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Return-to-work coordinators (RTWC) support people on sickness absence and is a new healthcare occupation in Sweden. Its practitioners represent a variety of professions, there is no common undergraduate training and vague role and competence descriptions. The aim was to explore differences in training and competence according to original professions (occupational therapists, physiotherapists, counselling, and other professions) and coordinators' views on which professions they believe provide the best competence for the role. All RTWCs (82) in one region were invited to answer a questionnaire (89% response rate). Mixed-methods analyses were applied. The results showed that counselling professions were more likely than other professional groups to have further training, particularly in conversation methods, and a lower proportion of them stated needing more knowledge about gender equality, social problems, insurance/benefit and conversation methods. The analysis of free-text answers identified three competence areas of importance: advice and guidance, a holistic view, and personality over profession. Occupational therapists and social workers were seen as having the best competence for the coordinating role. The results outline some common values, norms and important competences for RTWCs that could help develop the RTW coordination training and pave the way for RTWCs professionalisation process., Rehabiliteringskoordinatorer är en ny yrkesroll inom hälso – och sjukvården som stödjer sjukskrivna patienter i rehabiliteringsprocessen. Koordinatorerna saknar dock en tydlig roll – och kompetensbeskrivning, och det faktum att yrkesrollen saknar en gemensam yrkesutbildning och innehas och utvecklas av olika professioner gör den unik. Syftet med studien var att undersöka skillnader i kompetens baserat på rehabiliteringskoordinatorers olika grundprofessioner, samt vilka professioner de menade hade bäst kompetens för att arbeta som rehabiliteringskoordinator. Alla rehabiliteringskoordinatorer i en region bjöds in att svara på en enkät (89% svarsfrekvens). Både kvantitativa och kvalitativa analysmetoder användes. Resultaten visade att kuratorer hade mer vidareutbildning än övriga professioner, särskilt inom samtalsmetoder, och kuratorerna uppgav mindre behov av ytterligare kompetens inom områdena jämställdhet, sociala problem, försäkringar/bidrag och samtalsmetoder. Analysen av fritextsvaren visade att holistisk syn, personlighet framför profession samt rådgivning och vägledning ansågs vara tre viktiga kompetensområden för rehabiliteringskoordinatorer. Arbetsterapeuter och socionomer ansågs ha mest passande kompetens för att arbeta som rehabiliteringskoordinator. Resultaten adresserar några gemensamma grundvärden, normer och viktiga kompetensområden för rehabiliteringskoordinatorer som kan bidra i utvecklingen av utbildning för rehabiliteringskoordinatorer och bana väg för deras professionaliseringsprocess.

Purpose In recent decades, many countries have implemented return-to-work coordinators to combat high rates of sickness absence and insufficient collaboration in the return-to-work process. The coordinators should improve communication and collaboration between stakeholders in the return-to-work process for people on sickness absence. How they perform their daily work remains unexplored, and we know little about to what extent they collaborate and perform other work tasks to support people on sickness absence. This study examines which work models return-to-work coordinators use in primary healthcare, psychiatry and orthopaedics in Sweden. Methods A questionnaire was sent to all 82 coordinators in one region (89% response rate) with questions about the selection of patients, individual patient support, healthcare collaboration, and external collaboration. Random forest classification analysis was used to identify the models. Results Three work models were identified. In model A, coordinators were more likely to select certain groups of patients, spend more time in telephone than in face-to-face meetings, and collaborate fairly much. In Model B there was less patient selection and much collaboration and face-to-face meetings. Model C involved little patient selection, much telephone contact and very little collaboration. Model A was more common in primary healthcare, model C in orthopaedics, while model B was distributed equally between primary healthcare and psychiatry. Conclusion The work models correspond differently to the coordinator’s assignments of supporting patients and collaborating with healthcare and other stakeholders. The differences lie in how much they actively select patients, how much they collaborate, and with whom. Their different distribution across clinical contexts indicates that organisational demands influence how work models evolve in practice.

Purpose Return-to-work coordinators (RTWCs) give people on sick leave individualized support and coordinate between different stakeholders, including physicians. The aim of this study was to explore physicians’ experience of RTWCs and investigate factors that influence how much physicians collaborate with RTWCs, or refer patients to them, in primary, orthopaedic, and psychiatric care clinics. Materials and methods Of the 1229 physicians responding to a questionnaire, 629 physicians who had access to a RTWC in their clinic answered to questions about collaborating with RTWCs. Results Among physicians who had access to a RTWC, 29.0% collaborated with a RTWC at least once a week. Physicians with a more favourable experience of RTWCs reported more frequent collaboration (adjusted OR 2.92, 95% CI 2.06–4.15). Physicians also collaborated more often with RTWCs if they reported to often deal with problematic sick-leave cases, patients with multiple diagnoses affecting work ability, and conflicts with patients over sickness certification. Conclusions Physicians who had more problematic sick-leave cases to handle and a favourable experience of RTWCs, also reported collaborating more often with RTWCs. The results indicate that RTWCs’ facilitation of contacts with RTW stakeholders and improvements in the sickness certification process may be of importance for physicians. Implications for Rehabilitation This study of physicians’ experience of collaborating with return-to-work coordinators (RTWCs) observes that physicians reported more collaboration with or referrals to coordinators if they had a favourable experience of coordinators. The results indicate that physicians report more collaboration with or referrals to RTWCs if they had more problematic sick-leave cases to handle in the clinic. These findings imply that it might be possible to increase the collaboration between physicians and RTWCs in clinical settings by managing factors of importance.

Purpose: The return-to-work (RTW) process for people with multimorbidity and psychosocial difficulties can be complicated. This study explores the organisational prerequisites for coordinating these patients’ RTW processes from the perspective of coordinators in different clinical areas in Sweden. Material and methods: Six focus group interviews were conducted with 24 coordinators working in primary healthcare (PHC), psychiatric and orthopaedic clinics. The data were analysed thematically, inspiredby organisation theory. Results: Coordinators described varying approaches to people with multimorbidity and psychosocial difficulties, with more hesitancy among PHC coordinators, who were perceived by other coordinators as hindering patient flows between clinical areas. Most organisational barriers to RTW were identified in the healthcare sector. These were long waiting times, physicians drawing up inadequate RTW plans, coordinators being involved late in the sickness absence process, and lack of rehabilitation programmes for people with multimorbidity. The barriers in relation to organisations such as Social Insurance Agency and Employment Services were caused by regulations and differing perspectives, priorities, and procedures. Conclusion: Our findings indicate what is needed to improve the RTW process for patients with complex circumstances: better working conditions, steering, and guidelines; shorter waiting times; and a willingness among coordinators from different clinical areas to collaborate around patients.

In 2016–2017, a large Swedish hospital introduced a mobile team of asylum social workers to work with asylum-seeking and undocumented patients. Based on interviews with the asylum social workers and the theoretical concepts of jurisdiction and professional discretion, this study explores how they experienced their work and developed their specialist competence and strategies for health social work with migrants. The findings show that they not only relieved staff and supported patients and relatives but also systemised the knowledge about health social work with migrants and created a professional specialty with a socially, rather than medically, defined group of patients.

Background: Receiving support from a return-to-work (RTW) coordinator (RTWC) may be beneficial for people on long-term sick leave. The aim of this study was to investigate whether the number of contacts with an RTWC and their involvement in designing rehabilitation plans for the patients were associated with perceiving support for RTW, emotional response to the RTWC, and healthcare utilization. Methods: In this cross-sectional study, 274 patients who had recently been in contact with an RTWC in Swedish primary or psychiatric care answered questions regarding their interaction with an RTWC, perceived support for RTW, and emotional response to the RTWC. Results: Having more contact with an RTWC was associated with perceiving more support in the RTW process (adjusted OR 4.14, 95% CI 1.49-11.47). RTWC involvement in designing a rehabilitation plan for the patient was associated with perceiving more support in the RTW process from an RTWC and having a more positive emotional response to the RTWC. Conclusions: From the patient's perspective, this study indicates that the involvement of an RTWC and receiving a rehabilitation plan that an RTWC has helped to design might be perceived as important in the RTW process.

Yrket hälso- och sjukvårdskurator växte fram ur urbaniseringen vid förra sekelskiftet, men vilken betydelse urbaniseringen haft för kuratorsyrket har inte utforskats. I denna artikel undersöker vi hur kuratorns organisatoriska förutsättningar och professionella handlingsutrymme präglas av den urbana miljön. Tematisk analys genomfördes av individuella intervjuer och fokusgruppintervjuer med asylkuratorer och habiliteringskuratorer i Region Stockholm. Fyra teman framträdde: 1) Socialt arbete med urbaniseringsprocesser, 2) Globaliseringen och storstaden, 3) Effektivisering och handlingsutrymme samt 4) Storstadens många samverkansytor. En central slutsats är att den urbana miljön både kan innebära ett kraftigt begränsat handlingsutrymme, men också ge förutsättningar till ökat handlingsutrymme. Detta tycks bero på om styrning och utformning av uppdrag och arbetsuppgifter är framförhandlade utifrån patienters behov och utifrån kuratorsprofessionens egna villkor eller inte., Health social worker as a profession emerged from the urbanization in the early 20th century. Nevertheless, the importance of the urbanization for the profession has not been studied. In this article, we explore how the organizational prerequisites and professional discretion of health social workers is influenced by the urban environment. Individual and focus group interviews collected among health social workers specialised in immigration respectively working in habilitation services within the Stockholm Region. Data was analysed using thematic analysis. Four themes were discovered: 1) Social work with urbanisation processes, 2) Globalization and the city, 3) Efficiency and professional discretion, and 4) the Big city’s many areas of collaboration. The results indicate that the urban environment can involve both a very limited professional discretion, but also provide conditions for increased professional discretion. This depending on whether steering and formation of assignments and tasks are negotiated on the basis of patients’ needs and based on the professions’ own conditions.

Vi, 1 620 forskare samt lärare vid universitet och högskolor, är eniga med de unga bakom Auroramålet: De drabbas och riskerar att drabbas allvarligt av klimatkrisen under sin livstid. De klimatåtgärder vi vidtar i närtid avgör deras framtid. Sverige måste ta ansvar och göra sin rättvisa andel av det globala klimatarbetet. I strid med Parisavtalet ökar utsläppen av växthusgaser i en takt som gör att 1,5-gradersmålet kan överskridas om några år. De globala effekterna blir allt mer synliga med ständiga temperaturrekord, smältande isar, havshöjning och extremväder som torka, förödande bränder och skyfall med enorma översvämningar, som i Pakistan nyligen. Försörjningen av befolkningen utsätts för allvarliga hot i många länder. Minskningen av den biologiska mångfalden är extrem. Klimatkrisen är enligt WHO det största hotet mot människors hälsa i hela världen och barn utgör en särskilt sårbar grupp. Med Sveriges nordliga läge sker uppvärmningen här dubbelt så fort som det globala genomsnittet. Det förskjuter utbredningsområden för växtlighet och sjukdomsbärande insekter och ökar förekomsten av extremväder såsom värmeböljor, skogsbränder och översvämningar samt av många olika sorters infektioner och allergier. När extremväder ökar, ökar även stressen och risken för mental ohälsa. Värmeböljor ökar risken för sjukdom och död hos sårbara grupper som äldre, små barn och personer med kroniska sjukdomar. De negativa effekterna på hälsan kommer att öka i takt med klimatkrisen och barn riskerar att drabbas av ackumulerade negativa hälsoeffekter under hela sina liv. Redan i dag är mer än hälften av unga mellan 12 och 18 år i Sverige ganska eller mycket oroliga för klimat och miljö. Detta är förståeligt när våra beslutsfattare inte gör vad som krävs. Den juridiska och moraliska grunden för arbetet mot klimatförändringarna är att varje land måste göra sin rättvisa andel av det globala klimatarbetet. Centralt i det internationella klimatramverket är att rika länder med höga historiska, Aftonbladet Debatt

Debattartikel från 1944 svenska forskare och anställda i forskarvärlden.

Background The focus in HIV care so far have been to reach good physical conditions and through the UNAIDS 90-90-90 target. However, health also includes mental and social well-being as well as the absence of stigma and discrimination. The overall aim of this study is to explore the association between living as open with HIV as one wants and suicide thoughts among 16-29-year old young people living with HIV in Sweden. A secondary aim is to see how this can be understood in the intersections of gender and sexual identity. Methods This study is based on a national survey of young people living with HIV conducted at HIV-clinics in 2018. The survey had 173 respondents, giving a response rate of 36 percent. Logistic regression models were used to calculate odds ratios (OR) using suicide thoughts as the outcome variable and open with HIV status, gender and sexual identity as exposure variables. Gender and sexual identity was combined to investigate intersections.Results: The results show that suicidal thoughts are more common among young people who report that they were not as open as they wanted to be with their HIV status (OR 1.71 95% CI : 0.90 – 3.25). The analysis also indicate that the associations of suicide thoughts intersects with gender, sexual identity and openness with one’s HIV. In general, men had higher odds ratios of suicide thoughts if they reported not being as open as they wanted to with their HIV status, or belonging to a sexual minority, compared to heterosexual men being as open as they wanted. In women, the groups were smaller and the same pattern was not observed. Conclusions The findings add to previous knowledge and guide policy and practise as it point not only to the possibilities if being as open as one wants with HIV status but also to how this has different implications depending on the intersection of sex and sexual identity. The results pinpoint the need of larger studies to investigate intersections further.

Under 2016 införde Karolinska Universitetssjukhuset ett specialistteam med asylkuratorer inriktade på asylsökande och papperslösa patienter. Baserat på enkätdata och dokumentation undersöks de ordinarie kuratorernas erfarenheter av asylkuratorerna, om de upplevde att de ökade deras egna kunskaper på migrationsområdet, och i vilka frågor de sökt konsultation. Ju högre grad kuratorerna använde sig av asylkuratorerna, i desto större grad upplevde de att asylkuratorerna haft positiv inverkan på bemötande av patienterna och på de egna arbetsvillkoren och kunskaperna. Även hälften av de som inte involverat asylkuratorerna direkt i patientärenden hade fått ökad kunskap. Resultaten tyder på att specialistkuratorstjänster som formas utifrån sociala problemformuleringar, till skillnad från medicinska uppdelningar, skulle kunna stärka patienters sociala rättigheter och möjligheter till socialt stöd.

Qualitative interviews are generally conducted in person. As the coronavirus pandemic (COVID-19) prevents in-person interviews, methodological studies which investigate the use of the telephone for persons with different illness experiences are needed. The aim was to explore experiences of the use of telephone during semi-structured research interviews, from the perspective of participants and researchers. Data were collected from mobile phone interviews with 32 individuals who had common mental disorders or multimorbidity which were analyzed thematically, as well as field notes reflecting researchers' experiences. The findings reveal several advantages of conducting interviews using mobile phones: flexibility, balanced anonymity and power relations, as well as a positive effect on self-disclosure and emotional display (leading to less emotional work and social responsibility). Challenges included the loss of human encounter, intense listening, and worries about technology, as well as sounds or disturbances in the environment. However, the positive aspects of not seeing each other were regarded as more important. In addition, we present some strategies before, during, and after conducting telephone interviews. Telephone interviews can be a valuable first option for data collection, allowing more individuals to be given a fair opportunity to share their experiences.

Oncologists frequently have sickness certification (SC) consultations, however, little is known about their experiences of such tasks. OBJECTIVE: To investigate oncologists' experiences of organisational prerequisites for SC tasks, and if lack of resources was related to experiencing SC as problematic. METHOD: Questionnaire data from 342 oncologists in Sweden were used for descriptive statistics and to calculate odds ratios (OR) with 95% confidence intervals (CI). RESULTS: The majority (92.2%) had SC consultations weekly; 17.8% of the oncologists experienced such consultations as problematic weekly. About a third appreciated the national guidelines for SC (34.5%) and had joint routines/policies regarding SC at their clinic (29.7%). Experiencing SC consultations as problematic was associated with stating not having enough resources for such work (OR 3.47; 95% CI 1.92-6.25). Lack of resources was associated with: experiencing lack of competence in insurance medicine (3.34; 1.92-5.82), conflicts with patients regarding SC (4.22; 1.96-9.07), finding it problematic to manage the two roles as medical expert and as the patient's treating physician (3.31; 2.04-5.34), or to assess work capacity (2.28; 1.46-3.56). CONCLUSION: Although oncologists often had SC tasks, most did not experience them as problematic weekly. However, lack of resources for SC tasks was associated with experiencing SC as problematic.

Coordinators may play a key role during the return-to-work (RTW) process for people on sickness absence. There are still few studies on the newly implemented rehabilitation coordinators (RECO) within Swedish healthcare, and none focus on their competence. The aim of this study was to explore how persons with multimorbidity and psychosocial difficulties describe the professional competence of the RECO they encountered during their RTW process. The study takes a relational and practical approach in defining professional competence, including both what professionals do and what they possess. Interviews with 12 people with multimorbidity and psychosocial difficulties who had encountered a RECO during their RTW process were analysed using thematic analysis. Six different themes were found: communicative and coordinating skills; advisory and guidance skills; engagement and advocacy skills; being persistent and flexible; being empathic and therapeutic; being professional and trustworthy. Most of these are found in research on RTW coordinators, but being persistent, and having advisory, guidance, advocacy and therapeutic skills have not been recognised as important competences previously. This study adds patients' views on important professional competence that support the RTW process, which should be regarded in further developments of RECOs' functions and their competence descriptions.

Purpose: People with multimorbidity face a range of barriers in healthcare, and there is little knowledge about their challenges with regard to return-to-work (RTW). Rehabilitation coordinators, a new function in Swedish healthcare, support people in the RTW process. The present study had two aims: to explore what problems and barriers people with multimorbidity experience during their rehabilitation and RTW process and to explore in which domains the coordinators' support is perceived to be of importance. Methods: Interviews were conducted with 12 persons with multimorbidity who had contact with a rehabilitation coordinator during their sickness absence. Thematic analysis was guided by the case-management ecological model; this analysis was revised and adapted to the Swedish context. Results: The participants experienced problems in all domains of the model, namely: the healthcare system, the labor market and the workplace system, the sickness insurance system, and the personal system. Rehabilitation programs that did not accommodate combinations of diseases, social complexities and needs were felt to lead to worse symptoms, thus hindering rather than promoting RTW. An overall finding regarding support by coordinators is that interventions, regardless of domain, were felt to be valuable for people with multimorbidity. The coordinator was perceived to give most support by providing advice about and coordination with healthcare and employers. Sometimes the coordinator gave advice and coordination regarding the Social Insurance Agency, very occasionally the Public Employment Services. The coordinator gave least advice and coordination about social difficulties that hindered rehabilitation and RTW processes. Conclusion: People with multimorbidity perceive rehabilitation coordinator interventions as important in all domains investigated. Lack of advice and coordination, or rehabilitation programs that were not modified to the complexities of individual's circumstances

I den här boken ges olika exempel på situationer där professionella förväntas ingripa för att skydda barn och unga – alltifrån bristande föräldraomsorg, misshandel, exploatering, väpnade konflikter, socioekonomisk utsatthet, till att skydda barn från ökad utsatthet till följd av sjukdom eller funktionshinder. Men hur långt sträcker sig egentligen ansvaret hos enskilda professionella inom välfärdens institutioner? Med utgångspunkt i min och andras forskning och i egna erfarenheter av att arbeta med dessa frågor som hälso- och sjukvårdskurator, är ambitionen med detta kapitel att bringa lite reda i ett ibland svårnavigerat fält. Kapitlet handlar om de professionellas uppgift, oavsett om det gäller arbete som lärare, sjuksköterska, kurator, psykolog, polis, socionom, barnskötare eller något annat yrke där kontakter med barn är vanliga. Alla dessa utgör tillsammans första linjens försvar i välfärden för barn som riskerar att fara illa. När personal inom verksamheter som berör barn och unga misstänker att ett barn far illa och kan behöva stöd eller skydd, är de skyldiga att göra en så kallad orosanmälan till socialtjänsten. Kapitlet tar ett brett grepp om professionssystemet och anmälningsskyldigheten, och sätter det svenska systemet och definitionerna i ett internationellt perspektiv. Forskning om vad som tenderar att anmälas presenteras, liksom hittills opublicerade forskningsresultat om anmälningsorsaker bland olika kategorier av sjukhuspersonal. Kapitlet fördjupar sig också i orsaker till att professionella inte anmäler sin oro för barn, samt hur bedömningar av barns utsatthet påverkas av sociala normer och känslor.

Hospital personnel have been shown to report child maltreatment to social services less frequently than other professionals. This quantitative study shows that one-half of the respondents within the four largest Swedish children’s hospitals had never made a report. However, nurses’ and nurse assistants’ odds of being low reporters were significantly high, compared with physicians and hospital social workers. Longer working experience, access to guidelines and routines, and feelings of stress were strongly related to deciding not to report. Insecurity in assessment and ambivalence about how to act also had a strong effect, although different emotions had varying impacts on the different professions; hospital social workers were less strongly influenced by emotions in their decision-making., As manuscript in dissertation