16 resultados para Veterans, Disabled

em Helda - Digital Repository of University of Helsinki


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This thesis addresses the following broad research question: what did it mean to be a disabled Revolutionary War veteran in the early United States during the period from 1776 to roughly 1840? The study approaches the question from two angles: a state-centred one and an experiential one. In both cases, the theoretical framework employed comes from disability studies. Consequently, disability is regarded as a sociocultural phenomenon rather than a medical condition. The state-centred dimension of the study explores the meaning of disability and disabled veterans to the early American state through an examination of the major military pension laws of the period. An analysis of this legislation, particularly the invalid pension acts of 1793 and 1806, indicates that the early United States represents a key period in the development of the modern disability category. The experiential approach, in contrast, shifts the focus of attention away from the state towards the lived experiences of disabled veterans. It seeks to address the issue of whether or not the disabilities of disabled veterans had any significant material impact on their everyday lives. It does this through a comparison of the situation of 153 disabled veterans with that of an equivalent number of nondisabled veterans. The former group received invalid pensions while the latter did not. In comparing the material conditions of disabled and nondisabled veterans, a wide range of primary sources from military records to memoirs and letters are used. The most important sources in this regard are the pension application papers submitted by veterans in the early nineteenth century. These provide us with a unique insight into the everyday lives of veterans. Looking at the issue of experience through the window of the pension files reveals that there was not much difference in the broad contours of disabled and nondisabled veteran life. This finding has implications for the theorisation of disability that are highlighted and discussed in the thesis. The main themes covered in this study are: the wartime experiences of injured American soldiers, the military pension establishment of the early United States and the legal construction of disability, and the post-war working and family lives of disabled veterans. Keywords: disability, early America, veterans, military pensions, disabled people, Revolutionary War, United States, disability theory.

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In the future the number of the disabled drivers requiring a special evaluation of their driving ability will increase due to the ageing population, as well as the progress of adaptive technology. This places pressure on the development of the driving evaluation system. Despite quite intensive research there is still no consensus concerning what is the factual situation in a driver evaluation (methodology), which measures should be included in an evaluation (methods), and how an evaluation has to be carried out (practise). In order to find answers to these questions we carried out empirical studies, and simultaneously elaborated upon a conceptual model for driving and a driving evaluation. The findings of empirical studies can be condensed into the following points: 1) A driving ability defined by the on-road driving test is associated with different laboratory measures depending on the study groups. Faults in the laboratory tests predicted faults in the on-road driving test in the novice group, whereas slowness in the laboratory predicted driving faults in the experienced drivers group. 2) The Parkinson study clearly showed that even an experienced clinician cannot reliably accomplish an evaluation of a disabled person’s driving ability without collaboration with other specialists. 3) The main finding of the stroke study was that the use of a multidisciplinary team as a source of information harmonises the specialists’ evaluations. 4) The patient studies demonstrated that the disabled persons themselves, as well as their spouses, are as a rule not reliable evaluators. 5) From the safety point of view, perceptible operations with the control devices are not crucial, but correct mental actions which the driver carries out with the help of the control devices are of greatest importance. 6) Personality factors including higher-order needs and motives, attitudes and a degree of self-awareness, particularly a sense of illness, are decisive when evaluating a disabled person’s driving ability. Personality is also the main source of resources concerning compensations for lower-order physical deficiencies and restrictions. From work with the conceptual model we drew the following methodological conclusions: First, the driver has to be considered as a holistic subject of the activity, as a multilevel hierarchically organised system of an organism, a temperament, an individuality, and a personality where the personality is the leading subsystem from the standpoint of safety. Second, driving as a human form of a sociopractical activity, is also a hierarchically organised dynamic system. Third, in an evaluation of driving ability it is a question of matching these two hierarchically organised structures: a subject of an activity and a proper activity. Fourth, an evaluation has to be person centred but not disease-, function- or method centred. On the basis of our study a multidisciplinary team (practitioner, driving school teacher, psychologist, occupational therapist) is recommended for use in demanding driver evaluations. Primary in a driver’s evaluations is a coherent conceptual model while concrete methods of evaluations may vary. However, the on-road test must always be performed if possible.

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Neurotrophic factors play essential role in the development and functioning of the nervous system and other organs. Glial cell line-Derived Neurotrophic Factor (GDNF) family ligands (GFLs) are of particular interest because they promote the survival of dopaminergic neurons in vitro, in Parkinson s disease animal models and in patients. GDNF is also a potent survival factor for the central motoneurons and thus is considered as a potential lead for the treatment of amyotrophic lateral sclerosis. The survival promoting receptor complex for GFLs consists of a ligand-specific co-receptor, GFRα and a signal transducing module, receptor tyrosine kinase RET. At least GDNF and persephin, a GFL, have established functions outside central nervous system. GDNF is crucial for enteric nervous system and kidney development as well as for spermatogenesis. Persephin controls calcitonin secretion. Communication between cells often occurs in the extracellular matrix (ECM), a meshwork, which is secreted and deposited by the cells and is mainly composed of fibrillar proteins and polymerized sugars. We evaluated the relationship between GFLs and extracellular matrix components and demonstrated that three GFLs - GDNF, neurturin and artemin bind heparan sulfates with nanomolar affinities. The fourth member of the family - persephin binds these polysaccharides thousand times less tightly. GDNF, neurturin and artemin also bind with high affinity to heparan sulfate proteoglycan (HSPG) isolated from the nervous system, syndecan-3. GDNF signals through HSPGs, evoking Src family kinase activation. This signaling induces cell spreading, hippocampal neurite outgrowth in vitro and cellular migration. Specifically, GDNF signaling through syndecan-3 is important for embryonic cortical neuron migration. Syndecan-3-deficient mice, similarly to mice lacking GDNF, have less GABAergic neurons in their cortex, as compared to the wild-type mice. This fact provides indirect evidence that GDNF interaction with syndecan-3 is important for cortical brain development. Noteworthy, in non-neuronal tissues GFLs may signal via other syndecans. We also present the structural model for a GDNF co-receptor, GFRα1. The X-ray structure of the GFRα1 domain 3 was solved with 1.8 Å resolution, revealing a new protein fold. Later we also solved the structure of the truncated GFRα1 in the complex with GDNF and this model was confirmed by site-directed mutagenesis. In summary, our work contributed to the structural characterization of GFRα-based receptor complex and revealed a new receptor for GDNF, neurturin and artemin the HSPG syndecan-3. This information is critically important for the development of GFRα/RET agonists for the treatment of neurodegenerative diseases.

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The parenthood experience of a mother with a disabled child and the meaning of the social environment and parent-professional partnerships The importance of parental guidance when a family has a child with a disability or autism has been pointed out by several studies. The present research was based on the premise that by supporting the mother we can help the whole family to cope better and the professionals in day care or at school are able to support parents. The starting point was the subjective experience, which is also the central focus of the phenomenological method. The purpose of this study was firstly to describe the experience of the mother and the dialogue between mother and educational professionals. Secondly it was the task of this research to discover what kind of support and information the mother obtains from her social environment. At the background of this study there was the ecological theory of Bronfenbrenner, the ecocultural approach by Gallimore and the interactive examination of family that take into consideration the whole environment and personal situation. The research data was collected by interviewing the mothers, the day care personnel and the teachers at school. In this research there were a total of 32 interviews and 24 informants: 10 mothers who have a child with a disability and/or autism, 8 professionals in day care and 6 teachers at school. This study was longitudinal because the same mothers were interviewed twice, first in 1998 and then after five years in 2003. It was thus possible to get information on whether their life situation had changed and the nature of those changes. The data of this study was analysed by the method of phenomenological psychology that was applied for this study. The findings indicated that all mothers had experienced many complicated emotional feelings such as: anger, mourning, fear and sadness as well as love and bonding. It can be said that several human feelings existed at the same time. Mothers experienced that the support of the social environment, for example, relatives, families in the same situation and persons taking care of the child had significant meaning for their coping. However the life situation among the mothers varied. Mostly mothers received valuable support for their parenthood and they have adopted a strong emotion for manage ring. Mothers with an autistic child were more stressed than mothers with a mentally retarded child. A few mothers had numerous problems with taking care of their child and they did not get enough help. Same mothers were very exhausted too and the situation was quite the same after five years, when their child was teenager. All mothers said that after starting school the support for the family had significally diminished. Mothers said that dialogue with teacher got on without problems, but there were meetings seldom, so it wasn´t possible to get enough support for their parenthood. Keywords: parenthood, motherhood, disability, early special education, family-centred.

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The aim of the present research was to examine the validity of the RAND-36 measure of health-related quality of life among the working age rehabilitation clients. The research included two cross-sectional studies and one follow-up study. The subjects of the first study (n = 794) participated in the first period of the five following types of rehabilitation: occupationally oriented medical rehabilitation, musculoskeletal rehabilitation, medical rehabilitation for job burnout, rehabilitation for supporting the work ability and capacity of disabled subjects (vocational rehabilitation) and individualized rehabilitation between October 2000 and October 2001. The subjects of the second study (n = 990) participated in the same rehabilitation during their first rehabilitation period between May 2007 and May 2008. The first subjects participated in a follow-up period no later than May 2003 with the exception of the individual rehabilitation clients (n = 588). Based on the ICF classification, the RAND-36 provides a diverse measure of the health-related quality of life and of the capacity for subjective, perceived physical and psycho-social functioning. The construct properties of the RAND-36 measure proved to be very consistent on the basis of both the cluster and confirmatory factor analyses. At the group level, the RAND-36 measure was shown to be illustrative and sensitive in differentiating the clients’ rehabilitation needs. The results of cluster analyses with the two cross-sectional data indicated a consistent five-cluster solution of rehabilitation groups on the basis of the eight subscales of health-related quality of life. Each of these clusters represented a clear difference in their need for rehabilitation. The RAND-36 measure proved to be sensitive to change. The changes observed in the pre- and post-conditions in relation to all the subscales of quality of life were statistically significant. Depending on the rehabilitation type, different changes in the subscales of the measure were observed, and these changes corresponded to the different emphasis and goals of the specific type of rehabilitation intervention. Similarly, changes in the subscales of the measure were observed in relation to the RAND groups formed by cluster analysis, which were logical and corresponded to the problem profiles of these groups. The confirmatory factor analysis indicated a two-factor solution: an index of the capacity for physical functioning (self-rated general health, bodily pain, physical functioning, physical role functioning) and an index of the capacity for psycho-social functioning (psychological well-being, social functioning, psychological role functioning and energy). These two indices describing functional capacity proved also to be sensitive to change. This two-factor solution seems to be usable for group level analyses when assessing the effects of rehabilitation. The moderately strong correlation between the RAND-36 and work ability index suggests that they partly measure the same phenomenon: perceived health-related quality of life, subjective capacity for activity and perceived work ability have strong links. As expected, the capacity for physical functioning had a stronger correlation with work ability index than with the capacity for psycho-social functioning. According to the present research, the RAND-36 measure can be considered as a screening method for rehabilitation orientation in relation to rehabilitation needs and as a follow-up measure for the health-related quality of life among the working age clients. The RAND-36 measure is also shown to be a useful instrument in estimating the benefits of rehabilitation as well as in effectiveness research.

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This study analyzes the war-time rations the Finnish soldiers received on the front from 1939 until 1945. The main objective was to determine the contents of the rations and how they affected the soldiers' nutrition and morale. The information concerning food and feeding is mainly based on the official documents found in the Military Archives. Some additional material was from the historical literature, some from memoirs, or from the veterans who personally experienced the front. The documents in the Archives of Military Medicine provided information on the soldiers' deficiencies. During the Winter War, which took place from 30 November 1939 until 13 March 1940, ample food was available. The cold climate caused problems and the fresh food got frozen. However, no severe deficiency cases were reported and the morale was high. By contrast, during the Continuation War, which began in June, 1941 and ended in September, 1944, difficulties were experienced. At the time farming in the country faced serious problems due to the shortage of labour, fuel, etc. Furthermore, importing food was generally not possible. However, importing food mainly from Germany saved the Finns from hunger. In addition, the self activity of the soldiers on the front added somewhat to the food production. But the rations had to be reduced. Their energy values were consequently low, especially for the young men. Food was monotonous and occasionally caused complaints. The main sources of protein, vitamins and minerals were the whole cereal foods. Butter was fortified with vitamin A and vitamin C tablets were also distributed, to compensate for the scant food sources. Only approximately 300 serious deficiency cases required hospital care during the three years time, out of a total of 400 000 soldiers. Feeding the young soldiers during the war (1944 - 1945) in Lapland, which had been destroyed, was problematic but the increased rations also saved them from deficiencies. In spite of the severe difficulties experienced occasionally in feeding the soldiers during the wars, the system worked all the time. The soldiers were fed, the cases of nutritional deficiency and epidemics caused by food were kept very limited and the morale of soldiers remained high.

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The study examines various uses of computer technology in acquisition of information for visually impaired people. For this study 29 visually impaired persons took part in a survey about their experiences concerning acquisition of infomation and use of computers, especially with a screen magnification program, a speech synthesizer and a braille display. According to the responses, the evolution of computer technology offers an important possibility for visually impaired people to cope with everyday activities and interacting with the environment. Nevertheless, the functionality of assistive technology needs further development to become more usable and versatile. Since the challenges of independent observation of environment were emphasized in the survey, the study led into developing a portable text vision system called Tekstinäkö. Contrary to typical stand-alone applications, Tekstinäkö system was constructed by combining devices and programs that are readily available on consumer market. As the system operates, pictures are taken by a digital camera and instantly transmitted to a text recognition program in a laptop computer that talks out loud the text using a speech synthesizer. Visually impaired test users described that even unsure interpretations of the texts in the environment given by Tekstinäkö system are at least a welcome addition to complete perception of the environment. It became clear that even with a modest development work it is possible to bring new, useful and valuable methods to everyday life of disabled people. Unconventional production process of the system appeared to be efficient as well. Achieved results and the proposed working model offer one suggestion for giving enough attention to easily overlooked needs of the people with special abilities. ACM Computing Classification System (1998): K.4.2 Social Issues: Assistive technologies for persons with disabilities I.4.9 Image processing and computer vision: Applications Keywords: Visually impaired, computer-assisted, information, acquisition, assistive technology, computer, screen magnification program, speech synthesizer, braille display, survey, testing, text recognition, camera, text, perception, picture, environment, trasportation, guidance, independence, vision, disabled, blind, speech, synthesizer, braille, software engineering, programming, program, system, freeware, shareware, open source, Tekstinäkö, text vision, TopOCR, Autohotkey, computer engineering, computer science

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The international aid that the Evangelical Lutheran Church of Finland received between 1945 and 1948 is the topic of this historical study, in which the process of reconstruction of the Evangelical Lutheran Church of Finland is examined in a European context. The key questions are related not only to the achievements of the reconstruction programs but also to the purposes and objectives of the donating churches. The study pays particular attention to the changes in the ecclesiastical, political and economic fields after the Second World War and asks how the tense political atmosphere of a divided world affected the reconstruction programs of the churches. It is possible to distinguish three periods within the European church reconstruction process. To begin with, the year 1945 was, in general, the year of organization. Many churches had started planning reconstruction work already during the war, but only after the conflict in Europe had ceased did they have a chance to renew contacts, assess the damage and begin operations. The years 1946 and 1947 were the main years of the work. Large reconstruction organizations from American churches donated money, food, clothes and vitamins worth millions of dollars to the European churches. The work started to diminish as early as 1948, partly because Marshall Plan aid and the rising standard of living had reduced the need for material assistance in many countries and partly because other problems overshadowed the reconstruction work of the World Council of Churches: for example, most WCC resources at this time were directed to refugee programs and to Third World churhces. The most important donors from the Evangelical Lutheran Church of Finland's point of view were the American Section of the Lutheran World Federation, the World Council of Churches and the Churches of Denmark, Sweden and England. The amount of money and value of goods received by the Evangelical Lutheran Church of Finland totaled approximately 2.5 million dollars, from which about 60 per cent came from the Lutheran churches of America. The importance of the Lutheran World Federation was even greater because of the productive financial arrangements that increased the American Lutheran funds. In addition the Evangelical Lutheran Church of Finland imported hundreds of tons of tax-free coffee and sold this to Finns. The money gained was used mostly to rebuild destroyed church buildings and to support the work of different ecclesiastical organizations. Smaller amounts were used for scholarship programs, youth work, and supporting sick and disabled church workers.

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Prevention of cardiovascular diseases is known to postpone death, but in an aging society it is important to ensure that those who live longer are neither disabled nor suffering an inferior quality of life. It is essential both from the point of view of the aging individual as well as that of society that any individual should enjoy a good physical, mental and social quality of life during these additional years. The studies presented in this thesis investigated the impact of modifiable risk factors, all of which affect cardiovascular health in the long term, on mortality and health-related quality of life (HRQoL). The data is based on the all male cohort of the Helsinki Businessmen Study. This cohort, originally of 3.490 men born between 1919 and 1934 has been followed since the 1960s. The socioeconomic status of the participants is similar, since all the men were working in leading positions. Extensive baseline examinations were conducted among 2.375 of the men in 1974 when their mean age was 48 and at this time the health, medication and cardiovascular risk factors of the participants were observed. In 2000, at the mean age of 73, the HRQoL of the survivors of the original cohort was examined using the RAND-36 mailed questionnaire (n=1.864). RAND-36, along with the equivalent SF-36, is the world s most widely used means of assessing generic health. The response rate was generally over 90%. Mortality was retrieved from national registers in 2000 and 2002. For the six substudies of this thesis, the impact of four different modifiable cardiovascular risk factors (weight gain, cholesterol, alcohol and smoking) on the HRQoL in old age was studied both independently and in combination. The follow-up time for these studies varies from 26 up to 39 years. Mortality is reported separately or included in the RAND-36 scores for HRQoL. Elevated levels of all the risk factors examined among the participants in midlife led to a diminished life expectancy. Among survivors, lower weight gain in midlife was associated with better HRQoL, both physically and mentally. Higher levels of serum cholesterol in middle age indicated both an earlier mortality and a decline in the physical component of HRQoL in a dose-response manner during the 39-year follow-up. Mortality was significantly higher in the highest baseline category of reported mean alcohol consumption (≥ 5 drinks/day), but fairly comparable in abstainers and moderate drinkers during the 29-year follow-up. When HRQoL in old age was accounted for mortality, the men with the highest alcohol consumption in midlife clearly had poorer physical and mental health in old age, but the HRQoL of abstainers and those who drank alcohol in moderation were comparatively similar. The amount of cigarette smoking in midlife was shown to have had a dose-response effect on both mortality and HRQoL in old age during the 26 year follow-up. The men smoking over 20 cigarettes daily in middle age lost about 10 years of their life-expectancy. Meanwhile, the physical functioning of surviving heavy smokers in old age was similar to men 10 years older in the general population. The impact of clustered cardiovascular risk factors was examined by comparing two subcohorts of men who were healthy in 1974, but with different baseline risk factor status. The men with low risk had a 50 % lower mortality during the 29-years follow-up. Their RAND-36 scores for the physical quality of life in old age were significantly better, and the 2002 questionnaire examining psychological well-being indicated also significantly better mental health among the low-risk group. The results indicate that different risk factor levels in midlife have a meaningful impact on life-expectancy and the quality of these extra years. Leading a healthy lifestyle improves both survival and the quality of life.

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The main theme of the research centres on the idea that social inclusion can be analysed as inclusions and exclusions. The research is focused on the phenomenon of inclusion that is defined as widely understood social relationships and social binds emerging in a rehabilitation process. Information was gathered from 13 ex substance abusers, who had a background of heavy substance abuse for appr. 15 years and who have been sober for about 7 years. Also 34 persons who helped them to rehabilitate by the helped persons’ perspectives, were interviewed. The speciality of the research is that 5 of the ex abusers were also physically or mentally disabled. A Simmelian interaction process analysis was applied for the narrative analysis of the collected data. The aim of the analysis was to define different kinds of configurations of social relations and social binds. According to the research 3 different forms of inclusion are emerged in rehabilitation. At the early stage rehabilitation leans towards controlling the new sober life style (inclusion of life control). When people begin to rely on their temperance, they begin to make decisions about an own way of living (life political inclusion) and can also dissociate from the institutional thought patterns. People must also find a way into the circles of social relationships to develop own esteemed individual settings of codes for their action (inclusion of life orientation). The main result of the research represents the ‘mechanism of the social’ of rehabilitation. It is composed of the forms of inclusion mentioned above, their contents and the specific reflection mechanism of inclusion. It consists of the heavy structure of the disciplines of the rehabilitation system and the light structure of social worlds. Finally rehabilitation in the long run seems to lean on aesthetic of social relationships – how the person is connected to the circle of social relationships in this reflection. The conclusions are the following. The role of institutional disciplines is an important social resource for controlling life. Other institutions, i.e. the institutions of adult education offer opportunities to organize the abuser’s life. Unfortunately, the institutional rehabilitation seems to offer feeble help, especially to those who are actualising a kind of life orientation that does not comply with legitimated institutional thought patterns. If the helpers cannot define the need for aid in this situation, the helped easily becomes perversely socially excluded. In a discreet way the institutional rehabilitation is shaping subjectivities of the ex abusers by transferring responsibilities for them. This incident already increases the uncertainty of life of ex abuser, who is disposed towards feeling shame and inferiority. It is more secure to strengthen social binds with the institutional rehabilitation and its membership. Thus, getting individually responsible increases addictive behaviours.

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Transition to adulthood of severely disabled adolescents. Diversity in individual life courses. The focus of this study is to examine the transition to adulthood of severely disabled adolescents as part of their life course. The data for this study were gathered through interviews with nine severely disabled adolescents, who were interviewed several times over a period of eight years. At the beginning of the study the adolescents were between 18 and 24 years old. The informants had severe disabilities manifesting themselves as physical incapacity, cerebral palsy, vision or hearing impairment, neurological disease, or developmental disability. One of the adolescents communicated with symbols. All except one used a wheelchair. As severely disabled adolescents, they received benefits from Kela for persons with severe disabilities, such as the higher-rate or special disability allowance or disability pension, the higher-rate or special pensioners' care allowance, or medical rehabilitation services. The interviews focused on a number of selected themes such as relationships, family, education, work, leisure-time activities, dating, decision-making, independence, happiness, and one s self-image and identity. Data were also derived from interviews with five experts. Two of the experts interviewed were severely disabled themselves. The theoritical foundation of the study lies in perviuos research on the severly disabled, the transition to adulthood and the life course. The method of analysis and interpretation is qualitative and based on interviews with the adolescents. In terms of the analytical process, the focus is on recognizing individual events in the transition process to adulthood and identifying the meanings assigned to them by the adolescents. The narratives also provide a method to shed light on the individuality of the transition. The individual situations of severely disabled adolescents vary, and their disability impacts the range of options available to them as they plan their life course. The medical and social models of disability also have an effect on life courses. Although severely disabled adolescents are able to attain some goals, they remain outsiders in many respects. Key words: Disabled person, severely disabled person, adolescent, transition to adulthood, identity, life course.

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Conflict, Unity, Oblivion: Commemoration of the Liberation War by the Civic Guard and the Veterans´ Union in 1918-1944 The Finnish Civil War ended in May 1918 as a victory for the white side. The war was named by the winners as the Liberation War and its legacy became a central theme for public commemorations during the interwar period. At the same time the experiences of the defeated were hindered from becoming a part of the official history of Finland. The commemoration of the war was related not only to the war experience but also to a national mission, which was seen fulfilled with the independence of Finland. Although the idea of the commemoration was to form a unifying non-political scene for the nation, the remembrance of the Liberation War rather continued than sought to reconcile to the conflict of 1918. The outbreak of the war between the Soviet Union and Finland in 1939 immediately affected the memory culture. The new myth of the Miracle of the Winter War, which referred to the unity shown by the people, required a marginalization of controversial memory of the Liberation War. This study examines from the concepts of public memory and narrative templates how the problematic experience of a civil war developed to a popular public commemoration. Instead of dealing with the manipulative and elite-centered grandiose commemoration projects, the study focuses on the more modest local level and emphasizes the significance of local memory agents and narrative templates of collective memory. The main subjects in the study are the Civil Guard and the Veterans´ Union. Essential for the widespread movement was the development of the Civic Guard from a wartime organization to a peacetime popular movement. The guards, who identified themselves trough the memories and the threats of civil war, formed a huge network of memory agents in every corner of the country. They effectively linked both local memory with official memory and the civic society with the state level. Only with the emergence of the right wing veteran movement in the 30ies did the tensions grow between the two levels of public memory. The study shows the diversity of the commemoration movement of the Liberation War. It was not only a result of a nation-state project and political propaganda, but also a way for local communities to identify and strengthen themselves in a time of political upheaval and uncertainty.

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The aim of this study has been to challenge or expand the present views on special education. In a series of six articles this thesis will directly or indirectly debate questions relating to inclusive and exclusive mechanisms in society. It is claimed that the tension between traditionalism and inclusionism within special education may harm the legitimation of special education as a profession of the welfare state. The articles address the relationship between these two approaches. The traditionalism-inclusionism controversy is partly rooted in different ways of understanding the role of special education with respect to democracy. It seems, however, that the traditionalism-inclusionism controversy tends to lead researchers to debate paradigmatic positions with each other than to develop alternative strategies for dealing with the delicate challenge of the differences within education. ---- There are three major areas of this discussion. The first part presents the theory of research programmes as a way of describing the content, the possibilities, and the problems of the different approaches. The main argument is that the concept of research programmes more clearly emphasizes the ethical responsibilities involved in research within the field of special education than does the paradigmatic approach. The second part considers the social aspects of the debate between traditionalism and inclusionism from different perspectives. A central claim made is that the work seen within special education must be understood as a reaction to the social and political world that the profession is part of, and that this also is part of a specific historical development. Even though it is possible to claim that the main aim for special education is to help people that are looked at as disabled or feel disabled, it is also necessary to understand that the profession is highly constrained by the grand narrative of the welfare state and the historical discourse that this profession is part of. The third part focuses on a central aspect of special education: the humanistic solutions towards people who are left behind by ordinary education. The humanistic obligation for special education is part of the general aim of the welfare state to provide an education for a democratic and an inclusive society. This humanistic aim and the goal to offer an education for democracy seem therefore, to dominate the understanding of how special education works.

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Objectives. The thesis objective was to analyze how person-centred planning is applied to develop short term care in interaction between the disabled children, their families and the workers of the family service centre of Eteva Järvenpää. The thesis contributes to developing the methods of person-centred planning. I applied theoretical frameworks of activity theory and developmental work research, family-based work framework and disability phenomenon. The research questions were: What development needs did the families of disabled children have for the services? How were viewpoints of disabled children, their families and Eteva workers noticed in person-centred planning in the interaction between the disabled children, their families and Eteva workers? What disturbances and development challenges emerged during the person-centred planning? Methods. I first analysed the local history of the disability sector and the short term care to analyse challenges arising from the local history. The actural research material consisted of interviews with four families, two person-centred planning discussions and two discussions where the person-centred planning was reflected by the families.I used interaction voice analysis as defined by the activity theory and developmental work research. From the recorded interviews and discussions I analysed scripts, disturbances, innovation attempts and innovations. From the discussions I analysed also the interaction types (cooperation, coordination and communication). Results and conclusions. As problems, the families considered the scarce resources and the inflexibility of services. The challenges of developing the short term care were how to transfer information from short term care to home, how to develop activities for the children and how to take into account the individual needs of the children in the short term care. Both from the local history analysis and from the family interviews arised the conflict between caring and fulfilling the individual needs. In person-centred planning, the voice of the child was either interpreted by other family members or guided by family members or workers. I modelled the progress of person-centred planning in a two-dimensional coordination. Person-centred planning should be deepened in cooperation between the child, the family and the workers in everyday situations at home and during the short term care. The challenge is to expand person-centred planning to become cross-organizational cooperation connecting the actors of the child s service network in everyday life. Avainsanat Nyckelord - Keywords short term care, activity theory and developmental work research, person-centred planning, disability