Current Care Guidelines for Cardiopulmonary Resuscitation : Implementation, skills and attitudes

Background: The national resuscitation guidelines were published in Finland in 2002 and are based on international guidelines published in 2000. The main goal of the national guidelines, available on the Internet free of charge, is early defibrillation by nurses in an institutional setting. Aim: To study possible changes in cardiopulmonary resuscitation (CPR) practices, especially concerning early defibrillation, nurses and students attitudes of guideline implementation and nurses and students ability to implement the guideline recommendations in clinical practices after publication of the Current Care (CC) guidelines for CPR 2002. Material and methods: CPR practices in Finnish health centres; especially concerning rapid defibrillation programmes, as well as the implementation of CC guidelines for CPR was studied in a mail survey to chief physicians of every health centre in Finland (Study I). The CPR skills using an automated external defibrillator (AED) were compared in a study including Objective stuctured clinical examination (OSCE) of resuscitation skills of nurses and nursing students in Finnish and Swedish hospital and institution (Studies II, III). Attitudes towards CPR-D and CPR guidelines among medical and nursing students and secondary hospital nurses were studied in surveys (Studies IV, V). The nurses receiving different CPR training were compared in a randomized trial including OSCE of CPR skills of nurses in Finnish Hospital (Study VI). Results: Two years after the publication, 40.7% of Finnish health centres used national resuscitation guidelines. The proportion of health centres having at least one AED (66%) and principle of nurse-performed defibrillation without the presence of a physician (42%) had increased. The CPR-D training was estimated to be insufficient regarding basic life support and advanced life support in the majority of health centres (Study I). CPR-D skills of nurses and nursing students in two specific Swedish and Finnish hospitals and institutions (Study II and III) were generally inadequate. The nurses performed better than the students and the Swedish nurses surpassed the Finnish ones. Geriatric nurses receiving traditional CPR-D training performed better than those receiving an Internet-based course but both groups failed to defibrillate within 60 s. Thus, the performance was not satisfactory even two weeks after traditional training (Study VI). Unlike the medical students, the nursing students did not feel competent to perform procedures recommended in the cardiopulmonary resuscitation guidelines including the defibrillation. However, the majority of nursing students felt confident about their ability to perform basic life support. The perceived ability to defibrillate correlated significantly with a positive attitude towards nurse-performed defibrillation and negatively with fear of damaging the patient s heart by defibrillation (Study IV). After the educational intervention, the nurses found their level of CPR-D capability more sufficient than before and felt more confident about their ability to perform defibrillation themselves. A negative attitude toward defibrillation correlated with perceived negative organisational attitudes toward cardiopulmonary resuscitation guidelines. After CPR-D education in the hospital, the majority (64%) of nurses hesitated to perform defibrillation because of anxiety and 27 % hesitated because of fear of injuring the patient. Also a negative personal attitude towards guidelines increased markedly after education (Study V). Conclusions: Although a significant change had occurred in resuscitation practices in primary health care after publication of national cardiopulmonary resuscitation guidelines the participants CPR-D skills were not adequate according to the CPR guidelines. The current way of teaching is unlikely to result in participants being able to perform adequate and rapid CPR-D. More information and more frequent training are needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation affect the nursing students and nurses attitudes toward cardiopulmonary resuscitation guidelines. CPR-D education increased the participants self-confidence concerning CPR-D skills but it did not reduce their anxiety. AEDs have replaced the manual defibrillators in most institutions, but in spite of the modern devices the anxiety still exists. Basic education does not provide nursing students with adequate CPR-D skills. Thus, frequent training in the workplace has vital importance. This multi-professional program supported by the administration might provide better CPR-D skills. Distance learning alone cannot substitute for traditional small-group learning, tutored hands-on training is needed to learn practical CPR-D skills. Standardized testing would probably help controlling the quality of learning. Training of group-working skills might improve CPR performance.

Species-specific and Indication-based Use of Antimicrobials in Dogs, Cats, Cattle and Horses in Finland : Data collected using three different methods

Increasing antimicrobial resistance in bacteria has led to the need for better understanding of antimicrobial usage patterns. In 1999, the World Organisation for Animal Health (OIE) recommended that an international ad hoc group should be established to address human and animal health risks related to antimicrobial resistance and the contribution of antimicrobial usage in veterinary medicine. In European countries the need for continuous recording of the usage of veterinary antimicrobials as well as for animal species-specific and indication-based data on usage has been acknowledged. Finland has been among the first countries to develop prudent use guidelines in veterinary medicine, as the Ministry of Agriculture and Forestry issued the first animal species-specific indication-based recommendations for antimicrobial use in animals in 1996. These guidelines have been revised in 2003 and 2009. However, surveillance on the species-specific use of antimicrobials in animals has not been performed in Finland. This thesis provides animal species-specific information on indication-based antimicrobial usage. Different methods for data collection have been utilized. Information on antimicrobial usage in animals has been gathered in four studies (studies A-D). Material from studies A, B and C have been used in an overlapping manner in the original publications I-IV. Study A (original publications I & IV) presents a retrospective cross-sectional survey on prescriptions for small animals at the Veterinary Teaching Hospital of the University of Helsinki. Prescriptions for antimicrobial agents (n = 2281) were collected and usage patterns, such as the indication and length of treatment, were reviewed. Most of the prescriptions were for dogs (78%), and primarily for the treatment of skin and ear infections most of which were treated with cephalexin for a median period of 14 days. Prescriptions for cats (18%) were most often for the treatment of urinary tract infections with amoxicillin for a median length of 10 days. Study B (original publication II) was a retrospective cross-sectional survey where prescriptions for animals were collected from 17 University Pharmacies nationwide. Antimicrobial prescriptions (n = 1038) for mainly dogs (65%) and cats (19%) were investigated. In this study, cephalexin and amoxicillin were also the most frequently used drugs for dogs and cats, respectively. In study C (original publications III & IV), the indication-based usage of antimicrobials of practicing veterinarians was analyzed by using a prospective questionnaire. Randomly selected practicing veterinarians in Finland (n = 262) recorded all their antimicrobial usage during a 7-day study period. Cattle (46%) with mastitis were the most common patients receiving antimicrobial treatment, generally intramuscular penicillin G or intramammary treatment with ampicillin and cloxacillin. The median length of treatment was four days, regardless of the route of administration. Antimicrobial use in horses was evaluated in study D, the results of which are previously unpublished. Firstly, data collected with the prospective questionnaire from the practicing veterinarians showed that horses (n = 89) were frequently treated for skin or wound infections by using penicillin G or trimethoprim-sulfadiazine. The mean duration of treatment was five to seven days. Secondly, according to retrospective data collected from patient records, horses (n = 74) that underwent colic surgery at the Veterinary Teaching Hospital of the University of Helsinki were generally treated according to national and hospital recommendations; penicillin G and gentamicin was administered preoperatively and treatment was continued for a median of three days postoperatively. In conclusion, Finnish veterinarians followed well the national prudent use guidelines. Narrow-spectrum antimicrobials were preferred and, for instance, fluoroquinolones were used sparingly. Prescription studies seemed to give good information on antimicrobials usage, especially when combined with complementary information from patient records. A prospective questionnaire study provided a fair amount of valuable data on several animal species. Electronic surveys are worthwhile exploiting in the future.

Kriitkko Einari J. Vehmas ja moderni taide

The doctoral dissertation Critic Einari J. Vehmas and Modern Art deals with one of the central figures of the Finnish art scene and his work as an art critic, art museum curator and cultural critic. The main body of research material consists of the writings of Einari J. Vehmas (1902 1980) from 1937 to the late 1960s. Vehmas wrote art reviews for magazines, and from the year 1945 he was a regular art critic for one of the major newspapers in Finland. Vehmas was heavily inclined towards French literature and visual arts. Marcel Proust and Charles Baudelaire influenced his views on the nature of art from the late 1920s onwards. Vehmas is commonly regarded as the most influential art critic of post-war Finland. His writings have been referred to and cited in numerous research papers on Finnish 20th-century art. A lesser known aspect of his work is his position as the deputy director of the Ateneum Art Museum, the Finnish national gallery. Through his art museum work, his opinions also shaped the canon of modern art considered particularly Finnish following the second world war. The main emphasis of the dissertation is on studying Vehmas s writings, but it also illustrates the diversity of his involvement in Finnish cultural life through biographical documents. The long chronological span of the dissertation emphasises how certain central themes accumulate in Vehmas s writings. The aim of the dissertation is also to show how strongly certain philosophical and theoretical concepts from the early 20th century, specifically Wassily Kandinsky s principle of inner necessity and Henri Bergson s epistemology highlighting intuition and instinct, continued to influence the Finnish art discourse even in the early 1960s, in part thanks to the writings of Vehmas. Throughout his production, Vehmas contemplated the state and future of modern art and humanity. Vehmas used a colourful, vitalistic rhetoric to emphasise the role of modern art as a building block of culture and humanity. At the same time, however, he was a cultural pessimist whose art views became infused with anxiety, a sense of loss, and a desire to turn his back on the world.

Eläinlääkärin pehmeät direktiivit

Tutkielmassa selvitetään, millaisia direktiivejä eli ohjailevia lausumia eläinlääkäri käyttää potilasvastaanottonsa aikana vaikuttaakseen eläimen tai sen omistajan toimintaan. Lähtökohtana on huomio siitä, että eläinlääkäri pehmentää etenkin eläimenomistajalle suunnattuja ohjeita, neuvoja ja pyyntöjä erilaisin kielellisin keinoin. Kaiken kaikkiaan eläinlääkärin direktiivit vaikuttavat kontekstissaan toimivilta, tilanteeseen sopivilta ja riittävän kohteliailta. Tutkielmassa pohditaan, miksi tiettyjä direktiivejä on tarpeen pehmentää enemmän kuin toisia, ja millaisin keinoin tätä pehmeää, kohteliasta puhetta luodaan. Tutkimusmenetelmänä on keskustelunanalyysi. Aineistona on yhdeksän vuonna 2009 videokuvattua potilaskäyntiä eteläsuomalaiselta eläinlääkäriasemalta. Tallenteissa esiintyy kolme eri eläinlääkäriä, jotka kaikki ovat naisia. Aineistoa on yhteensä noin 100 minuuttia, ja se on litteroitu keskustelunanalyysin konventioiden mukaisesti. Keskusteluasetelma on aiempiin keskustelunanalyyttisiin tutkimuksiin verrattuna poikkeuksellinen, koska tilanteessa on osallistujana ei-kielellinen olento, eläin. Vaikka eläimen ei voida odottaa ymmärtävän kieltä, sillekin esitettäviä direktiivejä usein pehmennetään. Määrällisesti merkittävimmiksi pehmentämisen keinoiksi osoittautuvat passiivi ja modaaliverbit. Passiivilla puhuja välttää mainitsemasta puhuteltavan persoonaa ja tietyssä kontekstissa tekee toiminnasta näennäisesti yhteistä. Modaaliverbeillä toiminnasta tehdään ei-ehdotonta, kun se ilmaistaan esimerkiksi luvallisena tai kannattavana. Modaaliverbeihin yhdistyy usein nollapersoona, jolla myös vältetään persoonan mainitseminen. Lisäksi keskusteluissa esiintyy runsaasti muita pehmentämisen keinoja, esimerkiksi epäsuoria ilmauksia ja varauksia kuten ehkä. Yllättävää on jos-partikkelin avulla muodostettavan ohjailevan lausuman suhteellinen yleisyys eläinlääkärikeskusteluissa. Jos otat tosta kiinni -tyyppinen direktiivi on saanut melko vähän huomiota aiemmissa direktiivitutkimuksissa mutta on tässä keskustelukontekstissa ilmeisen käyttökelpoinen. Tutkimuksessa selviää, että paljas, pehmentämätön imperatiivikäsky esitetään eläimenomistajalle vain poikkeustilanteessa, jossa suoruudelle on erityinen tarve. Eläimelle imperatiivikäskyjä voidaan kuitenkin esittää muulloinkin.

Puolustuskykyinen valtio vai Ruotsin hälytyskello? : Suomen sotilasstrateginen asema kylmän sodan alkuvuosien asiantuntija-arvioissa

The doctoral thesis deals with Finnish and foreign expert s analyses of Finland s military strategic position and defence capability, dating back to the early years of the Cold War. Finland s military high command prepared assessments of the country s strategic position and of the capability of the Defence Forces as grounds for defence planning. Since Finland was located on the Cold War dividing line, the foreign powers were also monitoring the development of Finland s situation. The research carried out had access to the armed forces internal assessments, as well as to analyses prepared by the military intelligence services of Sweden, Britain and the United States. One of the working hypotheses was that after the WWII the ability military leadership to estimate the security political needs of the country and the organisation of its defence was severely weakened so that the dangers of the international development were not perceived and the gradual erosion of defence capability was partly unnoticed. This hypothesis proved to be wrong. Even if the Finnish military intelligence was much weaker than during the war, it was able to provide the military leadership with information of the international military development for the most part. The military leadership was also fully aware of the weakening of the defence capability of the country. They faced the difficult task of making the country s political leadership, i.e. President Paasikivi and the government, also understand the gravity of the situation. Only in the last years of his term in office Paasikivi started to believe the warnings of the military. According to another hypothesis, outside observers considered the Finnish armed forces to primarily act as reinforcements for the Soviet Red Army, and they believed that, in the event of a full-scale war, the Finns would not have been able or even willing to resist a Soviet invasion of Sweden and Norway through Finland. The study confirmed that this was approximately the view the Swedes, the British and the Americans had of the Finnish forces. Western and Swedish intelligence assessments did not show confidence in Finland s defence ability and the country was regarded almost as a Soviet satellite. Finland s strategic position was, however, considered slightly different from that of the Soviet-occupied Eastern European countries. Finland had been forced to become part of the Soviet sphere of interest and security system and this was sealed by the Finno-Soviet Treaty of Friendship, Cooperation, and Mutual Assistance in 1948. Finland had little importance to the military interests of the Western powers. In Sweden s defence planning, however, Finland played a significant role as an alarm bell of a possible Soviet surprise attack, as well as defensive frontline and buffer zone.

Matkailurakentaminen ja sen diskursiivinen rakentuminen Kilpisjärvellä

This master s thesis examines tourism related housing and related discourses in the village of Kilpisjärvi, Finland. I study the tourism development in Kilpisjärvi and the debate related to this process. My methodology is based on discourse and content analysis. The purpose of this study is to examine and classify the discourses of tourism related housing and what are the lessons learned from the recent development of Kilpisjärvi. Kilpisjärvi is the northernmost village in western Finnish Lapland, located in the middle of the highest mountain area of Finland. The area has been reindeer herding area of Saami people for centuries, but it has lacked permanent settlement until the beginning of 20th century. The first tourist accommodation was built in 1930s, followed by the road in 1940s and the hotel in 1950s. Traditionally the area has attracted skiers and hikers. The area is also known for its extraordinary nature and rare plant life. Tourism development was slow in Kilpisjärvi until the turn of millennium when rapid growth in tourism related housing was triggered by extensive land use planning. Small wilderness village of Kilpisjärvi has grown to a tourism centre with over 800 beds in commercial enterprises, more than hundred second-homes, and two large caravan areas. This development has raised conflicts among villagers. The empirical part of this study is based on the interviews of 17 permanent dwellers of Kilpisjärvi and three Norwegian cottage owners. Six discourses can be distinguished: 1) Nature and landscape, 2) Economy, 3) Place, 4)Reindeer herding, 5) Governance and 6) Possibilities to influence decision-making. The first discourse stressed that tourism development and building should adapt to nature and landscape, while economic discourse stressed the economical importance of tourism to Kilpisjärvi and the municipality of Enontekiö. The third discourse noted the change of Kilpisjärvi as a place due to the boom of tourism development. The discourse of reindeer herding was clearly distinguished from others, seeing tourism development merely negative. Governance was seen as an important tool in regulating development, but many saw that the municipal administration has failed to take into account other aspects of tourism development than economical factors. Many villagers saw their influence in decision-making weak, while landowners and municipal decision-makers were seen as oligarchy in land-use planning regardless of formal participatory planning process enforced by law. I conclude that it is important to take into account the diversity of local discourses in tourism development and land use issues. Transparent and genuine participatory planning process would promote sustainable development, prevent conflicts and allow decisions and development which would satisfy larger number of local dwellers than presently.

Construing and Defining the Out of Control : Addiction in the Media 1968-2008.

The four scientific articles comprising this doctoral dissertation offer new information on the presentation and construction of addiction in the mass media during the period 1968 - 2008. Diachronic surveys as well as quantitative and qualitative content analyses were undertaken to discern trends during the period in question and to investigate underlying conceptions of the problems in contemporary media presentations. The research material for the first three articles consists of a sample of 200 texts from Finland s biggest daily newspaper, Helsingin Sanomat, from the period 1968 - 2006. The fourth study examines English-language tabloid material published on the Internet in 2005 - 2008. A number of principal trends are identified. In addition to a significant increase in addiction reporting over time, the study shows that an internalisation of addiction problems took place in the media presentations under study. The phenomenon is portrayed and tackled from within the problems themselves, often from the viewpoint of the individuals concerned. The tone becomes more personal, and technical and detailed accounts are more and more frequent. Secondly, the concept of addiction is broadened. This can be dated to the 1990s. The concept undergoes a conventionalisation: it is used more frequently in a manner that is not thought to require explanation. The word riippuvuus (the closest equivalent to addiction in Finnish) was adopted more commonly in the reporting at the same time, in the 1990s. Thirdly, the results highlight individual self-governance as a superordinate principle in contemporary descriptions of addiction. If the principal demarcation in earlier texts was between us and them , it is now focused primarily on the individual s competence and ability to govern the self, to restrain and master one's behaviour. Finally, in the fourth study investigating textual constructions of female celebrities (Amy Winehouse, Britney Spears and Kate Moss) in Internet tabloids, various relations and functions of addiction problems, intoxication, body and gender were observed to function as cultural symbols. Addiction becomes a sign, or a style, that represents different significations in relation to the main characters in the tabloid stories. Tabloids, as a genre, play an important role by introducing other images of the problems than those featured in mainstream media. The study is positioned within the framework of modernity theory and its views on the need for self-reflexivity and biographies as tools for the creation and definition of the self. Traditional institutions such as the church, occupation, family etc. no longer play an important role in self-definition. This circumstance creates a need for a culture conveying stories of success and failure in relation to which the individual can position their own behaviour and life content. I propose that addiction , as a theme in media reporting, resolves the conflict that emanates from the ambivalence between the accessibility and the individualisation of consumer society, on the one hand, and the problematic behavioural patterns (addictions) that they may induce, on the other.

Keskiluokkainen kulutuseetos 1920–1950-luvuilla syntyneiden suomalaisten kulutuskerronnassa

Tutkielmassa tarkastellaan suomalaista kulutuskulttuuria ja sen muuttumista kulutuskerronnan kautta. Aineisto koostuu 39 iäkkään, 1920–1950-luvuilla syntyneen, suomalaisen kuluttajaelämäkerroista, jotka kerättiin kirjoituskilpailulla. Tutkielmassa analysoidaan informanttien kulutukseen ja rahankäyttöön liittämiä hyveitä sekä sitä, millaisista kulutuseetoksista hyveet kertovat. Elämäkertojen erittelyyn ja tulkintaan on sovellettu lähiluentaa. Analyysin avulla on rakennettu tulkinta keskiluokkaisesta kulutuseetoksesta. Tutkimuksen teoreettinen viitekehys pohjautuu kulutuksen normatiivisia merkityksiä, kulutuseetoksia ja keskiluokkaisuutta käsitteleviin tutkimuksiin. Tulkintaa ohjaa lisäksi ymmärrys tutkittavan sukupolven elämänkulusta suomalaisen kulutusyhteiskunnan kehityksen näkökulmasta. Tutkittavan sukupolven elämän aikana kotitalous on kehittynyt agraarisen yhteiskunnan omavaraisesta tuotantoyksiköstä vauraan yhteiskunnan kulutukseen ja sosiaaliseen uusintamiseen keskittyväksi instituutioksi. Palkkatyöläisyys, vapaa-aika ja kulutusmahdollisuudet ovat lisääntyneet, ja yhteiskuntaa leimaa keskiluokkaistuminen. Elämäkerroista löytyvät säästäväisyyden ja vaatimattomuuden hyveet kertovat talonpoikaisen kulutueetoksen olevan edelleen keskeinen kulutuseetos, mutta niukkuuden hyveellistämisen lisäksi kulutuskerronnasta löytyy myös modernimpia tapoja suhtautua kulutukseen. Tulkitsen kuluttajaelämäkerroista löytyvien järkevyyden, tavallisuuden ja työnteon hyveiden kertovan keskiluokkaisuudesta. Hyveellinen kuluttaminen on keskiluokkaisessa kulutuseetoksessa talonpoikaista kulutuseetosta sallivampaa. Se määrittyy niukan kuluttamisen sijaan kohtuullisen ja tavallisen kuluttamisen hyveellistämiseksi. Keskiluokkaisessa kulutuseetoksessa on hyväksyttävää nauttia kohtuudella ja järkevästi omalla työllä ansaitusta vaurastumisesta. Talonpoikaisesta kulutuseetoksesta poiketen keskiluokkainen kulutuseetos hyväksyy kulutuksesta saatavan nautinnon. Sanonta ”ensin työ, sitten huvi” kuvaa keskiluokkaisen kulutuseetoksen tapaa suhtautua vaurastumisen mukanaan tuomaan kulutuskulttuuriin ja sen nautintoihin.

Carbon dynamics in peatlands under changing hydrology : Effects of water level drawdown on litter quality, microbial enzyme activities and litter decomposition rates

Pristine peatlands are carbon (C) accumulating wetland ecosystems sustained by a high water level (WL) and consequent anoxia that slows down decomposition. Persistent WL drawdown as a response to climate and/or land-use change directly affects decomposition: increased oxygenation stimulates decomposition of the old C (peat) sequestered under prior anoxic conditions. Responses of the new C (plant litter) in terms of quality, production and decomposability, and the consequences for the whole C cycle of peatlands are not fully understood. WL drawdown induces changes in plant community resulting in shift in dominance from Sphagnum and graminoids to shrubs and trees. There is increasing evidence that the indirect effects of WL drawdown via the changes in plant communities will have more impact on the ecosystem C cycling than any direct effects. The aim of this study is to disentangle the direct and indirect effects of WL drawdown on the new C by measuring the relative importance of 1) environmental parameters (WL depth, temperature, soil chemistry) and 2) plant community composition on litter production, microbial activity, litter decomposition rates and, consequently, on the C accumulation. This information is crucial for modelling C cycle under changing climate and/or land-use. The effects of WL drawdown were tested in a large-scale experiment with manipulated WL at two time scales and three nutrient regimes. Furthermore, the effect of climate on litter decomposability was tested along a north-south gradient. Additionally, a novel method for estimating litter chemical quality and decomposability was explored by combining Near infrared spectroscopy with multivariate modelling. WL drawdown had direct effects on litter quality, microbial community composition and activity and litter decomposition rates. However, the direct effects of WL drawdown were overruled by the indirect effects via changes in litter type composition and production. Short-term (years) responses to WL drawdown were small. In long-term (decades), dramatically increased litter inputs resulted in large accumulation of organic matter in spite of increased decomposition rates. Further, the quality of the accumulated matter greatly changed from that accumulated in pristine conditions. The response of a peatland ecosystem to persistent WL drawdown was more pronounced at sites with more nutrients. The study demonstrates that the shift in vegetation composition as a response to climate and/or land-use change is the main factor affecting peatland ecosystem C cycle and thus dynamic vegetation is a necessity in any models applied for estimating responses of C fluxes to changes in the environment. The time scale for vegetation changes caused by hydrological changes needs to extend to decades. This study provides grouping of litter types (plant species and part) into functional types based on their chemical quality and/or decomposability that the models could utilize. Further, the results clearly show a drop in soil temperature as a response to WL drawdown when an initially open peatland converts into a forest ecosystem, which has not yet been considered in the existing models.

HALLINNONTASOJEN VÄLINEN DIALOGI JA ERITYISOPETUKSEN MUUTOS BYROKRAATTISENA INSTITUUTIONA : - Kymppikuntien loppuraportin ja Erityisopetuksen strategian sisällönanalyyttinen vertailu

The rise of Special education numbers in Finland has caused a situation where Finland s ten largest LEA s so called kymppikunnat (ten communes) have expressed their growing concern of organizing the special education in the current institutional settings. The LEA s started the conversation of redefining special education system in 2004. Their aim was to target the governments attention to the problematics of special education. By the request of the Ministry of Education the LEA s prepared a final report concerning the central questions in the Finnish special education system. On the basis of the LEA s survey it became even clearer that the legislation, funding system and curriculum are tightly linked together. The following LEA s took part into the writing process Espoo, Helsinki, Jyväskylä, Kuopio, Lahti, Lappeenranta, Tampere, Turku and Vantaa. The report was hand over to the Ministry of Education at 18.8.2006. After the delivery the Ministry organized special education development group meetings 17 times in the year 2007. The result of the LEA s report and the development meetings was a new Special Education Strategy 2007. I am observing the dialogue between administrational levels in governmental institutions change process. The research is a content analysis where I compare the Erityistä tukea tarvitsevan oppilaan opetuksen järjestämisen uudistaminen osana yhtenäistä perusopetusta- kohti laatua ja joustavuutta (The renewal of the organization of teaching for student with special educational needs as part of unified education for all - towards quality and flexibility) document to Erityisopetuksen strategia (Special education strategy) document. My aim was to find out how much of their own interests have the LEA s been able to integrate into the official governmental documentation. The data has been organized and analyzed quantitatively with Macros created as additional parts in Microsoft Excel software. The document material has also been arranged manually on sentence based categorization into an Excel matrix. The results have been theoretically viewed from the special education reform dialogue perspective, and from the angle of the change process of a bureaucratic institution. My target has been to provide a new viewpoint to the change of special education system as a bureaucratic institution. The education system has traditionally been understood as a machine bureaucracy. By the review provided in my pro gradu analysis it seems however that the administrational system in special education is more of a postmodern network bureaucracy than machine bureaucracy. The system appears to be constructed by overlapping, crossing and complex networks where things are been decided. These kinds of networks are called "governance networks . It seems that the governmental administrational - and politic levels, the third sector actors and other society s operators are mixed in decision making.

Lapsen osallisuuden mahdollistaminen päiväkodin toimintakulttuurissa : Tilastollinen tutkimus osallisuuden tasomallista

Children s participation has been a subject in the international research since past ten years. This research has explored participation from the standpoint of the UN s Convention of the Rights of the Child and focused mainly on schoolchildren or on the working youth s chances in developing countries to have impact on their own lives (eg. Sinclair, 2004 and Thomas, 2002). In Finland there has been less research about the children s rights while the main focus has been on the customers of the child welfare system. This study examines children s participation in Helsinki metropolitan area via the views and the practices of the personnel of early childhood education. The adopted viewpoint is Shier s level model of participation (2001), in which the children s participation process is building in phases, is observed via the everyday actions of the kindergarten personnel. Attention has been paid on the special characteristics of the Finnish early childhood education. This study was part of VKK-Metro s research project. The inquiry in May 2010 was directed to all working teams in the kindergartens of the Helsinki metropolitan area. Of these 56.59 % (1116 teams) answered. The quantitative data analyzed by principal component analysis gave four principal components, from which three were named after Shier s participation model. The fourth component included variables about rules and power. The level model of participation fit well to assess early childhood education in the Helsinki metropolitan area. The professionalism of the personnel became emphasized in the area of everyday interactions between the personnel and the children. Important aspects of the children s participation are to become heard, to get support in the play and in interaction and to be able to share both power and responsibility with personnel of the early childhood education.

Humanitaarisuuden varjossa : Poliittiset tekijät lastensiirroissa Ruotsiin sotiemme aikana ja niiden jälkeen

The evacuation of Finnish children to Sweden during WW II has often been called a small migration . Historical research on this subject is scarce, considering the great number of children involved. The present research has applied, apart from the traditional archive research, the framework of history-culture developed by Rüsen in order to have an all-inclusive approach to the impact of this historical event. The framework has three dimensions: political, aesthetic and cognitive. The collective memory of war children has also been discussed. The research looks for political factors involved in the evacuations during the Winter War and the Continuation War and the post-war period. The approach is wider than a purely humanitarian one. Political factors have had an impact in both Finland and Sweden, beginning from the decision-making process and ending with the discussion of the unexpected consequences of the evacuations in the Finnish Parliament in 1950. The Winter War (30.11.1939 13.3.1940) witnessed the first child transports. These were also the model for future decision making. The transports were begun on the initiative of Swedes Maja Sandler, the wife of the resigned minister of foreign affairs Rickard Sandler, and Hanna Rydh-Munck af Rosenschöld , but this activity was soon accepted by the Swedish government because the humanitarian help in the form of child transports lightened the political burden of Prime Minister Hansson, who was not willing to help Finland militarily. It was help that Finland never asked for and it was rejected at the beginning. The negative response of Minister Juho Koivisto was not taken very seriously. The political forces in Finland supporting child transports were stronger than those rejecting them. The major politicians in support belonged to Finland´s Swedish minority. In addition, close to 1 000 Finnish children remained in Sweden after the Winter War. No analysis was made of the reasons why these children did not return home. A committee set up to help Finland and Norway was established in Sweden in 1941. Its chairman was Torsten Nothin, an influential Swedish politician. In December 1941 he appealed to the Swedish government to provide help to Finnish children under the authority of The International Red Cross. This plea had no results. The delivery of great amounts of food to Finland, which was now at war with Great Britain, had automatically caused reactions among the allies against the Swedish imports through Gothenburg. This included the import of oil, which was essential for the Swedish navy and air force. Oil was later used successfully to force a reduction in commerce between Sweden and Finland. The contradiction between Sweden´s essential political interests and humanitarian help was solved in a way that did not harm the country´s vital political interests. Instead of delivering help to Finland, Finnish children were transported to Sweden through the organisations that had already been created. At the beginning of the Continuation War (25.6.1941 27.4.1945) negative opinion regarding child transports re-emerged in Finland. Karl-August Fagerholm implemented the transports in September 1941. In 1942, members of the conservative parties in the Finnish Parliament expressed their fear of losing the children to the Swedes. They suggested that Finland should withdraw from the inter-Nordic agreement, according to which the adoptions were approved by the court of the country where the child resided. This initiative failed. Paavo Virkkunen, an influential member of the conservative party Kokoomus in Finland, favoured the so-called good-father system, where help was delivered to Finland in the form of money and goods. Virkkunen was concerned about the consequences of a long stay in a Swedish family. The risk of losing the children was clear. The extreme conservative party (IKL, the Patriotic Movement of the Finnish People) wanted to alienate Finland from Sweden and bring Finland closer to Germany. Von Blücher, the German ambassador to Finland, had in his report to Berlin, mentioned the political consequences of the child transports. Among other things, they would bring Finland and Sweden closer to each other. He had also paid attention to the Nordic political orientation in Finland. He did not question or criticize the child transports. His main interest was to increase German political influence in Finland, and the Nordic political orientation was an obstacle. Fagerholm was politically ill-favoured by the Germans, because he had a strong Nordic political disposition and had criticised Germany´s activities in Norway. The criticism of child transports was at the same time criticism of Fagerholm. The official censorship organ of the Finnish government (VTL) denied the criticism of child transports in January 1942. The reasons were political. Statements made by members of the Finnish Parliament were also censored, because it was thought that they would offend the Swedes. In addition, the censorship organ used child transports as a means of active propaganda aimed at improving the relations between the two countries. The Finnish Parliament was informed in 1948 that about 15 000 Finnish children still remained in Sweden. These children would stay there permanently. In 1950 the members of the Agrarian Party in Finland stated that Finland should actively strive to get the children back. The party on the left (SKDL, the Democratic Movement of Finnish People) also focused on the unexpected consequences of the child transports. The Social Democrats, and largely Fagerholm, had been the main force in Finland behind the child transports. Members of the SKDL, controlled by Finland´s Communist Party, stated that the war time authorities were responsible for this war loss. Many of the Finnish parents could not get their children back despite repeated requests. The discussion of the problem became political, for example von Born, a member of the Swedish minority party RKP, related this problem to foreign policy by stating that the request to repatriate the Finnish children would have negative political consequences for the relations between Finland and Sweden. He emphasized expressing feelings of gratitude to the Swedes. After the war a new foreign policy was established by Prime Minister (1944 1946) and later President (1946 1956) Juho Kusti Paasikivi. The main cornerstone of this policy was to establish good relations with the Soviet Union. The other, often forgotten, cornerstone was to simultaneously establish good relations with other Nordic countries, especially Sweden, as a counterbalance. The unexpected results of the child evacuation, a Swedish initiative, had violated the good relations with Sweden. The motives of the Democratic Movement of Finnish People were much the same as those of the Patriotic Movement of Finnish People. Only the ideology was different. The Nordic political orientation was an obstacle to both parties. The position of the Democratic Movement of Finnish People was much better than that of the Patriotic Movement of Finnish People, because now one could clearly see the unexpected results, which included human tragedy for the many families who could not be re-united with their children despite their repeated requests. The Swedes questioned the figure given to the Finnish Parliament regarding the number of children permanently remaining in Sweden. This research agrees with the Swedes. In a calculation based on Swedish population registers, the number of these children is about 7 100. The reliability of this figure is increased by the fact that the child allowance programme began in Sweden in 1948. The prerequisite to have this allowance was that the child be in the Swedish population register. It was not necessary for the child to have Swedish nationality. The Finnish Parliament had false information about the number of Finnish children who remained in Sweden in 1942 and in 1950. There was no parliamentary control in Finland regarding child transports, because the decision was made by one cabinet member and speeches by MPs in the Finnish Parliament were censored, like all criticism regarding child transports to Sweden. In Great Britain parliamentary control worked better throughout the whole war, because the speeches regarding evacuation were not censored. At the beginning of the war certain members of the British Labour Party and the Welsh Nationalists were particularly outspoken about the scheme. Fagerholm does not discuss to any great extent the child transports in his memoirs. He does not evaluate the process and results as a whole. This research provides some possibilities for an evaluation of this sort. The Swedish medical reports give a clear picture of the physical condition of the Finnish children when arriving in Sweden. The transports actually revealed how bad the situation of the poorest children was. According to Titmuss, similar observations were made in Great Britain during the British evacuations. The child transports saved the lives of approximately 2 900 children. Most of these children were removed to Sweden to receive treatment for illnesses, but many among the healthy children were undernourished and some suffered from the effects of tuberculosis. The medical inspection in Finland was not thorough. If you compare the figure of 2 900 children saved and returned with the figure of about 7 100 children who remained permanently in Sweden, you may draw the conclusion that Finland as a country failed to benefit from the child transports, and that the whole operation was a political mistake with far-reaching consequenses. The basic goal of the operation was to save lives and have all the children return to Finland after the war. The difficulties with the repatriation of the children were mainly psychological. The level of child psychology in Finland at that time was low. One may question the report by Professor Martti Kaila regarding the adaptation of children to their families back in Finland. Anna Freud´s warnings concerning the difficulties that arise when child evacuees return are also valid in Finland. Freud viewed the emotional life of children in a way different from Kaila: the physical survival of a small child forces her to create strong emotional ties to the person who is looking after her. This, a characteristic of all small children, occurred with the Finnish children too, and it was something the political decision makers in Finland could not see during and after the war. It is a characteristic of all little children. Yet, such experiences were already evident during the Winter War. The best possible solution had been to limit the child transports only to children in need of medical treatment. Children from large and poor families had been helped by organising meals and by buying food from Denmark with Swedish money. Assisting Finland by all possible means should have been the basic goal of Fagerholm in September 1941, when the offer of child transports came from Sweden. Fagerholm felt gratitude towards the Swedes. The risks became clear to him only in 1943. The war children are today a rather scattered and diffuse group of people. Emotionally, part of these children remained in Sweden after the war. There is no clear collective memory, only individual memories; the collective memory of the war children has partly been shaped later through the activities of the war child associations. The main difference between the children evacuated in Finland (for example from Karelia to safer areas with their families) and the war children, who were sent abroad, is that the war children lack a shared story and experience with their families. They were outsiders . The whole matter is sensitive to many of such mothers and discussing the subject has often been avoided in families. The war-time censorship has continued in families through silence and avoidance and Finnish politicians and Finnish families had to face each other on this issue after the war. The lack of all-inclusive historical research has also prevented the formation of a collective awareness among war children returned to Finland or those remaining permanently abroad.. Knowledge of historical facts will help war-children by providing an opportunity to create an all-inclusive approach to the past. Personal experiences should be regarded as part of a large historical entity shadowed by war and where many political factors were at work in both Finland and Sweden. This means strengthening of the cognitive dimension discussed in Rüsen´s all-inclusive historical approach.

Physical activity and diabetic complications in patients with type 1 diabetes

Type 1 diabetes is associated with the risk for late diabetic complications which are divided into microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (cardiovascular disease, CVD) diseases. The risk for diabetic complication can be reduced by effective treatment, most importantly the glycaemic control. Glycaemia in type 1 diabetes is influenced by the interplay between insulin injections and lifestyle factors such as physical activity and diet. The effect of physical activity in patients with type 1 diabetes is not well known, however. The aim of this thesis was to investigate the physical activity and the physical fitness of patients with type 1 diabetes with special emphasis on glycaemic control and the diabetic complications. The patients included in the study were all part of the nationwide, multicenter Finnish Diabetic Nephropathy (FinnDiane) Study which aims to characterise genetic, clinical, and environmental factors that predispose to diabetic complications in patients with type 1 diabetes. In addition, subjects from the IDentification of EArly mechanisms in the pathogenesis of diabetic Late complications (IDEAL) Study were studied. Physical activity was assessed in the FinnDiane Study in 1945 patients by a validated questionnaire. Physical fitness was measured in the IDEAL Study by spiroergometry (cycle test with measurement of respiratory gases) in 86 young adults with type 1 diabetes and in 27 healthy controls. All patients underwent thorough clinical characterisation of their diabetic complication status. Four substudies were cross-sectional using baseline data and one study additionally used follow-up data. Physical activity, especially the intensity of activities, was reduced in patients affected by diabetic nephropathy, retinopathy, and CVD. Low physical activity was associated with poor glycaemic control, a finding most clear in women and evident also in patients with no signs of diabetic complications. Furthermore, low physical activity was associated with a higher HbA1c variability, which in turn was associated with the progression of renal disease and CVD during follow-up. A higher level of physical activity was also associated with better insulin sensitivity. The prevalence of the metabolic syndrome in type 1 diabetes was also lower the higher the physical activity. The aerobic physical fitness level of young adults with type 1 diabetes was reduced compared with healthy peers and in men an association between higher fitness level and lower HbA1c was observed. In patients with type 1 diabetes, a higher physical activity was associated with better glycaemic control and may thus be beneficial with respect to the prevention of diabetic complications.