Chinese immigrants to Finland: A qualitative study of housing, employment, access to health care and child care as sociological dimensions in their settlement process

The Master’s thesis is qualitative research based on interviews of 15 Chinese immigrants to Finland in order to provide a sociological perspective of the migration experience through the eyes of Chinese immigrants in the Finnish social welfare context. This research is mainly focused upon four crucial aspects of life in the settlement process: housing, employment, access to health care and child care. Inspired by Allardt’s theoretical framework ‘Having, Loving and Being’, social relationships and individual satisfaction are examined in the case of Chinese interviewees dealing with the four life aspects. Finland was not perceived as an attractive migration destination for most Chinese interviewees in the beginning. However, with longer residence in Finland, the Finnish social welfare system gradually became a crucial appealing factor in their permanent settlement in Finland. And meanwhile, social responsibility of attending their old parents in China, strong feelings of being isolated in Finland, and insufficient integration into the Finnish society were influential factors for their decision of returning to China. Social relationships with personal friends, migration brokers, schools, employers and family relatives had great influences in the four life aspects of Chinese immigrants in Finland. The social relationship with the Finnish social welfare sector is supportive to Chinese immigrants, but Chinese immigrants do not heavily rely on Finnish social protection. The housing conditions were greatly improved over time while the upward mobility in the Finnish labour market was not significant among Chinese immigrants. All Chinese immigrants were satisfied with their current housing by the time I interviewed them while most of them had subjective feelings of being alienated in the Finnish labour market, which seriously prevented them from integrating into the Finnish society. In general, Chinese immigrants were satisfied with the low cost of accessing the Finnish public health care services and affordable Finnish child day care services and financial subsidies for children from the Finnish social welfare sector. This research also suggests that employment is the central basis in well-being. Support from the Finnish social welfare sector can improve the satisfaction levels among immigrants, especially when it mitigates the effects of low-paid employment. As well, my empirical study of Chinese immigrants in Finland shows that Having (needs for materials), Loving (needs for social relations) and Being (needs for social integration) are all involved in the four concrete aspects (housing, employment, access to health care and child care).

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

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

Independent and mediating organizational commitment effects of trust in leadership on employees' job satisfaction and : a study within social and health care sector

The purpose of this study was to examine whether trust in supervisor and trust in senior management enhance employees' job satisfaction and organizational commitment, and whether trust mediates the relationship between perceived justice and these outcomes. Trust in supervisor was expected to mediate the effects of distributive justice and interactional justice, and trust in senior management was expected to mediate the effects of procedural justice. Theoretical background of the study is based on the framework for trust in leadership developed by Dirks and Ferrin (2002). According to the framework, perceived fairness of leaders' actions helps employees to draw inferences about the basis of the relationship and about leaders' characters. This allows trust formation. Reciprocation of care and concern in the relationship and confidence in leaders' characters are likely to enhance employees' job satisfaction and organizational commitment. This study was conducted with cross-sectional data (A/ = 960) of employees from social and health care sector. Hypotheses were studied using correlation analysis and several hierarchical regression analyses. Significances of the mediations were assessed using the Sobel test. Results partially supported the hypotheses. Trust in leadership was positively related to job satisfaction and organizational commitment. Trust in senior management mediated the relationship between procedural justice and the outcomes. Some support was also found for the mediating effect of trust in supervisor in the relationship between distributive justice and organizational commitment. Due to high correlation between trust in supervisor anil interactional justice, it wasn't possible to study the mediating e fleet of trust in supervisor in the relationship between interactional justice and the outcomes. Against expectations, results indicated that trust in senior management had a mediating effect in the relationship between distributive justice and organizational commitment, and in the relationship between interactional justice and organizational commitment. Results also indicated that trust in supervisor had a mediating effect in the relationship between procedural justice and organizational commitment.

Differential cellular recognition pattern to M. tuberculosis targets defined by IFN-gamma and IL-17 production in blood from TB plus patients from Honduras as compared to health care workers: TB and immune responses in patients from Honduras

Background: A better understanding of the quality of cellular immune responses directed against molecularly defined targets will guide the development of TB diagnostics and identification of molecularly defined, clinically relevant M.tb vaccine candidates. Methods: Recombinant proteins (n = 8) and peptide pools (n = 14) from M. tuberculosis (M.tb) targets were used to compare cellular immune responses defined by IFN-gamma and IL-17 production using a Whole Blood Assay (WBA) in a cohort of 148 individuals, i.e. patients with TB + (n = 38), TB- individuals with other pulmonary diseases (n = 81) and individuals exposed to TB without evidence of clinical TB (health care workers, n = 29). Results: M.tb antigens Rv2958c (glycosyltransferase), Rv2962c (mycolyltransferase), Rv1886c (Ag85B), Rv3804c (Ag85A), and the PPE family member Rv3347c were frequently recognized, defined by IFN-gamma production, in blood from healthy individuals exposed to M.tb (health care workers). A different recognition pattern was found for IL-17 production in blood from M.tb exposed individuals responding to TB10.4 (Rv0288), Ag85B (Rv1886c) and the PPE family members Rv0978c and Rv1917c. Conclusions: The pattern of immune target recognition is different in regard to IFN-gamma and IL-17 production to defined molecular M.tb targets in PBMCs from individuals frequently exposed to M.tb. The data represent the first mapping of cellular immune responses against M.tb targets in TB patients from Honduras.

Evaluation of a national evidence-based health care course via teleconference in a developing country

Rationale, aims and objectives Continuing health education is essential but challenged. in 2006, the Brazilian Cochrane Center, in collaboration with the Ministry of Health, launched a mass teaching initiative in evidence-based health care (EBH) for public-sector professionals via teleconferencing. This 152-hour, interactive EBH course has enrolled over 4500 professionals. This study aimed to assess the acquisition EBH knowledge and skills, as well as the attitudes and perceptions of a sample of students enrolled in the 2009 course via teleconferencing.Methods This prospective cohort study analyzed three aspects of this 152-hour EBH course that recruited 1040 volunteer participants, all public health sector employees working in 131 different hospitals or health agencies. Pre- and post-course tests using a modified version of the Berlin questionnaire with 20 multiple-choice questions were used to examine knowledge acquisition in a sample of 297 students. Tests were completed upon registration and at course completion. the research projects submitted by 872 participants were evaluated to assess skill acquisition. Answers to an anonymous survey assessed the attitudes and perceptions of 914 participants.Results There was a significant increase in knowledge from baseline to course completion (mean scores 8.2 +/- 3.3 versus 13.7 +/- 3.0, P < 0.001). Over 90% of the research projects were judged to be of adequate quality (appropriate rationale for the study, well-formulated research question and feasible execution); over 95% of the participants were satisfied with the course.Conclusion the Brazilian EBH course via teleconference improved the knowledge and skills of public-sector health professionals and was approved by the vast majority of students.

Cloud Computing - health care's silver lining.

Cloud computing is the technology prescription that will help the UK’s National Health Service (NHS) beat the budget constraints imposed as a consequence of the credit crunch. The internet based shared data and services resource will revolutionise the management of medical records and patient information while saving the NHS millions of pounds.

VAMP - a vision based sensor network for health care hygiene

Adequate hand-washing has been shown to be a critical activity in preventing the transmission of infections such as MRSA in health-care environments. Hand-washing guidelines published by various health-care related institutions recommend a technique incorporating six hand-washing poses that ensure all areas of the hands are thoroughly cleaned. In this paper, an embedded wireless vision system (VAMP) capable of accurately monitoring hand-washing quality is presented. The VAMP system hardware consists of a low resolution CMOS image sensor and FPGA processor which are integrated with a microcontroller and ZigBee standard wireless transceiver to create a wireless sensor network (WSN) based vision system that can be retargeted at a variety of health care applications. The device captures and processes images locally in real-time, determines if hand-washing procedures have been correctly undertaken and then passes the resulting high-level data over a low-bandwidth wireless link. The paper outlines the hardware and software mechanisms of the VAMP system and illustrates that it offers an easy to integrate sensor solution to adequately monitor and improve hand hygiene quality. Future work to develop a miniaturized, low cost system capable of being integrated into everyday products is also discussed.

Health care and neoliberalism in Ireland: withholding the gift and corrupting the social contract

The health of a nation tells much about the nature of a social contract between citizen and state. The way that health care is organised, and the degree to which it is equitably accessible, constitutes a manifestation of the effects of moments and events in that country's history. Using four case studies, this thesis uses a historical genealogical approach to explain the evolution of Ireland's particular version of health care provision. The total social fact of the gift relationship, central to all human relations, will be used to form a theoretical and conceptual framework on which to build an analysis of Ireland's health and welfare conditions. Additionally, social contract theory will enable an examination of the role of solidarity in relation to social expectations around health care provision. Through the analysis of these cases, the complex matrix of the influential forces that have shaped current conditions are exposed and revealed, enabling a critical understanding of the extent of acquiescence to the inequitable system that arguably exists. The vulnerability of citizens in need of care to the external and global effects of market forces and neoliberalism, therefore, becomes central to any argument for state-provided health and welfare. The hegemony of such forces can be seen to influence the manner in which the idea of individual self-reliance, in place of collective solidarity, is conceptualised and subsequently infiltrated into a range of aspects of the social world. For example, the particular discourse of the market and of economic concerns succeeds in shaping understandings of responsibilities around central areas of health and welfare. Similarly the 'possessor principle' can be seen to be misplaced within the context of health and social care, but yet has become normalised within this discourse. Within this matrix of complex influencing factors, the welfare state struggles to impose a balance between market values and social values. Responsibilities of the state to support and compensate its citizens for the ills of the market have become devalued, as the core values of classical liberalism have become distorted beyond recognition, leaving instead bare neoliberal concerns. This thesis traces the genealogical origins of this transition within the recent history of Irish health care and thereby reveals the embedding of individualism in place of solidarity, the on going reneging of the social contract and the corruption of the gift relationship.

Private health care coverage and increased risk of obstetric intervention

Background: When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria. Methods: Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors. Results: 403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43). Conclusions: Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.

Anti-cholinergic load, health care utilization, and survival in people with advanced cancer: a pilot study.

INTRODUCTION: Anti-cholinergic medications have been associated with increased risks of cognitive impairment, premature mortality and increased risk of hospitalisation. Anti-cholinergic load associated with medication increases as death approaches in those with advanced cancer, yet little is known about associated adverse outcomes in this setting. METHODS: A substudy of 112 participants in a randomised control trial who had cancer and an Australia modified Karnofsky Performance Scale (AKPS) score (AKPS) of 60 or above, explored survival and health service utilisation; with anti-cholinergic load calculated using the Clinician Rated Anti-cholinergic Scale (modified version) longitudinally to death. A standardised starting point for prospectively calculating survival was an AKPS of 60 or above. RESULTS: Baseline entry to the sub-study was a mean 62 +/- 81 days (median 37, range 1-588) days before death (survival), with mean of 4.8 (median 3, SD 4.18, range 1 - 24) study assessments in this time period. Participants spent 22% of time as an inpatient. There was no significant association between anti-cholinergic score and time spent as an inpatient (adjusted for survival time) (p = 0.94); or survival time. DISCUSSION: No association between anti-cholinergic load and survival or time spent as an inpatient was seen. Future studies need to include cognitively impaired populations where the risks of symptomatic deterioration may be more substantial.