga handläggare att arbeta tidigt och aktivt i sjukfallen. För att professionalisera handläggarna avsatte Försäkringskassan under 2012 särskilda medel för att utbilda och kompetensutveckla handläggare som arbetar med sjukpenning och samordning kring samordningsuppdraget, där en utbildning i motiverande samtal (MI) ingick.I projektet har en tidigare delrapport publicerats (Socialförsäkringsrapport 2014:16) där fokus var på implementeringen av MI. En av de farhågor som rapporterades i delrapporten var att inte kunna integrera och vidmakthålla användningen av MI i det dagliga arbetet. I denna slutrapport undersöks förutsättningar för användning av MI i det dagliga arbetet inom Försäkringskassan, samt upplevda effekter av satsningen på individ- och verksamhetsnivå.Specifika frågeställningar är:Vilka individuella och organisatoriska–praktiska förutsättningar har underlättat respektive försvårat handläggares fortsatta användning av MI i dagligt arbete?Vilka effekter av satsningen på MI kan identifieras på individ- och verksamhetsnivå?Rapporten bygger på ett datamaterial bestående av en enkät till handläggare (n=880), samt intervjuer med 5 enhetschefer och 16 handläggare vid fyra lokalkontor. Intervjuerna är uppföljande intervjuer från en större datainsamling som rapporterades i projektets delrapport.Resultaten av studien tyder på att många av handläggarna en tid efter MIutbildningen fortfarande har ett engagemang kring metoden, och att många anger att de tillämpar den i möten med sjukskrivna, dock med stor variation avseende vilka av metodens verktyg som används. Merparten av handläggarna har gått utbildningen och tyckt att den har varit bra, och det finns ett intresse hos många handläggare för att fortsätta använda och utveckla sin tillämpning av metoden. Många handläggare anser också att de har kunnat se förbättringar i mötet med sjukskrivna i de fall där de tillämpat MI.Samtidigt riktas mycket kritik mot hur Försäkringskassan har hanterat satsningen på MI, där den genomgående bilden är att organiserad uppföljning och träning har saknats. Det finns en allmänt spridd uppfattning att MI inte har prioriterats i verksamheten, och att chefer inte har visat intresse för huruvida metoden tillämpas eller ej. Således kan det konstateras att den utvecklingspotential och det engagemang som handläggarna uppvisar inte har tagits om hand i verksamheten. Handläggare är också starkt kritiska till möjligheterna att använda och utveckla sin kunskap i metoden i relation till rådande arbetssituation. I intervjuer och enkäter beskrivs en mycket pressad verksamhet där inget utrymme finns för reflektion och lärande.
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| 32. |
- Ståhl, Christian, et al.
(author)
-
Implementering och användning av motiverande samtal (MI) inom Försäkringskassan
- 2014
-
Reports (other academic/artistic)abstract
- Inom ramen för en satsning på att utveckla samordningsuppdraget avsatte Försäkringskassan under 2012 särskilda medel för att utbilda och kompetensutveckla samtliga handläggare i motiverande samtal (MI). Syftet var att professionalisera handläggarna och att utveckla och förstärka metoder inom samordningsuppdraget.MI är en klientcentrerad samtalsmetod med syfte att underlätta beteendeförändringar. Metoden fokuserar på motivationsfrågor och ska användas när en person känner sig ambivalent inför en förändring. MI har främst använts inom behandling av alkohol- och drogmissbruk. Då individer med sjukskrivningsproblematik ofta kämpar med sviktande motivation kan det antas att MI har potential att vara användbar som en utgångspunkt för handläggares möten med sjukskrivna, särskilt i de fall då problematiken berör ambivalens eller behov av att ändra livsstil. Det finns dock i dagsläget mycket begränsad empirisk forskning om användningen av MI i relation till sjukskrivna, och den evidens som finns för metoden berör andra tillämpningsområden.Syftet med föreliggande rapport är att kartlägga och analysera implementeringen av MI och förutsättningar för tillämpning av metoden inom Försäkringskassan. I rapporten analyseras hur olika aktörer inom organisationen uppfattar implementeringen och tillämpningen av MI i arbetet, vilka förutsättningar som finns för införande och användning av MI, samt hur sjukskrivna uppfattar mötet med handläggare som utbildats i metoden. Rapporten bygger på intervjuer med chefer, koordinatorer, handläggare och samordningscoacher inom Försäkringskassan, samt observationer av möten mellan handläggare och sjukskrivna och därpå följande intervjuer med de sjukskrivna.
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| 33. |
- Ståhl, Christian, 1980-
(author)
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In Cooperation We Trust : Interorganizational Cooperation in Return-to-Work and Labour Market Reintegration
- 2010
-
Doctoral thesis (other academic/artistic)abstract
- The overarching aim of this thesis is to study Coordination Associations (CAs) as a structure for interor-ganizational cooperation in rehabilitation, return-to-work and labour market reintegration. This has been done through empirical studies of two CAs in eastern Sweden.Central questions for the thesis are:How have representatives on different hierarchical levels in the participating organizations experi-enced cooperation within the structure of CAs?What influence do different organizational and/or professional preferences have on interorganiza-tional cooperation?The four studies in this thesis have had different approaches to studying interorganizational cooperation.Study I was concerned with a specific work form, namely interdisciplinary rehabilitation teams, where the analysis concerned how the different professionals in these teams perceived the common work, and how they interpreted the concept of work ability, which is a central concept for determining eligibility for sickness benefits.Study II focused on managers and board members of the CAs in order to determine their motives for and commitment to interorganizational cooperation. The analysis was concerned with the organizational identification and the self-interest of each actor, where the issue of trust between representatives from dif-ferent organizations was specifically targeted in the analysis.Study II focused on managers and board members of the CAs in order to determine their motives for and commitment to interorganizational cooperation. The analysis was concerned with the organizational identification and the self-interest of each actor, where the issue of trust between representatives from dif-ferent organizations was specifically targeted in the analysis.Study III aimed to elucidate the perspectives of officials in different organizations connected to the CAs regarding both the development of cooperation in the CAs, and how the recent changes in sickness insurance regulations will influence future cooperation.Study IV focused on different perspectives regarding the concept of work ability among representa-tives from all participating organizations, since changes in sickness insurance regulations have changed the assessment process and therefore also the demands for interorganizational cooperation.The general methodological approach to the studies in this thesis has been explorative; qualitative methods have been used, involving interviews, focus groups and problem-based group discussions. Inter-views and focus groups have had an open-ended structure, and the material has been analysed through qualitative content analysis.The aim of the Coordination Associations studied in this thesis has been to bridge the gaps between the participating organizations by promoting consensus through common work forms. However, the re-sults from the studies show that such ambitions are troublesome in highly specialized public organizations. Cooperation in the CAs has to a large extent been organized as collaborative work forms rather than as coordination of existing practices. The collaboration has been based on an idea of consensus, where all organizations were expected to participate on equal terms and find common work forms. Although it has been shown that officials from different organizations can work together, the managerial level’s priorities are more determined by their organizational goals and values, which makes them unwilling to finance collaborative work on a longer term.Another theme of the thesis is the lack of cooperation between the public rehabilitation system and the employers. The public actors lack knowledge of working conditions, and since the work principle guides the rehabilitation process, it is necessary to incorporate employers into the cooperation to facilitate sustainable return-to-work and labour market reintegration.A central conclusion of the thesis is that consensus is not a reasonable starting point when designing cooperation structures between public organizations. A sustainable cooperation structure needs to incorpo-rate and coordinate the different actors’ priorities into a long-term cooperation strategy, rather than base the cooperation on vulnerable collaboration projects.
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| 34. |
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| 35. |
- Ståhl, Christian, et al.
(author)
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Promoting occupational health interventions in early return to work by implementing financial subsidies : a Swedish case study
- 2013
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In: BMC Public Health. - : BioMed Central. - 1471-2458. ; 13
-
Journal article (peer-reviewed)abstract
- BackgroundIn 2010, the Swedish government introduced a system of subsidies for occupational health (OH) service interventions, as a part in a general policy promoting early return to work. The aim of this study was to analyse the implementation of these subsidies, regarding how they were used and perceived.MethodsThe study was carried out using a mixed-methods approach, and comprises material from six sub-studies: a register study of the use of the subsidies, one survey to OH service providers, one survey to employers, one document analysis of the documentation from interventions, interviews with stakeholders, and case interviews with actors involved in coordinated interventions.ResultsThe subsidized services were generally perceived as positive but were modestly used. The most extensive subsidy – for coordinated interventions – was rarely used. Employers and OH service providers reported few or no effects on services and contracts. OH service providers explained the modest use in terms of already having less bureaucratic routines in place, where applying for subsidies would involve additional costs. Information about the subsidies was primarily communicated to OH service providers, while employers were not informed.ConclusionsThe study highlights the complexity of promoting interventions through financial incentives, since their implementation requires that they are perceived by the stakeholders involved as purposeful, manageable and cost-effective. There are inherent political challenges in influencing stakeholders who act on a free market, in that the impact of policies may be limited, unless they are enforced by law.
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| 36. |
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| 37. |
- Ståhl, Christian, 1980-, et al.
(author)
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Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System
- 2011
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In: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 33:15-16, s. 1373-1382
-
Journal article (peer-reviewed)abstract
- Purpose: This article analyses Swedish rehabilitation professionals’ perspectives on how changed sickness insurance regulations will affect their practice and cooperation, with a special focus on work ability assessments. Method: Two groups of representatives (n=15) from different organizations involved in rehabilitation and return-towork met 7 times to discuss their practice from a cooperation perspective. The groups worked with a tutor according to a problem-based methodology to discuss how their practice is influenced by new structures for cooperation. The material was analysed inductively using qualitative content analysis. Results: The results show that work ability assessments are often made without considering work characteristics. Officials at the Social Insurance Agency do not consider themselves competent in assessing work ability. The basis for decisions of eligibility for sickness benefits is thus weak, which is troublesome from a legal perspective. The officials do not cooperate with employers or occupational health services in work ability assessments. Conclusions: Recent policy changes calls for comprehensive cooperation between the insurance system, health care, employment services and employers. This study shows that there are flaws in this cooperation. The design of the system is in conflict with the policy ambition of increasing return-to-work, because it disregards employers as cooperation partners.
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| 38. |
- Ståhl, Christian, 1980-, et al.
(author)
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The Work Ability Divide : Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams
- 2009
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In: Journal of occupational rehabilitation. - : Springer Netherlands. - 1053-0487 .- 1573-3688. ; 19:3, s. 264-273
-
Journal article (peer-reviewed)abstract
- Stakeholder cooperation in return to work has been increasingly emphasised in research, while studies on how such cooperation works in practise are scarce. This article investigates the relationship between professionals in Swedish interdisciplinary rehabilitation teams, and the aim of the article is to determine the participants’ definitions and uses of the concept of work ability. Methods The methods chosen were individual interviews with primary health care centre managers and focus groups with twelve interdisciplinary teams including social insurance officers, physicians, physiotherapists, occupational therapists, medical social workers and coordinators. Results The results show that the teams have had problems with reaching a common understanding of their task, due to an inherent tension between the stakeholders. This tension is primarily a result of two factors: divergent perspectives on work ability between the health professionals and the Social Insurance Agency, and different approaches to cooperative work among physicians. Health professionals share a holistic view on work ability, relating it to a variety of factors. Social insurance officers, on the other hand, represent a reductionistic stance, where work ability is reduced to medical status. Assessments of work ability therefore tend to become a negotiation between insurance officers and physicians. Conclusions A suggestion from the study is that the teams, with proper education, could be used as an arena for planning and coordinating return-to-work, which would strengthen their potential in managing the prevention of work disability.
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| 39. |
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| 40. |
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| 41. |
- Wendel, Kerstin, et al.
(author)
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Long-term cognitive functional limitations post stroke: objective assessment compared with self-evaluations and spouse reports.
- 2008
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In: International Journal of Rehabilitation Research. - 1473-5660. ; 31:3, s. 231-239
-
Journal article (peer-reviewed)abstract
- This study was part of a Swedish interdisciplinary research project targeting accessibility problems in public transport for people with cognitive functional limitations (CFLs). The objective was to describe and compare different assessment perspectives of long-term CFLs among community citizens having had CFLs in the acute stroke phase but with moderate physical limitations. Eighty-four participants in ordinary housing 18-36 months post stroke, initially sampled from a national quality stroke register, received data collection home-visits. The Cognistat screening instrument was used for an objective assessment, and a study-specific questionnaire for self-evaluations of CFLs. A revised form of the latter questionnaire was used for reports from spouses of a subset of 30 participants. The agreement between self-evaluated CFLs and spouse reports was analysed by percentage agreement and Cohen's kappa, whereas differences in ratings were tested by McNemar's test, as were differences between objective and self-evaluated/spouse-reported occurrence of CFLs. Regardless of the different perspectives applied, CFLs were frequent. In absence of significant difference in ratings, the percentage agreement between self-evaluations and spouse reports was good or very good, whereas kappa values were less encouraging. Overall, participants and spouses expressed more CFLs, as compared with the screening. Most consistency was demonstrated for the area of calculation. When researchers and clinicians solely rely on cognitive screenings in their investigations, there is a considerable risk for underestimations of CFLs.
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| 42. |
- Wendel, Kerstin, et al.
(author)
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Post-stroke functional limitations and changes in use of mode of transport
- 2010
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In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1651-2014 .- 1103-8128. ; 17:2, s. 162-174
-
Journal article (peer-reviewed)abstract
- Purpose: To investigate the use of different modes of transport and long-term changes among stroke survivors with cognitive functional limitations (CFLs), and to study differences among sub-groups (decreased/ceased vs. unchanged and increased public transport use) regarding physical functional limitations (PFLs), CFLs, depression, and social activity outside home. Method: Survey of 79 individuals living in the community with CFLs post-stroke (mean 26 months). Well-established and study-specific instruments were used capturing the mode of transport use, CFLs (professionally assessed and self-reported), depression symptoms, and PFLs. Results: Over one third of the participants reported decreased/ceased use of bus and train, among whom more PFLs were found in comparison with those reporting unchanged use and more depression was found in comparison with those showing increased use. There were no sub-group differences concerning occurrence of CFLs and decrease in social activity. The use of own car or motorbike had largely ceased, most often replaced by Special Transportation Service or travelling by private car or taxi. Yet 27% were still frequent car drivers. Conclusion: The results indicate considerably affected use of modes of transport after stroke, and higher frequencies of PFLs and symptoms of depression among those with decreased/ceased public transport use.
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