Monimuotoisuus ja esteettömyys : Näkövammaisten asiantuntijoiden työelämäkokemuksia

The purpose of this study is to analyse education, employment, and work-life experiences of visually impaired persons in expert jobs. The empirical data consists of 30 thematic interviews (24 visually impaired persons, 1 family-member of a visually impaired person, 5 persons working with diversity issues), of supplementary articles, and of statistics on the socio-economic status of the visually impaired. The interviewees experiences of education and employment have been analysed by a qualitative method. The analysis has been deepened by reflecting it against the recent discussion on the concept of diversity. The author s methodological choice as a disability researcher has been to treat the interviewees as co-researchers rather than objects of research. Accessibility in its different forms is a prerequisite of diversity in the workplace, and this study examines what kind of accessibility is required by visually impaired professionals. Access to working life depends on the attitudes prejudices and expectations that society has towards a minority group. Social accessibility is connected with internal relationships in the workplace, and achieving social accessibility is a bilateral process. Information technology has revolutionised the visually impaired people s possibilities of accessing information and performing expert tasks. Accessible environment, good mobility skills, and transportation services enable visually impaired employees to get to their workplaces and to navigate there with ease. Integration has raised the level of education and widened the selection of career options for the visually impaired. However, even visually impaired people with academic degrees often need employment support services. Visually impaired professionals are mainly employed in the public and third sector. Achieving diversity in the labour market is a multiactor process. Social support services are needed, as well as courage and readiness from employers to hire people with disabilities. The organisations of the visually impaired play an important role in affecting the attitudes and providing peer support. Visually impaired employees need good professional skills, blindness skills, and social courage, and they need to be comfortable with their disability. In the workplace, diversity may actualise as diverse ways of working: the work is done by using technical aids or other means of compensating for the lack of eyesight. When an employee must find compensatory solutions for disability-related limitations at work, this will also develop his/her problem-solving abilities. Key words: visually impaired, diversity, accessibility, working life

Pengarna eller livet? : En kvalitativ och longitudinell studie om långtidsarbetslösa unga i ett aktörsperspektiv

Your money or your life? A qualitative follow-up study of the young unemployed from an actor perspective is a qualitative and longitudinal study following 36 unemployed young people in Helsinki over a span of ten years. The purpose of the study is to shed light on how a few young people view employment/unemployment and their lives and future, how they as unemployed perceive their encounters with society, and how society supports them. Four so-called key informants were followed at a finer level of empirical detail. They were chosen for the thematic interviews because of their different personalities, starting points and preferences. Although some differences were expected, what the results show is quite striking. The individual stories raise a number of questions about differences between young people, about society s view of the young unemployed, and about the principles behind the so-called activation policy and how society s support is distributed. The key informants descriptions underline that the group young unemployed does not consist of individuals who are alike but that life is complex, that paid work and unemployment can be perceived very differently, and that background and unofficial support can have consequences for self-perception and for ways of looking at the future, vocational choices, paid work and activation policy. Margaret S. Archer s theory of Morphogenesis and Barbara Cruikshank s theory of constructing democracies compose the study s theoretical framework. The key informants stories give a picture of a formal support system that, even though it puts part of the responsibility for unemployment on the individuals themselves, in the name of fairness and equality, treats them in an impersonal way, not giving their personal situation and wishes much weight. As a consequence, those who share the dominant values of society do well, while others who do not are faced with difficulties. The bigger the gap between society s and the individual s values, the bigger the risk to be met by little understanding and by penalties. And vice versa: Those who initially have the right values and know how to deal with authorities get heard and their opinions get accepted. The informants ask for a more personal encounter, which could improve both the atmosphere and the clients experiences of being heard. Still the risk of having a more individualistic system should be addressed, as a new system might generate new winners, but just as well give new losers. Finally, we have to ask if the so-called activation policy is looking for answers primarily to a macro-level problem on the micro-level. If it does not produce more jobs, its support for the unemployed will be insignificant. It is not enough to think about what to do at the grassroots level to make the system more functional and support job-seeking. If the current rate of unemployment endures, the quality of life of the unemployed should be addressed. A first step could be taken by placing less guilt on the unemployed. Instead of talking about activating the unemployed, discussion should be targeted at removing structural impediments to employment. If we want to have less polarisation between the those with paid work and those without, who often struggle with low incomes, we need to include the macro-level in the discussion. What does high unemployment mean in a work-based society, where the individual s self-perception and important social forms of support are linked to labour income? And what can be done at the macro-level to change this undesirable condition at the micro-level? Keywords: Unemployment, Youth, Public interventions, Activation policy, Individual actors, Qualitative, Longitudinal, Holistic, Helsinki, Finland

Slogans of Change : Three Outlooks on Finnish Television

The study Slogans of Change. Three Outlooks on Finnish Television Contents is concerned with alleged changes of television contents during the 1990s and 2000s, such as dumbing down, tabloidisation, entertainisation , and the like. Specifically, the focus is on the ways these changes might manifest in Finnish television. The aim of the study has been threefold: 1. To operationalise public and academic discussions about changes via specific slogans emerging from the debates; 2. Consequently, to study the slogans empirically and reflect on the findings with earlier research, including studies on institutional and audience-related aspects; 3. Finally, to suggest what the findings might mean regarding discussions about television s role, and what kinds of slogans or concepts might best serve future discussions and research. The empirical outlooks presented in this study offer analyses with three different sets of opposing slogans of change. The outlooks also follow three different traditions of the study of television. The first outlook focuses on quantity, as it gives a longitudinal (1993-2004), macro-level view on programme structures. The methodological approach is derived from media economic and policy studies. The claims that frame the analysis are convergence versus diversification of programme structures. The second outlook provides quantitative and qualitative views on the characteristics and quality  the term signifying essence as well as worth  of Finnish television journalism during sample weeks from the years 2002 and 2003. This outlook follows the traditions of quantitative content analysis found in journalism studies coupled with descriptive qualitative content analyses. The slogans reflected in this section are the lightening or widening of journalism. The third outlook narrows down the material and focuses at a micro-level on form; that is, communicative conventions in a small array of selected programmes in 1993, 2000 and during 2002-2004. The analyses have been inspired by the method of conversation analysis of verbal interaction, and coupled with qualitative close readings, with the focus of different communicative situations in the programmes. The catchphrases employed in this part are emotainment versus democratainment, coupled with more specific claims of discursive hybridisation and conversationalisation. The findings depict that, empirically, changes in Finnish television contents are not clear linear trends and cannot easily be moulded into neat slogans. The quantitative outlook on programme output during 1993-2004 depicts a tendency towards differentiation of channels, paving the way for the multi-channel digital system. The change in programme structures, however, is not dramatic on the level of total output. The second outlook suggests that the dualistic concepts, such as the pair information-entertainment, are not sufficient in understanding the array and changes of programmes that could be called journalism. The outlook on communicative conventions highlights hybridisation in the manner of television talk and its relation to broader debates on contents. Despite the three dissimilar empirical approaches, unifying aspects emerge. The outlooks suggest, albeit in different ways, tendencies toward distinction and polarisation. This study proposes that in order to facilitate a more nuanced understanding of the changes in television contents, dualistic slogans should be replaced with a multi-dimensional understanding of the concept of diversity.

Lähellä, mutta niin kaukana : Tutkimus naisten muuttoliikkeestä Suomen ja uudelleen itsenäistyneen Viron välillä

Immigration is one of the most topical international issues of our time. Worldwide, the number of immigrants has doubled over the last twenty years, and migration patterns have become so diversified that they now constitute a kind of “chaos”. The number and significance of women as migrants has also increased, which is earning women growing attention among scholars. This study looks at the migration of women, in particular mothers of small children, in both directions between Finland and Estonia, following the latter’s re- independence. The data consists of in-depth interviews conducted in 2005 with 24 Finnish and 24 Estonian immigrant women. The focus was on the women’s expectations and experiences of their new country of residence, acculturation – i.e. adjusting to a new environment, social networks in the country of origin and the new country, and models of motherhood following immigration. The primary research question was formulated as follows: Which factors have influenced the formation of female immigrants’ social ties, thus contributing to the formation of motherhood strategies and afecting internal family dynamics in the new country? The research consists of four previously published independent articles as well as a summary chapter. The study’s findings indicate that Finnish and Estonian women migrated for diferent reasons and at diferent times, and that their migration patterns also difered. Estonian migration occurred mainly in the 1990s, and most immigrants intended to return later to their country of origin. Regardless of the reason for migrating that they gave to immigration officials, other key reasons often included the desire for a more stable living environment and better income. Only four of the Estonian women had immigrated together with an Estonian husband, while two- thirds came because of marriage to a Finnish man. Most of the Finnish women, on the other hand, migrated after 2000 and either came with their family as a result of a spouse’s job transfer, or came by themselves to further their studies. In most cases, the migration was a temporary solution intended to promote one’s own or one’s spouse’s career advancement. Because the reasons for migrating were diferent between Finnish and Estonian women, their expectations of the new country and their status in it were also diferent. In terms of both social and economic standing, the position of Finnish immigrants was categorically better. The reason for migrating had an impact on one’s orientation toward the receiving society. Estonian women and Finns who migrated for marriage or edu cational reasons became immediately active in forming institutional and social ties in the new society. Conversely, the women had migrated because of work had little contact with Estonian society, and their social networks consisted of other Finnish immigrants. Furthermore, they maintained strong institutional and social ties to Finland and therefore felt no need to anchor themselves to Estonian society. The Finnish and Estonian women who were better integrated into the receiving country also maintained strong social ties to their country of origin. Women who became integrated into the receiving country as a result of giving birth to children utilized various services directed at families with children. In part, such services conveyed to the women the conceptions that were prevalent in the surrounding society concerning the treatment of children and the expectations on mothers, both of which difer to some extent in Finland and Estonia. had an impact on strategies of motherhood, internal family dynamics, and gender Regardless of the reason for migrating, or the country of origin, immigration equality. Most Estonian women had to do without the child-care help provided by relatives; before immigrating, some women had even had daily child-care assistance from family members. However, Estonian women who were married to Finns did receive help from the spouse and sometimes also the spouse’s relatives. Conversely, Finnish women who had immigrated because of a spouse’s job transfer were faced with the opposite situation, in which they bore the main responsibility for domestic work and child care. They were, however, in a position to pay for domestic help. Hence, the women who had integrated into a new society had to construct their own perceptions of motherhood by reconciling the motherhood models of both the cause of a spouse’s job transfer found that being a stay-at-home mother challenged previously self-evident behaviors. Receiving country and the country of origin, whereas women who had migrated because of a spouse’s job transfer found that being a stay-at-home mother challenged previously self-evident behaviors.

Human Rights in Action

In the post-World War II era human rights have emerged as an enormous global phenomenon. In Finland human rights have particularly in the 1990s moved from the periphery to the center of public policy making and political rhetoric. Human rights education is commonly viewed as the decisive vehicle for emancipating individuals of oppressive societal structures and rendering them conscious of the equal value of others; both core ideals of the abstract discourse. Yet little empirical research has been conducted on how these goals are realized in practice. These factors provide the background for the present study which, by combining anthropological insights with critical legal theory, has analyzed the educational activities of a Scandinavian and Nordic network of human rights experts and PhD students in 2002-2005. This material has been complemented by data from the proceedings of UN human rights treaty bodies, hearings organized by the Finnish Foreign Ministry, the analysis of different human rights documents as well as the manner human rights are talked of in the Finnish media. As the human rights phenomenon has expanded, human rights experts have acquired widespread societal influence. The content of human rights remains, nevertheless, ambiguous: on the one hand they are law, on the other, part of a moral discourse. By educating laymen on what human rights are, experts act both as intermediaries and activists who expand the scope of rights and simultaneously exert increasing political influence. In the educational activities of the analyzed network these roles were visible in the rhetorics of legality and legitimacy . Among experts both of these rhetorics are subject to ongoing professional controversy, yet in the network they are presented as undisputable facts. This contributes to the impression that human rights knowledge is uncontested. This study demonstrates how the network s activities embody and strengthen a conception of expertise as located in specific, structurally determined individuals. Simultaneously its conception of learning emphasizes the adoption of knowledge by students, emphasizing the power of experts over them. The majority of the network s experts are Nordic males, whereas its students are predominantly Nordic females and males from East-European and developing countries. Contrary to the ideals of the discourse the network s activities do not create dialogue, but instead repeat power structures which are themselves problematic.

Agoralla : avauksia ympäristöasiantuntijoiden vuorovaikutusprosesseista

Ympäristöasiantuntijoiden vuorovaikutusta on tutkittu agoralla (antiikin tori). Se on julkinen tila, jossa markkinat, politiikka, tiede ja yhteiskunta kohtaavat. Tutkimus kuuluu yhteiskuntatieteellisen ympäristötutkimuksen alaan, mutta siinä hyödynnetään myös tulevaisuudentutkimusta. Työn motivaationa on ollut tekijän monitieteinen koulutustausta: yhteiskuntatieteilijä ja luonnontieteilijä. Miten ja miksi vuorovaikutus eri asiantuntijoiden välillä on haasteellista ja merkityksellistä esimerkiksi metsän biodiversiteetin vähenemisen ehkäisemiseksi. Keskeisiä käsitteitä ovat asiantuntijuus, vuorovaikutus, tiedon luotettavuusja kontekstisidonnaisuus, Väitöskirja koostuu neljästä eri asiantuntijuustarinasta. Ensimmäinen (luku 2) perustuu haastatteluihin suomalaisten ja saksalaisten bio- ja yhteiskuntatietelijöiden käsityksistä luonnosta ja ympäristöstä. Tutkimusongelmana on luonnontieteilijöiden ja yhteiskuntatieteilijöiden Suomessa ja Saksassa ”kulttuurierot” luonnon ja ympäristön käsitteellistämisessä. Johtopäätöksenä on, että aistittu luonto, ympäröivä ympäristö sekä ihmisen muokkaama elinympäristö eivät tunne selkeitä tiede- eikä maanrajoja. Tämä luku toimii ponnahduslautana konstruktioiden taakse vuorovaikutuksen haasteisiin. Kirjan toinen tarina (luku 3) perustuu haastatteluihin suomalaisten metsän biodiversiteettiasiantuntijoiden vuorovaikutuksesta. Tutkimusongelman lähtökohtana on metsän biodiversiteetin väheneminen ja tästä seuraavat polittisetkin vuorovaikutustilanteet. Miten konteksti vaikuttaa eri asiantuntijoiden vuorovaikutukseen ja mitä tästä seuraa? Analyysin päätulos on implisiittisen, vahvasti kontekstisidonnaisen asiantuntijatiedon hyödyntämisen tarve ja voimavara metsän biodiversiteetin vähenemisen ennaltaehkäisemiksi. Kolmas tarina asiantuntijuudesta (luku 4) perustuu Etelä-Suomen metsien suojelutoimikunnassa (Metso) tehtyihin havainnointeihin. Tutkija on näin ollut itse eräänlaisella torilla havainnoijana. Tutkimusongelmana on ”ohipuhuminen”, tiedon luotettavuus ja implisiittien tiedon hyväksyttävyys. Johtopäätöksenä on asiantuntijuuden vahva kontekstisidonnaisuus hetkeen ja paikkaan ja yhteisen kielen (vrt. transdisiplinaarisuus) löytyminen yhteisen tavoitteen saavuttamiseksi. Merkittäviä välineitä vuorovaikutuksen onnistumiseen ovat esimerkiksi yhteinen vahva tavoitetila, interkatio, joka koskee läsnä olevia ihmisiä ei instituutioita sekä fasilitaattorin vahva rooli tulkkina ja välittäjänä. Neljäs tarina (luku 5) vie agoran konkretiaan. Tässä luvussa on kehitetty eläytymiskävely- menetelmää, jossa fasilitaattori (tutkija) johdattaa Espoon keskuksessa hallinnon, politiikan, asukkaiden ja konsultin edustajat aistimaan ja tulkitsemaan alueen sosiaalista tilaa, toiminnallisuutta ja elämyksellisyyttä. Ongelmana on aistimaailman asiantuntemuksen hyödyntämättömyys yhdyskuntasuunnittelun välineenä mm. asiantuntijoiden vuorovaikutuksen välineenä. Menetelmäkehitys on aluillaan, mutta jo tässä tapauksessa käy ilmi, että jaettu tila, jaetut aistikokemukset konkreettisella kävelyllä avaavaat vuorovaikutuksen uusiin ulottuvuuksiin, jossa implisiittiselle asiantuntemukselle annetaan sijansa vuorovaikutuksessa ja tätä kautta voidaan vaikuttaa myös tehtäviin päätöksiin, toimenpiteisiin. Johtopäätöksissä (luku 6) korostuu implisiittisen asiantuntijuuden merkitys. Onnistunut vuorovaikutteinen toiminta eri asiantuntijoiden kesken esimerkiksi erilaisia ympäristöongelmia –ja ilmiöitä ratkottaessa ja pohdittaessa vaatii vuorovaikutusosaamista. Tutkimuksen lopuksi suositellaan esimerkiksi ennakkoluulottomia avauksia agoralla. Asiantuntijuus ei ole yksi ja vain asiaatuntevuus on mahdollista. Agora on jatkuvassa liikkeessä ja juuri siinä piilee voimavara tulevaisuuden haasteisiin erilaisilla rajapinnoilla. Avainsanat: asiantuntijuus, vuorovaikutus, tieto, konteksti, agora

Ikääntyminen maalaiskylässä

Aging in a country village This dissertation examines what kind of environment of aging a small country village is, who elderly villagers are and what kind of everyday life they have. The qualitative material gathered through ethnographic field work at a village situated in Southern Finland consists of a field work diary and 34 interviews of elderly villagers. The dissertation is based on social gerontology and village research. The key concepts are: the environment of aging; locality and local identity; and way of life. The village is examined as a social and physical environment of aging. Difficulties regarding mobility are the biggest challenges for elderly villagers in their everyday life. The social environment of aging is constructed by historical, cultural and local factors. The village community is formed by many small sub-communities. An elderly villager s status in a village community and her/his social competence affect the formation of her/his social network and the quality of her/his environment of aging. The dissertation examines the local identities of older villagers and their relationships to the village. The local identities can be based on the village, memories or on many places, or a place and places may not be of great importance for a person s identity. The local identity of an older villager affects her/his experiences of living in the village and her/his future plans to move away from the village. The everyday life of an older villager is constructed by rhythms, routines and repetitions. However, there are differences between how everyday lives are arranged among elderly villagers, which are explained by the concept of a way of life. Four ways of life were found. Nature and its importance are a background to all four ways of life. A traditional way of life is based on continuity and hard work, a family-oriented way of life on family members and relatives. A mobile way of life is characterized by symbolic and concrete mobility. An original way of life is marked by independent loneliness . In practice, a person s way of life is always constructed by two or many ways of life.

Kahdestaan kotona : Tutkimus vanhoista pariskunnista

In this study, which pertains to the field of social gerontology and family research, I analyse the meaning of everyday life as perceived by elderly couples living at home. I use the ethnographic approach, with the aim of interpreting meanings from the elderly people s personal point of view and to increase understanding of their way of life. The study deepens our conception of what gives purpose to the everyday life of elderly people. The number of elderly couples is growing and, to an increasing extent, a couple will live and cope together to a ripe old age. Such coping can also be viewed as an important resource for society. Ethnography tries to get close to people's life practices. I examine the day-to-day life of elderly couples based on textual data, which I obtained by visiting the homes of 16 couples in a total of five small municipalities in Southern Finland. The couples had married soon after the war or in the early 1950s. I found that the aspiration towards continuity, which unites the concepts of place and home, housework and a long marriage, is the most important notion connecting the discussion themes. The results show that in the opinion of the elderly, the concept of a good life is intertwined with a long marriage spent at home, as well as its values. Old people find that they lead an independent life if they feel that they can hold on to the key features of their way of life. Elderly couples ability to cope with everyday life involves taking care of housework and other tasks around the home together. This means that they support one another and have common goals and aspirations. Daily tasks provide substance in the lives of elderly couples. Each day has its rhythm, and the pace of this rhythm is set by routine and habits. Satisfaction stems from the fact that you can do something you are good at. The couples have also revised the division of housework. Men have learned to perform new tasks around the house when their wives can no longer manage them by themselves. Some tasks are given up. Day-to-day life at home and around the house provides room for men s participation. Mutual support and care between husband and wife can also protect them from having to resort to outside or official help. Old couples integrate their life experiences and memories, as well as present and future risks and opportunities. They wish to carry on their lives as before, and still think that their present life corresponds with their idea of a good life. Key words: elderly couples, continuity theory of aging, everyday life, social gerontology, family research

Siperiaa sanoiksi - uralilaisuutta teoiksi : Kai Donner poliittisena organisaattorina sekä tiedemiehenä antropologian näkökulmasta

The doctoral dissertation, entitled Siperiaa sanoiksi - uralilaisuutta teoiksi. Kai Donner poliittisena organisaattorina sekä tiedemiehenä antropologian näkökulmasta clarifies the early history of anthropological fieldwork and research in Siberia. The object of research is Kai Donner (1888-1935), fieldworker, explorer and researcher of Finno-Ugric languages, who made two expeditions to Siberia during 1911-1913 and 1914. Donner studied in Cambridge in 1909 under the guidance of James Frazer, A. C. Haddon and W. H. R. Rivers - and with Bronislaw Malinowski. After finishing his expeditions, Donner organized the enlistment of Finnish university students to receive military training in Germany. He was exiled and participated in the struggle for Finnish independence. After that, he organized military offensives in Russia and participated in domestic politics and policy in cooperation with C. G. E. Mannerheim. He also wrote four ethnographic descriptions on Siberia and worked with the Scandinavian Arctic areas researchers and Polar explorers. The results of this analysis can be sum up as follows: In the history of ethnographic research in Finland, it is possible to find two types of fieldwork tradition. The first tradition started from M. A. Castrén's explorations and research and the second one from August Ahlqvist's. Donner can be included in the first group with Castrén and Sakari Pälsi, unlike other contemporary philologists, or cultural researcher colleagues, which used the method of August Ahlqvist. Donner's holistic, lively and participant-observation based way of work is articulated in his writings two years before Malinowski published his thesis about modern fieldwork. Unfortunately, Donner didn't get the change to continue his researche because of the civil war in Finland, and due to the dogmatic position of E. N. Setälä. Donner's main work - the ethnohistorical Siberia - encloses his political and anthropological visions about a common and threatened Uralic nation under the pressure of Russian. The important items of his expeditions can be found in the area of cultural ecology, nutritional anthropology and fieldwork methods. It is also possible to prove that in his short stories from Siberia, there can be found some psychological factors that correlate his early life history.

The Finnish Competition State and Entrepreneurial Policies in the Helsinki Region

The thesis examines the intensification and characteristics of a policy that emphasises economic competitiveness in Finland during the 1990s and early 2000s. This accentuation of economic objectives is studied at the level of national policy-making as well as at the regional level through the policies and strategies of cities and three universities in the Helsinki region. By combining the analysis of state policies, urban strategies and university activities, the study illustrates the pervasiveness of the objective of economic competitiveness and growth across these levels and sheds light on the features and contradictions of these policies on a broad scale. The thesis is composed of five research articles and a summary article. At the level of national policies, the central focus of the thesis is on the growing role of science and technology policy as a state means to promote structural economic change and its transformation towards a broader, yet ambivalent concept of innovation policy. This shift brings forward a tension between an increasing emphasis on economic aspects – innovations and competitiveness – as well as the expanding scope of issues across a wide range of policy sectors that are being subsumed under this market- and economy oriented framework. Related to science and technology policy, attention is paid to adjustments in university policy in which there has been increasing pressure for efficiency, rationalisation and commercialisation of academic activities. Furthermore, political efforts to build an information society through the application of information and communication technologies are analysed with particular attention to the balance between economic and social objectives. Finally, changes in state regional policy priorities and the tendency towards competitiveness are addressed. At the regional level, the focus of the thesis is on the policies of the cities in Finland’s capital region as well as strategies of three universities operating in the region, namely the University of Helsinki, Helsinki University of technology and Helsinki School of Economics. As regards the urban level, the main focus is on the changes and characteristics of the urban economic development policy of the City of Helsinki. With respect to the universities, the thesis examines their attempts to commercialise research and thus bring academic research closer to economic interests, and pays particular attention to the contradictions of commercialisation. Related to the universities, the activities of three intermediary organisations that the universities have established in order to increase cooperation with industry are analysed. These organisations are the Helsinki Science Park, Otaniemi International Innovation Centre and LTT Research Ltd. The summary article provides a synthesis of the material presented in the five original articles and relates the results of the articles to a broader discussion concerning the emergence of competition states and entrepreneurial cities and regions. The main points of reference are Bob Jessop’s and Neil Brenner’s theses on state and urban-regional restructuring. The empirical results and considerations from Finland and the Helsinki region are used to comment on, specify and criticise specific parts of the two theses.

Kynnyskysymyksiä : Huono-osaisimmat huumeiden käyttäjät ja matala kynnys

The study examines the term "low threshold" from the point of view of the most marginalized drug users. While using illicit drugs is criminalised and morally judged in Finland, users have special barriers to seek for care. Low threshold services aim at reaching drug users who themselves don t seek for help. "Low threshold" is a metaphor describing easy access to services. The theoretical frame of reference of the study consists of processing the term analytically and critically. The research work sets out to test the rhetoric of low threshold by making use of a qualitative multi-case study to find out, if the threshold of so called low threshold services always appears low for the most marginalized drug users. The cases are: the mobile unite offering health counselling, the day service centre for marginalized substance abusers and the low threshold project of the outpatient clinic for drug users in Helsinki and the health counselling service trial in Vyborg, Russia. The case study answer following questions: 1) How do the method of low threshold work out in the studied cases from the point of view of the most marginalized drug users? 2) How do potential thresholds appear and how did they develop? 3) How do the most marginalized drug users get into the care system through low threshold? The data consists of interviews of drug users, workers and other specialists having been accomplished in the years 2001 - 2006, patient documents and customer registers. The dissertation includes four articles published in the years 2006 - 2008 and the summary article. The study manifests that even low threshold is not always low enough for the most marginalized drug users. That expresses a highly multiproblematised and underpriviledged group of drug users, whose life and utilization of services are framed by deep marginalisation, homelessness, multi-substance use, mental and somatic illnesses and being repeatedly imprisoned. Using services is rendered difficult by many factors arising from the care system, drug users themselves and the action environment. In Finland thresholds are generally due to the execution of practical services and procedures not considering the fear of control and labelling as a drug user. When striving for further rehabilitating substance abuse care by means of low threshold services the marginalized drug users meet the biggest difficulties. They are due to inelastic structures, procedures and division of labour in the established care system and also to poor chances of drug users to be in action in the way expected by the care system. Multiproblematic multisubstance users become "wrong" customers by high expectations of care motivation and specializing in the care system. In Russia the thresholds are primarily caused by rigid control politics directed to drug users by the society and by the scantiness of care system. The ideology of reducing drug related harm is not approved and the care system is unwilling to commit to it. Low threshold turnes out to be relative as a term. The rhetoric of the care system is not enough to unilaterally define lowness of the threshold. The experiences of drug users and the actual activity to search for care determine the threshold. It does not appear the same for everybody either. Access of certain customer group to a service unit may even raise the threshold for some other group. The low threshold system also is surprisingly realized: you could not always tell in advance, what kind of customers and how many of them could be reached. Keywords: low threshold, marginalized drug users, harm reduction, barriers to services, outreach

Determinants of institutional care at older ages in Finland

Väitöskirjassa selvitettiin ikäihmisten laitoshoitoon siirtymisen todennäköisyyttä ja sen taustoja kansainvälisesti ainutlaatuisen rekisteriaineiston avulla. Selvitettäviä asioita olivat eri sairauksien, sosioekonomisten tekijöiden, puolison olemassaolon ja leskeksi jäämisen yhteys laitoshoitoon siirtymiseen yli 65-vuotiailla suomalaisilla. Tutkimuksessa havaittiin, että dementia, Parkinsonin tauti, aivohalvaus, masennusoireet ja muut mielenterveysongelmat, lonkkamurtuma sekä diabetes lisäsivät ikäihmisten todennäköisyyttä siirtyä laitoshoitoon yli 50 prosentilla, kun muut sairaudet ja sosiodemografiset tekijät oli otettu huomioon. Korkeat tulot vähensivät laitoshoidon todennäköisyyttä, kun taas puutteellinen asuminen (ilman peseytymistiloja tai keskus- tai sähkölämmitystä) sekä erittäin puutteellinen asuminen (ilman lämmintä vettä, vesijohtoa, viemäriä tai vesivessaa) lisäsivät todennäkösyyttä, kun muut sosiodemografiset tekijät, sairaudet ja asuinalue oli huomioitu. Kerrostalon hissittömyys ei ollut yhteydessä laitoshoidon todennäköisyyteen. Todennäköisyys siirtyä laitoshoitoon oli jostain syystä korkeampaa niillä ikäihmisillä, jotka asuivat vuokralla ja matalampaa omakotitalossa asuvilla ja niillä, joilla oli auto. Puolison olemassaolo vähensi ja leskeksi jääminen lisäsi laitoshoidon todennäköisyyttä huomattavasti. Todennäköisyys oli erityisen suuri, yli kolminkertainen, kun puolison kuolemasta oli kulunut enintään kuukausi verrattuna niihin, joiden puoliso oli elossa. Todennäköisyys laski, kun puolison kuolemasta kului aikaa. Miesten ja naisten tulokset olivat samansuuntaisia. Korkeat tulot tai koulutus eivät suojanneet riskiltä joutua laitoshoitoon puolison kuoltua. Puolison kuolema näyttää lisäävän hoidon tarvetta, kun kotona ei ole enää puolisoa tukemassa ja huolehtimassa kodin askareista. Laitoshoidon tarve vähenee, jos ja kun lesket ajan kuluessa oppivat elämään yksin. Toisaalta tutkimustulokset saattavat viitata myös siihen, että kaikkein huonokuntoisimmat lesket, jotka eivät pärjää yksin asuessaan, siirtyvät laitoshoitoon hyvin nopeasti puolison kuoltua. Tutkimuksessa oli mukana yhteensä yli 280 000 yli 65-vuotiasta henkilöä, joiden pitkäaikaiseen laitoshoitoon siirtymistä seurattiin tammikuusta 1998 syyskuuhun 2003. Laitoshoidoksi määriteltiin terveyskeskuksissa, sairaaloissa ja vanhainkodeissa tai vastaavissa yksiköissä tapahtuva pitkäaikainen hoito, joka kesti yli 90 vuorokautta tai oli vahvistettu pitkäaikaishoidon päätöksellä. Tutkimuksessa käytetty aineisto koottiin väestörekistereistä, sosiaali- ja terveydenhuollon rekistereistä ja lääkerekistereistä.