Immigrant Associations in the Metropolitan Area of Finland : Forms of Mobilisation, Participation and Representation

This study examines the role of immigrant associations in the societal and political integration of immigrants into Finnish society. The societal focus is on the ability of immigrant associations to mobilise their ethnic group members to participate in the socio-economic, cultural and political domains of Finnish society and in certain cases even beyond. The political integrative aims are the opportunities of immigrant associations to participate and represent the interests of their ethnic group in local and national policy making. This study focuses on associations in the Metropolitan Area of Finland, (Espoo, Helsinki and Vantaa).The qualitative research consisted of 71 interviews conducted with members of immigrant associations and civil servants. These interviews were mainly semi-structured, including some additional open-ended questions. Additional data consisted of documents, planning reports and of follow-up enquiries. -- In the analysis of the data I categorised thirty-two immigrant associations according to the activity forms and the description of the goals by the members. The four categories consisted of integrative, societal, ethno-cultural and transnational immigrant associations. Most of the immigrant associations belonged to the integrative category (15 of 32 associations). On the one hand the aims of these associations are to provide access for their ethnic group members into Finnish society, while on the other to strengthen the ethnic identity of their members by organising ethno-cultural activities. The societal associations only focused on activities with the objective of including immigrants into the Finnish labour market and educational system. The goal of ethno-cultural associations was to strengthen the ethnic identity of their ethnic group members. The transnational associations aimed at improving the living conditions of women and children in the members' country of origin. The possibilities for immigrant associations to mobilise their members depends partly on external financing. Subsidies have been allocated for societal activities in particular. There remains a risk of the crowding out of ethno-cultural activities: something which has already taken place in several European countries. Immigrant associations aim to strengthen the identity of immigrants mainly by organising social and ethno-cultural activities. Another important target was to provide peer support and therapy courses. Additionally, immigrant women's associations offer assistance to women who have encountered violence by providing counselling and in some cases access to shelter. The data showed that there is an ever growing need to pay heed to the well-being of women, children and elderly immigrants. The participation of immigrant associations in the municipalities' integrative issues takes place mainly through cooperative projects. Until the end of the 1990s there had not been much cooperation. The problem with the projects was that they had mainly been managed by civil servants, whereas members from immigrant associations had remained in a more passive position. Representation of immigrant associations in councils has been fairly weak. Immigrant associations are included in the multicultural councils of Espoo and Vantaa, but only in the planning stages. The municipality of Helsinki does not include immigrant associations due to the large number of organisations which causes problems in finding fair, democratic representation. At the national level, the ‘Advisory Board for Ethnic Relations’ – ETNO didn’t chose its members based on membership of ethnic associations, but based on belongingness to one of the larger language groups spoken by the foreign population in Finland. Since ETNO’s third period (2005-2007), the representatives of immigrant associations and ethnic minority groups have been chosen from proposed candidates. Key words: immigrant associations, integration, mobilisation, participation, representation, the Metropolitan area of Finland, immigrant (women), civil servants

Homeowners' Associations in Russia after the 2005 Housing Reform

The thesis examines homeowners associations as a part of the large-scale housing reform, implemented in Russia since 2005. The reform transferred housing management from the public sector to the private sector and to the citizens responsibility. The reform is a continuation to the privatisation of the housing stock that was started in Russia in the beginning of the 1990s, aiming to build a market-oriented housing sector in the country. The reform makes a fundamental change to the Soviet system, in which ownership along with management and maintenance of housing were monopolised by the state. Homeowners are now responsible for the management of the common areas in privatised houses, which is often realised by establishing a homeowners association. Homeowners associations are examined by using the so-called common-pool resource regime approach, with the main question being the ways in which taking care of common property collectively succeeds in practice. The study is based on interview data of St. Petersburg s homeowners associations. Using the common-pool resource theory the study demonstrates why implementation of the housing reform has not succeeded as expected. Certain elements that characterise a successful common-pool resource regime do not fulfill sufficiently in St. Petersburg s homeowners associations. Firstly, free-riding, that is, withdrawal from the association s joint decision-making and not making the housing payments is common, as effective sanctions to prevent it are missing in the legislation. That is, eviction or expelling a non-paying member from the association is not possible. Secondly, ownership of the land plot and common areas of the house, such as basements and attics, are often disputed between the associations and authorities. In the Soviet era, these common areas were public property along with the apartments, but in privatised houses they should, according to the legislation, belong to the associations property. Thirdly, solution of disputes between the associations and authorities and within the associations is difficult, as the court system tends to be bureaucratic and inefficient. In addition to the common-pool resource approach, the study also examines how social capital contributes to the associations effectiveness and democratic governance. The study finds that although homeowners associations have increased cooperation and tightened social relations between neighbours, social capital has not been able to prevent free-riding. The study shows that unlike it is often claimed, the so-called Soviet mentality , that is, residents passiveness and unwillingness to participate, is not the most important obstacle to the reform. Instead, the reform is impeded most of all by imperfect institutional arrangements and local authorities that prevent the associations from working as independent, self-governing associations.

Associations between personality traits and sleep quality and quantity in young adults

This thesis examines the associations between personality traits and sleep quantity and quality in young adults. Additionally the possible effects of birth status on these associations are examined. The data used in this thesis is part of a birth cohort study (Helsinki Study of Very Low Birth Weight Adults). The personality traits are based on the five-factor model of personality. The sleep quantity and quality are based on actigraphy assessments. Four hypothesis were made about the personality and sleep associations: (1) neuroticism is related to a lesser quality of sleep, (2) there will be more significant associations between personality traits and sleep quality than between personality traits and sleep quantity, (3) the Very Low Birth Weight (VLBW) as well as, (4) the Small for Gestational Age (SGA) status will affect the associations. Linear regressions were used to study the associations between personality traits and sleep quality and quantity. Whenever an association was significant, it was tested whether this association was moderated first, by the VLBW and second, by the SGA status of the participant. The results were mostly in line with previous research especially demonstrating the negative association between neuroticism and the quality of sleep and suggesting that vulnerability to stress decreases sleep quality. Also it was found that agreeableness and conscientiousness were associated with better sleep quality and extraversion was associated with lower sleep quantity. In addition SGA status moderated the personality and sleep associations. It is proposed that there are two factors behind the interaction. First, prenatally developing mechanisms have an effect on the development of sleep as well as personality. Second, differences in the postnatal environment, for instance the parenting practices, can account for this finding. Future research could focus especially on what kind of prenatal disturbances SGA infants have in the development of mechanisms related to sleep and personality. Also focusing on the differences in parental interaction might shed more light on the results.

Associations of interleukin-1 (IL-1) gene variation and IL-1 receptor antagonist phenotypes with immunological responses, metabolic dysregulation and type 2 diabetes

The upstream proinflammatory interleukin-1 (IL-1) cytokines, together with a naturally occurring IL-1 receptor antagonist (IL-1Ra), play a significant role in several diseases and physiologic conditions. The IL-1 proteins affect glucose homeostasis at multiple levels contributing to vascular injuries and metabolic dysregulations that precede diabetes. An association between IL-1 gene variations and IL-1Ra levels has been suggested, and genetic studies have reported associations with metabolic dysregulation and altered inflammatory responses. The principal aims of this study were to: 1) examine the associations of IL-1 gene variation and IL-1Ra expression in the development and persistence of thyroid antibodies in subacute thyroiditis; 2) investigate the associations of common variants in the IL-1 gene family with plasma glucose and insulin concentrations, glucose homeostasis measures and prevalent diabetes in a representative population sample; 3) investigate genetic and non-genetic determinants of IL-1Ra phenotypes in a cross-sectional setting in three independent study populations; 4) investigate in a prospective setting (a) whether variants of the IL-1 gene family are predictors for clinically incident diabetes in two population-based observational cohort studies; and (b) whether the IL-1Ra levels predict the progression of metabolic syndrome to overt diabetes during the median follow-up of 10.8 and 7.1 years. Results from on patients with subacte thyroiditis showed that the systemic IL-1Ra levels are elevated during a specific proinflammatory response and they correlated with C-reactive protein (CRP) levels. Genetic variation in the IL-1 family seemed to have an association with the appearance of thyroid peroxidase antibodies and persisting local autoimmune responses during the follow-up. Analysis of patients suffering from diabetes and metabolic traits suggested that genetic IL-1 variation and IL-1Ra play a role in glucose homeostasis and in the development of type 2 diabetes. The coding IL-1 beta SNP rs1143634 was associated with traits related to insulin resistance in cross-sectional analyses. Two haplotype variants of the IL-1 beta gene were associated with prevalent diabetes or incident diabetes in a prospective setting and both of these haplotypes were tagged by rs1143634. Three variants of the IL-1Ra gene and one of the IL-1 beta gene were consistently identified as significant, independent determinants of the IL-1Ra phenotype in two or three populations. The proportion of the phenotypic variation explained by the genetic factors was modest however, while obesity and other metabolic traits explained a larger part. Body mass index was the strongest predictor of systemic IL-1Ra concentration overall. Furthermore, the age-adjusted IL-1Ra concentrations were elevated in individuals with metabolic syndrome or diabetes when compared to those free of metabolic dysregulation. In prospective analyses the systemic IL-1Ra levels were found as independent predictors for the development of diabetes in people with metabolic syndrome even after adjustment for multiple other factors, including plasma glucose and CRP levels. The predictive power of IL-1Ra was better than that of CRP. The prospective results also provided some evidence for a role of common IL-1 alpha promoter SNP rs1800587 in the development of type 2 diabetes among men and suggested that the role may be gender specific. Likewise, common variations in the IL-1 beta coding region may have a gender specific association with diabetes development. Further research on the potential benefits of IL-1Ra measurements in identifying individuals at high risk for diabetes, who then could be targeted for specific treatment interventions, is warranted. It has been reported in the recent literature that IL-1Ra secreted from adipose tissue has beneficial effects on glucose homeostasis. Furthermore, treatment with recombinant human IL-1Ra has been shown to have a substantial therapeutic potential. The genetic results from the prospective analyses performed in this study remain inconclusive, but together with the cross-sectional analyses they suggest gender-specific effects of the IL-1 variants on the risk of diabetes. Larger studies with more extensive genotyping and resequencing may help to pinpoint the exact variants responsible and to further elucidate the biological mechanisms for the observed associations. This would improve our understanding of the pathways linking inflammation and obesity with glucose and insulin metabolism.

Hostility: A prospective study of the genetic and environmental background and associations with cardiovascular risk

Hostility is a multidimensional construct having wide effects on society. In its different forms, hostility is related to a large array of social and health problems, such as criminality, substance abuse, depression, and cardiovascular risks. Identifying and tackling early-life factors that contribute to hostility may have public health significance. Although the variance in hostility is estimated to be 18-50 percent heritable, there are significant gaps in knowledge regarding the molecular genetics of hostility. It is known that a cold and unsupportive home atmosphere in childhood predicts a child s later hostility. However, the long-term effects of care-giving quality on hostility in adulthood and the role of genes in this association are unclear. The present dissertation is part of the ongoing population-based prospective Young Finns study, which commenced in 1980 with 3596 3-18-year-old boys and girls who were followed for 27 years. The specific aims of the dissertation were first to study the antecedents of hostility by looking at 1) the genetic background, 2) the early environmental predictors, and 3) the gene environment interplay behind hostility. As a second aim, the thesis endeavored to examine 4) the association between hostility and cardiovascular risks, and 5) the moderating effect of demographic factors, such as gender and socioeconomic status, on this association. The study found potential gene polymorphisms from chromosomes 7, 14, 17, and 22 suggestively associated with hostility. Of early environmental influences, breastfeeding and early care-giving were found to predict hostility in adulthood. In addition, a serotonin receptor 2A polymorphism rs6313 moderated the effect of early care-giving on later hostile attitudes. Furthermore, hostility was shown to predict cardiovascular risks, such as metabolic syndrome and inflammation. Finally, parental socioeconomic status was found to moderate the association between anger and early atherosclerosis. The new genetic and early environmental antecedents of hostility identified in this research may help in understanding the development of hostility and its health risks, and in planning appropriate prevention. The significance of early influences on this development is stressed. Although the markers studied are individual- and family-related factors, these may be influenced at the societal level by giving accurate information to all individuals concerned and by improving the societal circumstances.

Dancing and Professional Dancers in Roman Egypt

The main aim of the study is to create a many-sided view of dancing in Roman Egypt (1st - early 4th centuries AD) and especially of the dancers who earned their living by dancing as hired performers. Even though dancers and other performers played a central part in many kinds of festivities throughout the ancient world, research on ancient professional dancers is rare and tends to rest on the ancient literature, which reflects the opinions of the elite. Documentary written sources (i.e., papyri, ostraka) the core of the present study are mentioned rather superficially, easily resulting in a stereotypical view of the dancers. This study will balance the picture of professional dancers in antiquity and of ancient dancing in a more general sense. The second aim characterizes this study as basic research: to provide a corpus of written sources from Greco-Roman Egypt on dancing and to discuss pictorial sources contemporary with the texts. The study also takes into account the theoretical discussion that centres on dancing as a nonverbal communicative mode. Dancers are seen as significant conveyors of social and cultural matters. This study shows that dancers were hired to perform especially in religious contexts, where the local associations on the village level also played an important part as the employers of the performers. These performers had a better standard of living in economic terms than the average hired worker, and dancers were better paid than other performers. In the Egyptian villages and towns, where the dancers performed and lived, the dancers do not seem to have been marginal because they were professionals or because of some ethnic or social background. However, their possible marginality may have occurred for reasons related to the practicalities of their profession (e.g., the itinerant life style). The oriental background of performers was a literary topos reflecting partly the situation in the centres of the empire, especially Rome, where many performers were of other than Roman origin. The connection of dancing, prostitution and slavery reflects the essential link between dance, body and gender: dancers are equated with such professions or socio-legal statuses where the body is the focus of attention, a commodity and a source of sensual pleasure; this dimension is clearly observable in ancient literature. According to the Egyptian documentary sources, there is no watertight evidence that professional dancers would have been engaged in prostitution and very little, if any, evidence that the disapproval of the professional dancers expressed by the ancient authors was shared by the Egyptians. From the 4th century onwards the dancers almost disappear from the documentary sources, reflecting the political and religious changes in the Mediterranean east.

Lost in translation? : Translating allusions in two of Reginald Hill's Dalziel & Pascoe novels

This study examines strategies used to translate various thematic and character delineating allusions in two of Reginald Hill's detective novels, The Wood Beyond and On Beulah Height and their Swedish translations Det mörka arvet and Dalen som dränktes. In this study, thematic allusions and allusions used in character delineation are regarded as intertextual networks. Intertextual networks comprise all the texts that are in one way or another embedded into a text, all the texts referred to in it and even the texts somehow rejected from a text's own canon. Studying allusions as intertextual networks makes it warranted to pay minute attention to even the smallest of details. Seen together, these little details form extensive networks of meaning that readers use to interpret the text. Allusion can be defined as a reference, often covert or indirect, to another text in a way that brings into the text some of the associations of that other text. A text is here understood broadly, hence sources of allusions include all cultural texts from literature and history to cinema and televisions serials. Allusions are culture bound and each culture tends to allude to its own cultural products. The set of transcultural allusions is therefore fairly small. Translation strategies are translatorial ways of solving translation problems. Being culture-bound, allusions are potential translation problems. In order to transmit the thoughts evoked by the allusions in source text readers to the target text readers translators may add guidance to the translated text. Often guidance is not added, which may result in changes in handling of themes or character delineation, clear in the source text but confusing or incomprehensible in the target text. However, norms in target culture may not always allow the translators the possibility to make the text comprehensible. My analyses of translation strategies show that in the two translated novels studied minimum change is a very frequently used strategy. This results in themes and character delineation losing some of the effect they have in the source texts. Perhaps surprisingly, the result is very much the same even where it is possible to discern that the two translators have had differing translation principles. Keywords: allusions, intertextuality, literary translation, translation strategies, norms, crime fiction, Hill, Reginald

Readers' resposes versus reader-response theories : An empirical study

This study examines both theoretically an empirically how well the theories of Norman Holland, David Bleich, Wolfgang Iser and Stanley Fish can explain readers' interpretations of literary texts. The theoretical analysis concentrates on their views on language from the point of view of Wittgenstein's Philosophical Investigations. This analysis shows that many of the assumptions related to language in these theories are problematic. The empirical data show that readers often form very similar interpretations. Thus the study challenges the common assumption that literary interpretations tend to be idiosyncratic. The empirical data consists of freely worded written answers to questions on three short stories. The interpretations were made by 27 Finnish university students. Some of the questions addressed issues that were discussed in large parts of the texts, some referred to issues that were mentioned only in passing or implied. The short stories were "The Witch à la Mode" by D. H. Lawrence, "Rain in the Heart" by Peter Taylor and "The Hitchhiking Game" by Milan Kundera. According to Fish, readers create both the formal features of a text and their interpretation of it according to an interpretive strategy. People who agree form an interpretive community. However, a typical answer usually contains ideas repeated by several readers as well as observations not mentioned by anyone else. Therefore it is very difficult to determine which readers belong to the same interpretive community. Moreover, readers with opposing opinions often seem to pay attention to the same textual features and even acknowledge the possibility of an opposing interpretation; therefore they do not seem to create the formal features of the text in different ways. Iser suggests that an interpretation emerges from the interaction between the text and the reader when the reader determines the implications of the text and in this way fills the "gaps" in the text. Iser believes that the text guides the reader, but as he also believes that meaning is on a level beyond words, he cannot explain how the text directs the reader. The similarity in the interpretations and the fact that the agreement is strongest when related to issues that are discussed broadly in the text do, however, support his assumption that readers are guided by the text. In Bleich's view, all interpretations have personal motives and each person has an idiosyncratic language system. The situation where a person learns a word determines the most important meaning it has for that person. In order to uncover the personal etymologies of words, Bleich asks his readers to associate freely on the basis of a text and note down all the personal memories and feelings that the reading experience evokes. Bleich's theory of the idiosyncratic language system seems to rely on a misconceived notion of the role that ostensive definitions have in language use. The readers' responses show that spontaneous associations to personal life seem to colour the readers' interpretations, but such instances are rather rare. According to Holland, an interpretation reflects the reader's identity theme. Language use is regulated by shared rules, but everyone follows the rules in his or her own way. Words mean different things to different people. The problem with this view is that if there is any basis for language use, it seems to be the shared way of following linguistic rules. Wittgenstein suggests that our understanding of words is related to the shared ways of using words and our understanding of human behaviour. This view seems to give better grounds for understanding similarity and differences in literary interpretations than the theories of Holland, Bleich, Fish and Iser.

Kansallista vai modernia : Taidegrafiikka osana 1930-luvun taidejärjestelmää

The theme of this doctoral thesis is the Finnish printmaking in the years 1930-1939. During this decade, there were approximately 100 artists making prints in Finland. Indeed, the period was an especially important one for printmaking. Associations for printmakers were founded in Helsinki and Turku, training in the field was launched, and the number of printmaking exhibitions increased considerably. Through their national organisations, Finnish printmakers participated in many exhibitions abroad, interaction with Nordic printmakers being especially intense. Thus, a firm basis for post-war developments was created. However, printmakers' activity- which had continued throughout the 1930s - declined notably after the Winter War broke out in the autumn of 1939. As a result, the period 1930-1939 forms a coherent and distinct unity in Finnish printmaking history. The study consists of two parts: the main text and an appendix in which the production of each printmaking artist active in the 1930s is examined separately. The study also includes a comprehensive list of the prints made in the course of the decade. One of the central themes is the printmakers' relationship to "Finnish nationalist" art and concepts of art in the 1930s. I analyse the various manifestations of this way of thinking in the visual arts of the period. Finnish fine art in the period between the world wars has usually been characterised as conservative, introverted and spiritually isolated from the modern European trends of the time. On the basis of this study, such a view is too simple. Many artists and printmakers adopted a modernistic notion of art that approached the newest in European modernism, including such trends as avant-garde classicism and general European new Objective Realism (Die neue Sachlichkeit). On the other hand, choosing Finnish nationalist motifs did not necessarily mean that the artist was opposed to modernism: modernist artists could still be interested in national themes. The relationship of 1930s printmaking to the world of nationalist ideas is examined in this doctoral thesis from several perspectives. Towards the end of the main text, I examine the issue from the point of view of selected artists. Another feature that emerged during the study and turned out to be surprisingly widespread was the close relationship of many artists to religious, theosophical and pantheistic views. I deal with this issue in greater detail through a few representative printmakers.

Teatteri liikkeessä : Työväenteatterit Suomen teatterikentällä ja työväenliikkeessä kaksiteatterijärjestelmän syntyyn asti vuonna 1922

Workers' theatres in Finland until 1922 The topic of this dissertation is the workers' theatres in Finland before the year 1922. The main question is: why did these amateur theatres within the workers' associations become part of the professional theatre field in the 1910s by getting state subsidy as local theatre institutions? How is it possible that they received this status even after the civil war in 1918 when new professional theatres were founded all over the country? The study also asks, what kind of position did workers' theatres have in the workers' associations and in the workers' movement, what did the Social Democrats and Communists think of theatre and in particular of workers' theatre, and what kind of repertoire did the workers' theatres perform? It is a particular feature of Finland that the professional theatre field was not organised and that the workers’ movement had a relatively strong political position. The study concludes that some workers' theatres were the only steady theatre institutions in their surroundings, and thus functioned as local popular theatres performing to all social groups. Although amateur-based, they started to resemble professional theatres. Even though the Social Democratic Party did not have a specific theatre policy, the leaders of the Party appreciated and supported the workers' theatres as educational institutions and worked for their artistic improvement. The workers' theatres were also largely approved of and seen as people's theatres thought to unite and educate the nation and the working class. This reveals the need for national consensus, in the 1910s against the Russian government who worked to dissolve the autonomous position of the Finnish state, and after the civil war (1918) against the threat of a communist revolution. A wave of agitating proletarian theatre was felt in Finland in the early 1920s but it was marginalised by the large anti-communist majority.

Viemärin päässä Kotkan kaupunki : Vesiensuojelun kehitys Kymijoen itäisen päähaaran suulla 1945-1970

The focus of this thesis is the marine environmental history of the eastern part and the estuary of the Kymi river from 1945 to 1970. There is no previous research on this area from an environmentally historical perspective, nor have many of the sources here discussed been previously used. Therefore the thesis expands academic understanding of local environmental processes and protection in and around the city of Kotka and the Kymi river. The thesis falls within the methodological field of socio-political history, as the research focus is centered on the local process of establishing the nature of environmental problems and solving them. The principal assumption has been that the city of Kotka, due to its ongoing expansion, was slow to respond to environmental hazards. The Kymi river was among the most degraded bodies of water during this period. Kotka on the other hand was a major center of wood processing industry and one of Finlands major industrial ports. In the past the river and its estuary had provided ample resources for fishers. It is this contradictory use of the environment that allows one to discuss the local struggle for the correct use of the environment. Primary sources include local and city archives, environmental studies, and legal documents linked with the above. The archives of the city of Kotka and of various private associations form the core sources. Environmental studies from the research period have been dealt with as sources to the local political power struggle. Alongside with current environmental research they also provide insight into the state of the environment. Another goals has been to accumulate environmental research for a future multidisciplinary study in this area. As a final conclusion it can be said that environmental degradation was widely understood as a problem only in the 1960s. The influential role of the city of Kotka however determined the pace with which these problems were then solved.

Sairaanhoitajaksi kasvattaminen : Sairaanhoitajakoulutus ja siinä käytetyt oppikirjat Suomessa vuoteen 1967 asti

The historical development of Finnish nursing textbooks from the late 1880s to 1967: the training of nurses in the Foucauldian perspective. This study aims, first, to analyse the historical development of Finnish nursing textbooks in the training of nurses and in nursing education: what Foucauldian power processes operate in the writing and publishing processes? What picture of nursing did early nursing books portray and who were the decision makers? Second, this study also aims to analyse the processes of power in nurse training processes. The time frame extends from the early stages of nurse training in the late 1880s to 1967. This present study is a part of textbook research and of the history of professional education in Finland. This study seeks to explain how, who or what contributed the power processes involved in the writing of nursing textbooks and through textbooks. Did someone use these books as a tool to influence nursing education? The third aim of this study is to define and analyse the purpose of nurse training. Michel Foucault´s concept of power served as an explanatory framework for this study. A very central part of power is the assembling of data, the supplying of information and messages, and the creation of discourses. When applied to the training of nurses, power dictates what information is taught in the training and contained in the books. Thus, the textbook holds an influential position as a power user in these processes. Other processes in which such power is exercised include school discipline and all other normalizing processes. One of most powerful ways of adapting is the hall of residence, where nursing pupils were required to live. Trained nurses desired to separate themselves from their untrained predecessors and from those with less training by wearing different uniforms and living in separate housing units. The state supported the registration of trained nurses by legislation. With this decision the state made it illegal to work as a nurse without an authorised education, and use these regulations to limit and confirm the professional knowledge and power of nurses. Nurses, physicians and government authorities used textbooks in nursing education as tools to achieve their own purposes and principles. With these books all three groups attempted to confirm their own professional power and knowledge while at the same time limit the power and expertise of others. Public authorities sought to unify the training of nurses and the basis of knowledge in all nursing schools in Finland with similar and obligatory textbooks. This standardisation started 20 years before the government unified nursing training in 1930. The textbooks also served as data assemblers in unifying nursing practices in Finnish hospitals, because the Medical Board required all training hospitals to attach the textbooks to units with nursing pupils. For the nurses, and especially for the associations of Finnish nurses, making and publishing their own textbooks for the training of nurses was a part of their professional projects. With these textbooks, the nursing elite and the teachers tended to prepare nursing pupils’ identities for nursing’s very special mission. From the 1960s, nursing was no longer understood as a mission, but as a normal vocation. Nurses and doctors disputed this view throughout the period studied, which was the optimal relationship between theory and practice in nursing textbooks and in nurse education. The discussion of medical knowledge in nursing textbooks took place in the 1930s and 1940s. Nurses were very confused about their own professional knowledge and expertise, which explains why they could not create a new nursing textbook despite the urgency. A brand new nursing textbook was published in 1967, about 30 years after the predecessor. Keyword: nurse, nurse training, nursing education, power, textbook, Michel Foucault

Pain in juvenile idiopathic arthritis : parents and children as agents of disease management

Juvenile idiopathic arthritis (JIA) is a severe childhood disease usually characterized by long-term morbidity, unpredictable course, pain, and limitations in daily activities and social participation. The disease affects not only the child but also the whole family. The family is expected to adhere to an often very laborious regimen over a long period of time. However, the parental role is incoherently conceptualized in the research field. Pain in JIA is of somatic origin, but psychosocial factors, such as mood and self-efficacy, are critical in the perception of pain and in its impact on functioning. This study examined the factors correlating and possibly explaining pain in JIA, with a special emphasis on the mutual relations between parent- and patient-driven variables. In this patient series pain was not associated with the disease activity. The degree of pain was on average fairly low in children with JIA. When the children were clustered according to age, anxiety and depression, four distinguishable cluster groups significantly associated with pain emerged. One of the groups was described by concept vulnerability because of unfavorable variable associations. Parental depressive and anxiety symptoms accompanied by illness management had a predictive power in discriminating groups of children with varying distress levels. The parent’s and child’s perception of a child’s functional capability, distress, and somatic self-efficacy had independent explanatory power predicting the child’s pain. Of special interest in the current study was self-efficacy, which refers to the belief of an individual that he/she has the ability to engage in the behavior required for tackling the disease. In children with JIA, strong self-efficacy was related to lower levels of pain, depressive symptoms and trait anxiety. This suggests strengthening a child’s sense of self-efficacy, when helping the child to cope with his or her disease. Pain experienced by a child with JIA needs to be viewed in a multidimensional bio-psycho-social context that covers biological, environmental and cognitive behavioral mechanisms. The relations between the parent-child variables are complex and affect pain both directly and indirectly. Developing pain-treatment modalities that recognize the family as a system is also warranted.

Spinaalistenoosipotilaiden psyykkinen hyvinvointi ennen leikkaushoitoa ja sen jälkeen

Surgical treatment of lumbar spinal stenosis (LSS) is a treatment option for those patients who remain severely symptomatic after a course of conservative treatment. Majority of the patients treated surgically enjoy good-to-excellent outcomes with respect to pain alleviation and functional recovery. However, between 20% and 40% of the patients who have surgery for LSS do not benefit from it. The knowledge of the psychological factors associated with recovery and treatment outcome is still scarce. The aim of this study was to assess LSS patients selected for surgical treatment. Specifically, the study assessed the prevalence of depression (Beck Depression Inventory, BDI) before surgical treatment and three months after the treatment. Also preoperative life satisfaction (four-item Life Satisfaction scale) of the LSS patients was studied. Furthermore, the patients satisfaction with surgery outcome at the three months postoperative stage was studied. One-fifth (20%) of the LSS-patients were found to have depression preoperatively. The patients assessments of the pain intensity or location were not associated with depression. The factors that did associate with depression were subjective disability of everyday living and poor life satisfaction. In addition to this, low sense of coherence and poor life satisfaction were associated with depression in logistic regression models. Significant associations were seen between preoperative depression and postoperative high disability scores, high symptom severity scores and higher pain intensity ratings. The patients with continuous depression (60% of the patients who had preoperative depression) showed less improvement in symptom severity, disability, pain and walking capacity than the patients who did not experience depression at any stage. In those patients who recovered from depression (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. One-fourth (25%) of the preoperative patients with LSS were found to be dissatisfied with life. The dissatisfied patients were significantly younger and had more self-reported somatic comorbidity. The dissatisfied patients had also elevated subjective disability scores and more extensive pain locations. Also lower coping resources and higher BDI scores were associated with life dissatisfaction. Younger age and somatic comorbidity were associated with life dissatisfaction in regression models. Two-thirds (66%) of the patients were at least clearly satisfied with the surgery outcome at three months postoperative stage. In group comparisons, the lack of physical, functional and emotional well-being was associated with the patients dissatisfaction with the surgery outcome. Younger age, postoperative symptom severity, disability and depression were independently associated with dissatisfaction with the surgery outcome. The results show that depression and psychological well-being are important factors with respect to LSS patients functional ability and recovery both before and three months after surgical treatment. Therefore, the clinical practice recommendations should include an assessment of depression