Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: A qualitative process evaluation

- Objectives Falls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators’ perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education. - Design A qualitative exploratory study. - Methods Data were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework. - Results Falls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours. - Conclusions Individualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment.

Radikalcyklisering vid syntes av polycykliska indoler och pyrroler

I de senaste två decennierna har radikalcyklisering, intramolekylär radikaladdition, utvecklats till en viktig syntesmetod för polycykliska indoler och pyrroler. De erhållna produktmolekylerna eller deras derivat är ofta naturliga eller syntetiska alkaloider som väckt biologiskt eller medicinskt intresse. Avhandlingen behandlar både intramolekylära radikaladditioner av pyrrolyl-, indolyl- eller indolylacylradikaler till -bindningar och intramolekylära additioner av flera olika radikaler till indolens eller pyrrolens -system. Också cykliseringar som delreaktioner i radikalkaskader behandlas. Radikalreaktioner kan släckas både oxidativt och reduktivt. För att bibehålla heteroarenens aromaticitet måste cykliseringar till pyrrol- eller indolringen släckas oxidativt. Oxidativa radikaladditioner till aromater benämns homolytiska aromatiska substitutioner. Det finns olika sätt att erhålla en reaktantradikal från en radikalprekursor. I vissa fall har radikalprekursorn en mycket labil bindning som kan brytas fotokemiskt eller med hjälp av en initiator. Till exempel kol-svavelbindningen av en O-etyl-S-alkylxanthat kan brytas på detta sätt. Ofta används dock en radikalmediator för att bilda en reaktantradikal från dess prekursor. Mediatorer är ofta föreningar, som under reaktionsförhållandena själv bildar radikaler med en stor affinitet för en prekursors specifika atom eller atomgrupp vilken abstraheras. Således fungerar mediatorn som mellanhand vid bildning av reaktantradikalen. Exempel på mediatorer av detta slag som använts vid syntes av polycykliska pyrroler och indoler är tributyltennhydrid, hexabutylditenn, tris(trimetylsilyl)silan, tributylgermaniumhydrid, dicumylperoxid, trietylboran, natriumarensulfinater (med ättiksyra) och Se-fenyl-p-toluenselenosulfonat. Också dimetylsulfoxid kan ses som mediator då den bildar metylradikaler vid Fentonreaktion i lösningsmedlet. Övergångsmetallsalter kan även bilda reaktantradikalen från prekursorn genom enelektronoxidationer eller -reduktioner. Vid syntes av polycykliska pyrroler och indoler har reaktantradikalen bildats genom enelektronoxidationer med Mn(OAc)3 eller Ag2+ (Miniscireaktion) och elektronreduktioner med ett Ni(I)-komplex eller SmI2. Avhandlingen är indelad enligt reagenset eller reagensen, som åstadkommer bildning av reaktantradikalen vid syntes av polycykliska indoler och pyrroler. Cirka hälften av avhandlingen behandlar tributyltennhydridmedierade cykliseringar då reagenset trots dess toxicitet är det överlägset mest använda. Avhandlingen diskuterar mekanismen för bildning av reaktantradikalen från prekursorn, cykliseringen och dess möjliga regioselektivitet, andra radikalreaktioner vid radikalkaskader och hur produktradikalen släcks.

The need for speed: Timely prevention of the dispersal of noxious weeds in relief fodder using efficient sampling procedures

Invasive and noxious weeds are well known as a pervasive problem, imposing significant economic burdens on all areas of agriculture. Whilst there are multiple possible pathways of weed dispersal in this industry, of particular interest to this discussion is the unintended dispersal of weed seeds within fodder. During periods of drought or following natural disasters such as wild fire or flood, there arises the urgent need for 'relief' fodder to ensure survival and recovery of livestock. In emergency situations, relief fodder may be sourced from widely dispersed geographic regions, and some of these regions may be invaded by an extensive variety of weeds that are both exotic and detrimental to the intended destination for the fodder. Pasture hay is a common source of relief fodder and it typically consists of a mixture of grassy and broadleaf species that may include noxious weeds. When required urgently, pasture hay for relief fodder can be cut, baled, and transported over long distances in a short period of time, with little opportunity for prebaling inspection. It appears that, at the present time, there has been little effort towards rapid testing of bales, post-baling, for the presence of noxious weeds, as a measure to prevent dispersal of seeds. Published studies have relied on the analysis of relatively small numbers of bales, tested to destruction, in order to reveal seed species for identification and enumeration. The development of faster, more reliable, and non-destructive sampling methods is essential to increase the fodder industry's capacity to prevent the dispersal of noxious weeds to previously unaffected locales.

On probability-based inference under data missing by design

Whether a statistician wants to complement a probability model for observed data with a prior distribution and carry out fully probabilistic inference, or base the inference only on the likelihood function, may be a fundamental question in theory, but in practice it may well be of less importance if the likelihood contains much more information than the prior. Maximum likelihood inference can be justified as a Gaussian approximation at the posterior mode, using flat priors. However, in situations where parametric assumptions in standard statistical models would be too rigid, more flexible model formulation, combined with fully probabilistic inference, can be achieved using hierarchical Bayesian parametrization. This work includes five articles, all of which apply probability modeling under various problems involving incomplete observation. Three of the papers apply maximum likelihood estimation and two of them hierarchical Bayesian modeling. Because maximum likelihood may be presented as a special case of Bayesian inference, but not the other way round, in the introductory part of this work we present a framework for probability-based inference using only Bayesian concepts. We also re-derive some results presented in the original articles using the toolbox equipped herein, to show that they are also justifiable under this more general framework. Here the assumption of exchangeability and de Finetti's representation theorem are applied repeatedly for justifying the use of standard parametric probability models with conditionally independent likelihood contributions. It is argued that this same reasoning can be applied also under sampling from a finite population. The main emphasis here is in probability-based inference under incomplete observation due to study design. This is illustrated using a generic two-phase cohort sampling design as an example. The alternative approaches presented for analysis of such a design are full likelihood, which utilizes all observed information, and conditional likelihood, which is restricted to a completely observed set, conditioning on the rule that generated that set. Conditional likelihood inference is also applied for a joint analysis of prevalence and incidence data, a situation subject to both left censoring and left truncation. Other topics covered are model uncertainty and causal inference using posterior predictive distributions. We formulate a non-parametric monotonic regression model for one or more covariates and a Bayesian estimation procedure, and apply the model in the context of optimal sequential treatment regimes, demonstrating that inference based on posterior predictive distributions is feasible also in this case.

Who does nutrition prevention work in Queensland? An investigation of structural and political workforce reforms

- Aim This study aimed (i) to determine the change in the number of government-funded nutrition positions following structural and political reforms and (ii) to describe the remaining workforce available to do nutrition prevention work, including student placements, in Queensland. - Methods Positions funded by the Queensland government were counted using departmental human resource data and compared with data collected 4 years earlier. Positions not funded by the government were identified using formal professional networks and governance group lists. Both groups were sent an online survey that explored their position name, funding source, employer, qualifications, years of experience, work in prevention and ability to supervise students. - Results There was a 90% reduction in the number of nutrition prevention positions funded by the government between 2009 (137 full time equivalents (FTE)) and 2013 (14 FTE). In 2013, 313 specialist (n = 92) and generalist (n = 221) practitioners were identified as potentially working in nutrition prevention throughout Queensland. A total of 30 permanent FTEs indicated over 75% of their work focused on prevention. This included the 14 FTE funded by the Queensland government and an additional 16 FTE from other sectors. Generalists did not consider themselves part of the nutrition workforce. - Conclusions Queensland experienced an extreme reduction in its nutrition prevention workforce as a result of political and structural reforms. This disinvestment by the Queensland government was not compensated for by other sectors, and has left marked deficits in public health nutrition capacity, including student placements.

Optimaalinen rangaistus talousrikoksesta : Tutkimus velallisen rikoksista

Optimal Punishment of Economic Crime: A Study on Bankruptcy Crime This thesis researches whether the punishment practise of bankruptcy crimes is optimal in light of Gary S. Becker’s theory of optimal punishment. According to Becker, a punishment is optimal if it eliminates the expected utility of the crime for the offender and - on the other hand - minimizes the cost of the crime to society. The decision process of the offender is observed through their expected utility of the crime. The expected utility is calculated based on the offender's probability of getting caught, the cost of getting caught and the profit from the crime. All objects including the punishment are measured in cash. The cost of crimes to the society is observed defining the disutility caused by the crime to the society. The disutility is calculated based on the cost of crime prevention, crime damages, punishment execution and the probability of getting caught. If the goal is to minimize the crime profits, the punishments of bankruptcy crimes are not optimal. If the debtors would decide whether or not to commit the crime solely based on economical consideration, the crime rate would be multiple times higher than the current rate is. The prospective offender relies heavily on non-economic aspects in their decision. Most probably social pressure and personal commitment to oblige the laws are major factors in the prospective criminal’s decision-making. The function developed by Becker measuring the cost to society was not useful in the measurement of the optimality of a punishment. The premise of the function that the costs of the society correlate to the costs for the offender from the punishment proves to be unrealistic in observation of the bankruptcy crimes. However, it was observed that majority of the cost of crime for the society are caused by the crime damages. This finding supports the preventive criminal politics.

Förutsättningarna för psykiatrisk vård oberoende av patientens vilja och patientens rättsskydd vid fattandet av vårdbeslutet

I arbetet analyseras de i mentalvårdslagen (1990/1116) stadgade förutsättningarna för psykiatrisk sjukhusvård oberoende av patientens vilja gällande myndiga patienter för vilka inte har utsetts en intressebevakare före fattandet av vårdbeslutet, samt bakgrunden till och en del av de svårigheter som förknippas med denna form av vård och härtill anknutet beslutsfattande. Problemen tillspetsas framförallt i situationer av intressekonflikt mellan patientens intressen respektive samhällets intressen. Utgångspunkten ligger främst i finländsk mentalvårdslagstiftning och rättspraxis, men för att på ett ändamålsenligt sätt kunna redogöra för bakgrunden till och förutsättningarna för dylikt förvaltningsrättsligt beslutsfattande görs även relevanta kopplingar till medicinska (psykiatriska) yrkesetiska riktlinjer och mentalvårdslagstiftning inom övriga Norden. Analysen omfattar även den Europeiska människorättsdomstolens praxis i fall som gäller frihetsberövande på basis av psykiatrisk vård, närmare bestämt artikel 5 (1)(e) i den europeiska människorättskonventionen. Patientens självbestämmanderätt, frihet och integritet är utgångspunkterna för alla slags vårdförhållanden. Dessa inbegriper bl.a. frivillighet och informerat samtycke då en person söker vård. Möjligheten att förordna en person till psykiatrisk vård oberoende av dennes vilja är ett lagstadgat undantag till dessa principer. Beslutsfattandet är bundet till strikta lagstadgade förutsättningar, vilkas bedömning kräver juridisk, men framförallt medicinsk kunskap, vilket också skapar gränser och utmaningar för de yrkespersoner som arbetar med dylika ärenden. Kombinationen av psykiatri, etik och juridik är nödvändig, men inte alltid enkel att göra, vilket märks inte minst på terminologin som tillämpas i mentalvårdslagstiftningen. I arbetet analyseras en del av den terminologi som tillämpas inom finsk och övrig nordisk mentalvårdslagstiftning. Syftet är att visa att definitionerna, tolkningarna, terminologin och synsättet på psykisk ohälsa som tillämpas inom den finländska mentalvårdslagstiftningen jämförelsevis kanske inte är de mest lämpliga eller tidsenliga. En annan svår uppgift, som framförallt lagstiftaren ställ(t)s inför, är utformningen av mentalvårdslagstiftning som är tillräckligt flexibel för att tillåta beaktande av särdragen i varje enskilt ärende, men som samtidigt är strikt nog för att förhindra godtycke och missbruk. En person som lider av allvarlig psykisk ohälsa befinner sig oftast i en ytterst utsatt position, och är ofta begränsat eller inte alls kapabel att göra en korrekt bedömning av sig själv och sin situation. Således sker den starka betoningen av patientens självbestämmanderätt på både gott och ont. Det är kanske inte alltid i en psykiatrisk patients bästa att få bestämma själv, vilket också är en av frågorna som omfattas av analysen i arbetet. Eftersom det psykiatriska vårdbeslutet till karaktären är ett (skriftligt) förvaltningsbeslut, skiljer det sig samtidigt från övrigt beslutsfattande inom vårdsektorn, vilket till största delen utgör faktisk förvaltningsverksamhet. För patienten innebär vårdbeslutet också ett administrativt frihetsberövande. Ingreppet i patientens grundläggande fri- och rättigheter är särskilt stort och upplevs ofta som mycket kränkande, och därför ställs särskilt strikta krav på iakttagande av det lagstadgade beslutsförfarandet och vårdförutsättningarna samt tillgodoseendet av patientens rättsskydd. Den offentliga hälso- och sjukvården är verksamhet som är underställd den offentliga förvaltningen, vilket innebär att de allmänna förvaltningsrättsliga rättsskyddsgarantierna är tillämpliga. I och med vårdbeslutets karaktär av förvaltningsbeslut, kan ändring i beslutet sökas genom besvär hos förvaltningsdomstolen. Dessa är också några av de frågor som behandlas i arbetet.

Prevention of foot ulcers in the at-risk patient with diabetes: A systematic review

Background Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration. Methods The available medical scientific literature in PubMed, EMBASE, CINAHL and the Cochrane database was searched for original research studies on preventative interventions. Both controlled and non-controlled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers. Results From the identified records, a total of 30 controlled studies (of which 19 RCTs) and another 44 non-controlled studies were assessed and described. Few controlled studies, of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, multiple RCTs with low risk of bias show the benefit for the use of daily foot skin temperature measurements and consequent preventative actions, as well as for therapeutic footwear that demonstrates to relieve plantar pressure and that is worn by the patient. To prevent recurrence, some evidence exists for integrated foot care when it includes a combination of professional foot treatment, therapeutic footwear and patient education; for just a single session of patient education, no evidence exists. Surgical interventions can be effective in selected patients, but the evidence base is small. Conclusion The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong, but is small for the use of other, sometimes widely applied, interventions and is practically nonexistent for the prevention of a first foot ulcer and non-plantar foot ulcer.

The effect of flexor tenotomy on healing and prevention of neuropathic diabetic foot ulcers on the distal end of the toe

Background Flexor tenotomy is a minimally invasive surgical alternative for the treatment of neuropathic diabetic foot ulcers on the distal end of the toe. The influence of infection on healing and time to heal after flexor tenotomy is unknown. Flexor tenotomy can also be used as a prophylactic treatment. The effectiveness as a prophylactic treatment has not been described before. Methods A retrospective study was performed with the inclusion of all consecutive flexor tenotomies from one hospital between January 2005 and December 2011. Results From 38 ulcers, 35 healed (92%), with a mean time to heal of 22 ± 26 days. The longest duration for healing was found for infected ulcers that were penetrating to bone (35 days; p = .042). Cases of prophylactic flexor tenotomies (n=9) did not result in any ulcer or other complications during follow-up. Conclusions The results of this study suggest that flexor tenotomy may be beneficial for neuropathic diabetic foot ulcers on the distal end of the toe, with a high healing percentage and a short mean time to heal. Infected ulcers that penetrated to bone took a significantly longer time to heal. Prospective research, to confirm the results of this retrospective study, should be performed.

Prevention and management of foot problems in diabetes: A summary guidance for daily practice 2015, based on the IWGDF Guidance Documents

In this 'Summary Guidance for Daily Practice', we describe the basic principles of prevention and management of foot problems in persons with diabetes. This summary is based on the International Working Group on the Diabetic Foot (IWGDF) Guidance 2015. There are five key elements that underpin prevention of foot problems: (1) identification of the at-risk foot; (2) regular inspection and examination of the at-risk foot; (3) education of patient, family and healthcare providers; (4) routine wearing of appropriate footwear, and; (5) treatment of pre-ulcerative signs. Healthcare providers should follow a standardized and consistent strategy for evaluating a foot wound, as this will guide further evaluation and therapy. The following items must be addressed: type, cause, site and depth, and signs of infection. There are seven key elements that underpin ulcer treatment: (1) relief of pressure and protection of the ulcer; (2) restoration of skin perfusion; (3) treatment of infection; (4) metabolic control and treatment of co-morbidity; (5) local wound care; (6) education for patient and relatives, and; (7) prevention of recurrence. Finally, successful efforts to prevent and manage foot problems in diabetes depend upon a well-organized team, using a holistic approach in which the ulcer is seen as a sign of multi-organ disease, and integrating the various disciplines involved.

IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes

Recommendations - 1 To identify a person with diabetes at risk for foot ulceration, examine the feet annually to seek evidence for signs or symptoms of peripheral neuropathy and peripheral artery disease. (GRADE strength of recommendation: strong; Quality of evidence: low) - 2 In a person with diabetes who has peripheral neuropathy, screen for a history of foot ulceration or lower-extremity amputation, peripheral artery disease, foot deformity, pre-ulcerative signs on the foot, poor foot hygiene and ill-fitting or inadequate footwear. (Strong; Low) - 3 Treat any pre-ulcerative sign on the foot of a patient with diabetes. This includes removing callus, protecting blisters and draining when necessary, treating ingrown or thickened toe nails, treating haemorrhage when necessary and prescribing antifungal treatment for fungal infections. (Strong; Low) - 4 To protect their feet, instruct an at-risk patient with diabetes not to walk barefoot, in socks only, or in thin-soled standard slippers, whether at home or when outside. (Strong; Low) - 5 Instruct an at-risk patient with diabetes to daily inspect their feet and the inside of their shoes, daily wash their feet (with careful drying particularly between the toes), avoid using chemical agents or plasters to remove callus or corns, use emollients to lubricate dry skin and cut toe nails straight across. (Weak; Low) - 6 Instruct an at-risk patient with diabetes to wear properly fitting footwear to prevent a first foot ulcer, either plantar or non-plantar, or a recurrent non-plantar foot ulcer. When a foot deformity or a pre-ulcerative sign is present, consider prescribing therapeutic shoes, custom-made insoles or toe orthosis. (Strong; Low) - 7 To prevent a recurrent plantar foot ulcer in an at-risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressure-relieving effect during walking (i.e. 30% relief compared with plantar pressure in standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) - 8 To prevent a first foot ulcer in an at-risk patient with diabetes, provide education aimed at improving foot care knowledge and behaviour, as well as encouraging the patient to adhere to this foot care advice. (Weak; Low) - 9 To prevent a recurrent foot ulcer in an at-risk patient with diabetes, provide integrated foot care, which includes professional foot treatment, adequate footwear and education. This should be repeated or re-evaluated once every 1 to 3 months as necessary. (Strong; Low) - 10 Instruct a high-risk patient with diabetes to monitor foot skin temperature at home to prevent a first or recurrent plantar foot ulcer. This aims at identifying the early signs of inflammation, followed by action taken by the patient and care provider to resolve the cause of inflammation. (Weak; Moderate) - 11 Consider digital flexor tenotomy to prevent a toe ulcer when conservative treatment fails in a high-risk patient with diabetes, hammertoes and either a pre-ulcerative sign or an ulcer on the distal toe. (Weak; Low) - 12 Consider Achilles tendon lengthening, joint arthroplasty, single or pan metatarsal head resection, or osteotomy to prevent a recurrent foot ulcer when conservative treatment fails in a high-risk patient with diabetes and a plantar forefoot ulcer. (Weak; Low) - 13 Do not use a nerve decompression procedure in an effort to prevent a foot ulcer in an at-risk patient with diabetes, in preference to accepted standards of good quality care. (Weak; Low)

The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: Development of an evidence-based global consensus

Foot problems complicating diabetes are a source of major patient suffering and societal costs. Investing in evidence-based, internationally appropriate diabetic foot care guidance is likely among the most cost-effective forms of healthcare expenditure, provided it is goal-focused and properly implemented. The International Working Group on the Diabetic Foot (IWGDF) has been publishing and updating international Practical Guidelines since 1999. The 2015 updates are based on systematic reviews of the literature, and recommendations are formulated using the Grading of Recommendations Assessment Development and Evaluation system. As such, we changed the name from 'Practical Guidelines' to 'Guidance'. In this article we describe the development of the 2015 IWGDF Guidance documents on prevention and management of foot problems in diabetes. This Guidance consists of five documents, prepared by five working groups of international experts. These documents provide guidance related to foot complications in persons with diabetes on: prevention; footwear and offloading; peripheral artery disease; infections; and, wound healing interventions. Based on these five documents, the IWGDF Editorial Board produced a summary guidance for daily practice. The resultant of this process, after reviewed by the Editorial Board and by international IWGDF members of all documents, is an evidence-based global consensus on prevention and management of foot problems in diabetes. Plans are already under way to implement this Guidance. We believe that following the recommendations of the 2015 IWGDF Guidance will almost certainly result in improved management of foot problems in persons with diabetes and a subsequent worldwide reduction in the tragedies caused by these foot problems.

Viljan visar vägen till identiteten : Berättelsetyper och teman i livsberättelser av kvinnliga teologer i Svenskfinland

Forskningens utgångspunkt var att tillföra information om kvinnliga teologers liv i Svenskfinland under en period då kyrkan hade omdefinierat sin syn på kvinnor som präster. Till forskningens intresseområden hörde frågan om hur situationen hade påverkat kvinnors motivation att välja teologiska studier och yrken samt hur situationen hade inverkat på kvinnliga teologer i arbetslivet. Forskningens uppgift är att ur ett identitetsperspektiv undersöka målgruppens egna skildringar av livet som kvinnlig teolog i Svenskfinland. Forskningsfrågan delades in i två delfrågor: 1)Hur har kvinnliga teologer kommit att välja studier, yrken och arbetsplats? 2)Vad har kvinnliga teologer upplevt i sina studier och arbetsliv? Forskningens material samlades in hösten 2003 genom en förfrågan per brev och genom en tidningsnotis i tidningen Kyrkpressen. Materialet bestod av livsberättelser som kvinnliga teologer i olika yrkesgrupper hade skrivit utgående ifrån rubriken ”Mitt liv som kvinnlig teolog i Svenskfinland”. Cirka 250 kvinnor hade avlagt teologisk examen på svenska i Finland. Antalet personer som deltog i undersökningen med sin livsberättelse var 27. Materialet analyserades kvalitativt och induktivt med en narrativ analys som tog fasta på teman och berättelsetyper i olika livsskeden: val av studier, studietid, val av karriär och erfarenheter från arbetslivet. Analysresultatet var att studievalets beskrivning kunde tolkas som en valsituation där egenskaper jämfördes med yrkesrollen, som en socialisationsprocess, som ett alternativ till tidigare studieinriktning eller som en process där kvinnoprästdiskussioner, intresse för teologi och teologuppgifter fick informanten att välja teologin. Teman från studietiden handlade om studiers fördröjning, om yrkesinriktning, om studier som förberedelse för arbetslivet och om kvinnoprästdiskussionens inverkan på yrkesinriktningen. Val av arbetsplatser och yrken beskrevs utgående ifrån kvinnliga teologers förändrade position, moderskapets inverkan på karriären, en strävan att hitta en arbetsplats som passade informanten, erfarenheter från en enda arbetsplats och karriärsbyte. Lektorer tog fasta på välsignelseaktens betydelse, kyrkoherdens stora inflytande på arbetets karaktär samt hur situationen förändrades då kvinnor tilläts bli präster. För en del präster innebar prästrollen att andra människor betonade att de var kvinnor. Några informanter hade behov av stöd både från Borgå stifts ledning och från andra kvinnliga präster under den första tiden med kvinnliga präster. Till en början upplevdes ledningens stöd inte alltid som tillräckligt men det förbättrades med tiden. Informanterna berättade inte så mycket om läraryrket. Inom forskning verkade teologtiteln vara naturlig, medan informanter med erfarenhet av annat än teologyrken ibland hade stött på reaktioner på sitt yrkesval eller sin arbetsroll. Finlandssvenskheten upplevdes av olika informanter både som tryggt och inskränkt. Eventuella kontakter till finska stift upplevdes positivt även om det egna sammanhanget upplevdes som viktigt. Trivsel på arbetsplatsen orsakades av subjektiva belöningar och i en del fall av att arbetet motsvarade informantens yrkesinriktning. Att vara kvinnlig teolog innebar ibland att informantens yrkesval tolkades av andra som ett ställningstagande för någon ideologi i kvinnoprästfrågan.

Större frihet - bättre lokalt anpassad service? : Förvaltningsreformer och kommunernas service för utvecklingsstörda 1994-2000

In the beginning of the 1990s the legislation regarding the municipalities and the system of central government transfers were reformed in Finland. This resulted in a move from detailed governmental control to increased municipal autonomy. The purpose of this decentralization was to enable the municipalities to better adapt their administration and service supply to local needs. The aim of this study was to explore the effects of the increased municipal autonomy on the organization of services for people with intellectual disabilities. Did the increased autonomy cause the municipalities to alter their service supply and production and did the services become more adapted to local needs? The data consists of statistical information on service use and production, and also of background data such as demographics, economics and political elections on 452 municipalities in Finland from the years 1994 and 2000. The methods used are cluster analysis, discriminant analysis and factor analysis. The municipalities could be grouped in two categories: those which offered mainly one kind of residential services and others which had more varied mixes of services. The use of institutional care had decreased and municipalities which used institutional care as their primary form of service were mostly very small municipalities in 2000. The situation had changed from 1994, when institutional care was the primary service for municipalities of all sizes. Also the service production had become more differentiated and the municipalities had started using more varied ways of production. More municipalities had started producing their own services and private production had increased as well. Furthermore, the increase in local autonomy had opened up possibilities for local politics to influence both the service selection and methods of production. The most significant motive for changes in the service structure was high unemployment and an increasing share of elderly people in the population, particularly in sparsely populated areas. Municipalities with a low level of resources had made more changes in their service organization while those with more resources had been able to carry on as before. Key words: service structure, service for people with intellectual disabilities, municipalities, contingency theory, New Public Management