Genetic background of bipolar disorder and related cognitive impairments

Bipolar disorder (BP) is a complex psychiatric disorder characterized by episodes of mania and depression. BP affects approximately 1% of the world’s population and shows no difference in lifetime prevalence between males and females. BP arises from complex interactions among genetic, developmental and environmental factors, and it is likely that several predisposing genes are involved in BP. The genetic background of BP is still poorly understood, although intensive and long-lasting research has identified several chromosomal regions and genes involved in susceptibility to BP. This thesis work aims to identify the genetic variants that influence bipolar disorder in the Finnish population by candidate gene and genome-wide linkage analyses in families with many BP cases. In addition to diagnosis-based phenotypes, neuropsychological traits that can be seen as potential endophenotypes or intermediate traits for BP were analyzed. In the first part of the thesis, we examined the role of the allelic variants of the TSNAX/DISC1 gene cluster to psychotic and bipolar spectrum disorders and found association of distinct allelic haplotypes with these two groups of disorders. The haplotype at the 5’ end of the Disrupted-in-Schizophrenia-1 gene (DISC1) was over-transmitted to males with psychotic disorder (p = 0.008; for an extended haplotype p = 0.0007 with both genders), whereas haplotypes at the 3’ end of DISC1 associated with bipolar spectrum disorder (p = 0.0002; for an extended haplotype p = 0.0001). The variants of these haplotypes also showed association with different cognitive traits. The haplotypes at the 5’ end associated with perseverations and auditory attention, while the variants at the 3’ end associated with several cognitive traits including verbal fluency and psychomotor processing speed. Second, in our complete set of BP families with 723 individuals we studied six functional candidate genes from three distinct signalling systems: serotonin-related genes (SLC6A4 and TPH2), BDNF -related genes (BDNF, CREB1 and NTRK2) and one gene related to the inflammation and cytokine system (P2RX7). We replicated association of the functional variant Val66Met of BDNF with BP and better performance in retention. The variants at the 5’ end of SLC6A4 also showed some evidence of association among males (p = 0.004), but the widely studied functional variants did not yield any significant results. A protective four-variant haplotype on P2RX7 showed evidence of association with BP and executive functions: semantic and phonemic fluency (p = 0.006 and p = 0.0003, respectively). Third, we analyzed 23 bipolar families originating from the North-Eastern region of Finland. A genome-wide scan was performed using the 6K single nucleotide polymorphism (SNP) array. We identified susceptibility loci at chromosomes 7q31 with a LOD score of 3.20 and at 9p13.1 with a LOD score of 4.02. We followed up both linkage findings in the complete set of 179 Finnish bipolar families. The finding on chromosome 9p13 was supported (maximum LOD score of 3.02), but the susceptibility gene itself remains unclarified. In the fourth part of the thesis, we wanted to test the role of the allelic variants that have associated with bipolar disorder in recent genome-wide association studies (GWAS). We could confirm findings for the DFNB31, SORCS2, SCL39A3, and DGKH genes. The best signal in this study comes from DFNB31, which remained significant after multiple testing corrections. Two variants of SORCS2 were allelic replications and presented the same signal as the haplotype analysis. However, no association was detected with the PALB2 gene, which was the most significantly associated region in the previous GWAS. Our results indicate that BP is heterogeneous and its genetic background may accordingly vary in different populations. In order to fully understand the allelic heterogeneity that underlies common diseases such as BP, complete genome sequencing for many individuals with and without the disease is required. Identification of the specific risk variants will help us better understand the pathophysiology underlying BP and will lead to the development of treatments with specific biochemical targets. In addition, it will further facilitate the identification of environmental factors that alter risk, which will potentially provide improved occupational, social and psychological advice for individuals with high risk of BP.

Health-Related Quality of Life and Mental Disorders in Finland

Quality of life (QoL) and Health-related quality of life (HRQoL) are becoming one of the key outcomes of health care due to increased respect for the subjective valuations and well-being of patients and an increasing part of the ageing population living with chronic, non-fatal conditions. Preference-based HRQoL measures enable estimation of health utility, which can be useful for rational rationing, evidence-based medicine and health policy. This study aimed to compare the individual severity and public health burden of major chronic conditions in Finland, including and focusing on reliably diagnosed psychiatric conditions. The study is based on the Health 2000 survey, a representative general population survey of 8028 Finns aged 30 and over. Depressive, anxiety and alcohol use disorders were diagnosed with the Composite International Diagnostic Interview (M-CIDI). HRQoL was measured with the 15D and the EQ-5D, with 83% response rate. This study found that people with psychiatric disorders had the lowest 15D HRQoL scores at all ages, in comparison to other main groups of chronic conditions. Considering 29 individual conditions, three of the four most severe (on 15D) were psychiatric disorders; the most severe was Parkinson s disease. Of the psychiatric disorders, chronic conditions that have sometimes been considered relatively mild - dysthymia, agoraphobia, generalized anxiety disorder and social phobia - were found to be the most severe. This was explained both by the severity of the impact of these disorders on mental health domains of HRQoL, and also by the fact that decreases were widespread on most dimensions of HRQoL. Considering the public health burden of conditions, musculoskeletal disorders were associated with the largest burden, followed by psychiatric disorders. Psychiatric disorders were associated with the largest burden at younger ages. Of individual conditions, the largest burden found was for depressive disorders, followed by urinary incontinence and arthrosis of the hip and knee. The public health burden increased greatly with age, so the ageing of the Finnish population will mean that the disease burden caused by chronic conditions will increase by a quarter up to year 2040, if morbidity patterns do not change. Investigating alcohol consumption and HRQoL revealed that although abstainers had poorer HRQoL than moderate drinkers, this was mainly due to many abstainers being former drinkers and having the poorest HRQoL. Moderate drinkers did not have significantly better HRQoL than abstainers who were not former drinkers. Psychiatric disorders are associated with a large part of the non-fatal disease burden in Finland. In particular anxiety disorders appear to be more severe and have a larger public health burden than previously thought.

Kahdestaan kotona : Tutkimus vanhoista pariskunnista

In this study, which pertains to the field of social gerontology and family research, I analyse the meaning of everyday life as perceived by elderly couples living at home. I use the ethnographic approach, with the aim of interpreting meanings from the elderly people s personal point of view and to increase understanding of their way of life. The study deepens our conception of what gives purpose to the everyday life of elderly people. The number of elderly couples is growing and, to an increasing extent, a couple will live and cope together to a ripe old age. Such coping can also be viewed as an important resource for society. Ethnography tries to get close to people's life practices. I examine the day-to-day life of elderly couples based on textual data, which I obtained by visiting the homes of 16 couples in a total of five small municipalities in Southern Finland. The couples had married soon after the war or in the early 1950s. I found that the aspiration towards continuity, which unites the concepts of place and home, housework and a long marriage, is the most important notion connecting the discussion themes. The results show that in the opinion of the elderly, the concept of a good life is intertwined with a long marriage spent at home, as well as its values. Old people find that they lead an independent life if they feel that they can hold on to the key features of their way of life. Elderly couples ability to cope with everyday life involves taking care of housework and other tasks around the home together. This means that they support one another and have common goals and aspirations. Daily tasks provide substance in the lives of elderly couples. Each day has its rhythm, and the pace of this rhythm is set by routine and habits. Satisfaction stems from the fact that you can do something you are good at. The couples have also revised the division of housework. Men have learned to perform new tasks around the house when their wives can no longer manage them by themselves. Some tasks are given up. Day-to-day life at home and around the house provides room for men s participation. Mutual support and care between husband and wife can also protect them from having to resort to outside or official help. Old couples integrate their life experiences and memories, as well as present and future risks and opportunities. They wish to carry on their lives as before, and still think that their present life corresponds with their idea of a good life. Key words: elderly couples, continuity theory of aging, everyday life, social gerontology, family research

Työkykyarviokokous moniammatillisen työryhmän päätöksentekotilanteena : Tutkimus vuorovaikutuksesta ja potilaan osallisuudesta

Work capacity assessment meeting as a decision-making situation of a multi-professional team a study on interaction and patient participation Multi-professional working has become an increasingly popular method of work in social and health care. The introduction of the viewpoints of several professionals is seen as a way to enhance the openness and quality of decision-making. However, so far relatively few study results are available on the implementation of this method in actual operations. This study examines one work method, a work capacity assessment meeting, along with medical certificates B and their enclosures written by the doctor to the patient after a meeting. After the theoretical and methodological chapter, providing background information, the study describes the structure of the meeting and the medical certificate as a constructive factor. This is followed by a discussion on the manner of assessing the various domains of the patient s functional capacity and the decision-making based on the assessed factors. Next, the study moves on to examine the effect of patient involvements on the conclusions and decisions that professionals make at the meeting. In conclusion, the study looks into how the voices of the professionals and the customer are transferred to the medical certificate. The material of the study consists of 11 meetings recorded on video, of which eight are work capacity assessment meetings and three are rehabilitation examination meetings. The first type of meeting is attended by a patient and a number of professionals, while the latter is attended only by the professionals. All the patients, whose cases are discussed in the work capacity assessment meetings, have a musculoskeletal disorder, while the rehabilitation meetings are related to patients who all also have some additional problem. The study material also consists of seven medical certificates B, written after a work capacity assessment meeting. For the most part, the material has been collected by the conversation analysis method. Moreover, also discourse analysis and a rhetorical approach were used. By using conversation analysis, it is possible to study closely how interaction is built up at the meeting and to examine how the actors implement their institutional assessment tasks in a co-operation that takes its form turn by turn. The four main findings of the study are as follows: firstly, the meeting is structured to a great extent on the basis of the medical certificate form to various phases of the meeting and the headings of the certificate are seen as communicative affordances at the meeting, directed primarily to the professionals that have assessed the patient s work capacity with various tests. The medical certificate is the ethno-method of the doctor acting as the chairman of the meeting that functions in two directions: it constructs the meeting and constitutes the task of the professionals as they produce contents for it. Secondly, the study describes the ways that are used to assess the different domains of the patient s work capacity, how they are described at the meeting and how a decision is taken when the assessment information has been saturated in the opinion of the team. Thirdly, the study brings up ways, with which the patient can influence the conclusions and decisions made by the professionals at the meeting. The study showed that the patient can affect the preconditions of his or her own future and wellbeing. Fourthly, the study describes how the wealth of expressions at the meeting is transferred to the certificate as an argumentative micro-cosmos, where the patient is classified to be recommended for rehabilitation or disability pension. An important finding is also how objective and subjective information and the voices of actors at the meeting are transferred to the statement in a strategic and intentional manner, with an orientation to the decision that will be taken at the insurance institution. The study results can be utilized in the training of professionals and in developing the operations of organisations performing the assessment of the work capacity of people suffering from musculoskeletal disorders.

Work Stress in the Nursing Profession : An Evaluation of Organizational Causal Attribution

The goal of this study was to examine the role of organizational causal attribution in understanding the relation of work stressors (work-role overload, excessive role responsibility, and unpleasant physical environment) and personal resources (social support and cognitive coping) to such organizational-attitudinal outcomes as work engagement, turnover intention, and organizational identification. In some analyses, cognitive coping was also treated as an organizational outcome. Causal attribution was conceptualized in terms of four dimensions: internality-externality, attributing the cause of one’s successes and failures to oneself, as opposed to external factors, stability (thinking that the cause of one’s successes and failures is stable over time), globality (perceiving the cause to be operative on many areas of one’s life), and controllability (believing that one can control the causes of one’s successes and failures). Several hypotheses were derived from Karasek’s (1989) Job Demands–Control (JD-C) model and from the Job Demands–Resources (JD-R) model (Demerouti, Bakker, Nachreiner & Schaufeli, 2001). Based on the JD-C model, a number of moderation effects were predicted, stating that the strength of the association of work stressors with the outcome variables (e.g. turnover intentions) varies as a function of the causal attribution; for example, unpleasant work environment is more strongly associated with turnover intention among those with an external locus of causality than among those with an internal locuse of causality. From the JD-R model, a number of hypotheses on the mediation model were derived. They were based on two processes posited by the model: an energy-draining process in which work stressors along with a mediating effect of causal attribution for failures deplete the nurses’ energy, leading to turnover intention, and a motivational process in which personal resources along with a mediating effect of causal attribution for successes foster the nurses’ engagement in their work, leading to higher organizational identification and to decreased intention to leave the nursing job. For instance, it was expected that the relationship between work stressors and turnover intention could be explained (mediated) by a tendency to attribute one’s work failures to stable causes. The data were collected from among Finnish hospital nurses using e-questionnaires. Overall 934 nurses responded the questionnaires. Work stressors and personal resources were measured by five scales derived from the Occupational Stress Inventory-Revised (Osipow, 1998). Causal attribution was measured using the Occupational Attributional Style Questionnaire (Furnham, 2004). Work engagement was assessed through the Utrecht Work Engagement Scale (Schaufeli & al., 2002), turnover intention by the Van Veldhoven & Meijman (1994) scale, and organizational identification by the Mael & Ashforth (1992) measure. The results provided support for the function of causal attribution in the overall work stress process. Findings related to the moderation model can be divided into three main findings. First, external locus of causality along with job level moderated the relationship between work overload and cognitive coping. Hence, this interaction was evidenced only among nurses in non-supervisory positions. Second, external locus of causality and job level together moderated the relationship between physical environment and turnover intention. An opposite pattern of interaction was found for this interaction: among nurses, externality exacerbated the effect of perceived unpleasantness of the physical environment on turnover intention, whereas among supervisors internality produced the same effect. Third, job level also disclosed a moderation effect for controllability attribution over the relationship between physical environment and cognitive coping. Findings related to the mediation model for the energetic process indicated that the partial model in which work stressors have also a direct effect on turnover intention fitted the data better. In the mediation model for the motivational process, an intermediate mediation effect in which the effects of personal resources on turnover intention went through two mediators (e.g., causal dimensions and organizational identification) fitted the data better. All dimensions of causal attribution appeared to follow a somewhat unique pattern of mediation effect not only for energetic but also for motivational processes. Overall findings on mediation models partly supported the two simultaneous underlying processes proposed by the JD-R model. While in the energetic process the dimension of externality mediated the relationship between stressors and turnover partially, all the dimensions of causal attribution appeared to entail significant mediator effects in the motivational process. The general findings supported the moderation effect and the mediation effect of causal attribution in the work stress process. The study contributes to several research traditions, including the interaction approach, the JD-C, and the JD-R models. However, many potential functions of organizational causal attribution are yet to be evaluated by relevant academic and organizational research. Keywords: organizational causal attribution, optimistic / pessimistic attributional style, work stressors, organisational stress process, stressors in nursing profession, hospital nursing, JD-R model, personal resources, turnover intention, work engagement, organizational identification.

Vaikeavammaisen nuoren aikuistuminen : Yksilöllinen ja erilainen elämänkulku

Transition to adulthood of severely disabled adolescents. Diversity in individual life courses. The focus of this study is to examine the transition to adulthood of severely disabled adolescents as part of their life course. The data for this study were gathered through interviews with nine severely disabled adolescents, who were interviewed several times over a period of eight years. At the beginning of the study the adolescents were between 18 and 24 years old. The informants had severe disabilities manifesting themselves as physical incapacity, cerebral palsy, vision or hearing impairment, neurological disease, or developmental disability. One of the adolescents communicated with symbols. All except one used a wheelchair. As severely disabled adolescents, they received benefits from Kela for persons with severe disabilities, such as the higher-rate or special disability allowance or disability pension, the higher-rate or special pensioners' care allowance, or medical rehabilitation services. The interviews focused on a number of selected themes such as relationships, family, education, work, leisure-time activities, dating, decision-making, independence, happiness, and one s self-image and identity. Data were also derived from interviews with five experts. Two of the experts interviewed were severely disabled themselves. The theoritical foundation of the study lies in perviuos research on the severly disabled, the transition to adulthood and the life course. The method of analysis and interpretation is qualitative and based on interviews with the adolescents. In terms of the analytical process, the focus is on recognizing individual events in the transition process to adulthood and identifying the meanings assigned to them by the adolescents. The narratives also provide a method to shed light on the individuality of the transition. The individual situations of severely disabled adolescents vary, and their disability impacts the range of options available to them as they plan their life course. The medical and social models of disability also have an effect on life courses. Although severely disabled adolescents are able to attain some goals, they remain outsiders in many respects. Key words: Disabled person, severely disabled person, adolescent, transition to adulthood, identity, life course.

Tuntemattomista vertaistuttaviksi : Esikoisäitien ja -isien perhevalmennusprosessi Espoon uudentyyppisessä perhevalmennuskokeilussa

From Strangers to Peer Acquaintances Mothers and Fathers with a First Born and their Experiences of the New Family Training Process in Espoo This research is composed of two interrelated case studies. The first case was a family training experiment conducted in the City of Espoo during 2003 2005. In the experiment, the content, duration and procedures were modified from the previous family training policy. The new family training system stressed peer group activities and the peer support formed between the participating mothers and fathers. The second case comprised the stories of 14 parents about the family training process. The aim of the research was to find out whether peer group activities and support was demonstrated between the participating parents during the family training process. The second case and its narrative material constituted the main research material. The narrative material was collected by interviews. Eight mothers and six fathers were interviewed twice within a year between their sessions. The parents also filled in questionnaires about their daily life and participated in a drawing exercise, in which they visualized how they experienced the family training during the antenatal period, labour and the postnatal period. A narrative approach was applied to the analysis of the narrative material. The analysis consisted of several stages. In the final stage, the fathers main story was combined with all the participating fathers personal stories. The mothers main story was also constructed from their personal stories. The study implicated that in some parts the mothers and fathers main stories were similar. During the family training, previously unacquainted parents became peer acquaintances. In particular, the first born as a focus created interaction and cooperation among the parents. Parents in similar circumstances became significant to each other. Different figurations formed during the family training. However, the main stories did not always entwine. The mothers were in contact with the other mothers almost daily using mobile phones, email and mother-child activities. The fathers employed outside home met each other only during the family training meetings, but felt being supported by the other fathers. Some families visited one another outside of the family training. This new type of family training had characteristics typical of the project society. The parents peer activities were based on trust, negotiation and contracts between partners. The parents evaluated the benefits of participation in the family training. If they appreciated the activities with peers and peer compassion, they were willing to participate in the family training during the postnatal period. Keywords: family training, parenthood, motherhood, fatherhood, peer, peer group, peer support, social support, social relationships, figurations, the project society, pastoral power, epistolary power

Yliopisto-opetuksen yhteistoiminnallinen kehittäminen

The main aim of this work is to study the possibility of applying the cooperative learning approach to develop academic learning and teaching culture. In this work cooperative learning refers to a pedagogical approach that applies social psychological knowledge of group dynamics and small group teaching. Furthermore, theories of collaborative learning and organization development have been applied. Based on these theories a model of developing learning and teaching culture was developed. The model was tested in the development project that was carried out in the Faculty of Agriculture and Forestry of Helsinki University. The research questions were: How were the theories of cooperative and collaborative learning and organization development applied in the project? What kind of effects did the development project have on the learning and teaching culture? Through which kind of mechanisms did the project influence this culture? How should the development model be revised after the empirical test? The project lasted five years and the major part of the project consisted of a one-year pedagogical training course. Altogether 145 people (teachers, researchers, library staff, and students) participated in the training, two to three departments at a time. In the pedagogical training cooperative learning methods were widely used. A questionnaire was used to study effects of the development project. The questionnaire was sent to 87 people and 65.5 % answered it. Both the answers to the questionnaire and a sample of learning diaries (n=61) were used to study the mechanism of the project. A sample of the learning diaries consisted of two pedagogical training group members diaries. The frequency distributions were calculated as extrapolations from the answers to the structured questions. Furthermore the answers were classified by the main background variables. The analysis of the open answers to the questionnaire and the learning diaries were data-based. According to the answers to the questionnaire, the effects of the pedagogical training were as follows: The participants consider learning more as an active process of constructing knowledge. Furthermore they considered the individual learning styles and strategies, cooperation and motivation as more important part of the learning process than before the pedagogical training. The role of the teacher was viewed more challenging than before. Additionally the cooperation between teachers, other staff members and students had projected to increase. After the project had ended the teaching methods in the whole faculty were viewed to become varied and the teaching was considered to be more valued than before. According to the answers to the questionnaire, the project influenced through the following ways: the project stimulated the change process, provided new methods for learning and teaching, had an effect on conceptions of learning and teaching and facilitated meaningful communication with others (staff and students). The analysis of the learning diaries supported these findings. In addition, the analysis of the learning diaries deepened the understanding of how the cooperative learning methods supported positive learning atmosphere and reduced the negative effect of the status differences between the members of the group. The critical comments in the learning diaries could be interpreted as collision between cooperative and traditional teaching culture. Cooperative learning gives theory-based methods to develop academic learning and teaching culture. The approach helps the developer to create positive collaborative learning environment and gives ways to support learning in small groups, which can promote cultural change. On the other hand, to understand the whole process of organization development and promote change the theories of organizations and more sosioconstructivist theory of learning are needed. Cooperative learning, collaborative learning, higher education, group dynamics, social constructionism, organisational culture, organisation development

Kelan järjestämän kuntoutuksen kohdentuminen ja vaikutukset työkykyyn kunnallisilla työpaikoilla

Tutkimuksessa selvitettiin Kansaneläkelaitoksen (Kelan) järjestämän kuuden yleisimmän työssä käyvälle väestölle tarkoitetun kuntoutusmuodon kohdentumista kuntatyöntekijöille (n = 67 106 henkilöä). Lisäksi selvitettiin Kelan järjestämän tuki- ja liikuntaelinkuntoutuksen ja ASLAKkurssien vaikutuksia työkykyyn sekä verrattiin kahta fibromyalgiaa sairastaville tarkoitettua kuntoutusmuotoa. Muuttujatiedot kerättiin työnantajien omista ja kansallisista rekistereistä. Naiset olivat Kelan järjestämässä kuntoutuksessa yliedustettuina ja määräaikaisessa työsuhteessa työskentelevät aliedustettuina. Selkäkipukuntoutukseen osallistuneiden ja työnantajien palveluksessa seurannan loppuun saakka olleiden vuosittaiset hyvin pitkät sairauspoissaolot vähenivät kolmen kuntoutuksen jälkeisen vuoden ajaksi. Niskakipukuntoutukseen osallistuneilla ei todettu tätä muutosta. ASLAK-kuntoutukseen osallistuneiden sairauspoissaolopäivät ja hyvin pitkät sairauspoissaolokerrat vähenivät kuntoutusvuonna ja kolmena sen jälkeisenä vuonna samalle tasolle kuin kuntoutukseen osallistumattomilla kaltaistetuilla verrokeilla. Työkyvyttömyyseläkkeen riski oli kuntoutujilla neljän kuntoutuksen jälkeisen vuoden aikana verrokkeja pienempi. Fibromyalgiaa sairastavien kahden kuntoutusmuodon (fibromyalgiakurssi ja epäspesifinen tules-kuntoutus) vertailussa ei kuntoutuksen vaikutuksissa työkykykyyn todettu eroa. Kelan järjestämän kuntoutuksen sisällössä tarvitaan kriittistä arviointia, tutkimusta ja kehitystyötä, jotta yhteiskunnan odotus vaikuttavuudesta toteutuu.

Kevätviljojen siemenviljelyn jatkuvuus K- maatalouden sopimusviljelytiloilla 2010

Maisterin tutkielman tavoitteena oli kartoittaa kevätviljojen siemenviljelyn edellytyksiä Kmaatalouden sopimusviljelytiloilla. Erityisesti oltiin kiinnostuneita kansallisen siementuotantotuen poistumisen vaikutuksesta viljeltävien lajikkeiden lukumäärään ja viljelyaloihin. Tutkielman teoriaosassa tarkasteltiin viljojen siemenviljelyä, sen erityispiirteitä Suomessa ja siihen liittyvää lainsäädäntöä, asetuksia ja maatalouspolitiikkaa. Siemenviljelyä tarkasteltiin paitsi huoltovarmuuden näkökulmasta myös viljelyn taloudellisuuden näkökulmasta. Lisäksi esitettiin sertifioidun ja tilan oman siemenen käyttöön ja laajuuteen vaikuttavia tekijöitä ja siemenen sertifiointiprosessi. Tutkimuksen aineisto perustui maaliskuussa 2010 tehtyyn lomakekyselyyn, joka lähetettiin 119 K-maatalouden sopimussiemenviljelijälle. Kyselyyn vastasi 71 viljelijää, jolloin vastausprosentiksi muodostui 60. Tutkimusmenetelminä aineiston analysoinnissa käytettiin frekvenssijakaumia, keskiarvotestejä ja Kruskall-Wallisin testiä. Tutkimustulosten mukaan kansallisen siementuotannon tuen poistuminen vuoden 2011 alussa ei näyttänyt vaikuttavan siemenviljelyn jatkuvuuteen tai jatkohalukkuuteen. Siementuotannon tukea pidettiin varsin alhaisena, joten sen vaikutus viljelyyn osoittautui vähäiseksi. Huomattavasti enemmän siemenviljelyyn näytti vaikuttavan yleinen maatalouden ja etenkin viljanviljelyn alhainen kannattavuus. Siemenviljelijät katsoivat, etteivät esimerkiksi siementuotannon tuki tai tuen poistuminen korvaa riittävästi tuotannosta aiheutunutta lisätyötä. Toisaalta harva siemenviljelijä aikoi lopettaa tuotannon, vaikka pitivät viljanviljelyä huonosti kannattavana. Tällaiseen näkemykseen saattoi olla syynä se, että viljelijöillä oli siemententuotantoon soveltuva kalusto, ammattitaito ja rutiini tuotantoon. Tutkimukseen osallistuneet viljelijät katsoivat lisäksi, että oma maatila soveltui erittäin hyvin siemententuotantoon. Suurimpana uhkana siementuotannolle kyselyyn vastanneet viljelijät pitivät hukkakauraa omilla tai naapureidensa pelloilla.

Sense of Coherence : Determinants and consequences

ABSTRACT Sense of coherence (SOC) is a core concept within Antonovsky s salutogenic theory and is argued to be a psychological determinant of health. The present social-epidemiological study explores the associations between a wide range of generalized resistance resources of SOC among Finnish- and Swedish-speaking women and men with a view to gaining deeper insight into its developmental circumstances and determinants. Secondly, a five-year follow-up study was conducted in order to assess the stability of SOC in difficult life events. Finally the role and effect of SOC in the intentions to retire early was investigated in a prospective study. The above studies were based on two data sets: the Finnish 'Survey on Living Conditions' (ELO-94) conducted in 1994 by means of personal face-to-face interviews (N=6506), and a prospective postal survey of the 15-year Health and Social Support (HeSSup) study for which the baseline data was collected in 1998 (N=25 898) and the follow-up in 2003. The present study reveals that the level of SOC in adulthood is strongly dependent on close and successful social relationships during both childhood and adulthood, and that there is a strong association with qualitative work features. Not having a partner as well as being unable to use one s skills at work proved to threaten men s SOC in particular, whereas a lack of social support did the same for women. Otherwise, the association with generalized resistance resources turned out to be quite similar in both genders. Swedish-speaking Finns appear to have a slightly stronger SOC due to the better psycho-emotional circumstances in the childhood home and work circumstances in adulthood, in other words higher levels of generalized resistance resources compared to Finnish speakers. These language group differences did not concern any social-life factors included in the present study. The results of the five-year follow-up study suggest that SOC is not stable, and that the level clearly decreases after a negative life event. Even a strong SOC decreased during the follow-up period and, furthermore, was no more stable than a mediocre or weak SOC. There seems to be a clear and independent association with the intentions to retire early among both men and women following full adjustment. Swedish speakers appear to be less inclined to retire early than Finnish speakers. In the light of the present study, it seems that SOC is determined not only by socio-economic factors but also by close and successful social relationships during both childhood and adulthood. This applied to both genders and language groups. Interventions aimed at promoting the health of the disadvantaged should therefore focus on families with children, and extend later also to other than socio-economic spheres of life. SOC theory could also be applied in efforts to inhibit early retirement: management practices aimed at providing employees with a work environment and tasks that are comprehensible, manageable and meaningful could potentially decrease the intentions to retire early.

Kolmas sektori maaseutukunnissa

Tämän tutkimuksen tarkoituksena on hahmottaa, millaisena toimijana kolmas sektori eli järjestöt nähdään maaseutumaisissa kunnissa nyt, kun kunta- ja palvelurakenne on muuttumassa ja väestö ikääntymässä. Tutkimuksen perusteella maaseutukunnat odottavat kolmannelta sektorilta ja järjestöiltä panosta kaikkein eniten sosiaalisten verkostojen, niitä vahvistavan ihmisten kanssakäymisen ja yhteisöllisyyden vahvistajana. Erilaisten tapahtumien, kulttuuri-, liikunta-, nuoriso-, harrastus- ja vapaa-ajan toiminnan järjestäminen, ympäristönhoito, perinteen ja historian tallentaminen sekä asukas- ja kylätoiminnan ylläpitäminen ovat maaseutukunnissa toimivien järjestöjen vahvaa toimintakenttää. Tällaisen perinteisen järjestötoiminnan myös taloudellisen merkityksen nähdään korostuvan väestön terveyden ja toimintakyvyn eteen tehtävän ennaltaehkäisevän työn tarpeen kasvaessa. Toinen tutkimuksessa vahvasti esille noussut kolmannen sektorin toiminnan vahvuus liittyy järjestöjen toiminnan ihmisläheisyyteen ja inhimillisyyteen. Kuntakoon kasvaessa ja palvelutuotannon järjestelmien monimutkaistuessa monet tutut arkiset tavat hoitaa asioita menevät uusiksi. Varsinkin ikääntyville nämä muutokset ovat suuria ja aiheuttavat inhimillistä hätää, pelkoja ja kasvavaa yksinäisyyttä. Järjestöissä tämä avun tarve nähdään usein läheltä, ja ne ryhtyvät toimimaan avun ja palvelujen järjestämiseksi. Järjestöjen koetaan toimivan inhimillisesti, lähellä ihmisiä, helposti lähestyttävänä, tutuin kasvoin, kuuntelevin korvin, todellisiin tarpeisiin vastaten. Ajankohtainen poliittinen puhe tuo kolmannen sektorin esille nimenomaan palvelujen tuottajana. Järjestöt ovat myös monissa maaseutukunnissa paikallisesti merkittäviä palvelujen tuottajia ja työllistäjiä. Tutkimuksessa tuli kuitenkin selvästi esille se, ettei kolmannen sektorin palveluntuottajaroolin vahvistumista nähdä varsinkaan harvaan asutun maaseudun pienissä kunnissa kovin realistisena. Järjestöjen roolin ja tehtävien kasvua palvelujen tuottajana jarruttaa erityisesti rahoituksen epävarmuus sekä järjestöväen ikääntyminen ja aktiivisten toimijoiden vähäinen määrä. Kolmas sektori nähtiin varsinkin maaseutukunnissa tehdyissä haastatteluissa vapaaehtoistyön paikkana. Tämä työn järjestämisen periaate kolmatta sektoria määrittävänä tekijänä tuli esille huomattavasti useammin kuin esimerkiksi se, tavoitellaanko toiminnalla voittoa vai ei. On helppo ymmärtää, että kolmas sektori pyritään hahmottamaan vapaaehtoistyön paikaksi, varsinkin kun palvelujen tuottamisen rahoitus on sekä kunnissa että järjestöissä muodostumassa entistä vaikeammaksi kysymykseksi. Siihen, tehdäänkö työ järjestöissä palkattuna työnä vai vapaaehtoistyönä, sisältyy myös yksi kolmatta sektoria koskevan poliittisen keskustelun sokeista pisteistä. Keskustelussa ei ole edetty vielä siihen asti, että puhuttaisiin niistä rajoista, mitä maaseudun yhdistyksiltä ja niissä vapaaehtoiselta pohjalta toimivilta ihmisiltä voidaan ylipäätään edellyttää. Tämän tutkimuksen perusteella voidaan todeta, että mikäli kolmannen sektorin odotetaan osallistuvan sellaisten palvelujen tuottamiseen, jotka edellyttävät sitoutumista, säännöllisyyttä ja pitkäjänteisyyttä, ei tällaisia tehtäviä voida edellyttää hoidettavaksi järjestöissä vapaaehtoisvoimin, ilman korvausta. Tällaisten tehtävien hoitamiseen tarvitaan palkattuja työntekijöitä myös järjestöissä. Tarkasteltaessa kolmannen sektorin roolin ja tehtävien muuttumista maaseutumaisissa kunnissa ja peilattaessa sitä kuntien kasvaviin haasteisiin palvelujen järjestäjänä huomio keskittyy väistämättä ikääntyvän väestön tuki-, hoiva- ja hoitopalvelujen kysynnän kasvuun. Kolmannen sektorin kannalta keskeinen kysymys on, kuka tuottaa ja rahoittaa tulevaisuudessa nuorisopalvelut, liikuntapalvelut, kulttuuripalvelut, vapaa-ajan palvelut, virkistys- ja harrastustoimintaa tai ne välttämättömät tuki- ja hoivapalvelut, joihin kunnilla ei ole varaa. Suomessa on sellaisia alueita ja sellaisia palveluja, joissa julkiset palvelut eivät riitä ja yritysmäiselle palvelutuotannolle ei ole edellytyksiä. Järjestöjen palvelutoimintaa syntyy usein juuri tällaisiin tilanteisiin ja sinne, missä taloudellista voittoa tavoittelevia yrityksiä ei ole, joko toiminnan matalan tuottavuuden, pitkien välimatkojen ja harvan asutuksen aiheuttamien korkeampien tuotantokustannusten tai asiakkaiden alhaisen maksukyvyn takia. Ongelmallista on, ettei näitä maaseudun olosuhteita ja palvelumarkkinoiden erityispiirteitä ole otettu huomioon tuotaessa ja sovellettaessa EU-lähtöistä valtiontuki- ja kilpailulainsäädäntöä kansalliseen lainsäädäntöömme. Tämän tutkimuksen perusteella voidaan todeta, että Suomessa on alueita ja palveluja, joissa kansalaisten perusoikeuksien ja yhdenvertaisuuden toteutuminen on kyseenalaista, jos näitä maaseudun olosuhdetekijöitä ei huomioida esimerkiksi valtiontukea koskevissa säädöksissä ja palvelujen tuottamiseen ei ohjata julkista tukea. Tutkimuksessa tarkastellaan niitä määritelmiä ja rajapintoja, jotka liittyvät yritystoimintaan ja järjestötoimintaan, elinkeinotoimintaan ja yleishyödylliseen toimintaan, yleishyödyllisiin ja julkisiin palveluihin, taloudellisiin ja ei-taloudellisiin palveluihin, kuntien lakisääteisiin ja ei-lakisääteisiin tehtäviin sekä vapaaehtoistyöhön ja palkattuun ammattityöhön. Tutkimuksessa kysytään, miksi palveluja tuottavien järjestöjen ja yritysten välisen kilpailuneutraliteetin tulkinnoissa ja tätä koskevissa säädöksissä ollaan oltu Suomessa niin tarkkoja ja miksi aihe on noussut niin keskeiseksi keskusteltaessa järjestöjen roolista palvelujen tuottajana. Maaseudun pitkien etäisyyksien ja pienten asiakasmäärien palvelumarkkinoilla kilpailua suurempi ongelma on pikemminkin palvelutuottajien vähäinen määrä tai se, ettei tuottajia ja kilpailua ole lainkaan. Aiheellista on myös kysyä, mistä yritykset ja järjestöt kilpailevat, onko niiden tuottamien palvelujen sisältö sama, onko asiakasryhmä sama tai miten palvelujen tuottamiseen liittyvät laajemmat yhteiskunnalliset ja sosiaaliset tekijät tulee ottaa huomioon todellista kilpailutilannetta arvioitaessa. Tutkimus vahvistaa tarvetta keskustella ja tehdä poliittiset linjaukset siitä, miten Suomessa suhtaudutaan sellaisiin organisaatioihin, joiden lähtökohtana on taloudellisen voiton tavoittelun asemesta yhteiskunnallisen ongelman ratkaiseminen tai tietyn väestöryhmän, kuten lasten, vanhusten tai vammaisten tarpeisiin vastaaminen. Euroopan parlamentin tätä yhteisötaloutta koskeva päätös vuodelta 2009 velvoittaa jäsenmaat ottamaan omassa lainsäädännössään huomioon tämäntyyppisen sosiaaliset ja taloudelliset näkökohdat yhdistävän toiminnan.

Paimen vailla hiippakuntaa : Kenttäpiispan viran synty ja vaikutus sotilaspapiston asemaan Suomen puolustusvoimissa ja kirkossa vuosina 1939 - 1944

The main purpose of this research is to shed light on the factors that gave rise to the office of Field Bishop in the years 1939-1944. How did military bishophood affect the status of the head of military pastoral care and military clergy during these years? The main sources of my research are the collections in the Finnish National Archives, and I use a historical-qualitative method. The position of the military clergy was debated within both the Church and the Defence Forces before 1939. At that stage, Church law did not yet recognize the office of the leading military priest, the Field Dean. There had been a motion in 1932 to introduce the office of a military bishop, but the bishops' synod blocked it. The concept of Field Bishop appeared for the first time in 1927 in a Finnish military document, which dealt with pastoral care in the Polish military. The Field Dean in Finland had regularly proposed improvements to the salary of the military clergy before the Winter War. After the Winter War, arguments were made for strengthening the position of the military clergy: these arguments were based on the increased respect shown towards this clergy, especially due to their role in the care of the fallen, which had become their task during the war. Younger members of the military clergy in particular supported the demands to improve their position within the Church and the army. The creation of a Field Bishop was perceived as strengthening the whole military clergy, as the Field Bishop was envisioned as a bishop within the Church and a general within the Defence Forces. During that time the Field Dean was still without any military rank. The idea of a Field Bishop was recommended to Mannerheim in June 1940, after which the Defence Forces lent their support to the cause. The status of the military clergy, in Church law, made it to the agenda of the Church council in January 1941, thanks largely to the younger priests' group influence and Mannerheim's leverage. The bishops opposed the notion of a Field Bishop mostly on theological grounds but were ready to concede that the position the Field Dean in Church law required further defining. The creation of the office of Field Bishop was blocked in the Church law committee report issued close to the beginning of the Continuation War. The onset of that war, however, changed the course of events, as the President of the Republic appointed Field Dean Johannes Björklund as Field Bishop. Speculation has abounded about Mannerheim's role in the appointment, but the truth of the matter is not clear. The title of Field Bishop was used to put pressure on the Church, and, at the same time, Mannerheim could remain detached from the matter. Later, in September 1941, the Church council approved the use of the Field Bishop title to denote the head of military pastoral care in Church law, and Field Bishops were assigned some of the duties formerly pertaining to bishops. Despite all expectations and hopes, the new office of Field Bishop did not affect the status of the military clergy within the Defence Forces, as no ranks were established for them, and their salary did not improve. However the office of the Field Bishop within Army HQ was transformed from a bureau into a department in the summer of 1942. At the beginning of the Continuation War, the Field Bishop was criticized by certain military and Church clergy for favouring Russian Orthodox Christians in Eastern Karelia. Björklund agreed in principle with most of the Lutheran clergy on the necessity of Lutheranizing East Karelia but had to take into account the realities at Army HQ. As well, at the same time the majority of the younger clergy were serving in the army, and there was a lack of parish priests on the home front. Bishop Lehtonen had actually expressed the wish that more priests could have been released from the front to serve in local parishes. In his notes Lehtonen accused Björklund of trying to achieve the position of Field Bishop by all possible means. However, research has revealed a varied group of people behind the creation of the office of Field Bishop, including in particular younger clergy and the Defence Forces.

Encouragement and discouragement : Essays on taxation and government expenditure

This thesis consists of an introduction to a topic of optimal use of taxes and government expenditure and three chapters analysing these themes more in depth. Chapter 2 analyses to what extent a given amount of subsidies affects the labour supply of parents. Municipal supplement to the Finnish home care allowance provides exogenous variation to labour supply decision of a parent. This kind of subsidy that is tied to staying at home instead of working is found to have fairly large effect on labour supply decisions of parents. Chapter 3 studies theoretically when it is optimal to provide publicly private goods. In the set up of the model government sets income taxes optimally and provides a private good, if it is beneficial to do so. The analysis results in an optimal provision rule according to which the good should be provided when it lowers the participation threshold into labour force. Chapter 4 investigates what happened to prices and demand when hairdressers value added tax was cut in Finland from 22 per cent to 8 per cent. The pass-through to prices was about half of the full pass-through and no clear indication of increased demand for the services or better employment situation in the sector is found.

Aikuissosiaalityön asiakkaiden kokemuksia ja toiveita sosiaalityön tuesta ja avusta ja yhteistyöstä sosiaalityöntekijän kanssa

Tämä tutkielma käsittelee kunnallisen aikuissosiaalityön työikäisten asiakkaiden kokemuksia ja toiveita sosiaalityön tuesta ja avusta ja yhteistyöstä sosiaalityöntekijän kanssa. Tutkimus on laadullinen. Tutkimusaineisto on kerätty haastattelemalla yksilöhaastatteluna Helsingin kaupungin sosiaaliviraston sosiaaliaseman asiakkaita, jotka olivat sosiaalityöntekijän asiakkaina sosiaalityöntekijöiden työn painottuessa muuhun kuin toimeentulotukityöhön. Lähestymistapa on kuvaileva ja tulkitseva. Keskeisiä lähteitä ovat esimerkiksi Kirsi Juhilan teos Sosiaalityöntekijöinä ja asiakkaina (v. 2006) ja Kaarina Mönkkösen tutkimus Dialogisuus kommunikaationa ja suhteena (v. 2002) ja teos Vuorovaikutus – dialoginen asiakastyö (v. 2007). Asiakkaiden kokemukset tuesta ja avusta jäsentyivät neljäksi eri merkityskokonaisuudeksi, tuen muodoksi. Tuki näyttäytyi arjen sujumisen ja jäsentymisen tukemisena ja päihteettömän elämän tukemisena. Tuki oli myös aktivointia työn ja koulutuksen suuntaan sekä muuhun yhteisölliseen ja yhteiskunnalliseen osallisuuteen. Tuki näyttäytyi myös asianajona ja moniammatillisena tukena. Sosiaalityön toiminnallisilla ryhmillä sosiaalityöntekijän käyttäminä työmenetelminä oli merkitystä niin arjessa selviytymisen, päihteettömän elämän kuin yhteisöllisen ja yhteiskunnallisen osallisuuden tukemisessa. Asiakkaan ja sosiaalityöntekijän yhteistyö, asiakkaan kohtelu ja kokemukset saadusta tuesta ja avusta näyttäytyivät myönteisinä viime vuosien aikana. Asiakaslähtöinen, asiakkaan tilanteesta ja tarpeista lähtevä, asiakkaan omat näkemykset huomioiva, palvelu näytti hyvin pitkälle toteutuneen. Sosiaalityöntekijä nähtiin yleensä auttamishaluisena ja asiakasta ymmärtävänä ja sosiaalityöntekijältä myös toivottiin näitä asioita, samoin kuin asiakkaan puolella olemista, myötätuntoista asennetta ja yksilöllistä kohtelua. Asiakkaat kokivat sosiaalityöntekijän yleensä kuuntelevan heitä ja huomioivan heidän näkemyksensä omasta tilanteestaan. Asiakkaan kuuntelemista myös toivottiin. Asiakkaan ja työntekijän suhde näyttäytyi dialogisena suhteena. Sosiaalityöntekijää pidettiin rinnalla kulkijana, auttajana, asiakkaan palvelijana ja toivon ylläpitäjänä. Asiakassuhteen luottamuksellisuutta pidettiin tärkeänä. Sosiaalityö näyttäytyi lähes kaikilla suunnitelmallisena ja tavoitteellisena elämäntilanteen muutokseen tähtäävänä työskentelynä. Osalla työn painotus oli huolenpitotyössä. Yhteistyön onnistumista ja tuen saamista koettiin rajoittavan asiakkaasta itsestään johtuvat syyt ja juridishallinnollinen järjestelmä lakeineen ja ohjeineen. Asiakkaat näyttivät harjoittavan itsekontrollia eli yleensä hakivat sellaista tukea, etenkin taloudellista tukea, jota olettivat saavansa. Sosiaalityöntekijän toivottiin ottavan kantaa asioihin ja tuovan oman näkökulmansa keskusteluun, eli odotettiin dialogia ja työntekijän asiantuntemusta, jopa neuvoja. Toivottiin kokonaisvaltaista kohtaamista, missä näkyi tunnetason huomioimisen tärkeys asiatason lisäksi. Asiakkaan todellinen kyky muutokseen nousi esille asiana, joka sosiaalityössä tulisi huomioida. Asiakkaan tilanteen ymmärtämiseksi juuri tarvitaan yhteistyötä. Asiakkaan tukeminen toteutui asiakkaan ja sosiaalityöntekijän tapaamisissa ja muissa kohtaamisissa, mukaan lukien etuuksien myöntäminen. Tukeminen toteutui myös toiminnallisten ryhmien kautta ja moniammatillisena tukena.