11 resultados para January 1998
em Helda - Digital Repository of University of Helsinki
Resumo:
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.
Resumo:
Background. In Finland, the incidence of type 1 diabetes mellitus (T1DM) is the highest in the world, and it continues to increase steadily. No effective preventative interventions exist either for individuals at high risk or for the population as a whole. In addition to problems with daily lifelong insulin replacement therapy, T1DM patients with long-lasting disease suffer from various diabetes related complications. The complications can lead to severe impairments and reductions in functional capacity and quality of life and in the worst case they can be fatal. Longitudinal studies on the costs of T1DM are extremely rare, especially in Finland. Typically, in these studies, distinctions between the various types of diabetes have not been made, and costs have not been calculated separately for the sexes. Aims. The aim of this study was to describe inpatient hospital care and costs of inpatient care in a cohort of 5,166 T1DM patients by sex during 1973-1998 in Finland. Inpatient care and costs of care due to T1DM without complications, due to T1DM with complications and due to other causes were calculated separately. Material and Methods. The study population consisted of all Finnish T1DM patients diagnosed before the age of 18 years between January 1st in 1965 and December 31st in 1979 and derived from the Finnish population based T1DM register (N=5,120 in 1979 and N=4,701 in 1997). Data on hospitalisations were obtained from the Finnish Hospital Discharge Register. Results. In the early stages of T1DM, the majority of the use of inpatient care was due to the treatment of T1DM without complications. There were enormous increases in the use of inpatient care for certain complications when T1DM lasted longer (from 9.5 years to 16.5 years). For women, the yearly number of bed-days for renal complications increased 4.8-fold, for peripheral vascular disease 4.3-fold and for ophthalmic complications 2.5-fold. For men, the corresponding increases were as follows: 5-fold, 6.9-fold and 2.5-fold. The yearly bed-days for glaucoma increased 8-fold, nephropathy 7-fold and microangiopathy 6-fold in the total population. During these 7 years, the yearly numbers of bed-days for T1DM without complications dropped dramatically. The length of stay in inpatient care decreased notably, but hospital visits became more frequent when the length of duration of T1DM increased from 9.5 years to 16.5 years. The costs of treatments due to complications increased when T1DM lasted longer. Costs due to inpatient care of complications in the cohort 2.5-folded as duration of T1DM increased from 9.5 years to 16.5 years, while the total costs of inpatient care in the cohort dropped by 22% due to an 80% decrease in the costs of care of T1DM without complications. Treating complications of female patients was more expensive than treating complications of men when T1DM had lasted 9.5 years; the mean annual costs for inpatient care of a female diabetic (any cause) were 1,642 , and the yearly costs of care of complications were 237 . The corresponding yearly mean costs for a male patient were 1,198 and 167 . Treating complications of female patients was more expensive than that of male patients also when the duration of diabetes was 16.5 years, although the difference in average annual costs between sexes was somewhat smaller. Conclusions. In the early phases of T1DM, the treatment of T1DM without complications causes a considerable amount of hospital bed-days. The use of inpatient care due to complications of T1DM strongly increases with ageing of patients. The economic burden of inpatient care of T1DM is substantial.
Resumo:
This study is one part of a collaborative depression research project, the Vantaa Depression Study (VDS), involving the Department of Mental and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry of the Peijas Medical Care District (PMCD), Vantaa, Finland. The VDS includes two parts, a record-based study consisting of 803 patients, and a prospective, naturalistic cohort study of 269 patients. Both studies include secondary-level care psychiatric out- and inpatients with a new episode of major depressive disorder (MDD). Data for the record-based part of the study came from a computerised patient database incorporating all outpatient visits as well as treatment periods at the inpatient unit. We included all patients aged 20 to 59 years old who had been assigned a clinical diagnosis of depressive episode or recurrent depressive disorder according to the International Classification of Diseases, 10th edition (ICD-10) criteria and who had at least one outpatient visit or day as an inpatient in the PMCD during the study period January 1, 1996, to December 31, 1996. All those with an earlier diagnosis of schizophrenia, other non-affective psychosis, or bipolar disorder were excluded. Patients treated in the somatic departments of Peijas Hospital and those who had consulted but not received treatment from the psychiatric consultation services were excluded. The study sample comprised 290 male and 513 female patients. All their psychiatric records were reviewed and each patient completed a structured form with 57 items. The treatment provided was reviewed up to the end of the depression episode or to the end of 1997. Most (84%) of the patients received antidepressants, including a minority (11%) on treatment with clearly subtherapeutic low doses. During the treatment period the depressed patients investigated averaged only a few visits to psychiatrists (median two visits), but more to other health professionals (median seven). One-fifth of both genders were inpatients, with a mean of nearly two inpatient treatment periods during the overall treatment period investigated. The median length of a hospital stay was 2 weeks. Use of antidepressants was quite conservative: The first antidepressant had been switched to another compound in only about one-fifth (22%) of patients, and only two patients had received up to five antidepressant trials. Only 7% of those prescribed any antidepressant received two antidepressants simultaneously. None of the patients was prescribed any other augmentation medication. Refusing antidepressant treatment was the most common explanation for receiving no antidepressants. During the treatment period, 19% of those not already receiving a disability pension were granted one due to psychiatric illness. These patients were nearly nine years older than those not pensioned. They were also more severely ill, made significantly more visits to professionals and received significantly more concomitant medications (hypnotics, anxiolytics, and neuroleptics) than did those receiving no pension. In the prospective part of the VDS, 806 adult patients were screened (aged 20-59 years) in the PMCD for a possible new episode of DSM-IV MDD. Of these, 542 patients were interviewed face-to-face with the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Version 2.0. Exclusion criteria were the same as in the record-based part of the VDS. Of these, 542 269 patients fulfiled the criteria of DSM-IV MDE. This study investigated factors associated with patients' functional disability, social adjustment, and work disability (being on sick-leave or being granted a disability pension). In the beginning of the treatment the most important single factor associated with overall social and functional disability was found to be severity of depression, but older age and personality disorders also significantly contributed. Total duration and severity of depression, phobic disorders, alcoholism, and personality disorders all independently contributed to poor social adjustment. Of those who were employed, almost half (43%) were on sick-leave. Besides severity and number of episodes of depression, female gender and age over 50 years strongly and independently predicted being on sick-leave. Factors influencing social and occupational disability and social adjustment among patients with MDD were studied prospectively during an 18-month follow-up period. Patients' functional disability and social adjustment were alleviated during the follow-up concurrently with recovery from depression. The current level of functioning and social adjustment of a patient with depression was predicted by severity of depression, recurrence before baseline and during follow-up, lack of full remission, and time spent depressed. Comorbid psychiatric disorders, personality traits (neuroticism), and perceived social support also had a significant influence. During the 18-month follow-up period, of the 269, 13 (5%) patients switched to bipolar disorder, and 58 (20%) dropped out. Of the 198, 186 (94%) patients were at baseline not pensioned, and they were investigated. Of them, 21 were granted a disability pension during the follow-up. Those who received a pension were significantly older, more seldom had vocational education, and were more often on sick-leave than those not pensioned, but did not differ with regard to any other sociodemographic or clinical factors. Patients with MDD received mostly adequate antidepressant treatment, but problems existed in treatment intensity and monitoring. It is challenging to find those at greatest risk for disability and to provide them adequate and efficacious treatment. This includes great challenges to the whole society to provide sufficient resources.
Resumo:
This paper investigates to what extent the volatility of Finnish stock portfolios is transmitted through the "world volatility". We operationalize the volatility processes of Finnish leverage, industry, and size portfolio returns by asymmetric GARCH specifications according to Glosten et al. (1993). We use daily return data for January, 2, 1987 to December 30, 1998. We find that the world shock significantly enters the domestic models, and that the impact has increased over time. This applies also for the variance ratios, and the correlations to the world. The larger the firm, the larger is the world impact. The conditional variance is higher during recessions. The asymmetry parameter is surprisingly non-significant, and the leverage hypothesis cannot be verified. The return generating process of the domestic portfolio returns does usually not include the world information set, thus indicating that the returns are generated by a segmented conditional asset pricing model.
Resumo:
The operation environment in the roundwood trade in Finland in the 1990’s include several changes. They are changes in the structure of non-industrial private forest (NIPF) ownership, forest taxation, in forest legislation, in price recommendation agreement, diminishing resources of forestry extension services, etc. At the same time, the roundwood demand has been rising. All these developments cause uncertainty in wood procurement organisations, and call for research to find out how to adapt into the changing environment. The objective of this study is to produce information for roundwood purchasing planning and cus-tomer satisfaction management to be used by Stora Enso Metsä Customer Service, Helsinki. For this pur-pose, data needs to be gathered about the urban NIPFs and their forest estates, behaviour related to forestry and timber-selling, customer satisfaction in their latest timber selling transaction, and their opinions about Enso’s new customer service office and its service concept. To fulfil the objective of the study, a NIPF -owner -survey (N=1064, response rate 39,7%) was con-ducted in October 1998-January 1999. The sample was made on the basis of the marketing database of Stora Enso Oyj Forest Customer Service in Helsinki. In planning the frame of reference of the empirical study, the model of service quality by Grönroos was applied. The following aspects were included in the 7-page questionnaire: demographic, sosio-economic and forest estate background, relation to the forest service supply, behaviour related to forestry, timber-selling motives and behaviour, last contact organisation and its image in forestry business, expectations and percep-tions in the latest timber-selling transactions, and behavioural intentions. The results revealed that the share of women, pensioners and academically educated people among forest owners was quite high. The majority of the forest estates of the metropolitan forest owners were situ-ated in the provinces of South Finland and East Finland. The average forest estate area was considerably smaller than in a previous study. Economic and recreational objectives were most important in the use of forests. Forest Associations were involved in half of the roundwood sales transactions of the respondents in the metropolitan area. The wood quantity of transactions was considerably higher than the average in the whole country. Bank-organised forest-related activities, taxation infos and trips to the forest were the most popular activities. Among the services, silvicultural advices were needed mostly and stub treatment least. Brochure material related to stumpage timber sales and taxation were considered most important compared to material related to delivery sales. The service expectations were at highest for women and they were less satisfied with the service than men. 2nd and 3rd generation residents of the metropolitan area thought about the new customer service concept more positively than the 1st generation residents. Internet users under 60 years thought more positively about new satellite picture-based woodlot search concept. Cross-tabulation of factor scores against background variables indicated that women with relatively low education level a greater need to sell roundwood than entrepreneurs, white-collar workers and directors, and Internet users. Suspiciousness towards timber procurement organisations was relatively strong among women and those whose forest income share of the total income was either null or over 20 %. The average customer satisfaction score was negative in all nine questions. Statistical differences be-tween different companies did not exist in the average satisfaction scores. Stora Enso’s Helsinki forest cus-tomer service could choose the ability to purchase all timber grades as its competitive advantage. Out of nine service dimension included in the questionnaire, in this particular service dimension, Enso’s Helsinki forest customer service’s score exceeded most all organisations’ average customer satisfaction score. On the basis of importance – performance matrix, advice and quidance could have been provided more to the forest owners in their latest timber–selling transaction.
Resumo:
Tutkielmassa tarkastellaan yhtä kansainvälisten suhteiden ja diplomatian lähihistorian pulmallisinta haastetta, kysymystä Kosovon asemasta vuosina 1998–2010. Se oli yksi keskeisimmistä 1990-luvun Jugoslavian hajoamissotien solmukohdista ja suhtautuminen siihen jakaa edelleen kansainvälisen yhteisön rivejä maailmanlaajuisesti. Tapaus on erityisen mielenkiintoinen myös nationalismin ja historiapolitiikan kannalta, sillä Kosovo on sekä albaanien että serbien kansallisen identiteetin ydinaluetta. Varhaishistorian myytit ja etnohistorialliset kertomukset ovat olleet tärkeässä asemassa lukuisissa aluetta koetelleissa konflikteissa. Tutkimuksen lähtökohtana on historiapolitiikan lähestymistavan välttämättömyys kansainvälisesti politisoituneen ”Kosovon kysymyksen” ymmärtämisessä. Historiapolitiikan teoreettisen viitekehyksen soveltuvuuden koettelu diplomatian argumentaation ja kansainvälisten suhteiden analysoinnissa on olennainen osa tutkimuksen tehtävänasettelua, sillä varsinkaan Suomessa ei vastaavaa tutkimusta ole ennen tehty. Samalla tutkimuksen tavoitteena on luokitella, analysoida ja vertailla eri valtioiden diplomaattisten historia-argumenttien käyttöä Kosovon kysymyksen yhteydessä sekä tarkastella näiden argumenttien kautta suhtautumista kansallisiin etnohistorian tulkintoihin ja niiden käyttöön 1990-luvun retoriikassa. Tutkielman tärkeimpiä alkuperäislähteitä ovat YK:n turvallisuusneuvoston Kosovoa käsittelevien istuntojen pöytäkirjat vuosilta 1998–2010 sekä huhti- ja heinäkuussa 2009 YK:n kansainväliselle tuomioistuimelle (ICJ) toimitetut, Kosovon itsenäisyysjulistuksen lainmukaisuutta käsittelevät, kirjalliset lausunnot ja kommentit. Tutkimuskirjallisuuden osalta tutkielman tärkeimpiä lähteitä ovat muun muassa Oliver Jens Schmittin, Marc Wellerin ja Pekka Visurin teokset sekä monet albaanien ja serbien kansallisia historiakäsityksiä ilmentävät teokset. Tutkielman metodologisena apuvälineenä on sovellettu suomalaisessa tutkimuksessa aikaisemmin hyvin vähän käytettyä Karl-Georg Faberin mallia historian poliitisen käytön kategorisoimiseksi. Faberin mallia käytetään paitsi historia-argumenttien luokittelun kehikkona, myös ajattelua ohjaavana historianfilosofisena kolmitasoisena mallina. Sitä on täydennytty Chaïm Perelmanin ja Lucie Olbrechts-Tytecan retoriikan tutkimuksen teorialla. Tutkimuksen tärkeimpiä johtopäätöksiä on historiapolitiikan näkökulman ja Faberin mallin hedelmällisyyden toteaminen diplomatian argumentaation analysoinnissa. Samalla tutkimus osoittaa, että historia-argumenteilla oli (ja on edelleen) Kosovon kysymyksessä oma erityinen roolinsa, joka vaihteli ajallisesti ja teemoittain. Toisaalta kansalliset historiakäsitykset, kuten käsitys omasta kansasta uhrina, näkyivät argumenteissa selvästi, toisaalta pyrkimyksenä oli vältellä nationalistiseksi tulkittavia historia-argumentteja. Lisäksi monissa argumenteissa vaaditiin väkivaltaisen historian jättämistä taakse eurooppalaisen tulevaisuuden toivossa.
Resumo:
UNTAES oli YK:n kriisinhallintaoperaatio Kroatiassa vuosina 1996 1998, jonka tarkoitus oli auttaa Kroatian sodan jälkeen Kroatian valtiota ja Itä-Slavonian serbiyhteisöä Erdutin rauhansopimuksen täytäntöönpanossa, ja järjestää väliaikaishallinto Itä-Slavonian, Baranjan ja Länsi-Sirmiumin alueella siihen saakka kunnes alue, osa sodanaikaista serbitasavaltaa, olisi hallinnollisesti liitetty osaksi Kroatian valtiota. Useissa lähteissä on väitetty UNTAES-operaatiota onnistuneeksi kriisinhallintaoperaatioksi. Tämän tutkimuksen tavoite on tarkastella onnistumisväitteelle esitettyjä perusteita vertailemalla toisiinsa YK:n pääsihteerin raporteissa ja Kroatian hallituksen YK:lle osoittamissa kirjeissä esitettyjä näkökulmia operaation etenemisestä. Tutkielman teoreettinen viitekehys sisältää kriisinhallinnan käsitteen määrittelyn, konfliktin jälkeisten kehitysvaiheiden ja väliaikaishallinnon järjestämisen teoreettisen tarkastelun sekä Kroatian sodan historiallisen taustoituksen. Myös etnisten ryhmien ja monikansallisten kriisinhallintatoimijoiden kulttuurista kohtaamista käsitellään lyhyesti. Aineisto koostuu yhteensä kymmenestä YK:n pääsihteerin raportista, joista kunkin pituus on 5-18 sivua, sekä yhdestätoista Kroatian pysyvän YK-suurlähettilään välittämästä tai kirjoittamasta kirjeestä, joista kunkin pituus on liitteineen 2-40 sivua. Aineiston analyysiprossessissa on neljä eri vaihetta: aineiston luokittelu ja taulukointi, narratiivien koostaminen aineistosta, eri toimijoiden poimiminen aineistosta ja sijoittaminen A.J. Greimasin aktanttimallin kaavioon ja aktanttimallin soveltaminen ja tulkitseminen tutkimuskysymyksen näkökulmasta. Tutkimuksen pääasiallinen tulos on, että teknisesti Itä-Slavonian reintegraatiota voidaan perustellusti pitää onnistuneena, mutta UNTAES-operaation mandaattiin kirjatut operatiivisia tavoitteita laajemmat tavoitteet multietnisen yhteisön luomisesta eivät täysin toteutuneet operaation aikana. Aineiston mukaan eri toimijoiden välisessä yhteistyössä ja rauhansopimukseen täytäntöönpanossa on ollut puutteita. Pakolaisia on palannut sodan jälkeen alueelle odotuksia vähemmän, ja etnisten ryhmien väliset suhteet olivat jännitteiset operaation loputtua 1998. YK:n mandaattiin kirjatut tavoitteet multietnisen yhteiskunnan luomisesta olivat idealistisia siihen nähden että alueella asuvat serbit ja kroaatit olivat sotineet toisiaan vastaan vain joitakin kuukausia ennen UNTAES-operaation alkamista.