Children at psychiatric risk and their families in Bucharest, in the context of 25 years of changes after December 89’ Romanian Revolution

The aim of the present dissertation was to capture a picture of child and adolescent mental health in Romania, in the context of almost 25 years of changes following the Romanian Revolution of December ’89. A three-part study was carried out in order to provide consistent answers to the pre-defined objectives: to appraise the development of child and adolescent mental health services in Romania (Part I), to explore the characteristics of clinically-referred patients in a Romanian child and adolescent psychiatry department (Part II), to examine the children’s mental health state and its connections with family functioning and associated risk factors (Part III). A multi-method research approach was used, comprising one qualitative analysis and two quantitative research studies. Part I consisted of a comparative qualitative analysis of the answers given by 10 mental health professionals at a 12-questions open ended interview about the current situation in child and adolescent mental health in Romania, on three topics: changes, challenges, solutions. Part II involved a descriptive quantitative analysis of certain variables (e.g. age, gender, primary diagnosis, co-morbidities, time of hospitalization) conducted on the patients who had been admitted to the Child and Adolescent Psychiatry Department at “Prof. Dr. Alexandru Obregia” Psychiatry Hospital, Bucharest in 1991 and in 2013. Part III was conducted on 342 subjects enrolled in two clinical groups and one school group, this study being performed through a cross-sectional analysis on multi-informant child and adolescent mental health problems and competencies (CBCL, YSR, SDQ P, SDQ SR) and their interrelation with household information (HQ) and family functioning (FAD). Outlining the results it can be stated that: 1) The CAMH System in Romania is definitely set on the path of reorganization, including a higher involvement of beneficiaries and of the community. 2) The characteristics of the admitted patients have changed significantly during the last almost 25 years since `89 December Revolution, under the influence of word wide trends in child psychiatry and of administrative aspects of the mental health network in Romania. 3) The rates of main diagnoses and co-morbidities confirm the reports in literature, with Autism Spectrum Disorder being the most frequent childhood psychiatric disorders in this study. 4) The children’s mental health problems in the psychiatry group are comparable to those reported for other clinical populations. 5) Significant score differences were observed according to various household features and also meaningful associations between a child’s clinical status and different aspects of family functioning. The Romanian Child and Adolescent Psychiatry has started to adopt the norms and standards of the European Union. In the 25 years that have elapsed after the 1989 Revolution, many changes have occurred in Romanian CAMH, but many unresolved issues have also risen. Therefore, the major contribution of this thesis is that it provides a coherent and updated overview of the present-day situation from three different perspectives- those of mental healthcare professionals, the one observed in clinical patients and the one reported by children’s families.

The Future of Mobile Services and Wireless Applications in the Finnish Healthcare Sector

Työn päätavoitteena oli tutkia mobiilipalveluita ja langattomia sovelluksia Suomen terveydenhuollon sektorilla. Tutkimus havainnollistaa avain-alueita, missä mobiilipalvelut ja langattomat sovellukset voivat antaa lisäarvoa perinteiseen lääketieteen harjoittamiseen, ja selvittää, mitkä ovat tähän kehitykseen liittyvät suurimmat ongelmat ja uhkat sekä tutkimustuloksiin pohjautuvat mahdolliset palvelut ja sovellukset 5-10 vuoden kuluttua. Tutkimus oli luonteeltaan kvalitatiivinen ja tutkimuksen toteuttamiseen valittiin tulevaisuudentutkimus ja erityisesti yksi sen menetelmistä, delfoi-menetelmä. Tutkimuksen aineisto kerättiin kahdelta puolistrukturoidulta haastattelukierrokselta. Työn empiirinen osuus keskittyi kuvailemaan Suomen terveydenhuollon sektoria, siinä meneillään olevia projekteja sekä teknisiä esteitä. Lisäksi pyrittiin vastaamaan tutkimuksen pääkysymykseen. Tutkimustulokset osoittivat, että tärkeät alueet, joihin langaton kommunikaatio tulisi vaikuttamaan merkittävästi, ovat ensiaputoiminta, kroonisten potilaiden etämonitorointi, välineiden kehittäminen langattomaan kommunikaatioon kotihoidon parantamiseksi ja uusien toimintamallien luomiseksi sekä lääketieteellinen yhteistyö jakamalla terveydenhuoltoon liittyvät informaation lähteet. Työn tulosten perusteellavoitiin antaa myös muutamia toimenpide-ehdotuksia jatkotutkimuksia varten.

TURKU TAKING STEPS TOWARDS FUTURE - technology supports physical activity

Physical activity (PA) is an important field of healthcare research internationally and within Finland. As technology devices and services penetrate deeper levels within society, the need for studying the usefulness for PA turns vital. We started this research work by reviewing literature consisting of two hundred research journals, all of which have found technology to significantly improve an individual’s ability to get motivation and achieve officially recommended levels of physical activity, like the 10000 steps a day, being tracked with the help of pedometers. Physical activity recommendations require sustained encouragement, consistent performance in order to achieve the long term benefits. We surveyed within the city of Turku, how the motivation levels and thirty three other criterions encompassing technology awareness, adoption and usage attitudes are impacted. Our aim was to know the factors responsible for achieving consistent growth in activity levels within the individuals and focus groups, as well as to determine the causes of failures and for collecting user experience feedback. The survey results were quite interesting and contain impeccable information for this field. While the focus groups confirmed the theory established by past studies within our literature review, it also establishes our research propositions that ict tools and services have provided and can further add higher benefits and value to individuals in tracking and maintain their activity levels consistently for longer time durations. This thesis includes two new models which dictate technology and physical activity adoption patterns based on four easy to evaluate criterions, thereby helping the healthcare providers to recommend improvements and address issues with an easy rule based approach. This research work provides vital clues on technology based healthcare objectives and achievement of standard PA recommendations by people within Turku and nearby regions.

The key practices of customer portfolio management (CPM) process in the medical and healthcare B2B industry

The goal of this study is to deepen the understanding of the customer portfolio management process. There are many models for the process, and they are not necessarily exclusive of each other. Consequently, the inclusion of many models might even prove out to be beneficial. Other theoretical framework include the current economical situation and its propose on customer portfolio management. With an understanding of the theoretical models as a background, the empirical part of this study compares Finnish multinational medical and healthcare technology companies’ customer portfolio management practices. The empirical research was carried out with theme interviews held with 11 sales and marketing managers or directors from four different companies. The goal was to discover the most essential practices of the process steps in the companies. The result of this study is that there is a lack of systematic customer portfolio management, but most companies are aiming to improve this in the near future. The most essential practices are analysis of sales, communication level, learning, and commitment to strategy of the focal company. Special characteristics of this industry include large business networks that include customers, professional end-users, institutions, universities, researchers, and key opinion leaders. The management and analysis of this comprehensive network has been seen to be extremely important for this industry.

Contemporary marketing in the high-tech industry: Perceptions of Finnish IT marketing professionals

Over the last 30 years, new technologies and globalization have radically changed the way in which marketing is conducted. However, whereas their effects on business in general have been widely discussed, the focus of the effects on marketing remains without clear recognition. Global research has been made to shed light onto the issue, but it has widely concentrated on the views of executives as well as the consumer markets. In addition, a research gap is existent in applying the concept of marketing change in a specific business-to-business (B2B) industry. Therefore, the main research question this study seeks to answer is: “How is contemporary marketing conducted in the high-technology industry?” In this research, the researcher considers the specific industry of high-technology. However, as the industry is comprised of differing markets, the focus will be given to one of the industry’s prime sectors – the information technology (IT) markets, where companies offer other firms products or services manufactured with advanced technology. The growing IT-market is considered of critical importance in the economies of technologically ready countries such as Finland, where this research is also conducted. Through multiple case studies the researcher aims to describe how the changes in technology, customer engagement and future trends have shaped the way in which successful high-tech marketing is conducted in today’s marketplace. Then, results derived from the empirical research are presented to the reader with links to existing literature. As a conclusion, a generalized framework is constructed to depict and ideal marketer-customer relationship, with emphasis on dynamic, two-way communication and its supporting elements of customer analytics, change adaptation, strategic customer communication and organizational support. From a managerial point of view, the research may provide beneficial information as contemporary marketing can yield profitable outcomes if managed correctly. As a new way to grasp competitive advantage, strategic marketing is much more data-driven and customer-focused than ever before. The study can also prove to be relevant for the academic communities, while its results may act as inspiring for new focus on the education trends of future marketers. This study was limited to the internal activities done at the high-tech industry, leaving out the considerations for co-marketing, marketing via business partners or marketing at other B2B-industries.

Evaluation of novel programs in health counseling – their effectiveness in the oral health of young children, and their acceptance by parents and professionals in public dental service.

Aim and design: To evaluate family-based health counseling for young children, and to study the significance of adding parental self-care or the training of professionals to the programs. The effectiveness and acceptability of the programs were evaluated by comparing two new programs with an earlier one. Subjects and methods: The study was carried out in Vantaa, which was divided into three study areas. The subjects consisted of children born in 2008, particularly fi rstborn children, while children born in 2006 formed the historical control. The fi rst of the new programs emphasized oral hygiene and use of fl uoride, and the second program focused on proper diet and use of xylitol. The main outcome measure was mutansstreptococci (MS) in the dental biofi lm of two-year-olds, and the opinions of parents and dental professionals were evaluated using questionnaires. Results: The programs found wide acceptance among dental professionals. There were no group-related differences found in the MS scores of the two-year-olds. However, all groups combined, father’s advanced level of education and child’s proper use of xylitol were associated with negative MS scores. In the opinion of parents, the oral healthcare guidance at least somewhat met their expectations. Conclusions: The present fi ndings suggest that providing training and support for professionals in health education is important. The addition of parental self-care to supplement programs aimed at young children does not improve the program, although it may improve parental readiness to change their own health habits. Counseling for families might be best carried out through a routine patient-centered program.

Governance of Healthcare Data: International Standards and Recommendations

In the global phenomenon, the aging population becomes a critical issue. Data and information concerning elderly citizens are increasing and are not well organized. In addition, these unstructured data and information cause the problems for decision makers. Since we live in a digital world, Information Technology is considered to be a tool in order to solve problems. Data, information, and knowledge are crucial components to facilitate success in IT service system. Therefore, it is necessary to study how to organize or to govern data from various sources related elderly citizens. The research is conducted due to the fact that there is no internationally accepted holistic framework for governance of data. The research limits the scope to study on the healthcare domain; however, the results can be applied to the other areas. The research starts with an ongoing research of Dahlberg and Nokkala (2015) as a theory. It explains the classification of existing data sources and their characteristics with the focus on managerial perspectives. Then the studies of existing frameworks at international and national level organizations have been performed to show the current frameworks, which have been used and are useful in compiling data on elderly citizens. The international organizations in this research are selected based on their reputations and the reliability to obtain information. The selected countries at national level provide different point of views between two countries. Australia is a forerunner in IT governance while Thailand is the country which the author has familiar knowledge of the current situation. Considered the discussions of frameworks at international and national organizations level illustrate the main characteristics of each framework. At international organization level gives precedence to the interoperability of exchanging data and information between different parties. Whereas at national level shows the importance of the acknowledgement of using frameworks throughout the country in order to make the frameworks to be effective. After the studies of both international and national organization levels, the thesis shows the summarized tables to answer the fitness to the proposed framework by Dahlberg and Nokkala whether the framework help to consolidate data from various sources with different formats, hierarchies, structures, velocities, and other attributes of data storages. In addition, suggestions and recommendations will be proposed for the future research.