Iäkkäiden potilaiden selviytyminen päivittäisistä toiminnoista keskisuomalaisessa erikoissairaanhoidossa

English summary: Elderly patients' coping with activities of daily living in Jyväskylä Central Hospital

Fractures in older people - incidence, predictors and consequences

In older populations, fractures are common and the consequences of fractures may be serious both for an individual and for society. However, information is scarce about the incidence, predictors and consequences of fractures in population-based unselected cohorts including both men and women and a long follow-up. The objective of this study was to analyse the incidence and predictors of fractures as well as functional decline and excess mortality due to fractures, among 482 men and 695 women aged 65 or older in the municipality of Lieto, Finland from 1991 until 2002. In analyses, Poisson’s, Cox proportional Hazards and Cumulative Logistic regression models were used for the control of several confounding variables. During the 12-year follow-up with a total of 10 040 person-years (PY), 307 (26%) persons sustained altogether 425 fractures of which 77% were sustained by women. The total incidence of fractures was 53.4 per 1000 PY (95% confidence intervals [95% CI]: 47.9 - 59.5) in women and 24.9 per 1000 PY (95% CI: 20.4 - 30.4) in men. The incidence rates of fractures at any sites and hip fractures were associated with increasing age. No significant changes in the ageadjusted incidence rates of fractures were found in either gender during the 12-year follow-up. The predictors of fractures varied by gender. In multivariate analyses, reduced handgrip strength and body mass index (BMI) lower than 30 in women and a large number of depressive symptoms in men were independent predictors of fractures. A compression fracture in one or more thoracic or upper lumbar vertebras on chest radiography at baseline was associated with subsequent fractures in both genders. Lower body fractures independently predicted both short- (0-2 years) and long-term (up to 8 years) functional decline in mobility and activities of daily living (ADL) performance during the 8-year follow-up. Upper body fractures predicted decline in ADL performance during longterm follow-up. In the 12-year follow-up, hip fractures in men (Hazard Ratio [HR] 8.1, 95% CI: 4.4-14.9) and in women (HR 3.0, 95% CI: 1.9-4.9), and fractures at the proximal humerus in men (HR 5.4, 95% CI: 1.6-17.7) were independently associated with excess mortality. In addition, leisure time inactivity in physical exercise predicted independently both functional decline and excess mortality. Fractures are common among older people posing serious individual consequences. Further studies about the effectiveness of preventing falls and fractures as well as improving care and rehabilitation after fractures are needed.

Kotona asuvan muistipotilaan läheisen sosiaali- ja terveyspalvelujen käyttö

Tutkimuksen tarkoituksena oli kuvata kotona asuvan muistipotilaan läheisen sosiaali- ja terveyspalvelujen käyttöä. Tavoitteena oli selvittää, miten muistipotilaaseen ja hänen läheiseensä itseensä liittyvät tekijät ovat yhteydessä muistipotilaan läheisen sosiaali- ja terveyspalvelujen käyttöön. Tutkimus oli osa Euroopan Unionin rahoittamaa RightTi-mePlaceCare -tutkimusprojektia (FP7-Health-F3-2010–242153). Tutkimuksen kohderyhmän muodostivat säännöllisen kotihoidon piirissä olevat yli 65-vuotiaat muistipotilaat sekä heidän läheiset (N=182). Tutkimus toteutettiin Varsinais-Suomessa kolmen kaupungin alueelta tarkoituksenmukaista otantaa käyttäen. Aineisto kerättiin 19.11.2010–29.2.2012 välisenä aikana muistipotilaiden kotona haastattelemalla muistipotilaan nimeämää yhtä läheistä strukturoidun haastattelulomakkeen avulla, joka sisälsi neljä mittaria. Resource Utilization in Dementia (RUD)-mittarilla kerättiin tietoa läheisten taustasta, ajankäytöstä ja sosiaali- ja terveyspalvelujen käytöstä. Läheisten elämälaatuun liittyvää terveydentilaa tutkittiin EQ-5D-mittarilla. Muistipotilaan päivittäisistä toiminnoista selviytymistä kuvattiin KATZ (The KATZ Index of Independence in Activities of Daily Living)-mittarin avulla ja kognitiivista toimintakykyä S-MMSE (Standardized Mini-Mental State Examination)-mittarilla. Aineisto analysoitiin tilastollisin menetelmien SPSS -tilasto-ohjelmalla. Läheisten keski-ikä oli 65 vuotta ja heistä yli puolet oli muistipotilaiden lapsia (54 %) ja naisia (60 %). Vajaa puolet (45 %) läheisistä asui muistipotilaan kanssa samassa taloudessa. Muistipotilaiden keski-ikä oli 83 vuotta ja heistä yli puolet (63 %) oli naisia. Läheisten sosiaali- ja terveyspalvelujen käyttö oli vähäistä. Eniten he käyttivät yleislääkärin, fysioterapeutin palveluita ja maksettuja kuljetuspalveluita. Muistipotilaiden puolisot ja heidän kanssaan asuvat sekä naispuoliset läheiset käyttivät eniten palveluita. Kyseiset tekijät olivat yhteydessä palvelujen käyttöön. Muistipotilaat tarvitsivat jonkin verran apua päivittäisissä toiminnoissa. Läheiset, jotka käyttivät eniten aikaa muistipotilaan päivittäisissä toiminnoissa auttamiseen, käyttivät enemmän palveluita. Läheisten palvelujen käyttö oli yhteydessä muistipotilaan valvontaan käytetyn ajan kanssa. Muistipotilaan ja hänen läheisensä taustaan liittyvillä tekijöillä on merkittävä rooli läheisten sosiaali- ja terveyspalvelujen käyttöön. Läheisten palvelujen käyttöön liittyvät tekijät tulee ottaa huomioon kun tuloksia hyödynnetään käytäntöön ja kun muistipotilaan läheisiä tukevia sosiaali- ja terveyspalveluita suunnitellaan ja kohdennetaan läheisille.

Olipa kerran muutos - Narratiivinen tutkimus organisaatiosta sisäisten ja ulkoisten muutospaineiden keskellä

Tutkimus kuvaa tarinallisuuden kautta organisaation sisäistä muutosta organisaation toimiessa muuttuvassa toimintaympäristössä. Teoriaosan keskeisinä käsitteinä ovat sosiaalinen identiteetti organisaatiossa sekä muutosjohtaminen. Tutkimus selvittää, miten jatkuva organisatorinen ja toimintaympäristöllinen muutos vaikuttivat organisaation muutoskykyyn ja sen jäseniin, minkälaista muutosjohtamista organisaatio muutostilanteessa tarvitsee ja millaisia vaikutuksia muutoksilla oli organisaation sisällä esiintyviin sosiaalisiin identiteetteihin. Organisaatiomuutos ilmeni organisaation työntekijöissä erilaisina reaktioina: osa menetti uskonsa organisaatioon, toiset turhautuivat ja kaipasivat vahvistusta toiminnalleen ja kolmansilla työn sujuminen nousi keskiöön. Muutospaineiden keskellä organisaatiossa tarvitaan uskottavaa muutosviestintää ja johtavaa identiteettiä, johon kaikki organisaation jäsenet voivat samaistua. Tämän sosiaalisen identiteetin synnyn mahdollistaa organisaation johdon aktiivinen muutosprosessin johtaminen. Myös keskijohdon rooli johdon muutosviestin vahvistamisessa on tärkeä muutosprosessin onnistumiselle ja sisäistämiselle. Muutoksen johtamisessa on oleellista ottaa ihmisten johtaminen osaksi päivittäistä toimintaa. Organisaation jäsenten tunnepohjaisen sitouttamisen kautta saavutetaan mahdollisuus toteuttaa onnistunut muutosprosessi. Keskijohdon tehtävänä on viestiä ylimmän johdon visio työntekijätasolle uskottavasti, jotta muutokseen sitoudutaan. Muutosprosessin onnistumista tulee seurata ja tukea organisaation johdon taholta.

Software Development Process Modeling. Developers Perspective to Contemporary Modeling Techniques

Formal software development processes and well-defined development methodologies are nowadays seen as the definite way to produce high-quality software within time-limits and budgets. The variety of such high-level methodologies is huge ranging from rigorous process frameworks like CMMI and RUP to more lightweight agile methodologies. The need for managing this variety and the fact that practically every software development organization has its own unique set of development processes and methods have created a profession of software process engineers. Different kinds of informal and formal software process modeling languages are essential tools for process engineers. These are used to define processes in a way which allows easy management of processes, for example process dissemination, process tailoring and process enactment. The process modeling languages are usually used as a tool for process engineering where the main focus is on the processes themselves. This dissertation has a different emphasis. The dissertation analyses modern software development process modeling from the software developers’ point of view. The goal of the dissertation is to investigate whether the software process modeling and the software process models aid software developers in their day-to-day work and what are the main mechanisms for this. The focus of the work is on the Software Process Engineering Metamodel (SPEM) framework which is currently one of the most influential process modeling notations in software engineering. The research theme is elaborated through six scientific articles which represent the dissertation research done with process modeling during an approximately five year period. The research follows the classical engineering research discipline where the current situation is analyzed, a potentially better solution is developed and finally its implications are analyzed. The research applies a variety of different research techniques ranging from literature surveys to qualitative studies done amongst software practitioners. The key finding of the dissertation is that software process modeling notations and techniques are usually developed in process engineering terms. As a consequence the connection between the process models and actual development work is loose. In addition, the modeling standards like SPEM are partially incomplete when it comes to pragmatic process modeling needs, like light-weight modeling and combining pre-defined process components. This leads to a situation, where the full potential of process modeling techniques for aiding the daily development activities can not be achieved. Despite these difficulties the dissertation shows that it is possible to use modeling standards like SPEM to aid software developers in their work. The dissertation presents a light-weight modeling technique, which software development teams can use to quickly analyze their work practices in a more objective manner. The dissertation also shows how process modeling can be used to more easily compare different software development situations and to analyze their differences in a systematic way. Models also help to share this knowledge with others. A qualitative study done amongst Finnish software practitioners verifies the conclusions of other studies in the dissertation. Although processes and development methodologies are seen as an essential part of software development, the process modeling techniques are rarely used during the daily development work. However, the potential of these techniques intrigues the practitioners. As a conclusion the dissertation shows that process modeling techniques, most commonly used as tools for process engineers, can also be used as tools for organizing the daily software development work. This work presents theoretical solutions for bringing the process modeling closer to the ground-level software development activities. These theories are proven feasible by presenting several case studies where the modeling techniques are used e.g. to find differences in the work methods of the members of a software team and to share the process knowledge to a wider audience.

Fetal alcohol spectrum disorders in Finnish children and adolescents : diagnosis, cognition, behavior, adaptation and brain metabolic alterations

Alcohol consumption during pregnancy can potentially affect the developing fetus in devastating ways, leading to a range of physical, neurological, and behavioral alterations most accurately termed Fetal Alcohol Spectrum Disorders (FASD). Despite the fact that it is a preventable disorder, prenatal alcohol exposure today constitutes a leading cause of intellectual disability in the Western world. In Western countries where prevalence studies have been performed the rates of FASD exceed, for example, autism spectrum disorders, Down’s syndrome and cerebral palsy. In addition to the direct effects of alcohol, children and adolescents with FASD are often exposed to a double burden in life, as their neurological sequelae are accompanied by adverse living surroundings exposing them to further environmental risk. However, children with FASD today remain remarkably underdiagnosed by the health care system. This thesis forms part of a larger multinational research project, The Collaborative Initiative on Fetal Alcohol Spectrum Disorders (the CIFASD), initiated by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) in the U.S.A. The general aim of the present thesis was to examine a cohort of children and adolescents growing up with fetal alcohol-related damage in Finland. The thesis consists of five studies with a broad focus on diagnosis, cognition, behavior, adaptation and brain metabolic alterations in children and adolescents with FASD. The participants consisted of four different groups: one group with histories of prenatal exposure to alcohol, the FASD group; one IQ matched contrast group mostly consisting of children with specific learning disorder (SLD); and two typically-developing control groups (CON1 and CON2). Participants were identified through medical records, random sampling from the Finnish national population registry and email alerts to students. Importantly, the participants in the present studies comprise a group of very carefully clinically characterized children with FASD as the studies were performed in close collaboration with leading experts in the field (Prof. Edward Riley and Prof. Sarah Mattson, Center for Behavioral Teratology, San Diego State University, U.S.A; Prof. Eugene Hoyme, Sanford School of Medicine, University of South Dakota, U.S.A.). In the present thesis, the revised Institute of Medicine diagnostic criteria for FASD were tested on a Finnish population and found to be a reliable tool for differentiating among the subgroups of FASD. A weighted dysmorphology scoring system proved to be a valuable additional adjunct in quantification of growth deficits and dysmorphic features in children with FASD (Study 1). The purpose of Study 2 was to clarify the relationship between alcohol-related dysmorphic features and general cognitive capacity. Results showed a significant correlation between dysmorphic features and cognitive capacity, suggesting that children with more severe growth deficiency and dysmorphic features have more cognitive limitations. This association was, however, only moderate, indicating that physical markers and cognitive capacity not always go hand in hand in individuals with FASD. Behavioral problems in the FASD group proved substantial compared to the typically developing control group. In Study 3 risk and protective factors associated with behavioral problems in the FASD group were explored further focusing on diagnostic and environmental factors. Two groups with elevated risks for behavioral problems emerged: length of time spent in residential care and a low dysmorphology score proved to be the most pervasive risk factor for behavioral problems. The results underscore the clinical importance of appropriate services and care for less visibly alcohol affected children and highlight the need to attend to children with FASD being raised in institutions. With their background of early biological and psychological impairment compounded with less opportunity for a close and continuous caregiver relationship, such children seem to run an especially great risk of adverse life outcomes. Study 4 focused on adaptive abilities such as communication, daily living skills and social skills, in other words skills that are important for gradually enabling an independent life, maintain social relationships and allow the individual to become integrated into society. The results showed that adaptive abilities of children and adolescents growing up with FASD were significantly compromised compared to both typically-developing peers and IQ-matched children with SLD. Clearly different adaptive profiles were revealed where the FASD group performed worse than the SLD group, who in turn performed worse than the CON1 group. Importantly, the SLD group outperformed the FASD group on adaptive behavior in spite of comparable cognitive levels. This is the first study to compare adaptive abilities in a group of children and adolescents with FASD relative to both a contrast group of IQ-matched children with SLD and to a group of typically-developing peers. Finally, in Study 5, through magnetic resonance spectroscopic imaging (MRS) evidence of longstanding neurochemical alterations were observed in adolescents and young adults with FASD related to alcohol exposure in utero 14-20 years earlier. Neurochemical alterations were seen in several brain areas: in frontal and parietal cortices, corpus callosum, thalamus and frontal white matter areas as well as in the cerebellar dentate nucleus. The findings are compatible with neuropsychological findings in FASD. Glial cells seemed to be more affected than neurons. In conclusion, more societal efforts and resources should be focused on recognizing and diagnosing FASD, and supporting subgroups with elevated risk of poor outcome. Without adequate intervention children and adolescents with FASD run a great risk of marginalization and social maladjustment, costly not only to society but also to the lives of the many young people with FASD.

Tietohallinnon haasteet kasvavassa ja kehittyvässä toimintaympäristössä – Toimintatutkimus suomalaisen PK-yrityksen kasvusta globaaliksi toimijaksi

Tutkimuksen tavoitteena on kuvata suomalaisen PK-yrityksen kasvamista globaa- liksi toimijaksi. Tapahtunut kasvu on tarkoittanut case-yrityksen kohdalla liike- vaihdon ja henkilöstömäärän kasvun lisäksi myös toimipaikkojen määrän kasvua ja organisaatiorakenteen monimutkaistumista. Näiden muutosten perusteella ja ta- pahtuneiden muutoskohtien avulla on löydettävissä yrityksen toimintaa kuvaavia vaiheita, joita ovat alkuvaihe, kasvuvaihe ja kypsä vaihe. Näiden vaiheiden jälkeen tulee vielä neljäs vaihe, eli uusiutumisvaihe tai laskeva vaihe. Tämän neljännen vaiheen suunta riippuu yrityksen kyvystä uusiutua ja kehittyä vastaamaan uusiin tuleviin haasteisiin joita aikaisempaa globaalimpi toiminta tuo tullessaan. Tapahtuneilla muutoksilla on ollut myös vaikutusta tietohallintoon. Tämä tieto- hallinnossa tapahtunut muutos onkin tämän tutkimuksen ydin, eli mitä haasteita ja vaatimuksia Trafotekin tietohallinto on kohdannut toiminnan eri vaiheissa, ja onko tietohallinto pystynyt omalta osaltaan vastaamaan näihin vaatimuksiin. Toiminnan alkuvaiheessa tietotekniikalla ei ollut suurtakaan strategista ja liike- toimintaa tukevaa roolia, ja tietohallinto pystyikin vastaamaan liiketoiminnan vaa- timuksiin. Tässä vaiheessa Trafotekissa ei ollut erillistä tietohallintoa, vaan tieto- tekniset työt hoidettiin muiden työtehtävien ohessa. Tietotekniset tehtävät olivat lähinnä tukitoimintoihin liittyviä tehtäviä. Kasvuvaiheessa tietotekniikan merkitys kasvoi, ja Trafotekiin tuli tarvetta luoda erillinen tietotekninen työtehtävä. Tässä toiminnan vaiheessa kyvykkyydet ja kypsyys eivät kuitenkaan kehittyneet halu- tulla tavalla, sillä kaikki käytössä oleva resursointi käytettiin edelleen päivittäisiin tukitoimintoihin, kehittämisen sijaan. Sama kehittymättömyys vaivasi toiminnan kypsässä vaiheessa. Tässä vaiheessa toki alettiin jo ymmärtää, että tietohallinnolla on strateginen rooli, joka tukee liiketoimintaa sen tavoitteiden saavuttamisessa. Tehty tutkimus tukee näkemystä siitä, että myös tietohallinnon kehittäminen on kokonaisvaltaista kehittämistä, jossa pitää huomioida toimintaa tukevia kyvyk- kyyksiä kaikissa toiminnan vaiheissa. Yrityksen kasvaessa myös tietohallinnon tu- lee kasvaa ja kehittyä. Osa tämän tutkimuksen tapahtumista oli tapahtunut ennen tämän tutkimustyön varsinaista aloittamista, eli ne kuvataan ja selitetään jälkijättöisesti. Kyseessä on toimintatutkimus, joka ajoittuu vuosiin 1996–2014. Avainsanat: globalisaatio, kansainvälinen kasvu, tietohallinto, tietohallinnon joh- taminen ja kehitys, kasvu-, kehitys- ja kypsyysmalli

Flexible Sensor for Wearable Vital Sign Monitoring System

In modern society, the body health is a very important issue to everyone. With the development of the science and technology, the new and developed body health monitoring device and technology will play the key role in the daily medical activities. This paper focus on making progress in the design of the wearable vital sign system. A vital sign monitoring system has been proposed and designed. The whole detection system is composed of signal collecting subsystem, signal processing subsystem, short-range wireless communication subsystem and user interface subsystem. The signal collecting subsystem is composed of light source and photo diode, after emiting light of two different wavelength, the photo diode collects the light signal reflected by human body tissue. The signal processing subsystem is based on the analog front end AFE4490 and peripheral circuits, the collected analog signal would be filtered and converted into digital signal in this stage. After a series of processing, the signal would be transmitted to the short-range wireless communication subsystem through SPI, this subsystem is mainly based on Bluetooth 4.0 protocol and ultra-low power System on Chip(SoC) nRF51822. Finally, the signal would be transmitted to the user end. After proposing and building the system, this paper focus on the research of the key component in the system, that is, the photo detector. Based on the study of the perovskite materials, a low temperature processed photo detector has been proposed, designed and researched. The device is made up of light absorbing layer, electron transporting and hole blocking layer, hole transporting and electron blocking layer, conductive substrate layer and metal electrode layer. The light absorbing layer is the important part of whole device, and it is fabricated by perovskite materials. After accepting the light, the electron-hole pair would be produced in this layer, and due to the energy level difference, the electron and hole produced would be transmitted to metal electrode and conductive substrate electrode through electron transporting layer and hole transporting layer respectively. In this way the response current would be produced. Based on this structure, the specific fabrication procedure including substrate cleaning; PEDOT:PSS layer preparation; pervoskite layer preparation; PCBM layer preparation; C60, BCP, and Ag electrode layer preparation. After the device fabrication, a series of morphological characterization and performance testing has been done. The testing procedure including film-forming quality inspection, response current and light wavelength analysis, linearity and response time and other optical and electrical properties testing. The testing result shows that the membrane has been fabricated uniformly; the device can produce obvious response current to the incident light with the wavelength from 350nm to 800nm, and the response current could be changed along with the light wavelength. When the light wavelength keeps constant, there exists a good linear relationship between the intensity of the response current and the power of the incident light, based on which the device could be used as the photo detector to collect the light information. During the changing period of the light signal, the response time of the device is several microseconds, which is acceptable working as a photo detector in our system. The testing results show that the device has good electronic and optical properties, and the fabrication procedure is also repeatable, the properties of the devices has good uniformity, which illustrates the fabrication method and procedure could be used to build the photo detector in our wearable system. Based on a series of testing results, the paper has drawn the conclusion that the photo detector fabricated could be integrated on the flexible substrate and is also suitable for the monitoring system proposed, thus made some progress on the research of the wearable monitoring system and device. Finally, some future prospect in system design aspect and device design and fabrication aspect are proposed.

Elämänlaatu ja iäkkäiden kaatumisten ehkäisy

Quality of life and fall prevention among the aged Improvement of quality of life is considered to be one of the most important goals of prevention, treatment and rehabilitation among the aged. The study aimed to describe and assess fall prevention interventions as a quality of life indicator, and to describe the social dimension of health-related quality of life among the aged. In addition, it aimed to assess the effects of fall prevention intervention on quality of life among the aged. The study was implemented by using a methodological triangulation. The data in the systematic review was retrieved from the databasis of medical and nursing sciences. Home-dwelling aged (n=19) participated in the qualitative study of a social dimension of quality of life. The data was gathered by the thematic interview method. The quantitative multifactorial fall prevention study comprised 591 participants, either the aged living at home or in sheltered housing, showing an increased risk of falling. Participants were randomized into an intervention or a control group. Follow-up measurements were carried out after a 12 month intervention. The data was collected by the 15D quality of life instrument and a structured questionnaire. Based on the systematic review, only in a few studies fall prevention produced positive effects on dimensions of quality of life (physical function, social function, vitality, mental health, environmental domain). Based on the thematic interview the social dimension of quality of life consisted of three themes: personal values, personal milieu and personal daily life. Based on the fall prevention program, depressive symptoms and distress decreased, managing in usual activities improved, sexual activity and phone contacts increased among men. In women, managing in usual activities improved, socializing increased and discomfort and symptoms decreased. Within the groups, self-perceived health improved among women in the intervention group and among men in the control groups. In addition, fear of falling and feelings of insecurity reduced among women in the intervention group. Personal daily life with its activities opened up new perspectives into the social dimension of good quality of life, which was emphasized especially in the interviews of the oldest participants. Multifactorial fall prevention can affect positively some physical and psychosocial dimensions of quality of life among the community-dwelling aged. Additional studies with larger sample sizes, longer follow-up periods and multiple outcome measures are needed. Fall prevention intervention may affect quality of life by different mechanisms, and the quantitative and qualitative assessment of its effects should also be included in the interventions of randomized controlled trials.

Supporting older people’s independent living at home through social and health care collaboration

Tässä tutkimuksessa tarkasteltiin ikäihmisten kotona asumista sosiaali- ja terveydenhuollon yhteistyön näkökulmasta. Tutkimuksen tarkoituksena oli lisätä ymmärrystä iäkkäiden kotihoidon asiakkaiden voimavaroista arjesta selviytymisen näkökulmasta, ja tutkia miten asiakkaiden hoito sosiaali- ja terveydenhuollon yhteistyönä toteutuu. Tutkimus oli poikkileikkaustutkimus, jossa sovellettiin kuvailevaa ja vertailevaa tutkimusasetelmaa. Tutkimusaineisto kerättiin yhden länsisuomalaisen kunnan kotihoidon asiakkailta (≥65 v.) ja heitä hoitavilta ammattihenkilöiltä. Kotihoidon 21 iäkästä asiakasta kuvasivat omia voimavarojaan arjesta selviytymisen näkökulmasta sekä kokemuksiaan hoidon toteutumisesta ammattihenkilöiden yhteistyönä. Aineisto kerättiin avoimella haastattelulla ja analysoitiin sisällön analyysillä. Lisäksi 25 kotihoidon ammattihenkilöä: 13 kotipalvelun työntekijää, 11 kotisairaanhoitajaa ja lääkäri kuvasivat kokemuksiaan iäkkään asiakkaan hoidon toteutumisesta ammattihenkilöiden yhteistyönä. Aineisto kerättiin fokusryhmähaastattelulla ja analysoitiin sisällön analyysillä. Näiden tulosten sekä aikaisemman kirjallisuuden perusteella laadittiin strukturoitu kyselylomake, jolla analysoitiin ja vertailtiin asiakkaiden ja ammattihenkilöiden näkemyksiä siitä, miten asiakkaiden hoito sosiaali- ja terveydenhuollon yhteistyönä toteutui. Esitestausten jälkeen kyselylomake lähetettiin 200 kotihoidon asiakkaalle ja 570 heitä hoitavalle kotihoidon työntekijälle: 485 kotipalvelun työntekijälle, 81 kotisairaanhoitajalle ja 4 lääkärille. Kyselyyn vastasi 120 asiakasta (60 %) ja 370 ammattihenkilöä (65 %). Ryhmien välisten erojen tarkastelussa käytettiin ristiintaulukointia, Pearsonin khin neliötestiä ja Fisherin tarkan todennäköisyyden testiä. Iäkkäiden asiakkaiden kuvauksissa voimavarat muodostuivat elämänhallinnan tunteesta ja toimintatahdon säilymisestä. Asiakkaat ammensivat arkeen voimaa harrastuksista ja sosiaalisesta verkostosta, mutta ulkopuolisten asettamat elämisen ehdot, terveydentilan heikkeneminen sekä yksinäisyys asettivat ikäihmisen ja hänen voimavaransa suurten haasteiden eteen. Tulokset osoittivat, että ammattihenkilöiden toiminta oli osittain ristiriidassa ikäihmisten omien odotusten kanssa, eikä se kaikilta osin tukenut asiakkaiden omia voimavaroja. Ammattihenkilöt tekivät hoitoon liittyviä päätöksiä ja toimintoja asiakkaiden puolesta, vaikka asiakkaille itselleen oli tärkeää elämänhallinnan tunne ja toimintatahdon säilyminen. Asiakkaiden voimavarojen tukemista moniammatillisena yhteistyönä vaikeuttivat ammattihenkilöiden vaikeus tunnistaa asiakkaiden omia voimavaroja sekä niitä uhkaavia tekijöitä, tiedon kulun ongelmat, tavoitteeton ja epäyhtenäinen tapa toimia sekä ammattihenkilöiden vastakkain asettuvat näkemyserot ja toimintatavat. Asiakkaiden ja ammattihenkilöiden näkemykset toteutetusta hoidosta erosivat toisistaan tilastollisesti merkitsevästi (p<0.05). Asiakkaat arvioivat sekä itsenäiseen toimintaan tukemisen että fyysisen, psyykkisen ja sosiaalisen tuen toteutuneen työntekijöitä huonommin. Yhteistyön kehittämishaasteita kotihoidossa ovat asiakkaan oman elämänsä asiantuntijuuden vahvistaminen, toimintakulttuurin muuttaminen asiakaslähtöiseksi tavoitteelliseksi toiminnaksi, ammattihenkilöiden roolien ja vastuun selkiyttäminen sekä tiedon kulun menetelmien kehittäminen. Tutkimus vahvistaa gerontologisen hoitotieteen tietoperustaa ja tuottaa uutta tietoa, jota voidaan soveltaa sosiaali- ja terveysalan koulutuksessa ja johtamisessa

An Infant with Food Allergy and Eczema in the Family – The Mental and Economic Burden of Caring

Allergic diseases including food allergy and eczema in an infant in combination with the everyday activities of caring for a family will pose challenges to parents. Only fragments of these challenges are revealed to health care professionals. Families have varying mental, social and economic resources to help them care for an allergic infant, and all such resources are important in determining how families succeed in meeting these challenges and the quality of the infant’s care. This study evaluated the whole burden to the family caused by an infant's allergic disease during the first 24 months of life. As the primary caregiver during this period is usually the mother, her perspective was considered important. Ecocultural theory, which considers families as capable of modifying the positive and negative forces facing them, was taken as the frame of reference. Data were collected as part of an ongoing prospective mother-infant study, and the methods included severity scoring of atopic dermatitis, dietary records, health-related quality of life measurements and assessments of the use of health care services and medications for treating the infant’s eczema, food allergy and asthma. Interviews with mothers were analysed by deductive content analysis on the basis of ecocultural theory and the family empowerment model. The theme “Living an ordinary family life” guided the organization of family activities essential for treating the infant's food allergy and eczema. These activities were sources of both strain and support for the mothers, the allergy-related supporting factors being the mother’s own knowledge of the allergy, hopes for an improvement in the infant’s condition, social support and work. An infant’s food allergy at the age of one year caused considerable strain for the mother in cases where the introduction of new foods into the child’s diet was delayed. This delay was still causing the mother additional strain when the child was 24 months of age. The infants waking at night at the ages of 12 and 24 months because of itching related to eczema caused strain for the mothers. The infants’ health-related quality of life was impaired at ages of 6 and 12 months compared with healthy infants. The principal reasons for impairments were itching, scratching and sleep disturbances at 6 and 12 months and treatment difficulties at 6 months. Problems with getting to sleep were reported at all stages irrespective of eczema and were also present in healthy infants. The economic impact of the treatment of allergic diseases on families during the first 24 months was 131 EUR (2006 value) in cases of eczema and 525 EUR in cases of food allergy. From the societal perspective, the costs of food allergy were a median of 3183 EUR (range 628–11 560 EUR) and of eczema a median of 275 EUR (range 94–1306 EUR). These large variations in costs in food allergy and eczema indicate that disease varies greatly . In conclusion, food allergy and eczema cause extra activities and costs to families which arrange these disease-related activities in such a way that they support the leading family theme “Living an ordinary family life”. Health care professionals should consider this thematic character of family life and disease-related activities in order to ensure that new treatments are sustainable, meaningful and tailored to daily activities. In addition, those mothers who are experiencing difficulties with food allergic infants or infants with eczema should be recognized early and provided with individual encouragement and support from health clinics. In the light of the present results, early detection of symptoms and effective parental guidance can contribute to the well-being and health-related quality of life of the child and family.

Semantic and fuzzy modelling for human behaviour recognition in smart spaces : a case study on ambient assisted living.

Human activity recognition in everyday environments is a critical, but challenging task in Ambient Intelligence applications to achieve proper Ambient Assisted Living, and key challenges still remain to be dealt with to realize robust methods. One of the major limitations of the Ambient Intelligence systems today is the lack of semantic models of those activities on the environment, so that the system can recognize the speci c activity being performed by the user(s) and act accordingly. In this context, this thesis addresses the general problem of knowledge representation in Smart Spaces. The main objective is to develop knowledge-based models, equipped with semantics to learn, infer and monitor human behaviours in Smart Spaces. Moreover, it is easy to recognize that some aspects of this problem have a high degree of uncertainty, and therefore, the developed models must be equipped with mechanisms to manage this type of information. A fuzzy ontology and a semantic hybrid system are presented to allow modelling and recognition of a set of complex real-life scenarios where vagueness and uncertainty are inherent to the human nature of the users that perform it. The handling of uncertain, incomplete and vague data (i.e., missing sensor readings and activity execution variations, since human behaviour is non-deterministic) is approached for the rst time through a fuzzy ontology validated on real-time settings within a hybrid data-driven and knowledgebased architecture. The semantics of activities, sub-activities and real-time object interaction are taken into consideration. The proposed framework consists of two main modules: the low-level sub-activity recognizer and the high-level activity recognizer. The rst module detects sub-activities (i.e., actions or basic activities) that take input data directly from a depth sensor (Kinect). The main contribution of this thesis tackles the second component of the hybrid system, which lays on top of the previous one, in a superior level of abstraction, and acquires the input data from the rst module's output, and executes ontological inference to provide users, activities and their in uence in the environment, with semantics. This component is thus knowledge-based, and a fuzzy ontology was designed to model the high-level activities. Since activity recognition requires context-awareness and the ability to discriminate among activities in di erent environments, the semantic framework allows for modelling common-sense knowledge in the form of a rule-based system that supports expressions close to natural language in the form of fuzzy linguistic labels. The framework advantages have been evaluated with a challenging and new public dataset, CAD-120, achieving an accuracy of 90.1% and 91.1% respectively for low and high-level activities. This entails an improvement over both, entirely data-driven approaches, and merely ontology-based approaches. As an added value, for the system to be su ciently simple and exible to be managed by non-expert users, and thus, facilitate the transfer of research to industry, a development framework composed by a programming toolbox, a hybrid crisp and fuzzy architecture, and graphical models to represent and con gure human behaviour in Smart Spaces, were developed in order to provide the framework with more usability in the nal application. As a result, human behaviour recognition can help assisting people with special needs such as in healthcare, independent elderly living, in remote rehabilitation monitoring, industrial process guideline control, and many other cases. This thesis shows use cases in these areas.

Litteracitet i fem högstadieungdomars en-till-en-datorpraktiker

The study focuses on five lower secondary school pupils’ daily use of their one-toone computers, the overall aim being to investigate literacy in this form of computing. Theoretically, the study is rooted in the New Literacy tradition with an ecological perspective, in combination with socio-semiotic theory in a multimodal perspective. New Literacy in the ecological perspective focuses on literacy practices and place/space and on the links between them. Literacy is viewed as socially based, in specific situations and in recurring social practices. Socio-semiotic theory embodying the multimodal perspective is used for the text analysis. The methodology is known as socio-semiotic ethnography. The ethnographic methods encompass just over two years of fieldwork with participating observations of the five participants’ computing activities at home, at school and elsewhere. The participants, one boy and two girls from the Blue (Anemone) School and two girls from the White (Anemone) School, were chosen to reflect a broad spectrum in terms of sociocultural and socioeconomic background. The study shows the existence of a both broad and deep variation in the way digital literacy features in the participants’ one-to-one computing. These variations are associated with experience in relation to the home, the living environment, place, personal qualities and school. The more varied computer usage of the Blue School participants is connected with the interests they developed in their homes and living environments and in the computing practices undertaken in school. Their more varied usage of the computer is reflected in their broader digital literacy repertoires and their greater number and variety of digital literacy abilities. The Blue School participants’ text production is more multifaceted, covers a wider range of subjects and displays a broader palette of semiotic resources. It also combines more text types and the texts are generally longer than those of the White School participants. The Blue School girls have developed a text culture that is close to that of the school. In their case, there is clear linkage between school-initiated and self-initiated computing activities, while other participants do not have the same opportunities to link and integrate self-initiated computing activities into the school context. It also becomes clear that the Blue School girls can relate and adapt their texts to different communicative practices and recipients. In addition, the study shows that the Blue School girls have some degree of scope in their school practice as a result of incorporating into it certain communicative practices that they have developed in nonschool contexts. Quite contrary to the hopes expressed that one-to-one computing would reduce digital inequality, it has increased between these participants. Whether the same or similar results apply in a larger perspective, on a more structural level, is a question that this study cannot answer. It can only draw attention to the need to investigate the matter. The study shows in a variety of ways that the White School participants do not have the same opportunity to develop their digital literacy as the Blue School participants. In an equivalence perspective, schools have a compensational task to perform. It is abundantly clear from the study that investing in one-to-one projects is not enough to combat digital inequality and achieve the digitisation goals established for school education. Alongside their investments in technology, schools need to develop a didactic that legitimises and compensates for the different circumstances of different pupils. The compensational role of schools in this connection is important not only for the present participants but also for the community at large, in that it can help to secure a cohesive, open and democratic society.