Unraveling the helix of change : An activity-theoretical study of health care change efforts and their consequences

M.A. (Educ.) Anu Kajamaa from the University of Helsinki, Center for Research on Activity, Development and Learning (CRADLE), examines change efforts and their consequences in health care in the public sector. The aim of her academic dissertation is, by providing a new conceptual framework, to widen our understanding of organizational change efforts and their consequences and managerial challenges. Despite the multiple change efforts, the results of health care development projects have not been very promising, and many developmental needs and managerial challenges exist. The study challenges the predominant, well-framed health care change paradigm and calls for an expanded view to explore the underlying issues and multiplicities of change efforts and their consequences. The study asks what kind of expanded conceptual framework is needed to better understand organizational change as transcending currently dominant oppositions in management thinking, specifically in the field of health care. The study includes five explorative case studies of health care change efforts and their consequences in Finland. Theory and practice are tightly interconnected in the study. The methodology of the study integrates the ethnography of organizational change, a narrative approach and cultural-historical activity theory. From the stance of activity theory, historicity, contradictions, locality and employee participation play significant roles in developing health care. The empirical data of the study has mainly been collected in two projects, funded by the Finnish Work Environment Fund. The data was collected in public sector health care organizations during the years 2004-2010. By exploring the oppositions between distinct views on organizational change and the multi-site, multi-level and multi-logic of organizational change, the study develops an expanded, multidimensional activity-theoretical framework on organizational change and management thinking. The findings of the study contribute to activity theory and organization studies, and provide information for health care management and practitioners. The study illuminates that continuous development efforts bridged to one another and anchored to collectively created new activity models can lead to significant improvements and organizational learning in health care. The study presents such expansive learning processes. The ways of conducting change efforts in organizations play a critical role in the creation of collective new practices and tools and in establishing ownership over them. Some of the studied change efforts were discontinuous or encapsulated, not benefiting the larger whole. The study shows that the stagnation and unexpected consequences of change efforts relate to the unconnectedness of the different organizational sites, levels and logics. If not dealt with, the unintended consequences such as obstacles, breaks and conflicts may stem promising change and learning processes.

Hapettunut LDL-kolesteroli akuutissa koronaarisyndroomassa

Tutkimuksessa selvitetään oksidatiivisen stressin yhteyttä akuuttiin sepelvaltimotautioireyhtymään. Tämä tehdään vertaamalla veren hapettuneen LDL-kolesterolin pitoisuuksia kolmessa potilasryhmässä. Siinä pohditaan myös LDL-kolesterolin käyttöä biologisena merkkisuureena diagnostiikassa. Tällä hetkellä ei ole biomarkkeria, joka osoittaisi akuutin sydrooman vaarassa olevat potilaat. Hapettuneen LDL-kolesterolin pitoisuus määritettiin potilaiden plasmasta ELISA-menetelmää käyttäen. Tulokset tukevat työhypoteesia ja tutkimus antaa arvokasta tietoa suomalaisten statiinilääkitystä käyttävien sepelvaltimotautipotilaiden oksidatiivisestä stressistä.

Jäätikön pinnanalaisten järvien hydrogeokemiallinen tutkimus läntisellä Kuningatar Maudin maalla, Etelämantereella

Tutkielma tarkastelee itäisellä Etelämantereella, läntisellä Kuningatar Maudin Maalla olevien jäätikön pinnanalaisten järvien (frozen lake) veden hydrogeokemiallisia ominaisuuksia. Keskeisin tutkimusalue on Vestfjellavuoristoketjun (73 74 °S, 13 16 °W) pohjoisimman vuoren, Basenin läheisyydessä sijaitseva jäätikön pinnanalainen järvi (Basen-järvi). Vertailevia tutkimuksia tehtiin lisäksi Plogenin ja Fossilryggenin nunatakkien läheisyydessä sekä Heimefrontfjellan vuoristoalueella. Tutkielma on Suomen Akatemian rahoittama grant # 54087 -hanke, ja siinä yhdistyvät Suomen tutkimusaseman, Aboan lähellä tehty geologinen, hydrogeologinen sekä glasiologinen tutkimus. Tutkimuksessa selvitetään Basenin jäätikön pinnanalaisen järven kemiallinen koostumus ja sen paikallinen ja ajallinen vaihtelu. Kemiallisen koostumuksen perusteella selvitetään myös ionien lähteet. Näytteenotto suoritettiin FINNARP 2003/04 Etelämanner-tutkimusretkellä. Basen -järveltä ja sen vieressä sijaitsevalta Basen -vuorelta kerättiin vesi-, suola-, kivi- ja moreeninäytteitä. Suola-, kivi- ja moreeninäytteillä selvitetään näytteissä silmillä havaittavan mineraalisaostuman koostumus. Kiinteän faasin kasvihuoneilmiö luo otolliset mahdollisuudet Basenin jäätikön pinnanalaisen järven synnylle ja kehitykselle. Basen -järven veden kemiallinen koostumus vaihtelee alueellisesti ja ajallisesti ja se on syntynyt kolmen komponentin yhteisvaikutuksesta: purovesien, nunatakilta sulavien lumien sekä sulaneen jään yhteisvaikutuksesta. Suurin vaikutus Basenin järven kemialliseen koostumukseen on kuitenkin Basenin rinteiltä virtaavilla purovesillä. Korkeimmat ionipitoisuudet havaittiin nunatakin reunan läheisyydessä. Basenin järven veden ionit ovat enimmäkseen ei-meriperäisiä. Runsain ioni on kalsium, jonka suurin lähde on jurakautisessa basaltissa esiintyvä mantelikarbonaatti. Basenin -järven vaiheista eteläisen talven aikana ei ole tietoa ja se, mitä talven aikana tapahtuu ja mikä saa veteen liuenneiden komponenttien pitoisuuden alenemaan, on vielä selvittämättä ja säilyy mahdollisena aiheena tulevaisuuden tutkimuksille.

Trade Blocs and the Cold War : The CMEA and the EC challenge, 1969-1976

The coherence of the Soviet bloc was seriously tested at the turn of the 1970s, as the Soviet Union and its allies engaged in intensive negotiations over their relations with the European Communities (EC). In an effort to secure their own national economic interests many East European countries began independent manoeuvres against the wishes of their bloc leader. However, much of the intra-bloc controversy was kept out of the public eye, as the battle largely took place behind the scenes, within the organisation for economic cooperation, the Council for Mutual Economic Assistance (CMEA). The CMEA policy-making process vis-à-vis the EC is described in this study with reference to primary archival materials. This study investigates the negotiating positions and powers of the CMEA member states in their efforts to deal with the economic challenge created by the progress of the EC, as it advanced towards the customs union. This entails an analysis of the functioning principles and performance of the CMEA machinery. The study traces the CMEA negotiations that began in 1970 over its policy toward the EC. The policy was finally adopted in 1974, and was followed by the first official meeting between the two organisations in early 1975. The story ends in 1976, when the CMEA s efforts to enter into working relations with the EC were seemingly frustrated by the latter. The first major finding of the study is that, contrary to much of the prior research, the Soviet Union was not in a hegemonic position vis-à-vis its allies. It had to use a lot of its resources to tame the independent manoeuvring of its smaller allies. Thus, the USSR was not the kind of bloc leader that the totalitarian literature has described. Because the Soviet Union had to spend so much attention on its own bloc-politics, it was not able to concentrate on formulating a policy vis-à-vis the EC. Thus, the Soviet leadership was dependent on its allies in those instances when the socialist countries needed to act as a bloc. This consequently opened up the possibility for the USSR s allies to manoeuvre. This study also argues that when the CMEA did manage to find a united position, it was a force that the EC had to reckon with in its policy-making. This was particularly the case in the implementation of the EC Common Commercial Policy. The other main finding of the study is that, although it has been largely neglected in the previous literature on the history of West European integration, the CMEA did in fact have an effect on EC decision-making. This study shows how for political and ideological reasons the CMEA members did not acknowledge the EC s supranational authority. Therefore the EC had no choice but to refrain from implementing its Common Commercial Policy in full.

Löydöstä muinaispuvuksi : arkeologisten tekstiilien ennallistaminen

From a find to an ancient costume - reconstruction of archaeological textiles Costume tells who we are. It warms and protects us, but also tells about our identity: gender, age, family, social group, work, religion and ethnicity. Textile fabrication, use and trade have been an important part of human civilization for more than 10 000 years. There are plenty of archaeological textile findings, but they are small, fragmentary and their interpretation requires special skills. Finnish textile findings from the younger Iron Age have already been studied for more than hundred years. They have also been used as a base for several reconstructions called muinaispuku , ancient costume. Thesis surveys the ancient costume reconstruction done in Finland and discusses the objectives of the reconstruction projects. The earlier reconstruction projects are seen as a part of the national project of constructing a glorious past for Finnish nationality, and the part women took in this project. Many earlier reconstructions are designed to be festive costumes for wealthy ladies. In the 1980s and 1990s many new ancient costume reconstructions were made, differing from their predecessors at the pattern of the skirt. They were also done following the principles of making a scientific reconstruction more closely. At the same time historical re-enactment and living history as a hobby have raised in popularity, and the use of ancient costumes is widening from festive occasions to re-enactment purposes. A hypothesis of the textile craft methods used in younger Iron Age Finland is introduced. Archaeological findings from Finland and neighboring countries, ethnological knowledge of textile crafts and experimental archaeology have been used as a basis for this proposition. The yarn was spinned with a spindle, the fabrics woven on a warp-weighted loom and dyed with natural colors. Bronze spiral applications and complicated tablet-woven bands have possibly been done by specialist craftswomen or -men. The knowledge of the techniques and results of experimenting and experimental archaeology gives a possibility to review the success of existing ancient costume reconstructions as scientific reconstructions. Only one costume reconstruction project, the Kaarina costume fabricated in Kurala Kylämäki museum, has been done using as authentic methods as possible. The use of ancient craft methods is time-consuming and expensive. This fact can be seen as one research result itself for it demonstrates how valuable the ancient textiles have been also in their time of use. In the costume reconstruction work, the skill of a craftswoman and her knowledge of ancient working methods is strongly underlined. Textile research is seen as a process, where examination of original textiles and reconstruction experiments discuss with each other. Reconstruction projects can give a lot both to the research of Finnish younger Iron Age and the popularization of archaeological knowledge. The reconstruction is never finished, and also the earlier reconstructions should be reviewed in the light of new findings.

Trichinella spiralis ja Trichinella nativa -loisten erittyminen ulosteisiin rotalla kokeellisen infektion jälkeen

Trichinella-suvun loiset ovat maailmanlaajuisesti levinneitä sukkulamatoja, jotka ovat infektiivisiä useille eläinlajeille ja tarttuvat myös ihmiseen. Loiset aiheuttavat ongelmia muun muassa lihateollisuudessa, haittaavat tuotantoeläinten terveyttä ja ovat elintarviketurvallisuusriski. Eri Trichinella-lajien infektiivisyys eri isäntäeläinlajeissa vaihtelee. Esimerkiksi Trichinella spiralis aiheuttaa rotassa voimakkaamman infektion kuin Trichinella nativa, mutta syytä loislajien erilaiseen infektiviteettiin samassa isäntäeläinlajissa ei tiedetä. Trichinella-loisten elämänkiertoon kuuluu sekä enteraali- eli suolistovaihe että parenteraalivaihe eli suoliston ulkopuolella tapahtuva vaihe. Vielä on epävarmaa, missä vaiheessa elämänkiertoa loislajien selviytyminen rotassa eroaa toisistaan. Tutkielmani kokeellisen osuuden tarkoituksena oli selvittää rotan ulosteita tutkimalla, kiinnittyykö toinen tutkituista Trichinella-lajeista (T. spiralis tai T. nativa) paremmin suolen seinämään ja tuleeko toinen nopeammin ulos suolesta. Mikäli rotan heikosti infektoivat T. nativa -loiset tulevat T. spiralis -loisia nopeammin ulosteen mukana ulos suolistosta, voidaan olettaa suolistovaiheen immuunipuolustuksen olevan ainakin osatekijä rotan kyvyssä puolustautua T. nativa –infektioita vastaan. Työ suoritettiin infektoimalla kuusi rottaa T. spiralis -loisella ja kuusi rottaa T. nativa -loisella. Lisäksi tutkimuksessa oli mukana kolme kontrollirottaa, joita ei infektoitu. Rottien ulosteet kerättiin seitsemän viikon ajalta, ja näytteet tutkittiin FLOTAC-menetelmällä. Ulosteista etsittiin Trichinella-loisten aikuis- ja toukkamuotoja. Ulostenäytteistä ei löytynyt yhtään loista. Kokeen jälkeen rotat lopetettiin ja niiden suolet tutkittiin, mutta suolistakaan ei löytynyt loisia. Lopetettujen eläinten lihasnäytteitä tutkimalla eläinten todettiin infektoituneen kyseessä olleelle loislajille tyypillisellä voimakkuudella. Kontrollirotista ei löydetty loisia. Koska rottien ulosteista tai suolista ei löytynyt loisia huolimatta onnistuneista infektoinneista, voidaan todeta käytetyn menetelmän olleen kokeeseen sopimaton. Mikäli loisia olisi löytynyt ulosteista, olisi ollut tarpeellista verrata eri lajeilla infektoitujen ryhmien tuloksia. Tieto siitä, tapahtuuko rotan suolistossa jotain, mikä heikentää toisen Trichinella-lajin infektiivisyyttä, olisi ollut merkittävä. Saadut tulokset olisivat olleet hyödyksi pohdittaessa parempia keinoja Trichinella-tartuntojen ennaltaehkäisyyn ja infektioiden hoitoon.

Elämää keskustassa ja kaupunkiseudun reunoilla. Urbaani ja jälkiesikaupungillinen elämäntyyli asumisen valinnoissa ja arkiliikkumisessa Helsingin seudulla.

The lifestyles of people living in single-family housing areas on the outskirts of the Greater Helsinki Region (GHR) are different from those living in inner city area. The urban structure of the GHR is concentrated in the capital on the one hand, and spread out across the outskirts on the other. Socioeconomic spatial divisions are evident as well-paid and educated residents move to the inner city or the single-family house dominated suburban neighbourhoods depending on their housing preferences and life situations. The following thesis explores how these lifestyles have emerged through the housing choices and daily mobility of the residents living in the new single-family housing areas on the outskirts of the GHR and the inner city. The study shows that, when it comes to lifestyles, residents on the outskirts of the region have different housing preferences and daily mobility patterns when compared with their inner city counterparts. Based on five different case study areas my results show that these differences are related to residents values, preferences and attitudes towards the neighbourhood, on the one hand, and limited by urban structure on the other. This also confirms earlier theoretical analyses and findings from the GHR. Residents who moved to the outskirts of Greater Helsinki Region and the apartment buildings of the inner city were similar in the basic elements of their housing preferences: they sought a safe and peaceful neighbourhood close to the natural environment. However, where housing choices, daily mobility and activities vary different lifestyles develop in both the outskirts and the inner city. More specifically, lifestyles in the city apartment blocks were inherently urban. Liveliness and highest order facilities were appreciated and daily mobility patterns were supported by diverse modes of transportation for the purposes of work, shopping and leisure time. On the outskirts, by contrast, lifestyles were largely post-suburban and child-friendliness appreciated. Due to the heterachical urban structure, daily mobility was more car-dependent since work, shopping and free time activities of the residents are more spread around the region. The urban structure frames the daily mobility on the outskirts of the region, but this is not to say that short local trips replace longer regional ones. This comparative case study was carried out in the single-family housing areas of Sundsberg in Kirkkonummi, Landbo in Helsinki and Ylästö in Vantaa, as well as in the inner city apartment building areas of Punavuori and Katajanokka in Helsinki. The data is comprised of residential surveys, interviews, and statistics and GIS data sets that illustrate regional daily mobility, socio-economic structure and vis-à-vis housing stock.

Helsingin matkailijakartta = Turistkarta över Helsingfors = Helsinki : Touristenkarte = Helsinki : tourist map = Helsinki : plan touristique

Kartta kääntöpuolella

Helsingin matkailijakartta = Turistkarta över Helsingfors = Helsinki : Touristenkarte = Helsinki : tourist map = Helsinki : plan touristique

Kartta kääntöpuolella