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.

Yhteisestä toiminnasta yhteiseen kieleen : keskustelunanalyyttinen tutkimus toisen kielen oppimisesta kielikylpypäiväkodin arkitilanteissa

This dissertation examines how Finnish-speaking children learn Swedish in an immersion kindergarten where the method of Canadian immersion is used. Within the framework of conversation analysis, this study explores how second language learning is situated in interaction and evidenced in the participants´ verbal and non-verbal behavior. The database consists of 40 hours of videotaped data collected in naturally occurring situations in a group of 15 four-year-old children during the first two years of their immersion. Due to the immersion method, all the children share the same L1, in this case Finnish, and the teachers understand Finnish. However, they speak only Swedish to the children in all situations and Swedish is learned in interaction without formal teaching. The aim of the study is to discover how the children´s second language competence gradually increases when they participate in interaction with the Swedish-speaking teachers. The study also sheds light on the methodological question of how second language learning can be analyzed with the method of conversation analysis. The focus is on showing how the second language is learned in interaction, especially on how learning is achieved collaboratively. In this study, the emerging second language competence is explored by investigating how the children show understanding of the teachers´ non-verbal and verbal actions during the first and the second semester of the immersion. The children´s use of Swedish is analyzed by investigating how they recycle lexical items and later even syntactic structures from the teachers´ Swedish turns. The results show that the teachers´ actions are largely understood by the children even at the beginning of the immersion. The analyzes of the children´s responsive turns reveal that they interpret the teachers´ turns on the basis of non-verbal cues at first. Especially at the beginning of the immersion, the participants orient to the progress of interaction and not to problems in understanding. Even in situations where the next actions show that the children do not understand what is said, they tend to display understanding rather than non-understanding. This behavior changes, however, when the children´s competence in their second language increases. At the second semester, the children both show understanding of the teachers´ verbal turns and also display their non-understanding by initiating repair when they do not understand. Understanding of the teachers´ verbal turns, including their syntactic structure, is manifested in the ways the children tie their turns to the teachers´ turns. Recycling, on the other hand, proves to be the way by which the children start to speak the second language. In this study, the children´s common L1 is evidenced to be an important resource in interaction. It allows the children to participate in their individual ways and to share their experiences both with each other and with the teachers. It also enables them to co-construct conversations that lead to collaborative learning. Moreover, the uninhibited use of L1 proves to be an important analytic tool that makes the immersion data especially fruitful for conversation analytic research on second language learning, since the children´s interpretations of the second language are in evidence even when they do not speak the second language.

Pelin henki. Moderni ja traditionaalinen tansanialaisessa jalkapalloilussa.

Antropologisessa ja muussa yhteiskunnallisessa tutkimuksessa magia on määritelty perinteisesti traditionaaliseksi ja menneisyyteen kuuluvaksi, kun taas urheilu on määritelty magian vastakohtana dynaamiseksi moderniksi. Tässä pro gradu -tutkielmassa tarkastellaan tansanialaista jalkapallomagiaa, jota on mahdotonta määrittää kyseisen dikotomian kumpaankaan kategoriaan. Tansaniassa tammi-syyskuussa 2010 kerätyn etnografisen aineiston perusteella tutkielmassa kuvaillaan, minkälaisia merkityksiä tansanialaiset itse antavat jalkapallomagialle ja miten nämä merkityksenannot liittyvät modernin ja traditionaalisen diskurssiin. Tutkielman pääteemana on tutkittavien tansanialaisten subjektiviteetti tai persoona, joka määritellään suhteessa muihin. Tansanialaisen jalkapallon historia juontaa juurensa siirtomaa-aikaan, jolloin siirtomaahallitsijat pyrkivät lajin avulla modernisoimaan paikallista väestöä ja opettamaan heille kurinalaisuutta ja lojaalisuutta. Tähän liittyi olettamus siitä, että kulttuurit kehittyvät teleologisesti kohti yhtä modernia. Tansaniassa jalkapallon suosio on nykyisin huikeaa, mutta suosio perustuu jo olemassa oleville kulttuurisille rakenteille. Tutkielmassa analysoidaan, kuinka Tansanian kahden vanhimman ja suurimman jalkapalloseuran historia linkittyy erityisesti traditionaalisiksi nimettyihin ngomatansseihin, joihin liittyy olennaisena elementtinä kilpailullisuus. Tutkimusaineistossa korostuvat jalkapallon ja magian ambivalentit luonteet. Tansanialaiset eivät itse määrittele jalkapallomagiaa suoraan traditionaaliseksi tai moderniksi. Heidän mielestään traditionaaliseen magiaan kuuluu, että yliluonnollisia voimia käyttääkseen henkilön täytyy vahingoittaa omaa perheenjäsentään. Traditionaalinen magia on erityisen vaarallista ja sitä käytetään pahaan. Jalkapallomagian avulla puolestaan pyritään ensisijaisesti suojelemaan omaa joukkuetta ja varmistamaan ottelun voitokas lopputulos. Toisaalta jalkapallojoukkueita myös verrataan laajennettuihin perheisiin, ja jalkapallomagian toimintamuodoissa on jatkuvuutta traditionaalisen magian mekanismeihin. Analyysin loppuosa perustuu Harri Englundin käyttämään lähestymistapaan, jossa magian avulla tuodaan esille tutkittavan yhteisön keskinäisissä sosiaalisissa suhteissa olevia jännitteitä. Englundin tutkimuksessa yhteisön jäsenen syyttäminen magian käyttämisestä on hyökkäys syytetyn henkilön moraalista laatua kohtaan. Syytetyiksi joutuvat ne, jotka eivät tee näkyviksi suhteita, joilla he ovat maallisen menestyksensä ansainneet. Tansanialaisen jalkapalloilun kontekstissa voitto tai häviö ei aiheuta syyttelyä maagisesta toiminnasta. Sen sijaan henkilön moraalista laatua arvioidaan jalkapalloyhteisössä sen perusteella, kuinka omistautuneita henkilöt ovat lajille ja joukkueelleen. Tutkielmassa tullaan johtopäätökseen, että tansanialaiset määrittävät jalkapallomagiaan sekä traditionaalisen että modernin piirteitä. He tuomitsevat oman edun tavoittelun yhteisen hyvän kustannuksella. Tämä tulee esille traditionaalisessa magiassa, jossa henkilö uhraa perheensä oman menestyksensä saavuttamiseksi. Vastaavasti jalkapallon yhteydessä henkilöitä syytetään niin sanotun jalkapalloperheen rikkomisesta ja lojaaliuden puutteesta. Tansanialaiset haluavat diskurssin tasolla moderniutta, mutta arvostavat myös traditionaalista jatkuvuutta. Modernius assosioituu eurooppalaisiin, mikä näkyy muun muassa siinä, että eurooppalaisilla ajatellaan olevan myös moderneimmat jalkapallomagian toimintatavat. Modernin ja traditionaalisen kategoriat ovat aktiivisesti kuviteltuja kategorioita, jotka kuitenkin vaikuttavat toimintaan ja toiminnan moraaliseen arvottamiseen myös konkreettisesti joskin ristiriitaisesti.

Early Growth and Later Health, Focus on Metabolic Syndrome, Obesity and Physical Activity

The Developmental Origins of Health and Disease Hypothesis proposes that adverse health outcomes in adult life are in part programmed during fetal life and infancy. This means that e.g. restricted nutrition during pregnancy programmes the offspring to store fat more effectively, to develop faster and to reach puberty earlier. These adaptations are beneficial in terms of short term survival. However, in developed countries these adaptations often lead to an increased risk of obesity and metabolic disturbances in later life, due to a mismatch between the prenatal and postnatal environment. This thesis aimed to study the role of early growth in people who are obese as adults, but metabolically healthy as well as in those who are normal in weight but metabolically obese. Other study aims were to assess whether physical activity and cardiorespiratory fitness are programmed early in life. The role of socioeconomic status in the development of obesity from a life course setting was also studied. These studies included 2003 men and women born in Helsinki between 1934 and 1944 with detailed information of their prenatal and childhood growth as well as living conditions. They participated in the detailed clinical examination during the years 2001-2004. A sub-group of the subjects participated in the UKK Institute 2-kilometre walk test. Metabolic syndrome was defined according to the 2005 criteria of the International Diabetes Federation. Among the obese men and women 20 % were metabolically healthy. Those with metabolic syndrome did not differ in birth size compared to the healthy ones, but by two years of age, they were lighter and thinner, and remained so up to 11 years. The period when changes in BMIs were predictive of the metabolic syndrome was from birth to 7 years. Of the normal weight individuals 17 % were metabolically obese. Again, there were no differences in birth size. However, by the age 7 years, those men who later developed metabolic syndrome were thinner. Gains in BMI during the first two years of life were protective of the syndrome. Children who were heavier, and especially taller, were more physically active, exercised with higher intensity and had higher cardiorespiratory fitness in their adult life than those who were shorter and thinner as children. Lower educational attainment and lower adult social class were associated with obesity in both men and women. Childhood social class was inversely associated with body mass index only in men while lower household income was associated with higher BMI in women. These results support the role of early life factors in the development of metabolic syndrome and adult life style. Early detection of risk factors predisposing to these conditions is highly relevant from a public health point of view.

"Säästän ja tuhlaan, mutta en osta mitään turhaa tai ylimääräistä" : helsinkiläislasten oma raha ja sen käyttö

Nykylapsuudesta on tullut varsin kulutuskeskeistä. Tämän päivän lapset kasvavat valtaisan tavara- ja elämysmaailman ympäröimänä ja he osallistuvat myös kuluttajina yhteiskuntaan. He ovat huomispäivän aikuiskouluttajia, joiden arvot ja asenteet kuluttamista kohtaan muotoutuvat osin jo lapsuudessa. Lapset ovat myös markkinoinnille kiinnostava kohderyhmä ja yhä nuoremmat tunnistavat mainoksista tuttuja brändejä. Tässä tutkimuksessa käsitellään helsinkiläislasten omaa rahaa heidän omasta näkökulmastaan. Useimmiten tämä oma raha on joko viikkorahaa tai kuukausirahaa. Näkökulma tutkimukseen on kulutussosiologinen. Teoreettisena viitekehyksenä on käytetty Viviana Zelizerin teoriaa rahan luokittelusta ja korvamerkitsemisestä. Kiinnostuksen kohteena ovat myös olleet lasten rahaan ja sen käyttöön liittyvät arvot. Tutkitut lapset ovat iältään 9.-13.- vuotiaita. Tutkimuksen pohjana on valmis aineisto, joka on kerätty Survey-tutkimuksena keväällä 2008. Aineiston analyysissä on käytetty sekä kvantitatiivista että kvalitatiivista lähestymistapaa. Analyysimenetelminä on käytetty ristiintaulukointia ja sisällönanalyysiä. Vaikka lapsuuteen ja nuoruuteen liitetään usein huoli holtittomasta kulutuksesta ja materialistisista arvoista, aineiston pohjalta voi väittää, että huoli on ainakin osittain aiheeton. Tutkimuksesta käy ilmi, että 9- 13-vuotiaiden helsinkiläislasten kulutustavat ovat yleisesti ottaen säästäväisyyttä ihannoivat, joskin myös materialistisia asenteita tulee ilmi. Helsinkiläislapset ovat omaksuneet aikuisyhteiskunnan luomat ja ylläpitämät asenteet "järkevästä" rahankäytöstä. Rahankäytössään lapset eivät näe minkäänlaista ristiriitaa, vaan sekä kuluttaminen, että säästäminen on lapsille hyvin luontevaa. Lapset, jotka ovat pienestä pitäen tottuneet mainoksiin ja markkinointiin suhtautuvat rahankäyttöön mutkattomasti ja järkevästi. Tutkimuksessa ei noussut missään vaiheessa ilmi, että lapset ihannoisivat kerskakulutusta tai ylenpalttista rahankäyttöä, vaan säästäväisyyden normi heijastui myös lasten retoriikassa. Kaiken kaikkiaan vaikutelma lasten suhteesta rahaan oli hyvin realistinen. He myös näyttivät ymmärtävän rahan arvon ja olivat valmiita säästämään päästäkseen tavoitteeseensa. Alueellisesti Helsinki näyttäytyy hyvin homogeenisena, eikä mittavia eroja lasten oman rahan määrässä esiinny.

Young Actors in Transnational Agoras : Multi-sited Ethnography of Cosmopolitan Micropolitical Orientations

This study examines young people s political participation in transnational meetings. Methodologically the study aims to shed light on multi-sited global ethnography. Young people are viewed here as a social age group sensitive to critical, alternative and even radical political participation. The diversity of the young actors and their actions is captured by using several different methods. What is more, the study spurs us coming from the Global North to develop social science research towards methodological cosmopolitanism and to consider our research practices from a moral cosmopolitan perspective. The research sites are the EU Presidency Youth Event (2006 Hyvinkää, Finland), the Global Young Greens Founding Conference (2007 Nairobi, Kenya), the European Social Forum (2008 Malmö, Sweden) and three World Social Forums (2006 Bamako, Mali; 2007 Nairobi Kenya and 2009 Belém, Brazil). The data consists of participant observation, documents and media articles of the meetings, interviews, photos, video, and internet data. This multidisciplinary study combines youth research, development studies, performative social science and political sociology. In this research the diverse field of youth political participation in transnational agoras is studied by using a cross-table of cosmopolitan resources (or the lack of them) and everydaymakers expert citizen dichotomy. First, the young participants of the EU Presidency youth event are studied as an example of expert citizens with cosmopolitan resources (these resources include, for example, language skills, higher education and international social network). Second, the study analyses those everyday-makers who use performative politics to demonstrate their political missions here and now. But in order to make the social movement global they need cosmopolitan resources to be able to use the social media tools and work globally. Third, the study reflects upon the difficulties of reaching those actors who lack cosmopolitan resources, either everyday-makers or expert citizens. The go-along method and the use of the interpreters are shown as ways to reach these young people s political missions. Fourth, the research underlines the importance of contact zones (i.e. spaces or situations where the aforementioned orientations and their differences temporarily disappear or weaken) for deeper democracy and for boosted dialogue between different kinds of participants. Keywords: political participation, young people, multi-sited ethnography, youth research, political sociology, development studies, performative social science