"Pintaa syvemmälle" : Eettinen pohdinta opettajan voimavarana luokanopettajan ja erityisopettajan silmin

The purpose of this study is to determine what class teachers and special teachers emphasise in ethical consideration, in which situations they find that ethical difficulties arise and how they would overcome them. In additions, the study aims to describe the effects of ethical con-sideration on the teachers` work. The theoretical backround is based on theories concerning the ethics of the teacher and the literature associated with education and teaching. The empirical study was based on data obtained through questionnaires and interviews. The questionnaires were posted to 470 randomly-selected class teachers and special teachers; 298 of them (63%) completed and returned the questionnaire, and 19 teachers were inter-viewed. The results of the questionnaires and the interviews were examined crosswise with a mixed-methods procedure. The questionnaires were analysed by factor analysis. Those items which rose above the av-erage served as the foundation for the analysis. The questionnaires also included open ques-tions. These questions and the interviews were analysed with a content analysis method. Some principles of this method were combined with the results of the questionnaires to in-crease mutual understanding. In this study, the ethical consideration of the teachers was divided in to four notable parts: 1) moral obligations, 2) respect for the teaching stuff, 3) the demand for responsibility, and 4) dependence on the situation. These items were also notable both in situations that were ethi-cally difficult for teachers and in their solutions to these situations. It became evident that these situations were very common in everyday work and resulted from the character of the teachers´ work. This study showed that the teacher meets the pupils as a group and that the teacher must examine according to the circumstances the truth, individuality, special ar-rangements and co-operation between the school and the parents. The teachers` continuous lack of time limited the ethical consideration. It emerged that the teachers consider their work very multi-faceted and that the sense of obligation, power and responsibility was inevitably received emphasis. The consciousness of authority and the responsibilities associated with it seemed, however, to strengthen this ac-tion. The study showed that the teachers, especially the young female ones, long for more solidarity. Significantly, such experience does not eliminate the importance of ethical consid-eration; on the contrary, it deepens it. According to the results, creating conditions and cir-cumstances for the teachers that open co-operation is inevitable, and easy interaction will in-evitably be possible in the future. There was not observed any differences in ethical consideration between class teachers and special teachers. Therefore, the integration of the pupils to general teaching cannot be consid-ered questionable. Teachers´ answers suggested that ethical consideration improved the tolerance of stress, increased self-confidence and courage as well as belief in the future. The teachers considered ethical consideration important and encouraging for it increased justice and empathy in the teachers´ work.

Etuoikeutettu sukupuoli? : Käsitys auktoriteetista Elisabeth Schüssler Fiorenzan feministisessä teologiassa

A Priviledged Gender? The Question of Authority in the Feminist Theology of Elisabeth Schüssler Fiorenza. Elisbeth Schüssler Fiorenza (b. 1938) is one of the pioneers of Christian feminist theology. The aim of this study is to analyze what she understands by the authority of women as (re)interpreters of the Bible and the Christian tradition. The research method is conceptual analysis, and the sources consist of Schüssler Fiorenza s key writings from 1975 to 2006. The starting point of the study is Schüssler Fiorenza s definition of the task of feminist theology as claiming women s intellectual-religious authority. It is assumed that the issue of authority offers an angle from which Schüssler Fiorenza s feminist theology can be understood as a whole. It is also supposed that the notion of authority opens up a perspective on the way Schüssler Fiorenza dialogues with non-theological feminist theory in her writings. The analysis is first directed to five key concepts of Schüssler Fiorenza s work: authority, patriarchy, androcentrism, gender and women-church, i.e. the ekklesia of wo/men. Special attention is given to her gender-theoretical considerations and her neologism wo/men, by which she refers to women and marginalized men. The aim of this conceptual analysis is to clarify her thought on the subjects of feminist theology. In addition, Schüssler Fiorenza s dialogue with other feminist scholars is evaluated. It is argued that eclecticism characterizes her way of treating non-theological feminist theory. Rewriting early Christian history from a feminist perspective is at the core of Schüssler Fiorenza s scholarship. From her early writings on, she argues for women s authority to define the Christian religion, past and present. In the 1990s Schüssler Fiorenza s theoretical background is feminist standpoint epistemology, and she represents feminist women as an epistemologically priviledged group. Later she claims to defend the epistemic authority of all those wo/men women and men who want to produce emancipatory knowledge. The analysis of Schüssler Fiorenza s work on feminist biblical interpretation shows that her stated aim to regard both women and men as subjects of feminist theology is not realized in the actual descriptions of her hermeneutical model. In fact, Schüssler Fiorenza argues for the authority of feminist women to interpret the Bible in their own interests . Thus in her work, women seem to figure as representatives of the priviledged gender in the field of biblical and theological knowledge.

Tanska keisari Kaarle V:n valtakunnan intresseissä 1521-1524

The master's thesis concerns the decisions of the imperial policy-makers in their Danish foreign policy during the crisis that culminated in the dissolution of the Nordic union of Kalmar during the years 1521-24. The sources consist of printed sources that mainly are collections of letters and diplomas, and additionally, acquaintance has been made with studies treating the subject. The aim of the study was to clarify the objectives, means and execution of the imperial policy and what priorizations did they make between the different objectives. Also, the part played by Denmark in the imperial foreign policy in general was to be assessed. Particularly, the aim was to find out and state a hierarchy between the importance of the different objectives by analyzing the choices made. It was observed that the continuing of peaceful relations in the North was clearly preferred in the imperial policy, especially as their war against France drew out. A war was seen as deteriorating the freedom of action of the main ally, king Christian II, and an armed conflict was to be prevented. The conceived impossibilty to intervene with armed forces to Christian's favour forced the imperial side to postpone their objectives in the fields of dynastical and alliance policy. In comparison to these, less weight was given to maintaining the rights and position of the empire and the rights granted in its name. To the Habsburgs, maintaining the economical embargo of Sweden, run forcefully by Christian II, was the least preferred objective. In light of the results of the master's thesis, the conceived priorities of the Northern European policy adopted by the imperial side resembled their political priorities in general.

Ajan sisäkkäiset tilat. Arkkitehtuuri, valokuva ja menneisyyden esittäminen W. G. Sebaldin romaanissa Austerlitz

In her thesis, Kaisa Kaakinen analyzes how the German emigrant author W. G. Sebald (1944-2001) uses architecture and photography in his last novel "Austerlitz" to represent time, history and remembering. Sebald describes time in spatial terms: it is like a building, the rooms and chambers of which are connected to each other. The poetics of spatial time manifests itself on multiple levels of the text. Kaakinen traces it in architectural representations, photographic images, intertextuality, as well as in the form of the text, using the concept of spatial form by Joseph Frank. Architectural and photographic representations serve as meeting points for different aspects and angles of the novel and illustrate the idea of a layered present that has multiple connections to the past. The novel tells a story of Jacques Austerlitz, who as a small child was sent from Prague to Britain in one of the so-called Kindertransports that saved children from Central Europe occupied by the National Socialists. Only gradually he remembers his Jewish parents, who have most likely perished in Nazi concentration camps. The novel brings the problematic of writing about another person's past to the fore by the fact that Austerlitz's story is told by an anonymous narrator, Austerlitz's interlocutor, who listens to and writes down Austerlitz's story. Kaakinen devotes the final part of her thesis to study the demands of representing a historical trauma, drawing on authors such as Dominick LaCapra and Michael Rothberg. Through the analysis of architectural and photographic representations in the novel, she demonstrates how Austerlitz highlights the sense of singularity and inaccessibility of memories of an individual, while also stressing the necessity - and therefore a certain kind of possibility - of passing these memories to another person. The coexistence of traumatic narrowness and of the infinity of history is reflected in ambivalent buildings. Some buildings in the novel resemble reversible figures: they can be perceived simultaneously as ruins and as construction sites. Buildings are also shown to be able to both cover and preserve memories - an idea that also is repeated in the use of photography, which tends to both replace memories and cause an experience of the presence of an absent thing. Commenting and critisizing some recent studies on Sebald, the author develops a reading which stresses the ambivalence inherent in Sebald's view on history and historiography. Austerlitz shows the need to recognize the inevitable absence of the past as well as the distance from the experiences of others. Equally important, however, is the refusal to give up narrating the past: Sebald's novel stresses the necessity to preserve the sites of the past, which carry silent traces of vanished life. The poetics of Austerlitz reflects the paradox of the simultaneous impossibility and indispensability of writing history.

Cognitive Functioning in Young Adults with Depression, Anxiety Disorders, or Burnout Symptoms : Findings from a Population-based Sample

Background. Evidence of cognitive dysfunction in depressive and anxiety disorders is growing. However, the neuropsychological profile of young adults has received only little systematic investigation, although depressive and anxiety disorders are major public health problems for this age group. Available studies have typically failed to account for psychiatric comorbidity, and samples derived from population-based settings have also seldom been investigated. Burnout-related cognitive functioning has previously been investigated in only few studies, again all using clinical samples and wide age groups. Aims. Based on the information gained by conducting a comprehensive review, studies on cognitive impairment in depressive and anxiety disorders among young adults are rare. The present study examined cognitive functioning in young adults with a history of unipolar depressive or anxiety disorders in comparison to healthy peers, and associations of current burnout symptoms with cognitive functioning, in a population-based setting. The aim was also to determine whether cognitive deficits vary as a function of different disorder characteristics, such as severity, psychiatric comorbidity, age at onset, or the treatments received. Methods. Verbal and visual short-term memory, verbal long-term memory and learning, attention, psychomotor processing speed, verbal intelligence, and executive functioning were measured in a population-based sample of 21-35 year olds. Performance was compared firstly between participants with pure non-psychotic depression (n=68) and healthy peers (n=70), secondly between pure (n=69) and comorbid depression (n=57), and thirdly between participants with anxiety disorders (n=76) and healthy peers (n=71). The diagnostic procedure was based on the SCID interview. Fourthly, the associations of current burnout symptoms, measured with the Maslach Burnout Inventory General Survey, and neuropsychological test performance were investigated among working young adults (n=225). Results. Young adults with depressive or anxiety disorders, with or without psychiatric comorbidity, were not found to have major cognitive impairments when compared to healthy peers. Only mildly compromised verbal learning was found among depressed participants. Pure and comorbid depression groups did not differ in cognitive functioning, either. Among depressed participants, those who had received treatment showed more impaired verbal memory and executive functioning, and earlier onset corresponded with more impaired executive functioning. In anxiety disorders, psychotropic medication and low psychosocial functioning were associated with deficits in executive functioning, psychomotor processing speed, and visual short-term memory. Current burnout symptoms were associated with better performance in verbal working memory and verbal intelligence. However, lower examiner-rated social and occupational functioning was associated with problems in verbal attention, memory, and learning. Conclusions. Depression, anxiety disorders, or burnout symptoms may not be associated with major cognitive deficits among young adults derived from the general population. Even psychiatric comorbidity may not aggravate cognitive functioning in depressive or anxiety disorders among these young adults. However, treatment-seeking in depression was found to be associated with cognitive deficits, suggesting that these deficits relate to increased distress. Additionally, early-onset depression, found to be associated with executive dysfunction, may represent a more severe form of the disorder. In anxiety disorders, those with low symptom-related psychosocial functioning may have cognitive impairment. An association with self-reported burnout symptoms and cognitive deficits was not detected, but individuals with low social and occupational functioning may have impaired cognition.

Dialogisuus ja kohtaaminen : Tutkimus kristillisten koulujen toimintakulttuurista kasvatussuhteen näkökulmasta

The main focus of this research was to describe the educational purpose of Christian schools within their operation culture. The Christian schools founded in Finland can be seen as part of a greater movement in Europe. In this research the dialogue and encounter in the educational scheme of Finnish Christian schools were examined by asking three research questions: 1. What is the nature of the dialogue in education in Finnish Christian schools? 2. How do the teachers describe themselves as educators? 3. What are the special characteristics in the operation culture of a Christian school? The educational relationship was regarded as fundamental and in the background reflected the absolute value of each student. Communication skills were viewed as essential in the building of relationships, which also included emotion communication skills as a broader view. The teachers expressed their comprehension of the meaning of the dialogue in the building of a relationship with practical examples. Students learned to understand one another's experiences by discussion and listening to one another. The values that created a connection were mutual appreciation, honesty, taking the other one into account, and the ability for empathy. Caring was regarded as a relationship between people, as well as a genuine mutual encounter, in which all parties would listen to one another and be heard by others. The respondents thought that individual attention and time were the keys to reaching well-being and an encounter. Students' commitment to the community was supported by mutual agreements, identifying with the common world, and encounters. The appearance of Christian love agape was named as the basis for an educational relationship. The answers emphasised shared everyday life at school. According to the teachers, the willingness for personal growth enabled encounters, although growth as such was often regarded as difficult. Cognitive emphasising and emotional experiencing from a dynamic perspective, were the means by which students' ethical understanding was comprehended. The teachers named three key factors to create a confidential relationship: a respectful attitude, courage, and genuineness. Within the school operational environment, a sense of community was emphasised, in which each student was taken into account individually. The active role of parents was an essential part of the school culture. The administration of the schools appeared committed. The additional pressure in school work came from efforts to ensure the official status of the school, as well as the large amount of administrative work involved in a private school. According to the research data, there was no evidence to support any elitism that is often associated with private schools.

The role of probiotics in Helicobacter pylori infection

Helicobacter pylori (H. pylori) infection is a major cause of chronic gastritis and peptic ulcer disease, and it is also designated as a class-I carcinogen for stomach cancer. The role of probiotics in the treatment of gastrointestinal infections is increasingly documented as an alternative or complement to antibiotics, with the potential to decrease the use of antibiotics or reduce their adverse effects. These studies were conducted to investigate the role of probiotics in the treatment of H. pylori infection. Various aspects included: an investigation of the effects of a probiotic combination consisting of Lactobacillus rhamnosus GG, L. rhamnosus LC705, Propionibacterium freudenreichii ssp. shermanii JS and Bifidobacterium breve Bb99 or B. lactis Bb12 as a supplementation to H. pylori eradication therapy, with special reference to tolerability, effectiveness, and microbiota alterations following the treatment; discovering the role of probiotics in vivo with H. pylori infected and uninfected patients, as well as with an in vitro model of H. pylori infection. The probiotic combination therapy was able to reduce significantly the total symptom score, which takes into account both the frequency and the severity of the adverse effects, during the eradication treatment. The supplementation did not improve the success of the eradication treatment significantly, though some difference was seen in the eradication percentages (91% vs. 79%). The quantities of predominant bacterial groups were altered significantly following the triple treatment. Probiotics slightly counteracted the effects of anti-H. pylori treatment, monitored as significantly less alterations in the total numbers of aerobes and lactobacilli/enterococci group bacteria. After probiotic intervention, L. rhamnosus GG adhered to a minority of the patients upper gastrointestinal mucosa, but all of the probiotics survived well through the gastrointestinal tract transit with and without antimicrobial treatment. Probiotic intervention decreased gastrin-17 levels in H. pylori infected patients and appeared to decrease the 13C-urea breath test values. In in vitro Caco-2 cell line experiments, probiotics inhibited H. pylori adhesion to intestinal epithelial cells. Both L. rhamnosus strains, P. freudenreichii ssp. shermanii JS and the combination inhibited the H. pylori-induced acute cell leakage. Simultaneously, both L.rhamnosus strains and the combination transiently improved the epithelial barrier function. The pro-inflammatory effects prevailed when the probiotics were used in combination. According to this series of studies, probiotic combination could have some potential in reducing adverse effects induced by H. pylori eradication treatment and beneficial effects on H. pylori infected subjects.

Predictors of disability retirement: From early intentions to retirement

The strong tendency of elderly employees to retire early and the simultaneous aging of the population have been major topics of policy and scientific debate. A key concern has been the financing of future pension schemes and possible labour shortage, especially in social and health services within the public sector. The aging of the population is inevitable, but efforts can be made to prevent or postpone early exit from the labour force, e.g., by identifying and intervening in the factors that contribute to the process of early retirement due to disability. The associations of intentions to retire early, poor mental health and different psychosocial factors with the process of disability retirement are still poorly understood. The purpose of this study was to investigate the associations of intentions to retire early, poor mental health, work and family related psychosocial factors and experiences of earlier life stages with the process of disability retirement. The data were derived from the Helsinki Health Study (HHS, N=8960) and the Health and Social Support Study (HeSSup, N=25 901). The Helsinki Health Study is an ongoing employee cohort study among middle-aged women and men. The Health and Social Support Study is an ongoing longitudinal study of a working-age sample representative of the Finnish population. The analyses were restricted to respondents 40 years of age or older. Age and gender adjusted prevalence and incidence rates were calculated. Associations were studied by using logistic, multinomial and Cox regression. Strong intentions to retire early were common among employees. Poor mental health, unfavourable working conditions and work-to-family conflicts were clearly associated with increased intentions to retire early. Strong intentions to retire early predicted disability retirement. Risk of disability retirement increased in a dose-response manner with increasing number of childhood adversities. Poor mental and somatic health, life dissatisfaction, heavy alcohol consumption, current smoking, obesity and low socioeconomic status were also predictors of disability retirement. The impact of poor mental health and adverse experiences from earlier life stages, work and family related psychosocial factors, e.g., work-family interface, the subjective experience of well-being and health related risk behaviours on the process of disability retirement should be recognised. Preventive measures against disability retirement should be launched before subjective experience of ill health, work disability and strong intentions to retire early emerge.

Pain among employees : risk factors and consequences

The overall objective of this study was to gain epidemiological knowledge about pain among employee populations. More specifically, the aims were to assess the prevalence of pain, to identify socio-economic risk groups and work-related psychosocial risk factors, and to assess the consequences in terms of health-related functioning and sickness absence. The study was carried out among the municipal employees of the City of Helsinki. Data comprised questionnaire survey conducted in years 2000-2002 and register data on sickness absence. Altogether 8960 40-60 year old employees participated to the survey (response rate 67%). Pain is common among ageing employees. Approximately 29 per cent of employees reported chronic pain and 15 per cent acute pain, and about seven per cent reported moderately or severely limiting disabling chronic pain. Pain was more common among those with lower level of education or in a low occupational class. -- Psychosocial work environment was associated with pain reports. Job strain, bullying at workplace, and problems in combining work and home duties were associated with pain among women. Among men combining work and home duties was not associated with pain, whereas organizational injustice showed associations. Pain affects functional capacity and predicts sickness absence. Those with pain reported lower level of both mental and physical functioning than those with no pain, physical functioning being more strongly affected than mental. Bodily location of pain or whether pain was acute or chronic had only minor impact on the variation in functioning, whereas the simple count of painful locations was associated with widest variation. Pain accounted for eight per cent of short term (1-3 day) sickness absence spells among men and 13 per cent among women. Of absence spells lasting between four and 14 days pain accounted for 23 per cent among women and 25 per cent among men, corresponding figures for over 14 day absence spells being 37 and 30 per cent. The association between pain and sickness absence was relatively independent of physical and psychosocial work factors, especially among women. The results of this study provide a picture of the epidemiology of pain among employees. Pain is a significant problem that seriously affects work ability. Information on risk groups can be utilized to make prevention measures more effective among those at high risk, and to decrease pain rates and thereby narrow the differences between socio-economic groups. Furthermore, the work-related psychosocial risk factors identified in this study are potentially modifiable, and it should be possible to target interventions on decreasing pain rates among employees.

Multiple socioeconomic circumstances and health : associations and explanations among Finnish and British public sector employees

Socioeconomic health inequalities have been widely documented, with a lower social position being associated with poorer physical and general health and higher mortality. For mental health the results have been more varied. However, the mechanisms by which the various dimensions of socioeconomic circumstances are associated with different domains of health are not yet fully understood. This is related to a lack of studies tackling the interrelations and pathways between multiple dimensions of socioeconomic circumstances and domains of health. In particular, evidence from comparative studies of populations from different national contexts that consider the complexity of the causes of socioeconomic health inequalities is needed. The aim of this study was to examine the associations of multiple socioeconomic circumstances with physical and mental health, more specifically physical functioning and common mental disorders. This was done in a comparative setting of two cohorts of white-collar public sector employees, one from Finland and one from Britain. The study also sought to find explanations for the observed associations between economic difficulties and health by analysing the contribution of health behaviours, living arrangements and work-family conflicts. The survey data were derived from the Finnish Helsinki Health Study baseline surveys in 2000-2002 among the City of Helsinki employees aged 40-60 years, and from the fifth phase of the London-based Whitehall II study (1997-9) which is a prospective study of civil servants aged 35-55 years at the time of recruitment. The data collection in the two countries was harmonised to safeguard maximal comparability. Physical functioning was measured with the Short Form (SF-36) physical component summary and common mental disorders with the General Health Questionnaire (GHQ-12). Socioeconomic circumstances were parental education, childhood economic difficulties, own education, occupational class, household income, housing tenure, and current economic difficulties. Further explanatory factors were health behaviours, living arrangements and work-family conflicts. The main statistical method used was logistic regression analysis. Analyses were conducted separately for the two sexes and two cohorts. Childhood and current economic difficulties were associated with poorer physical functioning and common mental disorders generally in both cohorts and sexes. Conventional dimensions of socioeconomic circumstances i.e. education, occupational class and income were associated with physical functioning and mediated each other’s effects, but in different ways in the two cohorts: education was more important in Helsinki and occupational class in London. The associations of economic difficulties with health were partly explained by work-family conflicts and other socioeconomic circumstances in both cohorts and sexes. In conclusion, this study on two country-specific cohorts confirms that different dimensions of socioeconomic circumstances are related but not interchangeable. They are also somewhat differently associated with physical and mental domains of health. In addition to conventionally measured dimensions of past and present socioeconomic circumstances, economic difficulties should be taken into account in studies and attempts to reduce health inequalities. Further explanatory factors, particularly conflicts between work and family, should also be considered when aiming to reduce inequalities and maintain the health of employees.

Markers of systemic inflammation in diagnostics and in prediction of outcome of community-acquired infection

Sepsis is associated with a systemic inflammatory response. It is characterised by an early proinflammatory response and followed by a state of immunosuppression. In order to improve the outcome of patients with infection and sepsis, novel therapies that influence the systemic inflammatory response are being developed and utilised. Thus, an accurate and early diagnosis of infection and evaluation of immune state are crucial. In this thesis, various markers of systemic inflammation were studied with respect to enhancing the diagnostics of infection and of predicting outcome in patients with suspected community-acquired infection. A total of 1092 acutely ill patients admitted to a university hospital medical emergency department were evaluated, and 531 patients with a suspicion of community-acquired infection were included for the analysis. Markers of systemic inflammation were determined from a blood sample obtained simultaneously with a blood culture sample on admission to hospital. Levels of phagocyte CD11b/CD18 and CD14 expression were measured by whole blood flow cytometry. Concentrations of soluble CD14, interleukin (IL)-8, and soluble IL-2 receptor α (sIL-2Rα) were determined by ELISA, those of sIL-2R, IL-6, and IL-8 by a chemiluminescent immunoassay, that of procalcitonin by immunoluminometric assay, and that of C-reactive protein by immunoturbidimetric assay. Clinical data were collected retrospectively from the medical records. No marker of systemic inflammation, neither CRP, PCT, IL-6, IL-8, nor sIL-2R predicted bacteraemia better than did the clinical signs of infection, i.e., the presence of infectious focus or fever or both. IL-6 and PCT had the highest positive likelihood ratios to identify patients with hidden community-acquired infection. However, the use of a single marker failed to detect all patients with infection. A combination of markers including a fast-responding reactant (CD11b expression), a later-peaking reactant (CRP), and a reactant originating from inflamed tissues (IL-8) detected all patients with infection. The majority of patients (86.5%) with possible but not verified infection showed levels exceeding at least one cut-off limit of combination, supporting the view that infection was the cause of their acute illness. The 28-day mortality of patients with community-acquired infection was low (3.4%). On admission to hospital, the low expression of cell-associated lipopolysaccharide receptor CD14 (mCD14) was predictive for 28-day mortality. In the patients with severe forms of community-acquired infection, namely pneumonia and sepsis, high levels of soluble CD14 alone did not predict mortality, but a high sCD14 level measured simultaneously with a low mCD14 raised the possibility of poor prognosis. In conclusion, to further enhance the diagnostics of hidden community-acquired infection, a combination of inflammatory markers is useful; 28-day mortality is associated with low levels of mCD14 expression at an early phase of the disease.

Nutrition and Nutritional Care of Elderly People in Finnish Nursing Homes and Hospitals

Background: Malnutrition is a common problem for residents of nursing homes and long-term care hospitals. It has a negative influence on elderly residents and patients health and quality of life. Nutritional care seems to have a positive effect on elderly individuals nutritional status and well-being. Studies of Finnish elderly people s nutrition and nutritional care in institutions are scarce. Objectives: The primary aim was to investigate the nutritional status and its associated factors of elderly nursing home residents and long-term care patients in Finland. In particular, to find out, if the nursing or nutritional care factors are associated with the nutritional status, and how do carers and nurses recognize malnutrition. A further aim was to assess the energy and nutrient intake of the residents of dementia wards. A final objective was to find out, if the nutrition training of professionals leads to changes in their knowledge and further translate into better nutrition for the aged residents of dementia wards. Subjects and methods: The residents (n=2114) and patients (n=1043) nutritional status was assessed in all studies using the Mini Nutritional Assessment test (MNA). Information was gathered in a questionnaire on residents and patients daily routines providing nutritional care. Residents energy and nutrient intake (n=23; n=21) in dementia wards were determined over three days by the precise weighing method. Constructive learning theory was the basis for educating the professionals (n=28). A half-structured questionnaire was used to assess professionals learning. Studies I-IV were cross-sectional studies whereas study V was an intervention study. Results: Malnutrition was common among elderly residents and patients living in nursing homes and hospitals in Finland. According to the MNA, 11% to 57% of the studied elderly people suffered from malnutrition, and 40-89% were at risk of malnutrition, whereas only 0-16% had a good nutritional status. Resident- and patient-related factors such as dementia, impaired ADL (Activities of Daily Living), swallowing difficulties and constipation mainly explained the malnutrition, but also some nutritional care related factors, such as eating less than half of the offered food portion and not receiving snacks were also related to malnutrition. The intake of energy and some nutrients by the residents of dementia wards were lower than those recommended, although the offered food contained enough energy and nutrients. The proportion of residents receiving vitamin D supplementation was low, although there is a recommendation and known benefits for the adequate intake of vitamin D. Nurses recognized malnutrition poorly, only one in four (26.7%) of the actual cases. Keeping and analysing food diaries and reflecting on nutritional issues in small group discussions were effective training methods for professionals. The nutrition education of professionals had a positive impact on the energy and protein intake, BMIs, and the MNA scores of some residents in dementia wards. Conclusions: Malnutrition was common among elderly residents and patients living in nursing homes and hospitals in Finland. Although residents- and patient related factors mainly explained malnutrition, nurses recognized malnutrition poorly and nutritional care possibilities were in minor use. Professionals nutrition education had a positive impact on the nutrition of elderly residents. Further studies describing successful nutritional care and nutrition education of professionals are needed.

Tuomarin rooli siviili- ja hallintoprosessissa

Tutkielmassa on vertailtu tuomarin roolia siviiliprosessin dispositiivisissa asioissa ja hallintoprosessissa. Vertailussa käytetään apuna kahta ratkaisumallia, jotka ovat peräisin Carol Gilliganin kehittelemästä sukupuolten moraalikehityspsykologiasta. Siten naisen moraalisissa ratkaisuissa käytetään arvoja, jotka ovat muotoutuneet samaistumisen kokemuksena hoivaajaan ja joissa ihmissuhteiden ja vastuun merkitys on korostunut. Naisen eettisenä ratkaisumallina on vastuun etiikka, jossa painottuvat tilannekohtaisen oikeudenmukaisuuden arvot, vastuu, kohtuus ja joustavuus. Vastuun oikeuden heikko kohta on se, että heikompi ei vaadi oikeuksiaan ja hänen asemansa voi heikentyä edelleen. Vastuun etiikka liitetään tutkielmassa hallintoprosessin tuomarin rooliin, koska hallintoprosessin tuomari toimii virallisperiaatteen alaisena ja on selvitysvastuussa joustavassa prosessissa. Miehen moraalikehitys kumpuaa erillisyyden tunteesta hoivaajaansa ja siinä korostuu yksilöllisyys ja oikeuksien painottuminen. Eettinen ratkaisumalli on oikeuden etiikka, jolle on tyypillistä reilun pelin säännöt, tasapuolisuus, ongelmien abstrahoituminen ja muodollisuus. Oikeuden etiikan heikko kohta on tilannekohtainen kohtuuttomuus oikeuksien korostamisen vuoksi. Tämä ratkaisumalli liitetään siviiliprosessin dispositiiviseen menettelyyn. Tutkielman näkökulmana on yksityisen asianosaisen asema ja kokemus prosessissa. Asianosainen on eri asemassa prosesseissa siinä suhteessa, että siviiliprosessiin osallistuminen edellyttää käytännössä asianajajan apuun turvautumista. Hallintoprosessissa on pyrkimys siihen, että yksityinen pärjää ilman avustajaa. Syynä on pidetty heikkoa kaksiasianosaissuhdetta ja sitä, että yksityisen asemaa on tasapainotettava suhteessa viranomaistahoon. Silti siviiliprosessissa asetelma saattaa yhtä hyvin olla epätasapainossa siten, että yksityinen on tiedollisesti ja taidollisesti heikommassa asemassa kuin vastapuolensa. Tuomarin roolia vertaillaan prosesseissa menettelyperiaatteiden ja vastuun jakautumisen sääntöjen avulla. Asianosaiset ovat siviiliprosessissa vastuussa asian oikeudellistamisesta. Myös totuuden käsite muodostuu erilaiseksi, koska selvitysvastuullinen hallintotuomari on lopulta vastuussa selvityksen riittävyydestä, kun taas siviiliprosessissa asianosaisen oikeussuojapyyntö rajaa totuuden. Siviiliprosessia on moitittu liiasta muodollisuudesta varsinkin sovittelukeskustelussa. Muodollisuus vaikeuttaa asianosaisen osallistumismahdollisuuksia ja etäännyttää häntä oikeusjutun käsittelystä. Muodollisuus edistää kuitenkin oikeusvarmuutta. Tuomioistuinsovittelussa on sanouduttu irti muodollisuudesta ja siinä sivussa myös aineellisesta oikeudesta. Sovittelussa on olemassa vaara siitä, että heikomman asema heikkenee entisestään. Joustava prosessi nähdään asianosaisen osallistumisen kannalta suotavampana menettelynä. Joustavuuden syynä on hallintoprosessissa käsiteltävien asioiden monimuotoisuus. Joustavuus ilmenee käytännössä virallisperiaatteen noudattamisena. Tuomarin toiminnan on oltava puolueetonta, mutta heikko asianosaissuhde ja yksityisen heikompi asema vaikuttavat siten, että tuomarin toiminta on tasapainottavaa paitsi yksityisen suuntaan, mutta myös yleisen edun suuntaan. Joustavuuden vuoksi asianosaisen luottamus saattaa vaarantua sen vuoksi, että prosessi ei ole ennakoitavaa ja prosessiasetelmaa on vaikea hahmottaa. Siten hallintoprosessissa onkin paineita oikeudellistamisen suuntaa. Joustavuuden rajana on puolueettomuuden vaatimus. Siviiliprosessissa puolueettomuus on kaksiasianosaissuhteen vuoksi korostuneempi kuin hallintoprosessissa. Puolueettomuuden vaatimus saattaa kuitenkin vaikuttaa siten, että tuomari ei voi auttaa heikompaa osapuolta riidan oikeudellistamisessa. Siten puolueettomuudella legitimoidaan vahvemman prosessiosapuolen asemaa. Olisiko virallisperiaatteesta apua siviiliprosessin muodollisuuden ongelmaan ja tasapainottamaan epätasapainoista suhdetta prosessiosapuolten välillä? Siviiliprosessi ja hallintoprosessi ovat lähentyneet toisiaan ja oikeuskirjallisuudessa on ennustettu tämän kehityksen jatkuvan. Myös oikeuden ja vastuun etiikka lähentyvät aikuisiässä toisiaan siten, että vastuun etiikka vahvistuu oikeuksien tärkeyden hahmottamisella ja oikeuden etiikassa kehittyy käsitys kohtuudesta. Prosessien kehityksessä olisi toivottavaa, että otettaisiin oppia toisen prosessilajin kehityksestä ja kokemuksista.

Kuka on potilas? : Suomalaisen sikiöseulontakäytännön sosiaalieettistä tarkastelua

Who is the patient? A social-ethical study of the Finnish practice of prenatal screening. The aim of this study is to examine the Finnish practice of prenatal screening from a social-ethical perspective. Analyzing ethical problems in medicine and medical practice only on a general scale may conceal relevant ethical dilemmas. Previous studies have suggested that many pregnant women view the prenatal screening practices customary in the Finnish maternal care system as intimidating and oppressive. This study analyzes the ethical questions of prenatal screening by focusing on the experiences and decision-making of a pregnant woman. Finnish women s experiences of and decision-making on the most common prenatal screening methods are reflected in the basic principles of biomedical ethics described by Tom L. Beauchamp and James F. Childress in Principles of Biomedical Ethics. To concretize women s experiences I refer to studies of Finnish women s experiences of prenatal screenings. This study shows that the principles of autonomy, non-maleficence and beneficence seem to materialize rather poorly in the Finnish practice of prenatal screening. The main ethical problem with prenatal screening is that the likelihood of a foetal cure is very limited and, upon detection of an affected foetus, the choice is usually whether to continue with the pregnancy or to undergo an abortion. Although informed consent should be required, women s participation in prenatal testing is, in many cases at least, not based on their active decision. Many women experience severe anxiety when they receive a positive screening result and must wait for the final results. Medical studies indicate that long- term anxiety may negatively influence the foetus and the mother-child relationship. This study shows that the practice of prenatal screening as such may cause more harm than benefit to many pregnant women and their foetuses. This study examines the decision-making process of a pregnant woman by using the theory of medical casuistry described in Jonsen, Siegler and Winslade s Clinical Ethics. This study focuses on each of the four points of view recommended by the theory. The main problem seems to be the question of whom the patient of prenatal screening is and whom the practice is intended to benefit: the mother, the foetus, the family or society? This study shows that the concepts of health in Finnish maternal care in general, and of the prenatal screening system in particular, differ considerably. It also demonstrates that the purpose and the aims of prenatal screening, aside from the woman s right to choose, has been expressed neither in Finnish public health programmes nor in the public recommendations of prenatal screening. This study suggests that the practice of prenatal screening is a statement, though unexpressed, of public health policy and as such comprises part of the policy of disability. This study further demonstrates that through a single explicit aim (the woman s right to choose) society actually evades its obligation to women by saddling pregnant women with the entire moral responsibility as well as the possible negative consequences of her choice, such as sorrow, regrets and moral balancing. The study reveals several ethical problems in the Finnish practice of prenatal screening. Such problems should be dealt with as the Finnish practice of prenatal screening advances.

Lahjoittamiseen rohkaisevat motivaatiotekijät Yhteisvastuukeräyksen keräysesitteissä

Tutkimuksen tehtävänä on tarkastella niitä keinoja, joita Yhteisvastuukeräys on käyttänyt keräysesitteissään houkutellakseen ihmisiä osallistumaan keräykseen. Lisäksi tutkimuksessa pohditaan käytettyjen keinojen yhteensopivuutta luterilaisen sosiaalietiikan kanssa. Tutkielman näkökulma on eettinen. Tutkittava aineisto on koottu Kirkkopalveluiden arkistosta ja se sisältää Yhteisvastuukeräyksestä vuosittain julkaistut keräysesitteet vuosilta 1959, 1960, 1974 sekä vuodesta 1979 vuoteen 2003. Luterilaisen sosiaalietiikan osalta tutkimuksessa tukeudutaan erityisesti suomalaiseen tutkimustraditioon, jota edustavat Antti Raunio, Tuomo Mannermaa sekä Jaana Hallamaa. Tutkimus on toteutettu referoimalla ja analysoimalla aineistoa sekä erilaisia tekstikokonaisuuksia ja pyrkimällä muodostamaan niiden pohjalta tutkimustehtävän kannalta mielekkäitä temaattisia kokonaisuuksia. Tutkielma sisältää neljä päälukua, joista ensimmäisessä käsitellään Yhteisvastuukeräyksen historiaa. Katsauksen tarkoituksena on esitellä keräyksen taitekohtia, jotka ovat vaikuttaneet sen toimintaan sekä keräysorganisaation diakonisen itseymmärryksen muodostumiseen. Seuraavat kolme päälukua käsittelevät aineiston pohjalta muodostettuja temaattisia kokonaisuuksia. Ensimmäinen kokonaisuus esittelee palkitsemisen yhtenä lahjoittamiseen rohkaisevana motivaatiotekijänä. Tutkimuksessa esitetään, että palkitseminen on osoitus pyrkimyksestä hyödyntää ihmisen luontaista itsekkyyttä. Käyttämällä hyväksi tätä ominaisuutta Yhteivastuu-keräys jättää huomioimatta sen, että luterilaisesta näkökulmasta katsottuna sisäinen motivaatio on teon arvioinnin kannalta olennainen tekijä ja moraalin tehtävänä on pyrkiä paljastamaan väärät ja itsekkäät motiivit. Toisaalta palkitseminen näyttää olevan myös vastoin Antti Raunion esittämää tulkintaa kristillisen avustutyön perusteista. Kristillisen avustustyön tulisi pohjautua lahjan-ajatukseen eikä sillä tulisi pyrkiä tavoittelemaan ulkopuolisia päämääriä tai palkintoja. Toinen temaattinen kokonaisuus käsittelee lähimmäisyyttä ja lähimmäisen tarpeisiin vastaamista motivaatioon vaikuttavana tekijänä. Yhteisvastsuukeräyksen esitteissä lähimmäinen on kuvattu kahdella tavalla: avun tarvitsijana ja avun vastaanottajana. Esitystavoilla on pyritty vakuuttamaan lahjoittaja siitä, että apu on tarpeen ja että avun vastaanottaja kykenee hyödyntämään saamansa tuen. Lähimmäinen avun tarvitsijana ja lähimmäisen tarve näyttävät olevan laupiaaseen samarialaiseen liitetyn vertauksen ja Kultaisen säännön mukaan myös luterilaisen tarkestelutavan keskiössä. Toisaalta nykyinen hyvinvointiyhteikunnan malli, jota myös luterilainen sosiaalietiikka korostaa, edellyttää ihmisiltä taloudellista itsenäisyyttä sekä halua toimia tuottavalla tavalla yhteisön hyväksi. Nämä näkökulmat yhdessä näyttävät tukevan Yhteisvastuukeräyksen käyttämää esitystapaa. Kolmas temaattinen kokonaisuus esittelee auttamisen päämääriin ja tavoitteisiin viittavat tavat motivoida lahjoittajaa. Löydetyt keinot jakaantuvat kahteen ryhmään sen mukaan onko niissä pyritty viittaamaan auttamisella konkreettisesti saavutettuihin tuloksiin vai arvoihin. Molemmat lähestymistavat kutsuvat lahjoittajaa vastustamaan epäoikeudenmukaisuutta ja köyhyyttä. Lutherin käsitys omaisuudesta, sen käytöstä sekä oppi pelatuksesta, joka on ihmisen omista teoista riippumaton, vaikuttivat yhdessä siihen, että luterilaiseen sosiaalieettiseen ajatteluun voitiin luontevasti yhdistää ajatus köyhyydestä yhteiskunnallisena epäkohtana. Toisaalta valtiolle siirtynyt päävastuu huolehtia köyhistä ja huonompiosaisista, on vaikuttanut kirkon mahdollisuuksiin toimia aktiivisena auttajana. Konkreettisen auttamistyön sijaan kirkon köyhyyden vastainen työ painottuu yhteiskunnalliseen ja poliittiseen vaikuttamiseen. Yhteisvatuukeräyksen esitteissä kantaaottavuuden ja yhteiskunnallisen kritiikin sijaan on panostettu avustustyön konkreettisuuteen ja yksilön vastuuseen ja vaikutusmahdollisuuksiin. Avainsanat: Yhteisvastuukeräys, lahjoittaminen, motivaatio, sosiaalietiikka - luterilaisuus