Purpose. The aim of this study was to describe the experience of return to work (RTW) after stroke from the patient's perspective.Method. Six patients who had their first ever stroke in 2001, were <65 years of age and were working at the time of their stroke were included. Information was obtained via an open-ended interview. The material was transcribed verbatim and analysed using Giorgi's empirical phenomenology.Results. Rehabilitation was perceived as primarily aimed at restoring bodily functions and a return to everyday activities, rather than at promoting a return to work. It was not experienced as adapted to the participants' needs or their age. The workplace was experienced as very important in the rehabilitation process. When the informants experienced that the rehabilitation professionals were not taking action, they took control of the situation themselves. The informants expressed pride in their own capacity to take the initiative and in their ability to take action. Both self-employed and employed informants said they had possibilities and opportunities to take action since their work situation was flexible. The informants' adaptation to a new role at work was perceived as facilitated by the understanding and positive attitude of co-workers.Conclusion. Among this group of stroke patients, the individual patient's capacity and ability to return to work was enhanced by motivation or "will" and self-efficacy in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. There are similarities between the RTW process and processes of health promotion.

The findings strengthen the notion that workplace-based return-to-work interventions need to take social relations amongst workplace actors into account. They also highlight the importance and relevance of the varied roles of different workplace actors during two relatively unseen or grey areas, of return-to-work: the pre-return and the post-return sustainability phase. Attention to the invisibility of return-to-work efforts of some actors and uncertainty about how and when to enact return-to-work between workplace actors can promote successful and sustainable work ability for the re-entering worker.

Background and Purpose-Stroke mortality is decreasing in Sweden, as is the case in other Western European countries.However, both decreases and increases have been reported in Sweden for persons younger than age 65 years. The aim of this study was to compare the incidence of stroke in Sweden between the periods 1989 and 1991 and 1998 and 2000 in persons aged 30 to 65 years. Methods-All first-ever stroke patients aged 30 to 65 years in the Swedish Hospital Discharge Register between 1989 and 2000 were included. Results-The age-standardized, 3-year average incidence increased by 19%, from 98.9 to 118.0 per 100 000 among men, and by 33%, from 48.4 to 64.4 among women, between 1989 and 1991 and 1998 and 2000. The largest increase was seen among those younger than 60 years. On a county level, the change in age-standardized stroke incidence varied from small decreases (Ϫ3%) to large increases (82%). Conclusion-Stroke incidence increased in Sweden for both men and women between 1989 and 2000. The increase was larger among women. This calls for action when it comes to studying risk factors and planning for prevention and health promotion and indicates the need for gender-specific studies.

Objectives: The study aims to identify individual and workplace factors associated with early return to work [RTW] -defined as within 3 months -and factors associated with later RTW -between 3 and 12 months after being sick-listed -in a cohort of newly sick-listed individuals with common mental disorders.Methods: In a prospective cohort study, a cross-sectional analysis was performed on baseline measures of patients granted sick leave due to common mental disorders. A total of 533 newly sicklisted individuals fulfilled the inclusion criteria and agreed to participate. A baseline questionnaire was sent by post within three weeks of their first day of certified medical sickness; 354 (66%) responded. Those who were unemployed were excluded, resulting in a study population of 319 individuals. Sick leave was recorded for each individual from the Social Insurance Office during one year. Analyses were made with multiple Cox regression analyses.Results: Early RTW was associated with lower education, better work ability at baseline, positive expectations of treatment and low perceived interactional justice with the supervisor. RTW after three months was associated with a need to reduce demands at work, and turnover intentions.Conclusions: Early RTW among sick-listed individuals with common mental disorders seems to be associated with the individual's need to secure her/his employment situation, whereas later RTW is associated with variables reflecting dissatisfaction with work conditions. No health measures were associated with RTW. The study highlights the importance of considering not only health and functioning, but also workplace conditions and relations at the workplace in implementing RTW interventions.

A case-control study was performed to elucidate the strength of the relation between musculoskeletal disorders in the neck and shoulders and physical, organisational, and psychosocial aspects of the work environment. Cases were identified as those persons who consulted a physician in a community in southern Sweden for new musculoskeletal disorders in the neck and shoulders during a study period from August 1988 to the end of October 1989. One hundred and nine cases were collected and clinically examined. The cases also answered the Nordic questionnaire on symptoms as well as a questionnaire on work conditions and background factors. Controls were drawn as a random sample of the working population in the community where the cases appeared. A total of 637 controls answered the same questionnaires as the cases. Odds ratios (ORs) were calculated by logistic regression. The odds ratios were 11P4 for women, 4 9 for immigrant background, and 3-7 for current smoking. To exercise rarely, compared with often, appeared as a preventive factor with an OR of 03. The ORs for various determinants of physical work load were 7'5 for repetitive movements demanding precision, 13-6 for light lifting, 3-6 for uncomfortable sitting positions, 4-8 for work with lifted arms, and 3 5 for a rushed work pace. Regarding work organisational determinants, the ORs were 16-5 for ambiguity of work role (uncertainty whether the person could manage the work) 2-6 for low quality work, and 3-8 for high demands on attention. Several of the determinants showed a significant dose-response relation with disease. It seems that work organisation and psychosocial work conditions are as important determinants for disease in the neck and shoulders as are the physical work conditions.

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The aim of this study was to evaluate a theory-based method for workplace health promotion (WHP) with regard to possible facilitation of empowerment processes. The intervention tool was the pedagogic method known as problem-based learning (PBL). The aim of the intervention was to promote empowerment and health among the employees. The intervention was implemented in three organizations within the public sector in Sweden, in a bottom-up approach. All employees, including management, in each organization, were offered the opportunity to participate (n = 113) and 87% (n = 97) participated. The intervention was implemented in 13 groups of six to eight participants who met once a week over a period of 4 months. The predetermined overall goal of the intervention was to promote employee health within the organizational setting. A facilitator in each group and a group-specific mutual agreement guided the intervention, as did the problem solving process. The participants set goals and developed strategies to reach their goals between the meetings. Thirty informants were interviewed in seven focus groups after the intervention about the intervention method and the process, following a semi-structured theme guide. The phenomenographic analysis resulted in six descriptive categories: reflection, awareness and insight, self-direction and self-management, group coherence, social support and actions. The results correspond to established theories of components of empowerment processes. The method initiated processes of change at organizational, workplace and individual levels as the participants examined their work situation, determined problems and initiated solutions. Social support and group coherence were expressed as essential in order to transform challenging strategies into action and goal realization. The findings indicate that systematic improvements of social support and group coherence among employees ought to be facilitated by the organization as a health-promoting arena. PBL appears to be a profitable and powerful instrument with the potential to enable empowerment.

Flow is an experience of enjoyment, intrinsic motivation and absorption, which may occur in situations involving high challenges and high skill utilization. This study investigated the likelihood of experiencing work-related flow in relation to the job strain categories of the demand-control model, and to job resources such as social capital and an innovative learning climate. A questionnaire was sent out to employees in nine Swedish organizations (n = 3667, 57% response rate). Binary logistic regressions analysis was performed. The results show that active jobs, low-strain jobs, a high degree of social capital and innovative learning climate increased the likelihood of experiencing work-related flow. In jobs with high decision latitude, regardless of demands, there was an increased likelihood to benefit from social capital and an innovative learning climate. The results emphasize the importance of autonomy and skill utilization, to enable the use of additional job resources in order to promote workrelated flow and well-being at work.