This anthology is comprised of six papers, introducing readers to at variety of topics relevant to the Strategies for Health arena. The papers are intended to reflect the breadth of research conducted in Strategies for Health. The aim is to contribute to a greater understanding of the concept of health and provide insight into some strategies for improvement of health and safety. The anthology was edited by Per Nilsen, in cooperation with Lennart Nordenfelt and Kerstin Ekberg, who served as an Editorial Committee.

Aims: To investigate the awareness and knowledge of hazardous drinking limits among the general population in Sweden and the extent to which people estimate their alcohol consumption in standard drinks to assess their level of drinking.

Methods: A population-based study involving 6000 individuals selected from the total Swedish population was performed. Data were collected by means of a postal questionnaire. The mail survey response rate was 54.3% (n = 3200) of the net sample of 5891 persons.

Results: With regard to drinking patterns, 10% of the respondents were abstainers, 59% were sensible drinkers and 31% were classified as hazardous drinkers. Most of the abstainers (80%), sensible drinkers (64%) and hazardous drinkers (56%) stated that they had never heard about the standard drink method. Familiarity with the hazardous drinking concept also differed between the three categories although ∼61% of sensible and hazardous drinkers expressed awareness of the concept (46% of the abstainers). Knowledge about the limits for sensible drinking was very poor. Between 94 and 97% in the three categories did not know the limit. There was a statistically significant association between having visited health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits. Similarly, there was a significant association between having had at least one alcohol conversation in health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits.

Conclusion: The results can be seen as a major challenge for the health-care system and public health authorities because they imply that a large proportion of the Swedish population does not know when alcohol consumption becomes a threat to their health. The current strategy to disseminate knowledge about sensible drinking limits to the population through the health-care system seems to have failed and new means of informing the population are warranted.

Background: University students in Sweden routinely receive proactive mail-based alcohol Internet interventions sent from student health services. This intervention provides personalized normative feedback on alcohol consumption with suggestions on how to decrease drinking. Earlier feasibility trials by our group and others have examined effectiveness in simple parallel-groups designs.Objective: To evaluate the effectiveness of electronic screening and brief intervention, using a randomized controlled trial design that takes account of baseline assessment reactivity (and other possible effects of the research process) due to the similarity between the intervention and assessment content. The design of the study allowed for exploration of the magnitude of the assessment effects per se.Methods: This trial used a dismantling design and randomly assigned 5227 students to 3 groups: (1) routine practice assessment and feedback, (2) assessment-only without feedback, and (3) neither assessment nor feedback. At baseline all participants were blinded to study participation, with no contact being made with group 3. We approached students 2 months later to participate in a cross-sectional alcohol survey. All interventions were fully automated and did not have any human involvement. All data used in the analysis were based on self-assessment using questionnaires. The participants were unaware that they were participating in a trial and thus were also blinded to which group they were randomly assigned.Results: Overall, 44.69% (n = 2336) of those targeted for study completed follow-up. Attrition was similar in groups 1 (697/1742, 40.01%) and 2 (737/1742, 42.31% retained) and lower in group 3 (902/1743, 51.75% retained). Intention-to-treat analyses among all participants regardless of their baseline drinking status revealed no differences between groups in all alcohol parameters at the 2-month follow-up. Per-protocol analyses of groups 1 and 2 among those who accepted the email intervention (36.2% of the students who were offered the intervention in group 1 and 37.3% of the students in group2 ) and who were risky drinkers at baseline (60.7% follow-up rate in group 1 and 63.5% in group 2) suggested possible small beneficial effects on weekly consumption attributable to feedback.Conclusions: This approach to outcome evaluation is highly conservative, and small benefits may follow the actual uptake of feedback intervention in students who are risky drinkers, the precise target group.Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 24735383; http://www.controlled-trials.com/ISRCTN24735383 (Archived by WebCite at http://www.webcitation.org/6Awq7gjXG)

Avstämningsmötet är en metod inom Försäkringskassan som syftar till att ge bättre beslutsunderlag för deras bedömningar av sjukskrivnas arbetsförmåga och rehabiliteringsbehov. Målet är att förkorta sjukskrivningstider och snabbare få människor tillbaka i arbete.

I och med den kraftigt ökade sjukfrånvaron i slutet av 1990-talet uppmärksammades att Försäkringskassans tillämpning av sjukförsäkringens regelverk varierar mellan olika delar av landet och även mellan olika lokalkontor. Som en konsekvens påbörjades ett omfattande arbete med att professionalisera handläggningen genom att utveckla gemensamma metoder och arbetssätt. År 2005 gjordes en skärpning av lagstiftningen genom att starkare reglera de tidsgränser inom vilka ett avstämningsmöte skall hållas och man etablerade produktionsmål inom Försäkringskassan i termer av antal avstämningsmöten inom 90 dagar i sjukskrivningen.

I denna studie har 11 handläggare inom Försäkringskassan intervjuats om sin syn på avstämningsmötet som utredningsmetod och på vilket sätt den påverkar den sjukskrivnes återgång i arbete. Studien fokuserar på det första avstämningsmötet i sjukskrivningen, sex av dessa genomfördes före 90-dagars gränsen och fem genomfördes senare i sjukskrivningsprocessen.

Analyserna av intervjuerna resulterade i fem huvudområden som berör upplevelser av produktionskraven, förberedelser respektive genomförande av avstämningsmötet, läkarens roll vid avstämningsmötet samt mötets betydelse för återgång i arbete.

Handläggarna upplever en konflikt mellan kravet på att hålla produktionsmålet på avstämningsmöte inom 90 dagar och sin professionella bedömning av när ett avstämningsmöte passar in i rehabiliteringsprocessen. Ur handläggarnas perspektiv har det skett en värderingsförskjutning från en helhetssyn på rehabiliteringsprocessen med individen i centrum, till mer kortsiktiga produktionsmål som fragmenterar processen. Produktionskraven leder också till att vissa sjukskrivningsärenden som bedöms vara lämpade för ett avstämningsmöte måste prioriteras bort då de passerat tidsgränsen, medan man genomför andra möten, där både handläggaren och läkaren anser att det kommer för tidigt i rehabiliteringsprocessen. Avstämningsmötena riskerar att bli formaliserade och rutindrivna aktiviteter, snarare än allsidiga bedömningar.

Den formaliserade agendan vid avstämningsmötet tycks kunna leda till att deltagarna upplever en osäkerhet om mötets syfte, eller tolkar syftet annorlunda än handläggaren. Handläggaren uppfattar sig tappa kontrollen över mötet.

Av tidsskäl gör man ofta avkall på att kalla läkaren till mötet, trots att mötet syftar till att diskutera arbetsförmåga och sjukskrivningens omfattning. Såväl strukturen, den reglering som styr avstämningsmötet, som handläggarnas egna erfarenheter av hur kontakter med läkare fungerar, bidrar till att handläggarna utvecklar olika strategier för att undvika att bli beroende av läkarnas fysiska deltagande i mötet.

Det medicinska underlaget är centralt i bedömningen av individens arbetsförmåga, den ofta förekommande frånvaron av läkare, liksom den stora variationen i hur de fördjupade Sassam-utredningarna genomförs, skapar därför dilemman, som dock även kan innebära en handlingsfrihet för handläggaren i prioriteringar av ärenden.

Rapporten visar sammanfattningsvis handläggares dilemman i sin roll att översätta politiska beslut och mål till vardagens praktik. Resultaten visar också deras möjligheter att prioritera och hantera dessa dilemman inom ramen för en ökad administrativ kontroll.

Objective: The Job Demand Control model presents combinations of working conditions that may facilitate learning, the active learning hypothesis, or have detrimental effects on health, the strain hypothesis. To test the active learning hypothesis, this study analysed the effects of job demands and job control on general problem-solving strategies. Participants: A population-based sample of 4,636 individuals (55% women, 45% men) with the same job characteristics measured at two times with a three year time lag was used. Methods: Main effects of demands, skill discretion, task authority and control, and the combined effects of demands and control were analysed in logistic regressions, on four outcomes representing general problem-solving strategies. Results: Those reporting high on skill discretion, task authority and control, as well as those reporting high demand/high control and low demand/high control job characteristics were more likely to state using problem solving strategies. Conclusions: Results suggest that working conditions including high levels of control may affect how individuals cope with problems and that workplace characteristics may affect behaviour in the non-work domain.

Der Themenkomplex Integration und Inklusion bewegt die wissenschaftliche Heil- und Sonderpädagogik seit vielen Jahren, mit der Umsetzung inklusiver Ideen und Praktiken verbinden sich gleichwohl noch immer erhebliche Herausforderungen für die sonderpädagogische Disziplin und Profession. In der Folge der UN-Charta über die Rechte von Menschen mit Behinderungen hat die Auseinandersetzung mit dem Inklusionsanspruch eine neue Aktualität im Fachdiskurs gewonnen, die sich in den Beiträgen dieses Tagungsbandes widerspiegelt. Die Texte bieten einen Einblick in aktuelle Theoriediskurse und Forschungsergebnisse zur Inklusion in Bildungsinstitutionen. Eine theoretische und philosophische Auseinandersetzung mit dem Inklusionsbegriff und seinen Implikationen wird unter anderem aus gerechtigkeitstheoretischer und systemtheoretischer Perspektive geführt. Das Professionsverständnis von Heil- und SonderpädagogInnen im Kontext von Inklusion wird im Zusammenhang mit Fragen der Lehreraus- und -weiterbildung sowie mit der Schul- und Unterrichtsentwicklung erörtert. Aktuelle empirische Studien aus den Feldern der frühkindlichen Bildung und Schule sowie des Übergangs in die berufliche Bildung werden präsentiert.

Introduction The role, tasks and competencies of disability management professionals (DMPs) have increasingly become a focus of research in the last decade. However, the legal context in which DMPs work, how this affects their daily practice, and how this impacts their training curricula, has been neglected. This omission is problematic given that international training programs of disability management (DM) operate across different jurisdictions. Our study describes DMPs' practice in Ontario, Canada and considers jurisdiction-specific elements of disability management practice.

Methods The study is based on seven interviews and a focus group with five participants, who are either certified disability management professionals or who are involved with DMPs' training, as well as documentary analysis of the legal context of these professionals' practice.

Results The study shows how DMPs' practice is affected by the local legal context. The jurisdiction's socio-political framework requires DMPs to distinguish between occupational and non-occupational cases, a distinction which affects their practice and their recommendations to employers. This is in contrast to DM training which emphasises equal treatment of all people with disabilities.

Conclusions The research suggests that disability management practices may differ from one jurisdiction to the next and therefore emphasises the need to consider socio-political aspects in DMPs' practice as well as in the development of training programmes and cross-jurisdictional research.

The social and economic costs of injury and disability in the workplace has had an adverse impact on employers and societies throughout the world. International trends in worksite disability management policies and practices, as surveyed by the International Labor Organization, are explored. The impact of formal training for Disability Management Coordinators is discussed, as relates to reductions in unnecessary lost time and workplace disability costs. A disability management audit system is summarized, as a strategic planning process for developing return-to-work programs for workers with disabilities.

Background: The work in health services is knowledge intensive and based on continuous development. Managers should be able to give instructions, clarify tasks, support the priorities and provide staff with support and feedback. This puts a strong focus on leadership and learning. The National Board of Welfare in Sweden emphasises of the need for increased knowledge of learning-driven improvements in health and medical care. Managerial and team development are important tools  in the learning-driven improvements.

Purpose: The aim of this study was to describe and interpret heads of clinics' experiences and their importance regarding the learning and development of their staff at the workplace.

Method: The study is qualitative with a phenomenological approach. Interviews were conducted in 2011 and included feedback from a total of 19 heads of clinics from two hospitals in Sweden.

Results: Heads of clinics feel that they reinforce a transparent environment, give attention to employees, support reflection and broaden staff skills. Heads of clinics believe it is important to work with goals and long-term vision to create a holistic view and employee participation. Heads of clinics' experiences of barriers to learning-driven improvement is related to a lack of consensus among employees.

Conclusion: Heads of clinics' believe it is important to be a supportive, coaching manager who motivates staff to believe in themselves, do better and develop further. The perceived barriers to learning-driven improvements may be related to managers' lack of teaching abilities.

Rapporten redovisar resultatet av en studie av avstämningsmöten som ett effektivt redskap i den en­skildes rehabilitering. Nio avstämningsmöten spelades in på ljud­band­spelare och följdes genom del­tag­ande observation. Varje möte har följts upp med intervjuer med samtliga mötes­deltagare. Studerade möten och efterföljande intervjuer har analyserats med frågeställningar uti­från avstämnings­mötets kommunikativa processer och deltagarnas upplevelse av mötet och dess betydelse.

Analysen visar att de försäkrade har en relativt stor andel av det totala talutrymmet räknat i procent av det antalet ord som yttras under ett möte. Samtidigt visar efterintervjuerna att hälften av de försäkrade upplevde sig stå utanför händelsernas centrum under mötet. Detta uppfattades istället mest som en sak mellan andra deltagande parter såsom mellan Försäkrings­kassan och arbetsgivaren eller mellan Försäkringskassan och sjukvården. Det tycktes kräva ett relativt stort mått av initiativ från den försäkrade själv för ta aktiv del av mötet.

Analysen av interaktionen vid inspelade avstämningsmöten visar att en stor del av mötena ut­veck­lade sig som en slags förhandling där olika ”myndighetsröster” utgick från ”sitt” perspektiv i arbetet med att rehabilitera den försäkrade tillbaka till arbete. Under förhandlingen i mer okomplicerade fall tenderade handläggarna från Försäkringskassan snabbt acceptera de hinder för att förkorta rehabiliteringsprocessen som arbetsgivaren, stödd av den försäkrade, presenterade. I mer komplicerade fall tycks sjukvården utgöra den främsta gränspostering som legitimerar vid vilken tidpunkt och i vilken ut­sträck­­ning arbetsåtergång är möjlig. I diskussioner omkring individens arbetsförmåga domi­nerade aspekter som fysisk arbetso­för­måga hos individen tillsammans med fysiska hinder på arbets­platsen. Andra aspekter av arbets­för­måga så som motivation, social förmåga, kompetens etc. diskuterades i ringa utsträckning om alls.

Trots intentionen att avstämningsmöten ska bygga på samverkan mellan olika parter involv­erade i individens sjukskrivnings- och rehabiliteringsprocess tycks det finnas en väsentlig poten­tial för för­bättring av samordningen mellan framför allt Försäkringskassan och sjukvården, men även mellan Försäkringskassan och arbetsförmedlingen. En annan möj­­lig­het till för­bättring som framträder är hur resultatet av SASSAM-kartläggningen prak­tiskt kommer till användning under mötet för att öppna för en diskussion omkring resurser snarare än hinder och om arbetsförmåga ur ett flerdimensionellt perspektiv. Generellt saknades diskussioner om den försäkrades arbetsförmåga i relation till arbeten på arbetsmarknaden i stort.

Utifrån studiens resultat finns fog för fortsatt diskussion om avstämningsmötet ska vara den själv­klara metoden i alla sjukfall som överstiger en viss tidsgräns eller om det behövs en differentiering av såväl mötets upplägg och syfte som vilka som kommer ifråga för ett sådant möte. Mer varierande och målgruppsanpassade möten med en tydlig målsättning om samverkan och samarbete mellan medverkande parter skulle sannolikt öka mötets effektivitet och menings­fullhet. Färre avstämningsmöten skulle ge utrymme för större satsning på möten omkring försäkrade med svårare problematik. Det skulle vidare öka möjligheten för handläggare att specialisera sig också utifrån den problematik som gäller för olika grupper av försäkrade.

Objective: Early predictors of poor outcome after acute ischemic stroke may be useful in selecting patients for potentially beneficial but high-risk interventions. Design. Cohort study of patients given placebo in a randomized clinical trial. Setting. Multicenter trial at 139 U.S. and 14 Canadian hospitals. Patients. A cohort of 564 placebo-treated patients with major anterior circulation ischemic stroke enrolled in the Clomethiazole in Acute Stroke Study-Ischemic Stroke (CLASS-I) trial. Patients did not have significant impairment in consciousness at baseline and were enrolled within 12 hrs of symptom onset. Interventions: Prospective data collection of a number of clinical variables including use of a 6-point level of consciousness scale (1 = awake, 6 = no reaction to pain) to measure patients' level of consciousness at enrollment and 12 additional times during the first 24 hrs after enrollment. The ability of level of consciousness score and additional clinical data to predict 30-day mortality was assessed. Measurements and Main Results., At 1 month, 114 of 564 patients (20%) had died. In univariate analysis, factors significantly associated with mortality included older age, white race, higher National Institutes of Health Stroke Scale score, higher serum glucose, atrial fibrillation, and any impairment in level of consciousness (p < .05). After controlling for these factors, increasing level of consciousness score at 3 hrs after enrollment and at all but one subsequent time point was significantly associated with increased mortality (odds ratio, 1.8 per point, 95% confidence interval, 1.2-2.6, p = .003 at 3-hr time point). Maximum level of consciousness score during the initial 24 hrs of monitoring also predicted mortality (odds ratio, 1.9 per point, 95% confidence interval, 1.4-2.5, p < .001). Conclusion: The development of a decreased level of consciousness within the initial hours after stroke onset, as evaluated by a simple six-point scale, is a powerful independent predictor of mortality after major anterior circulation ischemic stroke.

Assessment of work ability and employability are core tasks for the welfare actors when an individual becomes sick-listed. The assessments are critical for the individual's future possibilities to remain on the labor market. Difficulties to perform these assessments given the structural conditions for the sick-leave and return-to-work process are discussed.

Arbets- och miljömedicin

– en lärobok om hälsa och miljö

Läroboken i arbets- och miljömedicin tar upp dagsaktuella frågor och ger förslag på hantering av arbets- och miljömedicinska ärenden.

Detta är den svenska lärobok som försöker samla hela det stora kunskapsområdet inom arbets- och miljömedicin. Med hänsyn till dynamiken inom området har i denna 3:e upplaga skett en uppdatering, förnyelse och komplettering. Den har fem nyskrivna kapitel: Arbets- och miljörelaterade hudsjukdomar – särskilt kontakteksem och prevention, Belastningsrelaterade sjukdomar, Ersättning vid arbetsskada, Företagshälsovård samt Luftföroreningar, global klimatpåverkan och hälsa. Liksom tidigare ges epidemiologi och toxikologi ett stort utrymme då dessa redskap utgör grunden för riskbedömning och riskkommunikation. Handläggning av arbets- och miljömedicinska larm presenteras som ett exempel på riskkommunikation. I särskilda kapitel behandlas psykosociala frågor och arbetsorganisation, hjärt-kärlsjukdomar samt arbetslivsinriktad rehabilitering. Kemiska hälsorisker är fortfarande aktuella och fordrar ofta miljöövervakning i form av biologiska exponeringsmarkörer och markörer för biologisk effekt, ex. genetiska förändringar. Miljöns påverkan på foster, reproduktion och cancer beskrivs, liksom miljörelaterade luftvägssjukdomar. Traditionella områden som buller, vibrationer, bekämpningsmedel, livsmedel och matförgiftning behandlas också. Översiktligt diskuteras aktuella arbets- och miljömedicinska frågor som klorering och hälsa, perfluorerade ämnen, nanomaterial och effekter av arbetslöshet. Ett särskilt kapitel ägnas åt etiska frågor inom arbets- och miljömedicin.

Arbetslivsinriktad rehabiltering används som begrepp för många olika typer av utredningar och åtgärder som underförstått eller uttalat syftar till att främja återgång i arbete för sjukskrivna. Det är emellertid fruktbart att differentiera mellan olika faser i processen för att tydliggöra bilden avseende vilka aktörer och vilka åtgärder som är lämpliga. Sjukskrivnings- och rehabilteringsprocessen kan indelas i fyra faser från att bli sjukskriven till att vara tillbaka i en aktiv arbetssituation. Med utgångspunkt från dessa faser diskuteras i vilken grad det finns evidens för åtgärder inom respektive fas.

Regeringens ambition att sätta in tidig rehabilitering vid sjukskrivning är lovvärd och stöds av forskning. Men en risk med de nya förslagen är att många sjukskrivna blir uppsagda redan efter sex månaders sjukskrivning, då arbetsförmågan ska testas mot hela arbetsmarknaden. Det skriver Kerstin Ekberg, professor i arbetslivsinriktad rehabilitering, i en kommentar till regeringens budgetproposition.    

Adults spend about 40% of their waking hours at work. The workplace is an important setting both in affecting people’s health and as an environment in which to promote health. Health in working life is not a technical, value-free process, but rather one influenced by the ideologies, beliefs and values of key actors, such as officials, workers and unions, employers, corporations and managers, experts and others (Levenstein & Woodings, 1997). Indeed, one of the defining characteristics of the workplace setting is that it brings together a variety of groups and individuals who have different agendas and priorities with regard to work and health (Naidoo & Wills, 2000). Hence, the relationship between work and health may be viewed in different ways by different actors; a conflict of interest may arise between the actors with regard to what comes first, health or productivity.

This text begins with a look at key concepts, theories and models to explain the relationship between health and work. This is followed by a discussion of important empirical findings and research concerning strategies to improve workplace health.

Inom ramen för Vinnovas Dynamosatsning (Dynamiska arbetsmarknader och organisationer) genomfördes forsknings- och utvecklingsprojketet Drivkrafter för ökad rörlighet, hälsa och kompentensförsörjning i samarbete med två arbetsgivar-/företagsringar i Östergötland. Projektet syftade till att utveckla och understödja rörlighet som ett medel för att förbättra hälsa och lärande i arbetslivet.

Under 2005/2006 utfördes ett särskilt delprojekt om samverkansfrågor i sjukskrivnings- och rehabiliteringsprocessen tillsammans med en grupp aktörer som alla är involverade i, eller berörs av rehabiliteringsprocessen för långtidssjukskrivna i Östergötlands län. Syftet för arbetsgruppen var att synliggöra hinder och möjligheter för samverkan mellan aktörerna och att finna former för en effektiv samverkan där även ringens resurser kan utnyttjas.

Arbetsgruppen har sammanträtt ett antal gånger och successivt kartlagt hur strukturerna för sjuksrkivnings- och rehabiliteringsprocessen ser ut idag och hur processen skulle kunna utvecklas i praktiken. Detta arbete presenteras i föreliggande rapport. Arbetsgruppen presenterar också ett gemensamt förslag för hur ett förbättrat flöde med tydligare ansvarsroller borde utformas.

Kärnpunkterna i arbetsgruppens förslag till samverkansformer är att

• Arbetsgivaren, med stöd av företagshälsovården, har tillsammans med den sjukskrivne huvudansvaret från första sjukskrivningsdag för att driva en process som syftar till återgång i arbete.
• Åtgärder bör komma igång mycket tidigt i sjukskrivningen.
• Arbetsgivaren bör i högre grad utnyttja företagshälsovårdens kompetens och arbetsgivarringens resureser i processen för återgång i arbete.
• Hälso- och sjukvården respektive Försäkringskassan skall i högre grad vara stödjande resurser i rehabiliteringsprocessen, och i mindre grad huvudaktörer som riskerar att stoppa upp flödet.
• Aretsförmedlingen som resurs bör utnyttjas mer och tidigare i processen än vad som vanligen är fallet idag.

Aim: The study aims to identify characteristics associated with long-term expectations of professional stability or mobility among recently sick-listed workers, and to study whether expectations of professional mobility and turnover intentions were associated with duration of sick leave.

Methods: A cross-sectional study was performed on baseline measures in a prospective cohort study of patients who were granted sick leave due to musculoskeletal (MSD) or mental (MD) disorders. A total of 1,375 individuals fulfilled the inclusion criteria. A baseline questionnaire was sent by mail within 3 weeks of their first day of certified medical sickness; 962 individuals responded (70%). The main diagnosis was MSD in 595 (62%) individuals and MD in 367 (38%).

Results: Expectations of ability to remain in the present profession in 2 years was associated with better health and health-related resources, younger age, higher education, and better effort-reward balance. Effort-reward imbalance, MD, high burnout scores, and better educational and occupational position were associated with turnover intentions. Low expectations of ability to remain in the present profession defined two vulnerable groups with regard to RTW, those with no turnover intentions were older, had lower personal resources, more often had MSD, and slower RTW rate. Those with turnover intentions had a clear effort-reward imbalance and high burnout scores.

Conclusions: The results of this explorative study underline the importance of differentiating RTW-interventions based on knowledge about the sick-listed person's resources in relation to the labor market and the work place, and their expectations of future employment and employability.

Syftet med föreliggande rapport är att bidra till ökad kunskap om uppfattningar om rörlighet i arbetslivet, hur samverkan för rörlighet utformas i praktiken, och förutsättningar för rörlighet inom och mellan organisationer. I detta projekt har samverkan skett med olika praktiker, framför allt med ringsamordnare, arbetsgivarföreträdare och fackliga företrädare i de två företagsringarna från Boxholm respektive Norrköping som varit delaktiga i projektet. Den empiriska basen utgörs i huvudsak av intervjuer med aktörer som företräder företagsringarna, arbetsgivare, fackliga organisationer samt offentliga myndigheter, främst Försäkringskassan men även bl.a. Länsarbetsnämnden, Företagshälsovården och Hälso‐ och sjukvården.

Två övergripande slutsatser om rörlighet inom och mellan organisationer dras utifrån detta forsknings‐ och utvecklingsprojekt. Den första slutsatsen är att olika aktörers arbete med att försöka stödja rörlighet inom och mellan organisationer sker i två s.k. stuprör – kompetensförsörjning och rehabilitering. Dessa stuprör kan, men behöver inte nödvändigtvis ha med varandra att göra. Så länge det inte finns ett helhetsperspektiv på rörlighet trampar varje aktör på i sitt eget stuprör.

Öppningen kan vara att på gemensam grund utveckla nya strategier för att hantera frivillig men även påtvingad rörlighet för att stödja lärande, hälsa och verksamhetsutveckling inom och mellan organisationer Detta förutsätter ett ökat lärande om hur rörlighet kan främja såväl människors som organisationers utveckling och hälsa, samt nya samverkansformer och tydligare aktörsroller och beröringspunkter för att mer effektivt kunna hantera rörlighet inom och mellan organisationer.

Den andra slutsatsen är att företagsringar är nödvändiga, men inte ett tillräcklig forum för rörlighet åtminstone om man inte bara vill begränsa rörlighet till rehabilitering. Företagsringar lägger fokus på rehabilitering. Företagsringar är en god resurs då inget annat har lyckats i rehabiliteringsarbetet. Om företagsringar ska vara det verktyg för rörlighet som önskas, pekar resultaten på behov av att bredda perspektivet på rörlighet och att arbeta mer med olika typer av rörlighet. Detta kan dock företagsringar inte göra själva eftersom arbetsgivare ”betalar” för de tjänster de vill att företagsringen ska utföra. Om tjänster ska utvecklas krävs att arbetsgivarna i ringen ställer krav på nya tjänster, vilket skulle innebära att företagsringar kan få en mer betydande roll vid för rörlighet. Viktiga frågor är vilket syfte ringen ska ha? Är ringen enbart en arena för rehabilitering eller ska ringen ha en annan roll i stödjandet av rörlighet inom och mellan organisationer, d.v.s. vara en arbetsmarknadsintermediär?

Frågor som rör chef- och ledarskap genererar alltid ett stort intresse såväl i arbetslivet som inom forskning. Det tema som fokuseras i den här rapporten är chef-/ledarskap och kön, särskilt könsfördelningen på ledande befattningar. I dagsläget är merparten av alla chefer i svenskt arbetsliv män. Män är överrepresenterade på chefsbefattningar i relation till samtliga anställda män i såväl privat som offentlig sektor. På de högsta chefsbefattningarna blir mansdominansen än tydligare (SCB, 2006). Mansdominansen på ledande befattningar kan sägas utgöra en utgångspunkt för de forskningsfrågor som formulerats inom forskningsområdet chef-/ledarskap och kön. Forskningsfrågorna handlar t.ex. om varför så få kvinnor är chefer samt på senare år om hur ledarskap är könsmärkt, dvs. hur ledarskap förknippas med kön. En återkommande fråga i mansdominerade organisationer är: Hur kan vi få fler kvinnor på ledande befattningar? Det är just denna problematik som fokuseras i föreliggande rapport som sammanfattar erfarenheter från ett forsknings- och utvecklingsprojekt som pågick från senhösten 2007 till senhösten 2008.

Syftet med föreliggande rapport är att kartlägga och analysera villkor för kvinnor och män att bli chefer och att utöva chef- och ledarskap, samt varför få kvinnor har chefspositioner. Utgångspunkten för denna analys är en empirisk studie inom ett globalt verkstadsindustriföretag baserad på intervjuer med chefer, både kvinnor och män, på olika chefsnivåer och från olika divisioner. Följande mer specifika frågeställningar har formulerats:

1. Vad karaktäriserar chefernas uppfattningar om ledarskap, chefsrekrytering, lärande och karriär, jämställdhet samt hälsa i företaget?
2. Vilka förutsättningar finns för kvinnor och män att rekryteras till chefspositioner samt utöva chef- och ledarskap i företaget?
3. Vilka orsaker finns till varför få kvinnor har chefspositioner i företaget?

För att kunna diskutera skillnader mellan kvinnors och mäns uppfattningar och villkor närmar vi oss forskningsfrågorna utifrån ett genusperspektiv. Med genusperspektiv avser vi i denna rapport synsättet att vi formas till kvinnor och män genom det vi gör, och de aktiviteter vi deltar i, i samspel med andra människor i det dagliga arbetet. Våra könsidentiteter är beroende av rådande, socialt konstruerade, föreställningar i samhället och vi lär oss och lär oss att förhålla oss till dessa föreställningar i det dagliga arbetet. Vi utvecklar dessa tankar ytterligare i kapitel 2.

Objectives

Research has shown that individuals reporting a low level of adjustment latitude, defined as having few possibilities to temporarily adjust work demands to illness, have a higher risk of sick leave. To what extent lack of adjustment latitude influences the individual when making the decision to take sick leave is unknown. We hypothesize that ill individuals are more likely to take sick leave on days when they experience a lack of adjustment latitude at work than on days with access to adjustment latitude.

Methods

A case-crossover design was applied to 546 sick-leave spells, extracted from a cohort of 1 430 employees at six Swedish workplaces, with a 3–12 month follow-up of all new sick-leave spells. Exposure to lack of adjustment latitude on the first sick-leave day was compared with exposure during several types of control periods sampled from the previous two months for the same individual.

Results

Only 35% of the respondents reported variations in access to adjustment latitude, and 19% reported a constant lack of adjustment latitude during the two weeks prior to the sick-leave spell. Among those that did report variation, the risk of sick leave was lower on days with lack of adjustment latitude, than on days with access (Odds Ratio 0.36, 95% Confidence Interval 0.25–0.52).

Conclusions

This is the first study to show the influence of adjustment latitude on the decision to take sick leave. Among those with variations in exposure, lack of adjustment latitude was a deterrent of sick leave, which is contrary to the à priori hypothesis. These results indicate that adjustment latitude may not only capture long-lasting effects of a flexible working environment, but also temporary possibilities to adjust work to being absent. Further studies are needed to disentangle the causal mechanisms of adjustment latitude on sick-leave.

BACKGROUND: The prerequisite for obtaining sickness benefit is reduced work ability for medical reasons in combination with work demands which cannot be adjusted accordingly. The aim of this study was to investigate if low levels of adjustment latitude, defined as the possibility to temporarily adjust work demands in case of ill health, influence sickness absence.

METHODS: A prospective cohort study of 1420 employees (47% participation, aged 19-68; 56% women) was conducted at six Swedish workplaces. Exposure to two general and nine specific types of adjustment latitude was ascertained at baseline. Outcome was defined as the first new employer-reported sick-leave spell during a follow-up of 3-12 months. Hazard ratios (HR) of sick leave, with 95% confidence intervals (CI), were estimated by Cox proportional hazards regression.

RESULTS: The incidence of sickness absence was 2.85/1000 person-days. The self-reported reasons for sick leave were mainly minor complaints such as colds, influenzas and headaches. Employees lacking adjustment latitude had an adjusted HR of sickness absence of 1.51 (95% CI 1.08-2.11). Among specific adjustment latitude types, those not having the possibility to work from home generated an HR of 1.86 (95% CI 1.31-2.64). The effects of lack of adjustment latitude were similar for men and women but seemed to vary between different occupations.

CONCLUSION: A low level of adjustment latitude at work is a risk factor for sickness absence.

Background

Although illness is an important cause of sick leave, it has also been suggested that

non-medical risk factors may influence this association. If such factors impact on the

period of decision making, they should be considered as triggers. Yet, there is no

empirical support available.

The aim was to investigate whether recent exposure to work-related psychosocial

events can trigger the decision to report sick when ill.

Methods

A case-crossover design was applied to 546 sick-leave spells, extracted from a

Swedish cohort of 1 430 employees with a 3-12 month follow-up of new sick-leave

spells. Exposure in a case period corresponding to an induction period of one or two

days was compared with exposure during control periods sampled from workdays

during a two-week period prior to sick leave for the same individual. This was done

according to the matched-pair interval and the usual frequency approaches. Results

are presented as odds ratios (OR) with 95% confidence intervals (CI).

Results

Most sick-leave spells happened in relation to acute, minor illnesses that substantially

reduced work ability. The risk of taking sick leave was increased when individuals

had recently been exposed to problems in their relationship with a superior (OR 3.63;

CI 1.44-9.14) or colleagues (OR 4.68; CI 1.43-15.29). Individuals were also more

inclined to report sick on days when they expected a very stressful work situation than

on a day when they were not under such stress (OR 2.27; CI 1.40-3.70).

Conclusions

Exposure to problems in workplace relationships or a stressful work situation seems

to be able to trigger reporting sick. Psychosocial work-environmental factors appear

to have a short-term effect on individuals when deciding to report sick.

Objectives: To investigate if exposure to an unusually low workload when ill can trigger taking sick leave. Methods: A case-crossover design was applied to 546 sick-leave spells obtained from a cohort of 1430 employees within six Swedish workplaces. New sick-leave spells were reported from the workplaces during 3 to 12 months follow-up. Exposure was assessed in structured participant interviews at sick leave. Case and control periods from the same individual were sampled according to the matched-pair and usual-frequency approaches. Results are presented as odds ratios with surrounding 95% confidence intervals. Results: The odds ratio of sick leave on a day with an unusually low workload was 2.57 (confidence interval, 1.07-6.16). Conclusions: Becoming ill on a day with a lower workload than usual can trigger the decision to take sick leave.

Att anpassa arbete till ohälsa är ett sätt att hantera bristande överensstämmelse mellan arbetets krav och individens kapacitet. En uppdelning kan göras mellan anpassningsmöjligheter, som "naturligt" finns i arbetet, och modifierat arbete, som innebär förändring av arbetssituationen som ett led i rehabilitering. Studier visar att ju fler anpassningsmöjligheter en person har i arbetet ju större är sannolikheten att han eller hon återgår i arbete efter lång sjukskrivning. Starkt stöd finns även för att modifierat arbete ökar sannolikheten att återgå efter lång sjukskrivning. Modifierat arbete kan dock ge upphov till negativa reaktioner bland arbetskamrater och därmed påverka modifieringarna negativt. Arbetsgivare kan även reagera olika på individers återgång i arbete efter sjukskrivning. Möjligheter till ett modifierat arbete kan t.ex. sammanhänga med en välkomnande attityd från arbetsgivaren.

Objective: Adjustment latitude describes opportunities to change demands at work when ill and may affect work ability. The aim here is to study the association between adjustment latitude and self-assessed work ability among men and women and employees from different occupational sectors.

Methods: This cross-sectional study used data from a questionnaire sent to 3020 employees in three occupational sectors in Sweden; 1430 responded. Subjects were divided into: full, moderately reduced, and greatly reduced work ability. Presence of nine adjustment opportunities was requested and subjects were divided into three groups. Each specific opportunity was also analyzed in relation to work ability. Multinomial logistic regression was used for analyses.

Results: Number of opportunities to adjust was associated with work ability among men and employees in health care. "Shortening the working day" was associated with work ability in most groups. For men and industrial employees, "postponing work", "going home and working later", and "working without disturbance" were associated with work ability. "To work from home" was associated with work ability among women and employees in insurance.

Conclusions: The assumption that adjustment latitude affects work ability is supported. Associations differ with regard to gender and occupational sectors. Further studies with longitudinal design and alternative samples are needed.

The authors studied the social gradient in sickness absence in relation to components of the illness flexibility model, which highlights conditions affecting whether people attend work when they are ill. The conditions studied were: adjustment latitude, attendance requirements at work, stimulating work, and health. The population sample was part of a panel originating in 1994 when 15,154 inhabitants of Stockholm County were randomly selected to receive a questionnaire covering, among other things, health and psychosocial conditions. New questionnaires were sent to the respondents in 1998 and 2002. This article analyzes the 2002 data, for 1,634 women and 1,063 men. These respondents had reported being employed or on leave of absence. In this sample, a social difference was found in sickness absence of 31 days or more per year. For manual workers, women had an odds ratio (OR) of 2.8 and men an OR of 3.4 for such absence compared with nonmanual workers of both sexes in high socioeconomic positions. All single potential confounders decreased these ORs. Adding all characteristics decreased the OR by 78 percent for women and 67 percent for men. The results indicate that the social gradient in sickness absence is due to differences in health and in working conditions when one is ill.

Much research has been done on interventions to reduce work-related musculoskeletal disorders (WMSDs) at the workplace. However, this problem is still a major concern in working life. The economic cost for WMSDs corresponds to between 0.5% and 2% of the gross national product in some European countries, and in 2007, 8.6% of workers in the EU had experienced work-related health problems during the previous 12 months. In Sweden, one in five of all employees have rated occurrence of WMSDs during the previous 12 months.

In spite of comprehensive ergonomic improvements of workplace and tool design in dentistry the prevalence of musculoskeletal disorders in neck, upper arms and back is reported to be between 64% and 93%.

The present thesis investigates if the perceived high exertion during work corresponds to actual physical exposures. Further, it is investigated if risk full physical exposures may be generated due to rationalisations. Specifically, changes in physical exposures are investigated prospectively during a period of rationalisations. Empirical data on production system performance, individual measured physical workload, and self-rated physical workload are provided.

High estimates of self-rated workload were found. These high scores for perceived workload were associated with high measured muscular workload in the upper trapezius muscles. Also, negative correlations were found between low angular velocities in the head, neck and upper extremities on the one hand, and estimates for perceived workload on the other. Both measured muscular workload and mechanical exposure among dentists indicate a higher risk of developing WMSDs than in occupational groups with more varied work content. Value-Adding Work (VAW) comprised about 57% of the total working time and compared to industrial work an increase with about 20 percent units is hypothesised. Furthermore, VAW compared to non-VAW (“waste”) implies more awkward postures and especially low angular velocities interpreted as constrained postures.

Consequently, when increasing the proportion of time spent in VAW due to rationalisations, work intensification is expected. However, at follow up, we did not find such work intensification.

Previous research indicates that rationalisation in working life may be a key factor in the development of WMSD. The present thesis suggests that ergonomics may then be considered proactively as part of the rationalisation process.

Swedish dentistry has been exposed to frequent rationalisation initiatives during the last half century. Previous research has shown that rationalisation often results in increased risk of developing work-related musculoskeletal disorders, thus reducing sustainability in the production system. In this prospective study, we assessed mechanical exposures among Swedish dentists in relation to specific rationalisations of clinical dental work during a six-year period. Body postures and movements of 12 dentists were assessed by inclinometry synchronised to video recordings of their work. No rationalisation effects could be shown in terms of a reduction in non-value-adding work (waste), and at job level, no major differences in mechanical exposure could be shown between baseline and follow-up. Conclusion: The present rationalisation measures in dentistry do not seem to result in rationalisation at job level, but may potentially be more successful at the overall dental system level. Practitioner summary: In contrast to many previous investigations of the mechanical exposure implications of rationalisation, the present rationalisation measures did not increase the level of risk for dentists. It is highlighted that all occupations involved in the production system should be investigated to assess production system sustainability.

Comprehensive rationalisations in Swedish dentistry suggest contribute to increase risk for MSDs among dentists. This prospective study focused on assessing changes in degree of rationalisation of clinical dental work by dentists during a six years period, with particular emphasis on time aspects and mechanical exposure. Twelve dentists were followed up by the means 45 minute’s video recordings and synchronised inclinometry measurements. The video recordings were analyzed by a loss analysis technique.

The results shows that non-VAW time proportion (waste) at the follow up was not reduced, but rather showed a trend towards an increase. Mechanical exposures during non-VAW and VAW were essentially not changed during the follow up time. The risk for MSDs for dentists due to mechanical exposure is unchanged. The used loss analysis technique has a lot to contribute in health care settings but the used concept applied needs further elaboration in the future.

Dentists reported high perceived physical work conditions. Working postures and movements of the head and upper extremities during dental work were registered with inclinometry measurements during four hours. The aim was to clarify the relationship between measured working postures/movements and perceived physical work conditions. Dentists worked with elevated arms and a rather steep forward inclination of the head. Correlations (r = -0.52 to -0.66) between inclination velocity and perceived workload on VAS scales were found, but there were only weak correlations between observed working postures. The different tasks involved in dental work provide limited variation in work movements and postures, measured by inclinometry. By alternating between sitting and standing, it might be possible to achieve variation in physical workload during dental work.

The present study investigates dental work in terms of time distribution and mechanical exposure in value-added and non-value-added tasks. Further rationalization of dental work would typically involve an increase in the proportion of value-added tasks. Information on mechanical exposure within classes of value-added and non-value-added tasks can be used to predict possible implications of rationalization.

Twenty-four dentists were investigated. Using a data logger, postures and movements were continuously recorded for each subject during four hours of work, which included 45 minutes of video recording. Time distribution and mechanical exposure for each work activity were calculated from the video recordings, using a loss analysis technique. Value-added tasks, which comprised 57% of the total working time, generally implied significantly more constrained mechanical exposures as compared with non-value-added tasks.

The results indicate that future rationalization of dental work, involving a reduction of nonvalue-added tasks, may increase the risk of developing musculoskeletal disorders.

BACKGROUND: While back pain and stressful work environment are shown to be important causes of sickness absence the effect of psychosocial resources on sickness absence, and on self assessed work ability, is less commonly investigated. The aim of this study was to assess these associations in a two-year follow-up study.

METHODS: 341 working people aged 45 to 64, randomly drawn from the population, responded to a questionnaire at baseline and at a two-year follow-up. Poisson regression was used to analyse the association of psychosocial factors (psychosocial instruments on work environment, emotional support and psychological resources) and previous back pain (low back and/or neck) at baseline with sickness absence (spells and days) at follow-up, controlling for effects of age, sex, BMI, smoking, alcohol, occupation, disease and previous sickness absence. Logistic regression was used to study the associations of psychosocial factors and previous back pain at baseline with self assessed prognosis of poor work ability six months from follow-up. Finally, a multivariate analysis tested the independent effects of previous back pain and 3 psychosocial factors derived in a factor analysis: 1. work environment; 2. emotional support; 3. psychological resources, on work ability and absence days and spells.

RESULTS: 80% of the sickness absence spells within the last 12 months before follow-up were short-term (<= 14 days). In the final model, high emotional support predicted more sickness absence spells (RR 1.36; 1.11-1.67) and days (RR 1.68, 1.22-2.31). Previous back pain (OR 2.56; 1.13-5.81), high emotional support (OR 1.58; 1.02-2.46), and low psychological resources (OR 0.62; 0.44-0.89) were related to poorer self assessed prognosis of work ability at follow up.

CONCLUSIONS: In a general middle aged working population high emotional support was related to more sickness absence and also poorer self assessed prognosis of work ability. Our findings suggest that both sickness absence and self assessed work ability are dependent of life outside work and can be affected by a person's close community.

Background: Crime in a neighbourhood has been recognized as a key stressor in the residential environment. Fear of crime is related to risk assessment, which depends on the concentration of objective risk in time and space, and on the presence of subjective perceived early signs of imminent hazard. The aim of the study was to examine environmental, socio-demographic, and personal correlates of safety-related concerns at the local level in urban communities. The specific aim was to investigate such correlates in contiguous neighbourhoods in a Swedish urban municipality. Methods: A cross-sectional study design was used to investigate three neighbourhood settings with two pair-wise conterminous but socially contrasting areas within each setting. Crime data were retrieved from police records. Study data were collected through a postal questionnaire distributed to adult residents (n = 2476) (response rate 56%). Composite dimensions of perceived residential safety were derived through a factor analysis. Logistic regression analysis was used to examine associations between high-level scores of the three safety-related dimensions and area-level crime rate, being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. Results: Three composite dimensions of perceived residential safety were identified: (I) structural indicators of social disorder; (II) contact with disorderly behavior; and (III) existential insecurity. We found that area-level crime rates and individual-level variables were associated with the dimensions structural indicators of social disorder and existential insecurity, but only individual-level variables were associated with the dimension contact with disorderly behavior. Self-assessed less favorable area reputation was found to be strongly associated with all three factors. Being female accorded existential insecurity more than being a victim of crime. Conclusion: We have identified environmental, socio-demographic, and personal correlates of safety-related concerns in contiguous neighbourhoods in a Swedish community. The results of this study suggest that residents self-assessed area reputation is an important underlying mechanism of perceived safety. We also found a difference in crime rates and safety-related concerns between areas with blocks of flats compared with small-scale areas although the neighbourhoods were close geographically.

The authors used a mixed methods approach to examine if the reputation of a housing area has bearing on residential wellbeing and social trust in three pairs of socioeconomically contrasting neighborhoods in a Swedish urban municipality. Multilevel logistic regression analyses were performed to examine associations between area reputation and residential wellbeing and social trust, controlling for the random effect of neighborhood and individual level sociodemographic factors. Qualitative data were analyzed to identify mechanisms of how neighborhood reputations were established. The housing area reputation was found to be strongly associated with wellbeing and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order The results suggest that area reputation is an important and probably underestimated dimension in the development of residential wellbeing and social trust in housing.

Background: Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Östergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries.

Methods: Prospective prescription data were obtained for 90% of the primary health care centres in Östergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff.

Results: During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45–64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1–2 days per week.

The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%).

Conclusion: Östergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals.

Background: Written prescriptions of physical activity, so‐called physical activity referral (PAR) schemes, have increased in popularity in recent years. Such schemes have mostly been evaluated in terms of efficacy. This study reports on a Swedish PAR scheme implemented in routine primary health care (PHC) measuring patients’ self‐reported adherence to physical activity prescriptions. The aim of this study was to evaluate adherence to physical activity prescriptions issued in everyday PHC at 3 and 12 months and to analyse the different characteristics associated with adherence to these prescriptions.

Methods: Prospective prescription data were obtained for 37 of the 42 PHC centres in Östergötland County, Sweden, during 2004. The study population consisted of 3300 patients issued PARs by ordinary PHC staff members. Odds ratios were calculated to identify the factors associated with adherence.

Results: The average adherence rate was 56% at 3 months and 50% at 12 months. In the descriptive analyses, higher adherence was associated with increased age, higher activity level at baseline, home‐based activities, prescriptions issued by professional groups other than physicians, and among patients issued PARs due to diabetes, high blood pressure and “other PAR reasons”. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline, and to prescriptions including home‐based activities, both at 3 and 12 months.

Conclusions: Prescriptions from ordinary staff in routine PHC yielded adherence in 50% of the patients in this routine care PAR scheme follow‐up. Patients’ activity level at baseline (being at least somewhat physically inactive) and being issued homebased activities were associated with higher adherence at both 3 and 12 months.

Background: Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity.

Methods: A regional public health survey was mailed to 13 440 adults (aged 18-84 years) living in Östergötland County (Sweden) in 2006. The survey was part of the regular effort by the regional Health Authorities.

Results: About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37%) had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity) more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support.

Conclusion: These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for their own physical activity levels, but also attribute responsibility for promoting increased physical activity to health care practitioners.

Introduction: Employee health, individual behaviors in an organizational context and perceived organizational justice are theoretically united. The empirical relationship, especially between behavioral responses and organizational justice and between behavioral responses, and especially job mobility, and health are not previously studied in any apparent

extent.

Aim: The main aim with the present dissertation was to study the relationship between organizational justice, behavioral responses, and health.

Methods: The present study was designed as a longitudinal, three-wave, panel study. A questionnaire was mailed to all employees in three regional organizations of the Swedish National Labour Market Administration (AMV) at 2001 (N=1010, response rate: 78%), 2002 (N=1078, response rate: 75%) and 2003 (N=1122, response rate: 74%).

In study I, a cross-sectional and longitudinal validation study, was analyses of variance, multi-trait/multiitem analyses, logistic regression analyses and different forms of factor analyses used to validate and evaluate the Hagedoorn et al. EVLN instrument. In study II, a longitudinal panel study, correlation and Structural Equation Modeling (SEM) analyses were used to elucidate the reciprocal relationship between behavioral responses and health. In study III, a longitudinal panel study, factor, correlation and SEM analyses were used to investigate the association between organizational justice, health and burnout. In study IV, a longitudinal panel study, was variance and General Linear Modeling (GLM) repeated measures analyses used to examine the relationship between turnover intentions, job mobility and health and burnout. In study V, a longitudinal panel study, variance, correlation, and SEM analyses were used to shed light upon the reciprocal relationship between health, burnout and job mobility with turnover intentions, organizational justice and age as affecting factors.

Results: Study I showed that the Hagedoorn et al. EVLN instrument was a valid instrument with the exception for the aggressive voice subscale that presents some obvious and distinct deficiencies. The results of study II indicate that the relation between behavioural responses versus health is mainly one-sided: behavioural responses predict psychosocial health. The behavioural response ‘exit’ at baseline was associated with worse psychosocial health at the two-year follow-up, while ‘considerate voice’ predicted good psychosocial health at the two-year follow-up. Good baseline physical health predicted a high degree of ‘exit’ behaviour after two years. Study III showed that organizational justice is cross-sectionally and longitudinally associated with physical, psychosocial health, and burnout. The two approaches to study organizational justice, as a global or threefold construct, should be regarded as complementary rather than exclusive. The results of study IV showed that external mobility had a positive effect on personal and work-related burnout compared with non-mobility and that the combined effects of turnover intentions and job mobility are additive rather than interactive. Finally, the results of study V showed that job mobility is a more distinct predictor of health and burnout than health and burnout is of job mobility. Turnover intentions, but not organizational justice, proved to have an effect on job mobility.

Conclusion: The present dissertation has elucidated the social-psychological relationship between organizational justice, behavioral responses and health. The results show that perceived organizational justice predicted good health and low degree of burnout. The results also show that active behavioural responses predict psychosocial health: pro-organizational behaviour, (considerate voice), was associated with high psychosocial health and a contra-organizational behaviour (exit) was associated with low psychosocial health. External job mobility showed a positive effect on burnout and is a more distinct predictor of health and burnout than health and burnout is of job mobility.