Mihin ryhmään itse haluat kuulua? : Kahdessa yläkoulun terveystiedon oppikirjassa rakentuvien terveysdiskurssien ja subjektipositioiden diskurssianalyyttistä tarkastelua

In the study, two upper elementary school health education textbooks were investigated. The purpose of the study was to examine the health discourses and subject- and reader positions constructed in text. Theoretically, the study is based on poststructuralist thought and critical sociology of health promotion. Methodologically, it draws mainly on critical lingvistics and new rhetorics. Textbooks were understood as informative, argumentative and persuasive texts in which different lexical and grammatical methods to secure the readers´ responsiveness were utilized. Also, the relations of the text to wider genres, social situations, structures, institutions and practices were investigated. The interpersonal and ideational dimensions of the texts were analysed with the aim of finding out the kinds of identities for and relations between the speaker and the ideal reader were constructed and the kinds of representations of health and the world around were produced in the textbooks. Multiple discourses of health, and genres and styles characteristic for many kinds of contexts and situations were found. The identities of and the relationships between the speaker and the ideal reader of the text were also multiple and changing. The text echoes both biomedical health discourse emphasizing prevention of illness and holistic discourse emphasizing personal welfare, fulfillment and happiness. Furthermore, traces for example from development psychological, ecological and civilization critical discourses were perceived. Formal scientific genre was found to be mixed with informal chatting imitating close and equal relationship between participants characteristic for advertisements and other persuasive texts, and obliging and ordering expression typical for school context and other situations where the relationship between participants is unequal and distant. The ideal reader of the text can be characterized as adolescent living in the world saturated by advertising and media. He or she is interested in the life of the celebrities, and is interested rather in her or his appearance, image and short-term enjoyment than health and long-term welfare. In the textbooks, healthy way of life is attempted to create a product which appeals to the values and interests of the imaginary public, the ideal reader of the text. Marketing healthy choices tend to reproduce stereotyped ideas of happiness, good life, youth and sex. Furthermore, individualizing approach mixed with wide definition of health legitimizes easily an erraneous impression of health, beauty and success being personal achievements dependent only on attitudes and competences.

Embedded Storytelling and Gender Negotiations in Githa Hariharan's First Three Novels

This thesis treats Githa Hariharan s first three novels The Thousand Faces of Night (1992), The Ghosts of Vasu Master (1994) and When Dreams Travel (1999) as a trilogy, in which Hariharan studies the effects of storytelling from different perspectives. The thesis examines the relationship between embedded storytelling and the primary narrative level, the impact of character-bound storytelling on personal development and interpersonal relationships. Thus, I assume that an analysis of the instabilities between characters, and tensions between sets of values introduced through storytelling displays the development of the central characters in the novels. My focus is on the tensions between different sets of values and knowledge systems and their impact on the gender negotiations. The tensions are articulated through a resistance and/or adherence to a cultural narrative, that is, a formula, which underlies specific narratives. Conveyed or disputed by embedded storytelling, the cultural narrative circumscribes what it means to be gendered in Hariharan s novels. The analysis centres on how the narratee in The Thousand Faces of Night and the storyteller in The Ghosts of Vasu Master relate to and are affected by the storytelling, and how they perceive their gendered positions. The analysis of the third novel When Dreams Travel focuses on storytelling, and its relationship to power and representation. I argue that Hariharan's use of embedded storytelling is a way to renegotiate and even reconceptualise gender. Hariharan s primary concern in all three novels is the tensions between tradition or repetition, and change, and how they affect gender. Although the novels feature ancient mythical heroes, mice and flies, or are set in a fantasy world of jinnis and ghouls, they are, I argue, deeply concerned with contemporary issues. Whereas the first novel questions the demands set by family and society on the individual, the second strives to articulate an ethical relationship between the self and the other. The third novel examines the relationship between representation and power. These issues could not be more contemporary, and they loom large over both the regional and global arenas.

Functional outcome and health-related quality of life after traumatic brain injury in the framework of the International Classification of Functioning, Disability and Health (ICF)

Traumatic brain injury (TBI) affects people of all ages and is a cause of long-term disability. In recent years, the epidemiological patterns of TBI have been changing. TBI is a heterogeneous disorder with different forms of presentation and highly individual outcome regarding functioning and health-related quality of life (HRQoL). The meaning of disability differs from person to person based on the individual s personality, value system, past experience, and the purpose he or she sees in life. Understanding of all these viewpoints is needed in comprehensive rehabilitation. This study examines the epidemiology of TBI in Finland as well as functioning and HRQoL after TBI, and compares the subjective and objective assessments of outcome. The frame of reference is the International Classification of Functioning, Disability and Health (ICF). The subjects of Study I represent the population of Finnish TBI patients who experienced their first TBI between 1991 and 2005. The 55 Finnish subjects of Studies II and IV participated in the first wave of the international Quality of life after brain injury (QOLIBRI) validation study. The 795 subjects from six language areas of Study III formed the second wave of the QOLIBRI validation study. The average annual incidence of Finnish hospitalised TBI patients during the years 1991-2005 was 101:100 000 in patients who had TBI as the primary diagnosis and did not have a previous TBI in their medical history. Males (59.2%) were at considerably higher risk of getting a TBI than females. The most common external cause of the injury was falls in all age groups. The number of TBI patients ≥ 70 years of age increased by 59.4% while the number of inhabitants older than 70 years increased by 30.3% in the population of Finland during the same time period. The functioning of a sample of 55 persons with TBI was assessed by extracting information from the patients medical documents using the ICF checklist. The most common problems were found in the ICF components of Body Functions (b) and Activities and Participation (d). HRQoL was assessed with the QOLIBRI which showed the highest level of satisfaction on the Emotions, Physical Problems and Daily Life and Autonomy scales. The highest scores were obtained by the youngest participants and participants living independently without the help of other people, and by people who were working. The relationship between the functional outcome and HRQoL was not straightforward. The procedure of linking the QOLIBRI and the GOSE to the ICF showed that these two outcome measures cover the relevant domains of TBI patients functioning. The QOLIBRI provides the patients subjective view, while the GOSE summarises the objective elements of functioning. Our study indicates that there are certain domains of functioning that are not traditionally sufficiently documented but are important for the HRQoL of persons with TBI. This was the finding especially in the domains of interpersonal relationships, social and leisure activities, self, and the environment. Rehabilitation aims to optimize functioning and to minimize the experience of disability among people with health conditions, and it needs to be based on a comprehensive understanding of human functioning. As an integrative model, the ICF may serve as a frame of reference in achieving such an understanding.