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.

Housing the skilled migrants in the Helsinki Metropolitan Area : International attractiveness of housing, neighbourhoods and the city region

The aim of this thesis is to examine the skilled migrants’ satisfaction with the Helsinki Metropolitan Area. The examination is executed on three scales: housing, neighbourhoods and the city region. Specific focus is on the built environment and how it meets the needs of the migrants. The empirical data is formed of 25 semi-structured interviews with skilled migrants and additionally 5 expert interviews. Skilled and educated workforce is an increasingly important resource in the new economy, and cities are competing globally for talented workers. With aging population and a need to develop its innovational structure, the Helsinki Metropolitan Area needs migrant workforce. It has been stated that quality of place is a central factor for skilled migrants when choosing where to settle, and from this perspective their satisfaction with the region is significant. In housing, the skilled migrants found the price-quality ratio and the general sizes of apartments inadequate. The housing market is difficult for the migrants to approach, since they often do not speak Finnish and there are prejudices towards foreigners. The general quality of housing was rated well. On the neighbourhood level, the skilled migrants had settled in residential areas which are also preferred by the Finnish skilled workers. While the migrants showed suburban orientation in their settlement patterns, they were not concentrated in the suburban areas which host large shares of traditional immigrant groups. Migrants were usually satisfied with their neighbourhoods; however, part of the suburban dwellers were unsatisfied with the services and social life in their neighbourhoods. Considering the level of the city region, the most challenging feature for the skilled migrants was the social life. The migrants felt that the social environment is homogeneous and difficult to approach. The physical environment was generally rated well, the most appreciated features being public transportation, human scale of the Metropolitan Helsinki, cleanliness, and the urban nature. Urban culture and services were seen good for the city region’s size, but lacking in international comparison.