Indicadores sociales y psicosociales de calidad de vida de las personas mayores en un municipio = Social and psychosocial quality of life indicators of older persons in a municipality

A research about the quality of life of the older persons of a municipality starting from the analysis of the perceptions, evaluations and expectations related to concrete spheres of their lives (familiar characteristics, housing, health, nearby environment, activities, needs and dependencies and persons helping them to satisfy needs) is presented. Answers to 1988 questionnaires obtained from two representative samples of older per - sons living in private homes in the city have been analysed: persons over 65 years old and a specific one composed by a sub-sample of the general one, with persons over 75 years living alone. Data shaping contextual indicators related to housing have been analysed. The auto - nomy to drive and the evaluation of on’s health seem to be positive indicators to take in account while sutying quality of life at these ages. Sentinel indicators of the physical and relational conditions in the family and indicators of dependency are analysed as well. The evaluations of the older persons about their own life conditions are also analysed through psychosocial indicators connected to housing, nearby environmenent, their activities andincomes. The results obtained are applicable in order to improve the decision making process in social intervention programmes developed in the field of ageing aiming to take into account their perspectives

Aineettomat markkinointiresurssit – brändi, imago ja maine

Tämän kandidaatintyön tarkoituksena on tarkastella aineettomien markkinointiresurssien – brändin, imagon ja maineen – määritelmiä sekä niiden etuja yrityksen liiketoiminnassa. Tarkastelu toteutetaan B2B-liiketoimintaympäristössä. Työ rakentuu viidestä osiosta, joista ensimmäisessä käsitellään aineettomia markkinointiresursseja ja niihin kuuluvaa suhdepääomaa. Toisessa, kolmannessa ja neljännessä osiossa käsitellään suhdepääomaan kuuluvien brändin, imagon ja maineen määritelmiä, etuja ja vaikutuksia yrityksen liiketoiminnassa. Viidennessä osiossa esitellään edellä mainittujen tekijöiden vaikutuksia asiakkaan ostopäätösprosessiin. Työssä käytetyn aineiston pohjalta tehtiin johtopäätös, että B2B-liiketoiminnassa toimiva yritys on yleensä itse brändi, jolla on sekä imago että maine. Brändi-imago ja brändin maine ovat merkittävässä roolissa asiakkaan ostopäätösprosessissa. Työn lopussa esitetään erilaisia asiakkaan ostopäätösprosessia kuvaavia malleja. Käytetyn aineiston ja mallien pohjalta on muodostettu malli brändi-imagon ja brändin maineen vaikutuksista asiakkaan ostopäätösprosessin eri tekijöihin.

Images of imagination : an aesthetic approach to education

Visual art practice has generally been described as a lonely affair, thinking about what an artist has experienced in the outside world. This study is an inquiry into a visual art practice of another kind: the relational one. The research purpose is twofold. The first purpose is to shed light on a visual artist’s conceptions of art, education and scholarship. The second purpose is to by reasoning on imagination and a rhizomatic formation interpret the relations created between art, multimodality and literacy learning as an aesthetic approach to education. By inquiry into a specific collaborated long-term art practice, the study conveys how the meaning making elements of an arts based learning practice gradually transform an artist’s and a teacher’s concepts of art education to an aesthetic approach to education. In the art practice examined the typical Finnish rye bread and a poem have represented a cultural theme that has been elaborated through art conventions. The poem and the rye bread have in the art practice been articulated as cultural representations of as well as symbolic projections on the Swedishspeaking minority culture in Finland. The study connects art informed inquiry to a hermeneutic research rationale where the research reasoning is generated through a rhizomatic alliance between empiric data and theories. The reasoning is constructed as an interpretation pattern that expands throughout the study. The study arguments that the rhizome as an aesthetic formation can be appropriate to refer to when articulating arts based meaning making and when creating arts based educational strategies, dialogues, aesthetic learning and multimodal literacy in education. The study investigates an aesthetic approach to research in education, which means that the art practice surveyed is interpreted through articulation appropriate to poetic aspects of art, education and research.

SME internationalisation from a network perspective : an empirical study on a Finnish-Greek business network

The study examines the internationalisation process of a contemporary SME firm and explores the impact of its business network on this development. The objective of the study is to understand SME internationalisation and its dynamics from a network perspective. The purpose of this research project is to describe and explore the development process of a firm and its business network by identifying the changes, critical events and influence factors that form this development. It is a qualitative case study, which focuses on a Finnish focal firm and its respective business network as it expands into the Greek market. It is a longitudinal research process, which covers a period of time from 1994 to 2004. The empirical study concentrates on the paper trading and converting business. The study builds on the network theory and the framework provided by Johanson and Mattsson's (1988) model on network internationalisation. The incremental internationalisation theories and network theories form the theoretical focus. The research project is organised according to a process view. The focal firm evolves from a domestically-oriented small subsidiary into an internationally experienced company, which has activities in several market areas and numerous business networks in various market segments and product categories. The findings illustrate the importance of both the domestic and foreign business network context in a firm's internationalisation process. The results of the study suggest theoretical modifications on a firm's internationalisation process by broadening the perspective and incorporating the strategic context of a firm. The findings suggest that internationalisation process is a non-linear process, which does not have a deterministic order in its development. The findings emphasise the significance of relational networks, both managerial and entrepreneurial, for establishing position in foreign markets. It implies that a firm's evolution is significantly influenced by its business network and by critical events. Business networks gain coherence due to common goals and they use accumulated capabilities to exploit market opportunities. The business network sets constraints and provides opportunities, which makes the related decision making strategically important. The firm co-evolves with its business network. The research project provides an instrumental case study with a description of an SME internationalisation process. It contributes to existing knowledge by illustrating dynamics in an international business network and by pinpointing the importance of suppliers, customers, partners, ownerships and competition to the internationalisation process.

Marketing culture of Finnish research libraries : an analysis of marketing attitude, knowledge and behaviour

The aim of the present dissertation is to investigate the marketing culture of research libraries in Finland and to understand the awareness of the knowledge base of library management concerning modern marketing theories and practices. The study was based onthe notion that a leader in an organisation can have large impact on its culture. Therefore, it was considered important to learn about the market orientation that initiates at the top management and flows throughout the whole organisationthus resulting in a particular kind of library culture. The study attempts to examine the marketing culture of libraries by analysing the marketing attitudes, knowledge (underlying beliefs, values and assumptions), behaviour (market orientation), operational policies and activities, and their service performance (customer satisfaction). The research was based on the assumption that if the top management of libraries has market oriented behaviour, then their marketing attitudes, knowledge, operational policies and activities and service performance should also be in accordance. The dissertation attempts to connect all these theoretical threads of marketing culture. It investigates thirty three academic and special libraries in the south of Finland. The library director and three to ten customers from each library participated as respondents in this study. An integrated methodological approach of qualitative as well as quantitative methods was used to gain knowledge on the pertinent issues lying behind the marketing culture of research libraries. The analysis of the whole dissertation reveals that the concept of marketing has very varied status in the Finnish research libraries. Based on the entire findings, three kinds of marketing cultures were emerged: the strong- the high fliers; the medium- the brisk runners; and the weak- the slow walkers. The high fliers appeared to be modern marketing believers as their marketing approach was customer oriented and found to be closer to the emerging notions of contemporary relational marketing. The brisk runners were found to be traditional marketing advocates as their marketing approach is more `library centred¿than customer defined and thus is in line of `product orientation¿ i.e. traditional marketing. `Let the interested customers come to the library¿ was appeared to be the hallmark of the slow walkers. Application of conscious market orientation is not reflected in the library activities of the slow walkers. Instead their values, ideology and approach to serving the library customers is more in tuneof `usual service oriented Finnish way¿. The implication of the research is that it pays to be market oriented which results in higher customer satisfaction oflibraries. Moreover, it is emphasised that the traditional user based service philosophy of Finnish research libraries should not be abandoned but it needs to be further developed by building a relational based marketing system which will help the libraries to become more efficient and effective from the customers¿ viewpoint. The contribution of the dissertation lies in the framework showing the linkages between the critical components of the marketing culture of a library: antecedents, market orientation, facilitators and consequences. The dissertationdelineates the significant underlying dimensions of market-oriented behaviour of libraries which are namely customer philosophy, inter-functional coordination,strategic orientation, responsiveness, pricing orientation and competition orientation. The dissertation also showed the extent to which marketing attitudes, behaviour, knowledge were related and impact of market orientation on the serviceperformance of libraries. A strong positive association was found to exist between market orientation and marketing attitudes and knowledge. Moreover, it also shows that a higher market orientation is positively connected with the service performance of libraries, the ultimate result being higher customer satisfaction. The analysis shows that a genuine marketing culture represents a synthesis of certain marketing attitudes, knowledge and of selective practices. This finding is particularly significant in the sense that it manifests that marketing culture consists of a certain sets of beliefs and knowledge (which form a specific attitude towards marketing) and implementation of a certain set of activities that actually materialize the attitude of marketing into practice (market orientation) leading to superior service performance of libraries.

Det vårdande samtalet

Syftet med studien är att utgående från ett vårdvetenskapligt perspektiv utveckla en teori för det vårdande samtalet, speciellt som det gestaltar sig i den psykiatriska vårdkontexten. Avsikten är primärt att tillföra den kliniska vårdvetenskapen kunskaper om hur samtal mellan vårdare och patienter kan lindra lidande. Studien tar sin utgångspunkt i ett vårdvetenskapligt perspektiv som har sina rötter i Katie Erikssons caritativa vårdteori. Den metodologiska ansatsen är hermeneutisk. Forskningen har genomförts i form av fem delstudier som publicerats i internationella vetenskapliga tidskrifter. Metoderna som använts är: 1) en fenomenologisk hermeneutisk ansats för att beskriva det vårdande samtalet som det skildras av sjuksköterskor och patienter i intervjuer, 2) kvalitativ forskningssyntes av studier rörande begreppen närvaro, beröring och lyssnande, 3) kvalitativ forskningssyntes av studier rörande begreppen narrativer, berättelser, mening och förståelse, 4) en hermeneutisk ansats inspirerad av Paul Ricoeurs hermeneutik för att undersöka hur psykiatriska patienter i samtal med vårdare berättar om lidande, 5) en hermeneutisk analys av de etiska fundamenten för ett vårdande samtal i ljuset av Paul Ricoeurs etik. Resultaten från de fem delstudierna formar utgångspunkten för en teori för hur ett vårdande samtal kan tolkas. Teorin består av tre aspekter, den relationella, den narrativa, och den etiska, vilka undersökts i delstudierna. I den relationella aspekten kan vårdaren genom att lyssna, beröra och vara med-varande skapa en närvaro. Genom vårdarens gåva av sin närvaro, d v s att vara tillgänglig och till förfogande med hela sitt väsen, visas möjligheten till ett möte med patienten utan roller och inlärda repliker. När patienten kan besvara denna gåva med en inbjudan att dela något av sin värld, skapas en förbindelse i vilken patienten kan dela sitt lidande och sin värld med vårdaren. Den narrativa aspekten gestaltas i samtalet som patientens berättelse om sitt lidande. Lidandeberättelsen tar sin början i den fasad som patienten skyddar sig mot lidande och skam med. Frågan om varför patienten lider banar vägen både för en ny förståelse av fasaden och också för upplevelsen av en vändpunkt när fasadens skydd överges, vilket leder till en upplevelse av mening-i-lidandet. Artikuleringen av berättelsens poäng, mening-med-lidandet innebär dels en ny tolkning och förståelse för de förhållanden som rådde vid berättelsens början, dels de nya preferenser för hur patienten vill leva sitt liv som vuxit fram. Den etiska aspekten gestaltas i en relation som på grund av patientens lidande och vårdarens medlidande är asymmetrisk, men omfattar en ömsesidig respekt. Genom caritas skapar vårdaren ett utrymme där patienten kan (åter)upprätta sin självaktning, autonomi och sitt ansvar och därmed skapa möjligheter för ett gott liv.

Career satisfaction among medical school professors: a case study in Brazil

OBJECTIVE: To investigate the career satisfaction of medical school professors in relation to initial motivation, satisfaction factors, and the desire to remain in the profession. METHODOLOGY: A qualitative methodology was used, based on questionnaires and semi-structured interviews with faculty members at a federal institution of higher education in Brazil. RESULTS: For 42.86% of the sample, teaching began while they were medical students; 80% had chosen teaching either as a vocation or due to influence from families or professors; 20% chose teaching as a professional opportunity. The majority, 57.14%, stated they were happy with teaching, and 51.42% did not plan to leave the career. Factors involved in satisfaction with teaching were: the possibility of remaining up-to-date in the medical profession, the feeling of doing their duty, their contribution to training future doctors, and contact with young people and the university setting. Factors leading to dissatisfaction were pedagogical (33.33%), economic (30.95%), institutional (14.28%), and relational (14.28%). CONCLUSIONS: Subjects expressed a positive attitude towards teaching, and because of their great personal satisfaction with the career, they did not plan to leave it. These findings should shed light on factors that interfere with career satisfaction and help increase those that promote satisfaction, thus improving the productivity and well-being of medical professors.

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Kirjallisuusarvostelu

Recepção audiovisual na educação médica: leituras de um vídeo educativo de psicologia médica por estudantes de medicina

Este estudo analisa a produção e a recepção do vídeo educativo Lição de Anatomia, a fim de compreender que sentidos são produzidos por alunos da disciplina de Psicologia Médica. Analisou-se o vídeo, entrevistaram-se seus produtores e foi feita uma exibição experimental, seguida de um grupo de discussão com estudantes de Medicina. O estudo da produção mostrou que o vídeo foi endereçado principalmente a estudantes de Medicina. Esperava-se provocar uma discussão e chamar a atenção para a formação médica como produtora de traumas e angústias. O estudo da recepção do vídeo mostrou que os espectadores estiveram, todo o tempo, conscientes da manipulação dos recursos estéticos do vídeo, não consideraram a narrativa crível e adotaram um posicionamento ideológico negociado, embora tenham compreendido e discutido alguns temas propostos pelo vídeo.

Resa i röstens landskap : en narrativ studie av hur lärare blir professionella röstanvändare

The theme of this thesis is the learning process that occurs when teachers become professional voice users. The aim is to explore what it (really) means to become a professional voice user in a teaching profession; thereby developing an understanding of how future education in this field can be arranged so as to both effectively prevent vocal problems and to develop oral didactical competence among teachers. The ambition is to describe, interpret, and understand the learning process through a combination of emic and ethic research perspectives. The theoretical frame of reference reflects the cross disciplinary character of the thesis. Voice problems are common among both student teachers and inservice teachers and adversely affect professional competence, identity and quality of life. Additionally, vocal problems are proven to have a negative impact on pupils´ learning. The individual elements of learning are explored in the light of experiential learning theory and transformative learning theory. The social elements of learning are explored in relation to the theory of situated learning. In addition, theories of teacher professionalisation in terms of competence and identity are outlined. The empirical study has a longitudinal and multi method character. It is anchored in a phenomenological hermeneutical tradition, more specifically in narrative inquiry. The point of departure is the learning experiences of ten student teachers, who attended a ten week long course on voice production as part of their teacher training at Åbo Akademi University, in the autumn of 2002 and the spring of 2003. Four interviews in the form of conversations were conducted with each participant. These were crystallised with a process diary, a Swedish Voice Handicap Index, a voice observation, and a video observation. A fifth interview was conducted with each participant five years post teacher training, in the spring of 2008. Participant observation was also conducted throughout the course. The research materials have been analysed and interpreted narratively using a phenomenological hermeneutical method. The results are presented descriptively as individual narratives, which are reflected in logopedic research materials. Learning is here understood as emergent awareness. This is followed by a meta narrative concerning learning as experiences in the four dimensions body, thought, feeling, and relation. Finally, interpretation is expressed with respect to the theory of relational education. Learning is here understood as a movement in the field between the actual and the possible voice. It is also viewed as fundamentally rooted in inter-human relationships, in moments of presence and coexistence. As a tentative answer to the call for an existential space for learning in order to be a professional voice user, I suggest the concept of a learning refuge as a locus for a learning process built on trust, mutuality and openness.

Making Sense of Shared Leadership. A case study of leadership processes and practices without formal leadership structure in the team context

Leadership is essential for the effectiveness of the teams and organizations they are part of. The challenges facing organizations today require an exhaustive review of the strategic role of leadership. In this context, it is necessary to explore new types of leadership capable of providing an effective response to new needs. The presentday situations, characterized by complexity and ambiguity, make it difficult for an external leader to perform all leadership functions successfully. Likewise, knowledge-based work requires providing professional groups with sufficient autonomy to perform leadership functions. This study focuses on shared leadership in the team context. Shared leadership is seen as an emergent team property resulting from the distribution of leadership influence across multiple team members. Shared leadership entails sharing power and influence broadly among the team members rather than centralizing it in the hands of a single individual who acts in the clear role of a leader. By identifying the team itself as a key source of influence, this study points to the relational nature of leadership as a social construct where leadership is seen as social process of relating processes that are co-constructed by several team members. Based on recent theoretical developments concerned with relational, practice-based and constructionist approaches to the study of leadership processes, this thesis proposes the study of leadership interactions, working processes and practices to focus on the construction of direction, alignment and commitment. During the research process, critical events, activities, working processes and practices of a case team have been examined and analyzed with the grounded theory –approach in the terms of shared leadership. There are a variety of components to this complex process and a multitude of factors that may influence the development of shared leadership. The study suggests that the development process of shared leadership is a common sense -making process and consists of four overlapping dimensions (individual, social, structural, and developmental) to work with as a team. For shared leadership to emerge, the members of the team must offer leadership services, and the team as a whole must be willing to rely on leadership by multiple team members. For these individual and collective behaviors to occur, the team members must believe that offering influence to and accepting it from fellow team members are welcome and constructive actions. Leadership emerges when people with differing world views use dialogue and collaborative learning to create spaces where a shared common purpose can be achieved while a diversity of perspectives is preserved and valued. This study also suggests that this process can be supported by different kinds of meaning-making and process tools. Leadership, then, does not reside in a person or in a role, but in the social system. The built framework integrates the different dimensions of shared leadership and describes their relationships. This way, the findings of this study can be seen as a contribution to the understanding of what constitutes essential aspects of shared leadership in the team context that can be of theoretical value in terms of advancing the adoption and development process of shared leadership. In the real world, teams and organizations can create conditions to foster and facilitate the process. We should encourage leaders and team members to approach leadership as a collective effort that the team can be prepared for, so that the response is rapid and efficient.

Alterações morfológicas do fígado após secção hepática parcial e omentoplastia

A omentoplastia é um método útil para o tratamento de traumas hepáticos graves. Apesar dos bons resultados dessa tática operatória para controlar a hemorragia, seus efeitos sobre a arquitetura hepática ainda não são bem conhecidos. Dessa forma, o presente trabalho teve como objetivo verificar a influência da omentoplastia em trauma experimental do fígado. Este estudo foi realizado em dez ratos submetidos a secção parcial do lobo hepático direito. Um segmento de omento maior foi introduzido dentro da ferida hepática, que foi suturada com fio de categute simples 5-0. Os animais foram seguidos durante sete (n=5) ou 21 (n=5) dias. Decorridos esses períodos, os aspectos macro e microscópicos do fígado foram avaliados. Todos os ratos suportaram a operação e sobreviveram durante o período estudado neste experimento. Os principais achados foram, no sétimo dia, necrose e abscessos do fígado distal à secção hepática. No 21° dia, a parte distal do fígado tornara-se fibrótica. Concluindo, a omentoplastia é de grande ajuda para controlar sangramentos hepáticos intensos decorrentes de trauma; porém, em ratos, a parte distal de uma ferida profunda muda suas características morfológicas.

Análise de 126 fraturas de face em crianças menores de 12 anos

As fraturas da face em crianças são infreqüentes e a melhor forma de tratamento ainda é a prevenção. Com isso nosso estudo busca caracterizar epidemiologicamente as fraturas de face em crianças enfatizando os sítios principais. Analisamos 126 fraturas de face em 98 crianças atendidas no HC-FMUSP, entre janeiro de 1990 e julho de 1996. A causa mais freqüente foi a queda de alturas e o osso da face mais acometido foi a mandíbula (29%), seguida do osso nasal (24%). Das fraturas da mandíbula, o corpo foi a região mais envolvida (31%), seguido do côndilo (27%). Traumas associados estiveram presentes em 24% dos casos, sendo traumatismo crânio-encefálico o mais freqüente. Os acidentes domésticos são as principais causas de fraturas de face em crianças, portanto, medidas preventivs simples podem ser adotadas objetivando diminuir o número desses acidentes.

Correção laparoscópica de hérnia diafragmática traumática crônica

Diaphragmatic hernia secondary to blunt or penetrating trauma is rarely by itself a fatal event. However, if unpercieved, it may lead to severe complications caused by herniation of abdominal contents to the ethorax. Blunt trauma related to car accidents is the most frequent cause of diaphragmatic hernias. Associated injuries are frequently observed, provoked by severe traumas of great impact. These blunt trauma hernias occur mainly on the left side due to abdominal anatomy, since the liver is usually located on the right side. When injuries are observed on the right they tend to be more severe, generally related to major trauma of solid organs. Less frequently diaphragmatic hernias may be bilateral. The management of diaphragmatic injury would appear to be a simple matter of suturing the defect. However, peroperative diagnosis can be difficult and even at the time of surgery some diaphragmatic injuries can be overlooked if carefull exploration is not done. Associated injuries tend to divert attention from the diaphragmatic injury. Laparoscopic diagnosis and repair have been described with successfull. Laparotomy or thoracotomy can be employed for surgical repair of traumatic diaphragmatic hernias. Standard (laboratory/imaging) examinations may fail to make the diagnosis. Recently, the laparoscopic approach has proved useful for more precise evaluation of such injuries, very often allowing immediate repair of these lesions.

Utilidade dos exames pré-operatórios em trauma

Os exames complementares são realizados rotineiramente no pré-operatório de procedimentos cirúrgicos médios e grandes. Entretanto, a sua utilidade é questionável, uma vez que muitos deles são normais ou seus resultados são previsíveis. O objetivo deste estudo foi avaliar a real utilidade da propedêutica complementar pré-operatória na prevenção de complicações cirúrgicas. Foram revistos 117 prontuários de pacientes submetidos a operações por traumas abdominais (66,6%) e/ou torácicos (33,4%) de grande porte, no Setor de Urgência do Hospital João XXIII de Belo Horizonte, no período de 1985- 1995. Avaliaram-se os exames complementares pré-operatórios e sua relação com eventuais complicações cirúrgicas. A idade dos 76 homens e 4l mulheres variou entre 20 e 79 anos. Os 49,2% dos exames laboratoriais alterados corresponderam a achados previsíveis pelo exame clínico. Somente 1,6% das anormalidades nesses exames foram relacionadas com complicações pós-operatórias. Nenhuma das 70,4% radiografias alteradas correlacionaram-se com complicações pós-operatórias. As complicações pós-operatórias mais freqüentes foram abscesso de parede, parada cardiorrespiratória e pneumonia. Nenhuma complicação poderia ter sido prevenida pelos exames complementares pré-operatórios. Os resultados obtidos nos exames complementares pré-operatórios não influenciaram as condutas, e as alterações encontradas não foram relacionadas às complicações cirúrgicas em serviço de urgência.