Hearing Impairment and Tinnitus in the Elderly

The purpose of this study was to gather information on hearing impairment and related factors among elderly people. The HHIE-S questionnaire (Hearing Handicap Inventory for Elderly-Screening) and a single hearing question (”Do you feel you have a hearing loss”) were compared to audiometric hearing thresholds (N=164). HHIE-S was reliable for detecting moderate or worse hearing impairment. The single question was equally sensitive and more specific in identifying mild hearing impairment. The prevalence of hearing impairment was evaluated in four age cohorts (70, 75, 80 and 85 years, N=4067) in Turku, Finland. The HHIE-S cut-off score >8 as an indicator of at least mild hearing impairment yielded prevalence values of 37.7% - 54.1%, and a score >18 (moderate or more severe hearing impairment) was 21.1% - 38.9%. The single question test was positive in 25.5% - 46.2%. Hearing aid compliance and problems experienced by hearing aid users were recorded as informed by the participants in a mailed interview (N=249/4067). The hearing aids were used daily by 55.4%, and never by 10.7%. Use sank with advancing age. The disturbance caused by tinnitus among 583 subjects was compared to their level of alexithymia (TAS-20) and depressiveness (BDI). Depressiveness was weakly associated with annoying tinnitus, but not alexithymia. The prevalence of hearing impairment can be measured by enquiry. Hearing aid compliance should be improved by technical means and better counseling. The factors affecting the distress experienced by tinnitus patients need further study.

Bry sig om : ett vårdvetenskapligt praxisbegrepp

’Bry sig om’ förekommer flitigt i sammanhang där människor vårdar och tar hand om varandra såväl i det vardagliga naturliga vårdandet som i det professionella vårdandet. ’Bry sig om’ är ett språkligt uttryck i människors vardagsspråk som hör samman med ’små vardagliga saker’ som är av betydelse. ’Bry sig om’ har även tydlig förbindelse med vårda och ansa i Erikssons caritativa vårdteori men har inte tidigare varit föremål för klinisk vårdvetenskaplig forskning vilket är bakgrunden till denna studie. Inom Erikssons caritativa vårdteori utgörs grundordningen av kärnbegreppen caritas, enheten människa, hälsa, lidande och vårdande. I den här avhandlingen är syftet att vidga förståelsen för kärnbegreppet vårdandet genom att utforska innebörden i praxisbegreppet ’bry sig om’. Studien har en hermeneutisk ansats och är en sammanläggningsavhandling med fyra delstudier i form av begreppsanalys och tre empiriska studier. Materialet i begreppsutredningen är etymologisk ordbok och svenska ordböcker. I de empiriska delstudierna består materialet av självbiografisk text skrivet av en patient och händelser som patienter och vårdare varit med om vilket förstås som betydelsefullt material för klinisk vårdvetenskaplig forskning. Den nya förståelsen gestaltas i ett tankemönster där ’bry sig om’ framträder som en inre etisk hållning där människan som är på plats kan finnas till och därmed betyda något för en annan människa. Att betyda något för en annan människa är uttryck för det naturliga omsorgsfulla vårdandet där patienten förnimmer en kärleksfull hållning i vårdarens varsamma kärleksfulla händer och varma röst. ’Bry sig om’, har sin grundval i det naturliga omsorgsfulla vårdandet som konstituerar människan som människa. Det som framkommit i avhandlingen är möjligheten att undersöka praxisbegrepp inom vårdvetenskapen där ’bry sig om’ bidragit till att synliggöra vårdandet och därmed innebörden och meningen i ansandet, lekandet och lärandet på ett nytt och annorlunda sätt ur ett kliniskt vårdvetenskapligt perspektiv.

Sivistyksestä sivilisaatioon. Kulttuurikäsitys J. V. Snellmanin historiallisessa ajattelussa

From Bildung to Civilisation. Conception of Culture in J. V. Snellman’s Historical Thinking The research explores Johan Vilhelm Snellman’s (1806–1881) conception of culture in the context of his historical thinking. Snellman was a Finnish, Swedish-speaking journalist, teacher and thinker, who held a central position in the Finnish national discourse during the nineteenth century. He has been considered as one of the leading theorists of a Finnish nation, writing widely about the themes such as the advancement of the national education, Finnish language and culture. Snellman is already a widely studied person in Finnish intellectual history, often characterised as a follower of G. W. F. Hegel’s philosophical system. My own research introduces a new kind of approach on Snellman’s texts, emphasising the conceptual level of his thought. With this approach, my aim is to broaden the Finnish research tradition on conceptual history. I consider my study as a cultural history of concepts, belonging also to the field of intellectual history. My focus is on one hand on the close reading of Snellman’s texts and on the other hand on contextualising his texts to the European intellectual tradition of the time. A key concept of Snellman’s theoretical thinking is his concept of bildning, which can be considered as a Swedish counterpart of the German concept of Bildung. The Swedish word incorporated all the main elements of the German concept. It could mean education or the so-called high culture, but most fundamentally it was about the self-formation of the individual. This is also the context in which Snellman’s concept of bildning has often been interpreted. In the study, I use the concept of bildning as a starting point of my research but I broaden my focus on the cognate concepts such as culture (kultur), spirit (anda) and civilisation. The purpose of my study is thus to illustrate how Snellman used and modified these concepts and from these observations to draw a conclusion about the nature of his conception of culture. Snellman was an early Finnish philosopher of history but also interested in the practice of the writing of history. He did not write any historical presentations himself but followed the publications in the field of history and introduced European historical writing to the Finnish, Swedish-speaking reading audience in his newspapers. The primary source material consists of different types of Snellman’s texts, including philosophical writings, lecture material, newspaper articles and private letters. I’m reading Snellman’s texts in the context of other texts produced both by his Finnish predecessors and contemporaries and by Swedish, German and French writers. Snellman’s principal philosophical works, Versuch einer spekulativen Entwicklung der Idee der Persönlichkeit (1841) and Läran om staten (1842), were both written abroad. Both of the works were contributions to contemporary debates on the international level, especially in Germany and Sweden. During the 1840s and 1850s Snellman had two newspapers of his own, Saima and Litteraturblad, which were directed towards the Swedish-speaking educated class. Both of the newspapers were very popular and their circulations were among the largest of their day in Finland. The topics of his articles and reviews covered literature, poetry, philosophy and education as well as issues concerning the economic, industrial and technical development in Finland. In his newspapers Snellman not only brought forth his own ideas but also spread the knowledge of European events and ideas to his readers. He followed very carefully the cultural and political situation in Western Europe. He also followed European magazines and newspapers and was well acquainted with German, French and also English literature – and of course Swedish literature to with which he had the closest ties. In his newspapers Snellman wrote countless number of literary reviews and critics, introducing his readers to European literature. The study consists of three main chapters in which I explore my research question in three different, yet overlapping contexts. In the first of these chapters, I analyse Snellman’n theoretical thinking and his concepts of bildning, kultur, anda and civilisation in the context of earlier cultural discourse in Finland as well as the tradition of German idealistic philosophy and neo-humanism. With the Finnish cultural discourse I refer to the early cultural discussion in Finland, which emerged after the year 1809, when Finland became an autonomous entity of its own as a Grand Duchy of Russia. Scholars of the Academy of Turku opened a discussion on the themes such as the state of national consciousness, the need for national education and the development of the Finnish language as a national language of Finland. Many of these academics were also Snellman’s teachers in the early years of his academic career and Snellman clearly formulated his own ideas in the footsteps of these Finnish predecessors. In his theoretical thinking Snellman was a collectivist; according to him an individual should always be understood in connection with the society, its values and manners, as well as to the traditions of a culture where an individual belongs to. In his philosophy of the human spirit Snellman was in many ways a Hegelian but his notion of education or ‘bildning’ includes also elements that connect him with the wider tradition of German intellectual history, namely the neo-humanist tradition and, at least to some extent, to the terminology of J. G. Herder or J. G. Fichte, for example. In this chapter, I also explore Snellman’s theory of history. In his historical thinking Snellman was an idealist, believing in the historical development of the human spirit (Geist in German language). One can characterise his theory of history by stating that it is a mixture of a Hegelian triumph of the spirit and Herderian emphasis on humanity (Humanität) and the relative nature of ‘Bildung’. For Snellman, the process of ‘bildning’ or ‘Bildung’ is being realised in historical development through the actions of human beings. Snellman believed in the historical development of the human civilization. Still Snellman himself considered that he had abandoned Hegel’s idea about the process of world history. Snellman – rightly or wrongly – criticised Hegel of emphasising the universal end of history (the realisation of the freedom of spirit) at the expense of the historical plurality and the freedom of each historical era. Snellman accused Hegel of neglecting the value and independency of different historical cultures and periods by imposing the abstract norm, the fulfilment of the freedom of spirit, as the ultimate goal of history. The historicist in Snellman believed in the individuality of each historical period; each historical era or culture had values, traditions and modes of thought of its own. This historicist in Snellman could not accept the talk about one measure or the end of history. On the other hand Snellman was also a universalist. He believed that mankind had a common task and that task was the development of ‘Bildung’, freedom or humanity. The second main chapter consists of two parts. In the first part, I explore the Finnish nationalistic discourse from the cultural point of view by analysing the notions such as a nation, national spirit or national language and showing how Snellman formulated his own ideas in a dialogic situation, participating in the Finnish discourse but also reacting to international discussions on the themes of the nation and nationality. For Snellman nationality was to a great extent the collective knowledge and customs or practices of the nation. Snellman stated that nationality is to be considered as a form of ‘bildning’. This could be seen not simply as affection for the fatherland but also for the mental identity of the nation, its ways of thinking, its practices, national language, customs and laws, the history of the nation. The simplest definition of nationality that Snellman gives is that nationality is the social life of the people. In the second part of the chapter I exam Snellman’s historical thinking and his understanding about historical development, interaction between different nations and cultures in the course of history, as well as the question of historical change; how do cultures or civilisations develop and who are the creators of culture? Snellman did not believe in one dominating culture but understood the course of history as a dialogue between different cultures. On the other hand, his views are very Eurocentric – here he follows the ideas of Hegel or for example the French historian François Guizot – for Snellman Europe represented the virtue of pluralism; in Europe one could see the diversity of cultures which, on the other hand, were fundamentally based on a common Christian tradition. In the third main chapter, my focus is on the writing of history, more precisely on Snellman’s ideas on the nature of history as a science and on the proper way of writing historical presentations. Snellman wrote critics on the works of history and introduced his readers to the writing of history especially in France, Sweden and German-speaking area – in some extend also in Britain. Snellman’s collectivistic view becomes evident also in his reviews on historical writing. For Snellman history was not about the actions of the states and their heads, nor about the records of ruling families and battles fought. He repeatedly stressed that history is a discipline that seeks to provide a total view of a phenomenon. A historian should not only collect information on historical events, since this information touches only the surface of a certain epoch or civilisation; he has to understand an epoch as totality. This required an understanding about the major contours in history, connections between civilisations and an awareness of significant turning points in historical development. In addition, it required a holistic understanding about a certain culture or historical era, including also the so-called inner life of a specific nation, a common people and their ways of life. Snellman wrote explicitly about ‘cultural history’ in his texts, referring to this kind of broad understanding of a society. In historical writing Snellman found this kind of broader view from the works of the French historians such as François Guizot and Jules Michelet. In all of these chapters, I elaborate the conceptual dimension of Snellman’s historical thinking. In my study I argue that Snellman not only adopted the German concepts of Bildung or Kultur in his own thinking but also developed the Swedish concepts in a way that include personal and innovative aspects. Snellman’s concept of bildning is not only a translation from ‘Bildung’ but he uses the Swedish concept in a versatile way that includes both the moral aspect of human development and social dimension of a human life. Along with ‘bildning’ Snellman used also the terms ‘kultur’ and ‘civilisation’ when referring to the totality of a certain nation or historical era, including both the so-called high culture (arts, science, religion) and the modes of thought as well as ways of life of the people as a whole. Unlike many of his Finnish contemporaries, Snellman did not use civilisation as a negative concept, lacking the moral essence of German term ‘Bildung’ or ‘Kultur’. Instead, for Snellman civilisation was a neutral term and here he comes close to the French tradition of using the term. In the study I argue that Snellman’s conception of culture in fact includes a synthesis of the German tradition of ‘Bildung’ and the French tradition of ‘civilisation’.

Serva ad ministrare : tjänandets ethos i vårdledarskap

Avhandlingen syftar till att ur ett vårdvetenskapligt perspektiv beskriva och upptäcka tjänandets meningsinnehåll samt fördjupa förståelsekunskap om tjänandets ethos i förhållande till vårdledarskap med en inriktning på det vårdadministrativa. Syftet är även att skapa en idealmodell som öppnar för en ny eller annorlunda förståelsehorisont för tjänandets ethos i vårdledarskap. Kunskapssökandet sker genom följande delstudier: (1) I begreppsbestämningen genomförs begreppsanalyser av tjäna och tjänst med avsikt att öppna för en grundförståelse och tankestruktur i forskningsuppgiften. (2) I det idéhistoriska spåras tjänandets ontologiska arv och idémönster fram genom tolkning av historiska källornas texter från 1900-talets första hälft i ljuset av sjuksköterskeledarskap utgående från Sophie Mannerheims, Bertha Wellins och Bergljot Larssons idéer och tankeströmningar. (3) Sökandet fortsätter i dagens kliniska kontextbas genom kvalitativa djupintervjuer med 30 deltagare (vårdledare och vårdare) från Finland, Sverige och Norge. Förförståelsen och forskningens teoretiska perspektiv har rötter i Erikssons caring science-tradition och vårdvetenskapens ontologiska grundantaganden som utvecklats vid Åbo Akademi, Enheten för vårdvetenskap i Vasa. Forskningsansatsen är inspirerad av H-G Gadamers filosofiska hermeneutik. Designen är explorativ-deskriptiv, idiografisk och implicerar ett hypotetisk-deduktivt tillvägagångssätt. Tjänandet och vårdledarskapets ethos upptäcks och tolkas genom det metodologiska närmandet: Erikssons hermeneutiska begreppsbestämningsmodell, idéhistoriska läsakt och hermeneutiska läsakt. Materialet bildar förståelsehorisonter genom den hermeneutiska dialogens successiva och oändliga rörelse. Horisonterna reflekteras mot teorikärnan för att öppna för ny förståelse av tjänandets meningsinnehåll, vårdledarskap och vårdadministration. I slutandet sker en horisontsammansmältning och en reflektiv anslutning till vårdvetenskapens teorikärna som visar hur tjänandets ethos blir evident i vårdledarskap. Resultatet visar att vårdledarskap som är tjänande för patienten och vårdkulturen synliggörs i vårdadministrationens kontext genom huvudets skärpa, handens gärningar och hjärtats visdom. Tjänandets sanna, goda och sköna tidlösa rörelse är riktad mot hälsa och helande. I dag sammankopplas tjänande inom vårdorganisationer med hälsoekonomiska förhållanden, effektivitet, produktivitet och rationalitet, vilket strider mot tjänandets värdegrund, människans värdighet och respekt för livet. Vårdorganisationernas etiska ansvar är att fungera som samhälleliga förebilder, tillrättalägga för vårdadministrationernas tjänande och stå i patientens tjänst. Gestaltningen av tjänandets ethos i vårdledarskap öppnar för nya diskurser, riktningar, visioner och handlingar i den vårdadministrativa verkligheten. Avhandlingen ger vårdvetenskapens systematiska grundforskning ett teoritillskott av fördjupad förståelse av tjänandets och vårdledarskapets historiska och samtida ontologiska evidens och ethos med applikationen på klinisk vårdvetenskap.

Työvoima- ja koulutustarvetutkimus : Pohjanmaa ja Keski-Pohjanmaa

Työvoima- ja koulutustarvetutkimus on TE-toimistojen vuosittain tekemä kysely-/haastatteluaineisto, jossa ennakoidaan alueiden yritysten tulevaisuudennäkymiä. Tämän tutkimuksen aineiston on tuottanut Pohjanmaan TE-toimisto. Kyselyt on suoritettu syksyllä 2013, ja ne ennakoivat Pohjanmaan ja Keski-Pohjanmaan alueiden yritysten näkymiä pääosin syksyyn 2014 asti. TE-toimistot valitsevat yhteistyössä ELY-keskusten kanssa vuosittain ne toimialat, joiden työnantajien työvoima- ja koulutustarpeisiin toimisto haluaa erityisesti keskittyä. Syksyn 2013 kyselyissä painotettiin metallialan yrityksiä, ja kyselyyn vastasi 102 metallialan yritystä ja 89 muiden alojen yritystä. Tässä tutkimuksessa ryhmät on käsitelty yrityssegmenteittäin ja seutukunnittain. Kyselyssä kysyttiin tietoja henkilöstön määrään, työvoimaan, koulutustarpeeseen, toimialakohtaiseen tietoon, verkostoitumiseen, suhdannenäkymiin, vientiin, ennakointitoimintaan, liiketoimintasuunnitelmiin, T&K&I-toimintaan, investointisuunnitelmiin, työorganisaatioon ja sukupolvenvaihdoksiin liittyen.

Issuant views of hell in contemporary Anglo-American theology

This problem of hell is a specific form of the problem of evil that can be expressed in terms of a set of putatively incompatible statements: 1. An omnipotent God could create a world in which all moral agents freely choose life with God. 2. An omnibenevolent God would not create a world with the foreknowledge that some (perhaps a significant proportion) of God’s creatures would end up in hell. 3. An omniscient God would know which people will end up in hell. 4. Some people will end up forever in hell. Since the late twentieth century, a number of British and North American philosophical theologians, inspired by C.S. Lewis, have developed a new approach to answering the problem of hell. Very little work has been done to systematize this category of perspectives on the duration, quality, purpose and finality of hell. Indeed, there is no consensus among scholars as to what such an approach should be called. In this work, however, I call this perspective issuantism. Starting from the works of a wide range of issuantist scholars, I distill what I believe to be the essence of issuantist perspectives on hell: hell is a state that does not result in universal salvation and is characterized by the insistance that both heaven and hell must issue from the love of God, an affirmation of libertarian human freedom and a rejection of retributive interpretations of hell. These sine qua non characteristics form what I have labeled basic issuantism. I proceed to show that basic issuantism by itself does not provide an adequate answer to the problem of hell. The issuantist scholars themselves, however, recognize this weakness and add a wide range of possible supplements to their basic issuantism. Some of these supplemented versions of issuantism succeed in presenting reasonable answers to the problem of hell. One of the key reasons for the development of issuantist views of hell is a perceived failure on the part of conditionalists, universalists and defenders of hell as eternal conscious torment to give adequate answers to the problem of hell. It is my conclusion, however, that with the addition of some of the same supplements, versions of conditionalism and hell as eternal conscious torment can be advanced that succeed just as well in presenting answers to the problem of hell as those advanced by issuantists, thus rendering some of the issuantist critique of non-issuantist perspectives on hell unfounded.

Interpersonal understanding and theory of mind

En populär idé inom dagens filosofiska och psykologiska forskning om interpersonlig förståelse, är idén att vi använder en kognitiv funktion (eller metod) för att förstå andra människor, en så kallad ”theory of mind” funktion. Denna idé förekommer inom ett brett vetenskapligt fält så som inom evolutionspsykologi, inom teorier om barns utveckling, inom teorier om autism, samt inom emotionsfilosofi och moralfilosofi. Avsikten i denna studie är att se närmare på vissa inflytelserika filosofiska och psykologiska teorier om interpersonlig förståelse, teorier som också har en stark koppling till empirisk forskning. I arbetet hävdar Gustafsson att teorierna ifråga avspeglar vissa klassiska, filosofiskt problematiska, antaganden. Dessa antaganden präglar teorierna ifråga samt påverkar hur de empiriska undersökningarna byggs upp och hur resultat tolkas.

Alterations in The States and Contents of Consciousness: Empirical and Theoretical Aspects

The main purpose of the present doctoral thesis is to investigate subjective experiences and cognitive processes in four different types of altered states of consciousness: naturally occurring dreaming, cognitively induced hypnosis, pharmacologically induced sedation, and pathological psychosis. Both empirical and theoretical research is carried out, resulting in four empirical and four theoretical studies. The thesis begins with a review of the main concepts used in consciousness research, the most influential philosophical and neurobiological theories of subjective experience, the classification of altered states of consciousness, and the main empirical methods used to study consciousness alterations. Next, findings of the original studies are discussed, as follows. Phenomenal consciousness is found to be dissociable from responsiveness, as subjective experiences do occur in unresponsive states, including anaesthetic-induced sedation and natural sleep, as demonstrated by post-awakening subjective reports. Two new tools for the content analysis of subjective experiences and dreams are presented, focusing on the diversity, complexity and dynamics of phenomenal consciousness. In addition, a new experimental paradigm of serial awakenings from non-rapid eye movement sleep is introduced, which enables more rapid sampling of dream reports than has been available in previous studies. It is also suggested that lucid dreaming can be studied using transcranial brain stimulation techniques and systematic analysis of pre-lucid dreaming. For blind judges, dreams of psychotic patients appear to be indistinguishable from waking mentation reports collected from the same patients, which indicates a close resemblance of these states of mind. However, despite phenomenological similarities, dreaming should not be treated as a uniform research model of psychotic or intact consciousness. Contrary to this, there seems to be a multiplicity of routes of how different states of consciousness can be associated. For instance, seemingly identical time perception distortions in different alterations of consciousness may have diverse underlying causes for these distortions. It is also shown that altered states do not necessarily exhibit impaired cognitive processing compared to a baseline waking state of consciousness: a case study of time perception in a hypnotic virtuoso indicates a more consistent perceptual timing under hypnosis than in a waking state. The thesis ends with a brief discussion of the most promising new perspectives for the study of alterations of consciousness.

Kjærlighet i forbundethet : en kraft i gamle menneskers åndelighet og verdighet

The thesis is rooted in caring science and the notion that the human being is an indivisible unity of body, soul and spirit. The purpose is to search for new, or expanded knowledge and understanding of the substance of the human’s spiritual space, as well as aspects that may constitute a foundation for the safeguard of human dignity. The clinical research study concerns the importance of spirituality and dignity in the care for older people. The thesis consists of three substudies with four articles, and the methodology is based on Gadamer’s philosophical hermeneutics. Through a metasynthesis of 17 research articles, sub-study I searched for understanding of the concept of spirituality as it may appear in reality (deduction). 17 older people were interviewed in sub-study II. This sub-study sought understanding for spirituality and dignity in the specific reality (induction). Sub-study III searched for theory development regarding spirituality, through a literature review of 20 research articles and a text by Tillich (abduction). The findings imply that spirituality entails human beings’ connectedness with one’s inner space and connectedness beyond oneself. Love in connectedness appears as a force in both spirituality and dignity. Themes portrayed include understanding of the spiritual space, religiousness, dignity, and spiritual care. The relationship between dignity and spirituality can be seen in the confirmation of human worth and care for the whole human being, including the spiritual dimension, and this is understood as a prerequisite for perceived dignity. It seems to be important that older people feel valued, loved, not abandoned, and alive. The theoretical model portrays love as a reunifying and connecting force that may foster confirmation, serving, longing and holiness. The movement towards connectedness may create room for the human being’s perception of dignity and holiness, and as such, it may be a force in the search for wholeness and becoming in health.

Christlich-religiöse Textwelt als translatorisch-hermeneutischer Gegenstand Gegenstandsbeschreibung und Herangehensweisen

Tämä teorialähtöinen, hermeneuttinen tutkimus sijoittuu käännöstieteen sekä uskonnon- ja kielifilosofian rajapintaan. Tutkimuksessa kuvataan kristinuskon tekstimaailmaa relevantin tulkintakehyksen kautta sekä esitetään tekstimaailman tulkintaan soveltuva lähestymistapa ammattikääntäjän eli välittävän vastaanottajan näkökulmasta. Tutkimus pureutuu käännösprosessin hermeneutiikkaan eli lähdetekstin ja sen maailman tulkintaan, ymmärtämiseen ja selittämiseen liittyviin aspekteihin. Tutkimuksessa ei esitetä käännösratkaisuja. Tutkimus nostaa esiin filosofisen ja teologisen hermeneutiikan peruskysymyksiä. Niitä ovat Raamatun tekstien vaikutushistoria, erilaiset todellisuus- ja kielikäsitykset, kirkon oppi, teologian pääsuuntaukset, uskonnolliset yhteisöt ja niiden perinteet, inhimillinen kulttuuri ja aika. Ne ovat ulottuvuuksia, jotka vaikuttavat kääntäjän tekstin- ja maailmantulkintaan ja vaativat laajojen kontekstien huomioonottamista sekä lähestymistä monista eri näkökulmista. Ludwig Wittgensteinin myöhäisfilosofiaan liittyvän kielipelin idea tarjoaa ajatusmallin, jonka avulla uskonnon käsite-, merkki- ja tekstimaailmalle voidaan luoda moninäkökulmainen tulkintakehys. Kielipelin käsitettä käytetään tässä tutkimuksessa tekstien samankaltaisuutta ja erilaisuutta kokoavana järjestelmänä, joka toimii intratekstuaalisesti eli sillä on omat pelisääntönsä, tulkinnan lähteensä sekä tunnistettava identiteetti. Järjestelmän keskiössä ovat uskonnon konstituioivat käsitteet ja kertomukset, jotka ovat muiden tulkintojen eli metatekstien lähde. Kääntäjän varsinaisina tulkintakohteina ovat metatekstit, eivät raamatunkääntämiseen liittyvät kysymykset suoranaisesti. Tutkimuksessa luodaan kuitenkin tulkintamalli, jonka mukaan metatekstejä ja raamatun tekstejä luetaan rinnakkain. Ymmärtäminen ja ongelmanratkaisu rakentuvat tekstuaalisen kommunikaation pohjalta. Tekstejä luetaan sekä sääntöteorian että narratiivisen teorian valossa. Kertomus puhuttelee vastaanottajaa eri tavalla kuin sääntö. Tulkintamallissa yhdistyvät sekä analyyttinen että luovan mielikuvituksen sallima lukutapa. Molemmat toimivat yhdessä kääntäjän tekstin- merkin- ja maailmantulkinnan apuna. Tutkimuksessa pohditaan myös tekstiteorettisia kysymyksiä, tekstin ja merkin käsitteitä sekä niiden toimintadynamiikkaa. Tulkinnan mekanismi esitetään semioosin käsitteen avulla. Teksti määritellään heuristiseksi ja eksemplaariseksi kuvaukseksi maailmasta, ja se edustaa vain osaa tulkintakokonaisuudesta. Kääntäjän hermeneuttinen kenttä ulotetaan tekstinulkoiseen maailmaan, käytäntöön ja elämänmuotoon.

Kallet til livets embete : mødre i helse og lidelse

Mothers represent the natural caring. Natural caring is the object of caring science and of research interest because it establishes the central core of professional caring. In this study, we encounter patients who are mothers in need of care in a psychiatric context. Motherhood involves taking responsibility that extends beyond one's own life, because the child represents possibilities in a yet unknown future. Understanding and knowledge about the mothers' struggle in health and suffering are of crucial importance to enable clinical practice to make provisions for and adapt to the individual patient. The overall purpose of this dissertation is to illuminate how the innermost essence of caring emerges in health and suffering in patients who are mothers in psychiatric care. The purpose of the study in a clinical sense is to seek to understand and illuminate the patient's inner world in health and suffering in terms of contextual, existential, ontological and ethical dimensions. The dissertation is exploratory and descriptive in nature and encompasses induction, deduction and abduction as logics tools of reasoning. A theoretical model of natural caring and a universal theoretical model of the innermost essence of caring is developed as seen from the patient's world in a psychiatric context. The dissertation is anchored in human science's view of the human being and the world and in caring science's perspective. Caring science's view of the human being as a unity comprising body, soul and spirit is central in the study's concept of the patient. This multi-dimensional conception of the human being encompasses the dissertation's basic values and is decisive for choice of methodology. Hermeneutic epistemology guided the interpretation of the empirical data, the paradigmatic theses and assumptions. The dialectical movement in interpretation moves back and forth between empirical data, caring science theory and philosophical theory and reveals deeper insight into meaningful content in the clinical context. The interpretation process comprises four levels of abstraction: rational, contextual, existential and ontological. Hermeneutic philosophy guides the inductive and deductive approach to interpretation, as well as the movement between the clinical context and the caring science paradigm. In this encounter between the visible and invisible reality, the image of natural caring – motherliness emerged. The dissertation consists of four studies. The first study is a systematic review of nineteen research articles. The three other studies are hermeneutical interpretations based on text materials from open interviews. Fifteen participants were interviewed, all of whom are mothers of children between 0 and 18 years of age. All were outpatients in the psychiatric specialist health service. In the interpretation process, the mothers' struggle in health and suffering emerges as a struggle between the inner and outer world. Being a mother and patient in health and suffering in a psychiatric context means to struggle to be oneself, to create oneself, to live and realize one's good deeds as a mother and human being. To be oneself, to possess oneself as a mother is not only a question of tending, playing and learning in order to master a practical situation or to survive. It involves constituting a deep, inner desire to courageously create oneself so that the child is able to realize his or her potential in health and suffering. Motherliness manifests itself in caring as a call to ministering humanity and life. The voice of motherliness is understood as the voice of life—the eternal, inner call of love and freedom. The inner call craves fulfilment. Motherliness in natural caring does not retreat. Motherliness defines the Other as freedom and proceeds without regard for all other exterior requirements to realizing wellbeing. The inner essence of caring is attentive, aware and heeds the call of the heart. The innermost essence of caring is to be and to make oneself responsible for the Other. Responsibility cannot be relinquished; free choice consists in whether or not to follow the call. To renounce the inner call to responsibility is to deny oneself and one's dignity as a human being. The theoretical models provide clinical and systematic caring science with knowledge and understanding based on the natural caring spirit inherent in the human being. The study elucidates and strengthens the ontological basic assumptions about the human being as a unity of body, soul and spirit, the sanctity of the human being and the core of caring, ethos. The results of the dissertation will provide clinical practice with knowledge about the inner movements of the mothers' souls in relation to their responsibility as mothers and human beings. Being able to understand the basic conditions for responsibility is crucial for developing care that encompasses mother and child and the mutual relationship between them. This is basic knowledge for developing attitudes and actions that meet and provide for the needs of the patient as mother and as a whole, suffering human being.

Urvilja : när livet är människans hem

This caring science study explores ‘Will’ as an ontological concept. The aim is to deepen the understanding of the essence of Will, and to highlight the manifestations of Will and how Will becomes evident in clinical caring. Will is ontological and universal. Will is connected with the essence of the human being, and manifests in the human being as will. The approach is inspired by Gadamer’s philosophical hermeneutics. The study’s horizon of understanding consists of Eriksson’s caritative theory and the caring science-tradition. The study’s research questions are as follows: What is the essence of Will? What are its manifestations? How does Will become evident in clinical caring? The hermeneutic interpretative movement is initiated by the material, which consists of the philosopher Arthur Schopenhauer’s texts, letters from experts and dictionaries. Meaning-bearing substance fragments in the material are intertwined with the original horizon of understanding through hermeneutical reading, hermeneutical interpretation and concept analysis in an oscillating interpretive movement. An abstraction occurs when the new substance is illuminated by the caring science ontology. The oscillating interpretive movement results in a reinterpreted horizon of understanding, which in turn provides the findings of the study. The reinterpreted horizon of understanding is presented in the form of a theoretical model and abductive theses. The essence of Will is represented in the theoretical model as the lifeaffirming and the loving force. Life and love are Will’s origin and destination. Will’s manifestations (its diversity) hold conditions and chance occurrences that obstruct Will. Hence the will of the human being does not necessarily appear in a way that is in tune with ontological Will. Will represents the lifeblood of ethos, and in this lifeblood love flows. Will acts by virtue of itself, and gives ethos its force. Will manifests in a way that ethos can affirm. When Will is affected by caring its force is active in the service of life and love. Being a caregiver entails acting as a world-eye, which means recognizing Will in diversity. For caregivers, being a world-eye means observing fragments of Will as it manifests in its original form in the real reality, and acting as the mirror of life. The human being who is able to perceive the fundamental values of life and to live according to these has understood the laws of life and entered upon the human calling. The human being then lives according to the fundamental order and has found a home in life.

The Concept of Betterness and Sport Competitions

It is common that people disagree on a question which athlete or team was the best in a particular sport competition. This thesis attempts to clarify these disputes by analysing the concept of betterness in the context of sport competitions. Betterness can be interpersonal, intrapersonal or a combination of the two. I focus on interpersonal betterness, that is, on superiority. For example, interpersonal betterness may be contested in a football match between the national teams of Germany and Argentina. My aim is to provide a philosophical account of interpersonal betterness. The account has two functions: descriptive and normative. It describes the shapes and forms in which superiority is instantiated in sport competitions. It also provides a consistent and accurate way to discuss superiority. The thesis consists of two parts. In the first part, I introduce, elaborate and illustrate my account, which in turn consists of three elements: (1) relations of superiority, (2) standards for the relations of superiority and (3) types of competition. I also discuss my account’s relevance to issues of sport ethics through the example of gender equity and women’s ski jumping. I conclude that this account will not end the disputes over which team or athlete was better in a particular competition. Instead, it provides tools for a more consistent discussion of the disputed issues. The second part of the thesis includes five reprinted original articles. The account presented in the first part is based on these publications.

The Nature of Object of Perception and Its Role in the Knowledge Concerning the External World

Questions concerning perception are as old as the field of philosophy itself. Using the first-person perspective as a starting point and philosophical documents, the study examines the relationship between knowledge and perception. The problem is that of how one knows what one immediately perceives. The everyday belief that an object of perception is known to be a material object on grounds of perception is demonstrated as unreliable. It is possible that directly perceived sensible particulars are mind-internal images, shapes, sounds, touches, tastes and smells. According to the appearance/reality distinction, the world of perception is the apparent realm, not the real external world. However, the distinction does not necessarily refute the existence of the external world. We have a causal connection with the external world via mind-internal particulars, and therefore we have indirect knowledge about the external world through perceptual experience. The research especially concerns the reasons for George Berkeley’s claim that material things are mind-dependent ideas that really are perceived. The necessity of a perceiver’s own qualities for perceptual experience, such as mind, consciousness, and the brain, supports the causal theory of perception. Finally, it is asked why mind-internal entities are present when perceiving an object. Perception would not directly discern material objects without the presupposition of extra entities located between a perceiver and the external world. Nevertheless, the results show that perception is not sufficient to know what a perceptual object is, and that the existence of appearances is necessary to know that the external world is being perceived. However, the impossibility of matter does not follow from Berkeley’s theory. The main result of the research is that singular knowledge claims about the external world never refer directly and immediately to the objects of the external world. A perceiver’s own qualities affect how perceptual objects appear in a perceptual situation.

Defining Sales and Operations Planning Process in an Environmental Management Company

Sales and operations research publications have increased significantly in the last decades. The concept of sales and operations planning (S&OP) has gained increased recognition and has been put forward as the area within Supply Chain Management (SCM). Development of S&OP is based on the need for determining future actions, both for sales and operations, since off-shoring, outsourcing, complex supply chains and extended lead times make challenges for responding to changes in the marketplace when they occur. Order intake of the case company has grown rapidly during the last years. Along with the growth, new challenges considering data management and information flow have arisen due to increasing customer orders. To manage these challenges, case company has implemented S&OP process, though initial process is in early stage and due to this, the process is not managing the increased customer orders adequately. Thesis objective is to explore extensively the S&OP process content of the case company and give further recommendations. Objectives are categorized into six different groups, to clarify the purpose of this thesis. Qualitative research methods used are active participant observation, qualitative interviews, enquiry, education, and a workshop. It is notable that demand planning was felt as cumbersome, so it is typically the biggest challenge in S&OP process. More proactive the sales forecasting can be, more expanded the time horizon of operational planning will turn out. S&OP process is 60 percent change management, 30 percent process development and 10 percent technology. The change management and continuous improvement can sometimes be arduous and set as secondary. It is important that different people are required to improve the process and the process is constantly evaluated. As well as, process governance is substantially in a central role and it has to be managed consciously. Generally, S&OP process was seen important and all the stakeholders were committed to the process. Particular sections were experienced more important than others, depending on the stakeholders’ point of views. Recommendations to objective groups are evaluated by the achievable benefit and resource requirement. The urgent and easily implemented improvement recommendations should be executed firstly. Next steps are to develop more coherent process structure and refine cost awareness. Afterwards demand planning, supply planning, and reporting should be developed more profoundly. For last, information technology system should be implemented to support the process phases.