Study protocol: Local labour market programs-institutional structures, organizational forms and lived experiences.

In this programme, we map and examine local labour market programmes (LLMPs) at the municipal level in Sweden. This includes their institutional structure and organisation, as well as the experiences of participants in the programmes, using a longitudinal approach with the aim to improve LLMPs. The long-term goal is to increasing the inclusion of LLMP participants in working life. To answer the programme's questions, data will be collected and analysed within the four work packages. In each work package, a mixed-method approach is applied with a combination of quantitative and qualitative methods. The programme is informed by three overarching general theoretical approached, tying together institutional ethnography, intersectional studies of structural inequalities on different levels, and the role of emotions in everyday work. At the organisational level (WP 1), we will investigate the circumstances under which LLMPs are performed and negotiated by those involved. Here, the internal organisation, activities and methods are the focus. This approach will result in knowledge about the characteristics of these organisations and the factors promoting the inclusion of underrepresented groups in working life. By examining the activities in LLMPs (WP 2), we will be able to determine how their institutional structure differs between regions in Sweden, how the different municipalities work with labour market policy, how they translate national policy into the local context, how they organise their work and which initiatives they choose to adopt. By examining the individual experiences of those who are directly affected by such incentives (WP 3), knowledge and understanding will be obtained of the connections between experiences and labour market policies. This will give important insights into the functioning of local programmes and of the opportunities to create entry into the labour market. Furthermore, in WP4 we will develop and test an effect evaluation of work methods used in LLMPs and their effect on clients' progress over time.

Qualitative identification and characterisation of self-reported symptoms arising in humans during experimental exposure to cold air.

BACKGROUND: Exposure to cold air is associated with increased morbidity and mortality in the general population. It is difficult to study the effects of whole-body exposure to cold air under controlled conditions in real life. OBJECTIVES: The aim of this study was to (1) explore and describe the experience of symptoms in humans during experimental and controlled exposures to cold air, by using controlled environmental chamber exposures and qualitative methodology, and to (2) categorise the symptoms. METHOD: The study used a randomised, double blind design, in which 34 subjects undertook rest and moderate-intensity exercise in an environmental chamber set to two or three different temperatures (0, -10, and -17°C) on separate occasions. During the chamber exposures, subjects were interviewed. Qualitative content analysis was selected as the method of analysis. FINDINGS: Subjects reported 50 distinct symptoms during the exposures. The symptoms were grouped into ten sub-categories and two major categories; airway versus whole-body symptoms. CONCLUSION: We have identified a broad range of symptoms in humans undertaking rest and moderate-intensity exercise at sub-zero temperatures. The symptoms and their categories may well be used to more extensively and quantitatively map cold-induced morbidity.

Experiences of working from a freestanding position as a case manager when supporting clients in the Swedish welfare system.

The Swedish state uses a case management function known as Personligt Ombud (PO). The role as PO differs from the traditional professional roles. It has a freestanding position in the welfare system. The aim of this study was to investigate POs' experiences of working from a freestanding position when supporting clients. Telephone interviews were conducted with 22 POs across Sweden. The interviews were recorded, transcribed, and analyzed by latent qualitative content analysis. The findings were reflected in three categories - freedom-promoted flexibility, surfing through a complex welfare system, and working for legitimacy. POs developed a holistic view to both the client as well as to the welfare system. POs experienced solely representing the client, which is a positive feature because part of the POs' role is advocating for the clients rights. The PO service differs from the PO service from other existing case management models and may need to develop strategies for decision-making and support in their own role. For example, they may use group supervision teams or 'reflective teams'. The freestanding position may also entail problems in terms of lack of legitimacy. It is important for POs to develop good platforms with the surrounding actors among others things to improve the co-ordination process. It could be interesting if the PO model would be tested in other countries that have a fragmented welfare system. The PO model may also be useful to other 'target groups' who are in need of co-ordinated rehabilitation services.

Important components to create personal working alliances with clients in the mental health sector to support the recovery process.

Personligt ombud (PO) is a Swedish version of case management that aims to support individuals with psychiatric disabilities. Guidelines to the PO service emphasize the different role that the PO plays with respect to the relationship with clients. The aim of this study was to investigate the components that POs found to be important in the relationship with clients. Telephone interviews with 22 POs across Sweden were carried out. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. The relationship with each client was described as the foundation of the POs' work; it was the only 'tool' they had. The findings were reflected in a main theme, which showed the importance of creating personal working alliances with each client where POs put the client at the center of the work and adjusted their support according to the client's needs at the time. Important components were that the PO and the client trusted each other, that the power between the PO and the client was balanced, and to be a personal support. Many of the components that POs found to be important are shown as essential in recovery-oriented services. POs followed the client in the process and remained as long as necessary and this is one way of bringing hope to the client's recovery process. However, the personal tone can be fraught with difficulties and to maintain professionalism, it is necessary to reflect, through discussions with colleagues, with the leader and in supervision.

Knowledge and attitude regarding recovery among mental health practitioners in Sweden.

The aim was to investigate the knowledge and the attitude regarding recovery among practitioners working in the Swedish mental health system, Personligt Ombud (PO), Supported Housing Team (SHT) and Psychiatric Out Patient Service (POPS), to determine whether and how knowledge and attitude regarding recovery differ between the three services. A web-based questionnaire based on the Recovery Knowledge Inventory was sent to the participants. Participant selection ensured that different parts of Sweden were represented. A multiple linear regression was used to examine the result under control of Sex, Age, Educational Level, Further Education, Relevant Work Experience and Training in Recovery. The result of the regression showed that POs had higher scores than both SHT and POPS on the subscales, even under control of other variables. The SHT differed significantly from POs on two of the subscales and POPS differed significantly from POs on all subscales. Personnel with university education, more work experience or specific training in recovery also had a higher mean score. Swedish practitioners need to learn more about certain aspects of the recovery process. The differences between the services may possibly be due to the services' organization, assignment and role. Other important aspects were the level of education and having specific training in recovery; the combination of these elements could facilitate the development of a recovery-oriented mental health system.