ESPOOLAISTEN KOETTU TERVEYS - Pienalue-estimoinnin soveltaminen aluetasoisen tiedon tuottamiseen

Koettu terveys on subjektiivinen mittari, jota voidaan käyttää objektiivisten mittareiden ohella kunnan sosiaali- ja terveyspolitiikan onnistumisen arviointiin sekä ohjaamaan palveluiden järjestämistä. Tutkimuksessa selvitettiin mahdollisuuksia tuottaa pienalue-estimointimenetelmillä tietoa Espoon eri alueiden 20–64 -vuotiaan väestön kokemasta terveydestä. Erityisesti työ keskittyi selvittämään; kuinka pienille Espoon alueille voidaan tuottaa luotettavaa tietoa käytettävissä olevasta otosaineistosta ja miten käytetty mallitaso sekä otoskoon kasvattaminen muiden pääkaupunkiseudun asukkaiden vastauksilla vaikuttaa estimointitulokseen? Tutkimusaineistona käytettiin vuoden 2008 aikana Helsingin sosiaalialan osaamiskeskuksen keräämän Pääkaupunkiseudun hyvinvointitutkimus -aineiston lisäksi Aluesarjat-tilastotietokannasta sekä Tilastokeskuksen Väestötilastopalvelusta saatavaa tietoa. Pienalue-estimointimenetelminä käytettiin malliavusteista GREG-estimointia sekä malliperusteista EBLUP-estimointia. Sekä Espoon että koko pääkaupunkiseudun otosaineistosta muodostettujen yksikkö- ja aluetason mallien parametrien ja Espoon eri alueiden 20–64 -vuotiaaseen väestöön liittyvän tiedon avulla tuotettiin alue-estimaatteja Espoon pien-, tilasto- ja suuralueille. Koetun terveyden aluekeskiarvon estimointi onnistui kaikilla aluetasoilla kyseisen aluetason malliin perustuvalla EBLUP-estimaattorilla. GREG-estimaattori onnistui vain suuraluetason estimoinnissa, muilla aluetasoilla alueiden pienet otoskoot huononsivat GREG-estimaatin tarkkuutta. Yksikkötason sekamallin huono selitysvoima ja mallista puuttuva selittäjä huononsivat siihen perustuvan EBLUP-estimaattorin tarkkuutta. Estimoinnin kannalta mallitasoa tärkeämmäksi osoittautui mallin hyvyyden toteutuminen. Voiman lainaaminen kohdejoukon ulkopuoliselta otokselta heikensi satunnaisvaikutuksen merkitsevyyttä ja alue-estimaattien välistä vaihtelua sekä lisäsi estimaattien tarkkuutta. Pienaluetiedon tuottaminen onnistuu EBLUP-estimaattoreilla jopa 85 pienalueelle noin 800 havainnon otosaineistosta, mikäli käytössä on luotettavaa lisäinformaatiota ja hyvä malli. GREG-estimaattori sallii huonomman mallin käytön, mutta edellyttää suurempia pienalueittaisia otoskokoja kuin EBLUP-estimaattorit. EBLUP-estimaattoreiden etuna on alueittaisen otoskoon lisäksi mahdollisuus perustaa estimointi sekä yksikkötasoiseen että aluetasoiseen malliin. Pienalueestimointimenetelmät lisäävät otosaineistojen hyödyntämismahdollisuuksia. Onnistumisen takaa menetelmiin sisältyvien, aineistoon ja malliin kohdistuvien vaatimusten huomiointi tiedonkeruun suunnitteluvaiheessa mm. kysymysten asettelussa. Pienalue-estimointimenetelmien käyttö edellyttää tilastollista osaamista, kriittisyyttä saatuja tuloksia kohtaan ja vastuullisuutta tuloksia julkaistaessa. Laatuvaatimukset täyttävät pienalue-estimaatit soveltuvat hyvin päätöksenteon tueksi, kun halutaan vertailla alueita ja kohdentaa resursseja tarvelähtöisesti.

Living arrangements and health

In line with major demographic changes in other Northern European and North American countries and Australia, being nonmarried is becoming increasingly common in Finland, and the proportion of cohabiters and of persons living alone has grown in recent decades. Official marital status no longer reflects an individual s living arrangement, as single, divorced and widowed persons may live alone, with a partner, with children, with parents, with siblings, or with unrelated persons. Thus, more than official marital status, living arrangements may be a stronger discriminator of one s social bonds and health. The general purpose of this study was to deepen our current understanding of the magnitude, trends, and determinants of ill health by living arrangements in the Finnish working-age population. Distinct measures of different dimensions of poor health, as well as an array of associated factors, provided a comprehensive picture of health differences by living arrangements and helped to assess the role of other factors in the interpretation of these differences . Mortality analyses were based on Finnish census records at the end of 1995 linked with cause-of-death registers for 1996 2000. The data included all persons aged 30 and over. Morbidity analyses were based on two comparable cross-sectional studies conducted twenty years apart (the Mini-Finland Survey in 1978 80 and the Health 2000 Survey in 2000 01). Both surveys were based on nationally representative samples of Finns aged 30 and over, and benefited from high participation rates. With the exception of mortality analyses, this study focused on health differences among the working-age population (mortality in age groups 30-64 and 65 and over, self-rated health and mental health in the age group 30-64, and unhealthy alcohol use in the age group 30-54). Compared with all nonmarried groups, married men and women exhibited the best health in terms of mortality, self-rated health, mental health and unhealthy alcohol use. Cohabiters did not differ from married persons in terms of self-rated health or mental health, but did exhibit excess unhealthy alcohol use and high mortality, particularly from alcohol-related causes. Compared with the married, persons living alone or with someone other than a partner exhibited elevated mortality as well as excess poor mental health and unhealthy alcohol use. By all measures of health, men and women living alone tended to be in the worst position. Over the past twenty years, SRH had improved least among single men and women and widowed women, and most among cohabiting women. The association between living arrangements and health has many possible explanations. The health-related selection theory suggests that healthy people are more likely to enter and maintain a marriage or a consensual union than those who are unhealthy (direct selection) or that a variety of health-damaging behavioural and social factors increase the likelihood of ill health and the probability of remaining without a partner or becoming separated from one s partner (indirect selection). According to the social causation theory, marriage or cohabitation has a health-promoting effect, whereas living alone or with others than a partner has a detrimental effect on health. In this study, the role of other factors that are mainly assumed to reflect selection, appeared to be rather modest. Social support, which reflects social causation, contributed only modestly to differences in unhealthy alcohol use by living arrangements, but had a larger effect on differences in poor mental health. Socioeconomic factors and health-related behaviour, which reflect both selection and causation, appeared to play a more important role in the excess poor health of cohabiters and of persons living alone or with someone other than a partner, than of married persons. Living arrangements were strongly connected to various dimensions of ill health. In particular, alcohol consumption appeared to be of great importance in the association between living arrangements and health. To the extent that the proportion of nonmarried persons continues to grow and their health does not improve at the same rate as that of married persons, the challenges that currently nonmarried persons pose to public health will likely increase.

The social patterning of health, smoking and drinking in Estonia, Latvia, Lithuania and Finland in 1994-2004

The Baltic countries share public health problems typical of most Eastern European transition economies: morbidity and mortality from non-communicable diseases is higher than in Western European countries. This situation has many similarities compared to a neighbouring country, Finland during the late 1960s. There are reasons to expect that health disadvantage may be increasing among the less advantaged population groups in the Baltic countries. The evidence on social differences in health in the Baltic countries is, however, scattered to studies using different methodologies making comparisons difficult. This study aims to bridge the evidence gap by providing comparable standardized cross-sectional and time trend analyses to the social patterning of variation in health and two key health behaviours i.e. smoking and drinking in Estonia, Latvia, Lithuania and Finland in 1994-2004 representing Eastern European transition countries and a stable Western European country. The data consisted of similar cross-sectional postal surveys conducted in 1994, 1996, 1998, 2000, 2002 and 2004 on adult populations (aged 20 64 years) in Estonia (n=9049), Latvia (n=7685), Lithuania (n=11634) and Finland (n=18821) in connection with the Finbalt Health Monitor project. The main statistical method was logistic regression analysis. Perceived health was found to be worse among both men and women in the Baltic countries than in Finland. Poor health was associated with older age and lower education in all countries studied. Urbanization and marital status were not consistently related to health. The existing educational inequalities in health remained generally stable over time from 1994 to 2004. In the Baltic countries, however, improvement in perceived health was mainly found among the better educated men and women. Daily smoking was associated with young age, lower education and psychological distress in all countries. Among women smoking was also associated with urbanisation in all countries except Estonia. Among Lithuanian women, the educational gradient in smoking was weakest, and the overall prevalence of smoking increased over time. Drinking was generally associated with young age among men and women, and with education among women. Better educated women were more often frequent drinkers and less educated binge drinkers. The exception was that in Latvian men and women both frequent drinking and binge drinking were associated with low education. In conclusion, the Baltic countries are likely to resemble Western European countries rather than other transition societies. While health inequalities did not markedly change, substantial inequalities do remain, and there were indications of favourable developments mainly among the better educated. Pressures towards increasing health inequalities may therefore be visible in the future, which would be in accordance with the results on smoking and drinking in this study.

Retirement Transition and Well-being : A 16-year Longitudinal Study

The ageing of the labour force and falling employment rates have forced policy makers in industrialized countries to find means of increasing the well-being of older workers and of lengthening their work careers. The main objective of this thesis was to study longitudinally how health, functional capacity, subjective well-being, and lifestyle change as people grow older, and what effect retirement has on these factors and on their relationships. The present study is a follow-up questionnaire study of Finnish municipal workers, conducted in 1981 to 1997 at the Finnish Institute of Occupational Health. In 1981, a postal questionnaire was sent to 7344 municipal workers in different parts of Finland. The respondents were born between 1923 and 1937. A total of 6257 persons responded to the first questionnaire. In the end, a total of 3817 persons had responded to all four (1981, 1985, 1992, 1997) questionnaires. (The response rate was 69% of the living participants). Cross-tabulations, comparison of means, logistic regression analyses and general linear models with repeated measures were used to derive the results. The transition from work life to retirement, and the following years as a pensioner were associated with many changes. Involvement in various activities increased during the transition stage but later decreased to the previous level. Physical exercise was an exception: it became increasingly popular over the years. Perceived health improved markedly from the working stage to the retirement transition stage, even though morbidity increased steadily during the follow-up. On the other hand, functional capacity decreased over the follow-up, especially among those who were occupationally active until the retirement stage. Subjective well-being remained stable during the follow-up period. There were, however, great differences based on the type of work, favouring those whose work had been mental in nature. The impact of activity level on maintaining well-being became greater during the follow-up, whereas the effect of physical functioning diminished. Good physical functioning and an active life-style contributed to staying on at work until normal retirement age. Also work-related factors, i.e. possibilities for development and influence at work, responsibility for others, meaningful work, and satisfaction with working time arrangements were positively related to continuing working. The transition from work to retirement had a positive impact on a person s health and functional capacity. The study results support the view that it should be possible to ease one s work pace during the last years of a work career. This might lower the threshold between work and retirement and convince people that there will still be time to enjoy retirement also a few years later.

Pathways to health : Determinants of health, health behaviour and health inequalities in early adulthood

There is increasing evidence that the origins of poor adult health and health inequalities can be traced back to circumstances preceding current socioeconomic position and living conditions. The life-course approach to examining the determinants of health has emphasised that exposure to adverse social and economic circumstances in earlier life or concurrent adverse circumstances due to unfavourable living conditions in earlier life may lead to poor health, health-damaging behaviour, disease or even premature death in adulthood. There is, however, still a lack of knowledge about the contribution of social and economic circumstances in childhood and youth to adult health and health inequalities, and even less is known about how environmental and behavioural factors in adulthood mediate the effects of earlier adverse experiences. The main purpose of this study was to deepen our understanding of the development of poor health, health-damaging behaviours and health inequalities during the life-course. Its aim was to find out which factors in earlier and current circumstances determine health, the most detrimental indicators of health behaviour (smoking, heavy drinking and obesity as a proxy for the balance between nutrition and exercise), and educational health differences in young adults in Finland. Following the ideas of the social pathway theory, it was assumed that childhood environment affects adult health and its proximal determinants via different pathways, including educational, work and family careers. Early adulthood was studied as a significant phase of life when many behavioural patterns and living conditions relevant to health are established. In addition, socioeconomic health inequalities seem to emerge rapidly when moving into adulthood; they are very small or non-existent in childhood and adolescence, but very marked by early middle age. The data of this study were collected in 2000 2001 as part of the Health 2000 Survey (N = 9,922), a cross-sectional and nationally representative health interview and examination survey. The main subset of data used in this thesis was the one comprising the age group 18 29 years (N = 1,894), which included information collected by standardised structured computer-aided interviews and self-administered questionnaires. The survey had a very high participation rate at almost 90% for the core questions. According to the results of this study, childhood circumstances predict the health of young adults. Almost all the childhood adversities studied were found to be associated with poor self-rated health and psychological distress in early adulthood, although fewer associations were found with the somatic morbidity typical of young adults. These effects seemed to be more or less independent of the young adult s own education. Childhood circumstances also had a strong effect on smoking and heavy drinking, although current circumstances and education in particular, played a role in mediating this effect. Parental smoking and alcohol abuse had an influence on the corresponding behaviours of offspring. Childhood circumstances had a role in the development of obesity and, to a lesser extent, overweight, particularly in women. The findings support the notion that parental education has a strong effect on early adult obesity, even independently of the young adult s own educational level. There were marked educational differences in self-rated health in early adulthood: those in the lowest educational category were most likely to have average or poorer health. Childhood social circumstances seemed to explain a substantial part of these educational differences. In addition, daily smoking and heavy drinking contributed substantially to educational health differences. However, the contribution of childhood circumstances was largely shared with health behaviours adopted by early adulthood. Employment also shared the effects of childhood circumstances on educational health differences. The results indicate that childhood circumstances are important in determining health, health behaviour and health inequalities in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing the unfortunate pathways leading to the development of poor health, health-damaging behaviour and health inequalities. It is crucially important to recognise the needs of children living in adverse circumstances as well as children of substance abusing parents. In addition, single-parent families would benefit from support. Differences in health and health behaviours between different sub-groups of the population mean that we can expect to see ever greater health differences when today s generation of young adults grows older. This presents a formidable challenge to national health and social policy as well as health promotion. Young adults with no more than primary level education are at greatest risk of poor health. Preventive policies should emphasise the role of low educational level as a key determinant of health-damaging behaviours and poor health. Keywords: health, health behaviour, health inequalities, life-course, socioeconomic position, education, childhood circumstances, self-rated health, psychological distress, somatic morbidity, smoking, heavy drinking, BMI, early adulthood

Trust, participation and health among ageing people : A cross-sectional cohort study of men and women born in 1926-30, 1936-40, and 1946-50 in the Lahti region, southern Finland

The purpose of the present study was to explore the associations between good self-rated health and economic and social factors in different regions among ageing people in the Päijät-Häme region in southern Finland. The data of this study were collected in 2002 as part of the research and development project Ikihyvä 2002 2012 (Good Ageing in Lahti region GOAL project). The baseline data set consisted of 2,815 participants born in 1926 30, 1936 40, and 1946 50. The response rate was 66 %. According to the previous studies, trust in other people and social participation as the main aspects of social capital are associated with self-rated health. In addition, socioeconomic position (SEP) and self-rated health are associated, but all SEP indicators do not have identical associations with health. However, there is a lack of knowledge of the health associations and regional differences with these factors, especially among ageing people. Regarding these questions, the present study gives new information. According to the results of this study, self-perceived adequacy of income was significantly associated with good self-rated health, especially in the urban areas. Similar associations were found in the rural areas, though education was also considered an important factor. Adequacy of income was an even stronger predictor of good health than the actual income. Women had better self-rated health than men only in the urban areas. The youngest respondents had quite equally better self-rated health than the others. Social participation and access to help when needed were associated with good self-rated health, especially in the urban area and the sparsely populated rural areas. The result was comparable in the rural population centres. The correlation of trust with self-rated health was significant in the urban area. High social capital was associated with good self-rated health in the urban area. The association was quite similar in the other areas, though it was statistically insignificant. High social capital consisted of co-existent high social participation and high trust. The association of traditionalism (low participation and high trust) with self-rated health was also substantial in the urban area. The associations of self-rated health with low social capital (low participation and low trust) and the miniaturisation of community (high participation and low trust) were less significant. From the forms of single participation, going to art exhibitions, theatre, movies, and concerts among women, and studying and self-development among men were positively related to self-rated health. Unexpectedly, among women, active participation in religious events and voluntary work was negatively associated with self-rated health. This may indicate a coping method with ill-health. As a whole, only minor variations in self-rated health were found between the areas. However, the significance of the factors associated with self-rated health varied according to the areas. Economic factors, especially self-perceived adequacy of income was strongly associated with good self-rated health. Also when adjusting for economic and several other background factors social factors (particularly high social capital, social participation, and access to help when needed) were associated with self-rated health. Thus, economic and social factors have a significant relation with the health of the ageing, and improving these factors may have favourable effects on health among ageing people.

Minästä toiseen : Lacanilaisen subjektin syntymä Anaïs Ninin House of Incestissä ja Hélène Cixous'n Dedans'issa

The study approaches two modern novels using the conceptual frame of Lacanian psychoanalysis, especially the Lacanian notion of subject. The novels can be described as subversive “Bildungsromans” (development novels) highly influenced by psychoanalytic thought. Anaïs Nin’s (1903—1977) “poetic novel” House of Incest (1936) is a story of sexual and artistic awakening while Hélène Cixous’s (b. 1937) first novel Dedans (1969) depicts the growth of a little girl whose father dies. Both are first novels and first person narratives. Concentrating in the narrator’s internal life the novels writings break with the realistic conventions of narrative, bringing forth the themes of anguish, alienation from the world and escape into the prison like realm of the self. The study follows roughly the Lacanian process of becoming a subject. Each chapter opens up with a quick introduction to the Lacanian concepts used in the following part that analyses the novels. The study can thus also be used as a brief introduction to Lacanian theory in finnish. The psychoanalytic narrative/story of the birth of the subject and the novels stories can be seen as mirroring each other. The method of the study is thus based on a dialogue between the theoretical concepts and the analyses. Novels are being approached as texts that break with the Cartesian notion of an autonomous subject making room for a dialectics of self and other, for a movement in which the “I” builds an identity mirroring itself with others. While both of the novels recount the birth of a character called I, they also have a first person narrator apart from the character “I”. Having constituted the self’s identity, the narrator finds from inside of the self also an other or “you” – this discovery is the final clue to the coffin of the autonomous self. From the Lacanian perspective man’s great Other is the order of language, Symbolic, which constitutes the individual, the speaking subject. Using this perspective the novels are interpreted as describing the process of becoming a subject of the Symbolic; subjected to Symbolic order. This “birth process” happens in particular in the Imaginary register, where the self’s identity is built. In the Imaginary or Mirror phase the “I” mirrors himself with different others (e.g. with his mirror image and the family members, the surrounding others) learning to see his body and his selfhood both as familiar and strange, other. In the Imaginary phase the novels’ characters are also trying to deal with the opposite realm of the Symcolic, the Real. The Lacanian Real is not the reality “before words” but a reality left over from the Symbolic, aside of it but constituted by the Symbolic, to be deducted only from within it. In the novels the Real is experienced as a womblike state where the self is immersed in the other’s body. The process of coming a subject of the Symbolic is depicted also as a process of renouncing the “dream of the womb”, which, if realized, could only mean the non-existence of the subject, i.e. death. The study concentrates on analysing the novels’ writing, where meanings are constantly changing: “I” becomes you, the father becomes a mother, inside becomes outside. This technique enables also the deconstruction of certain opposing notions in the novels. The Lacanian point of view exposes language as a constantly moving universe where the subject has no more stability than the momentary meanings language creates. The self’s identity depicted in the novels is a Lacanian fixed identity, whose growth is necessary but opposes the flux imminent to the Symbolic. The anguish experienced in the novels, in the “house of incest” or “inside”, is due to clinging on the unchanging “I”. However, the writing of the novels shows how the meaning of the “I” changes constantly and the fixity thus becomes movement. This way House of Incest and Dedans, despite their pessimistic stories, manage to create an image of a new, moving subject.

Lausunta taiteena ja tapahtumana : Tekstikeskeisyys, esittäjäkeskeisyys ja lausunnan positiot lausuntaa koskevan kirjallisen aineiston ja teatterintutkimuksen viitekehyksessä

The research is analyzing the Finnish tradition on poetry elocution both from the discource analytical and theatrical and view point. The main questions are, whether there still is a fixed position for elocution in the field of art or are we dealing with just one form of thearte? -- The art of elocution has been considered as an independent art form, sometimes even in opposition to theatre, which has been regarded as a very physical and emotional art form by the elocutionists themselves. The self-image of the Finnish elocution art has been born and firmly sustained from the notion that elocution is linked to literature. Elocution as an art form has been seen as "pure" and humbly serving literature and poetry. The main function of an elocutionist has been to understand and vocally express the meanings found in a poem to larger audience. -- This function has changed over the time. There have been a transition from the traditonal text-centeredness to performer-centeredness, even to performance-centeredness as a new wave of theatrical elements and methods have reached the circle of elocution. New forms of poetry performances, such as poetry reading and poetry slam are new challenges to elocution as it must reconsider it´s traditional function in a new artistic and cultural context.

Asiakkaan ja asiantuntijan pedagoginen suhde : Fenomenologinen tutkimus fysioterapiatilanteista asiakkaiden ja fysioterapeuttien kokemana

Väitöskirja on fenomenologinen tutkimus koetusta asiakas-asiantuntijasuhteesta. Tutkimuksen tarkoituksena on selvittää ihmisten välisiä asiakas-asiantuntijatilanteiden suhteita ja siten mahdollistaa asiakkaan hyvinvointia. Tutkimuskohteena on fysioterapiasuhde, jota aiemmin on selvitetty fysioterapeutin parantamisena, asiakkaan terveyden edistämisenä tai vuorovaikutussuhteena. Tässä tutkimuksessa mielenkiinto kohdistuu fysioterapiatilanteissa koettuihin asiakkaiden ja asiantuntijoiden välisiin suhteisiin. Tutkimukseen osallistuivat 16 fysioterapiatilanteen kokenutta asiakasta ja 16 saman tilanteen kokenutta fysioterapeuttia, jotka toimivat tutkimusajankohtana erikoissairaanhoidossa, kunnan terveyskeskuksessa tai yksityisessä fysioterapialaitoksessa. Avoimen yksilöhaastattelun tehtävänä oli kuvata mitä osanottaja koki juuri päättyneessä tilanteessa. Tutkimusaineiston analyysi etenee ensimmäisessä vaiheessa fenomenologisen tutkimuksen mukaan, yksilöllisten ihmisten välisten suhteiden koettujen merkitysten ja merkityskokonaisuuksien analyysiin ja merkitysperspektiivin synteesiin. Tutkimuksen ensimmäisen vaiheen yksilöllisten merkitysperspektiivien perusteella fysioterapiasuhde osoittautui muutossuhteeksi, mikä ei ollut erilainen eri organisaatioissa, vaan siinä ilmeni pedagogisen suhteen oppimisen ja ohjauksen piirteitä. Tutkimuksen toisessa vaiheessa vietiin pedagogisen suhteen mukaisesti yhteen ja vertailtiin yksilöllisten merkitysperspektiivien merkityksiä ja merkityskokonaisuuksia asiakkaiden ja fysioterapian asiantuntijoiden näkökulmina sekä saman tilanteen yhteisenä koettuna näkökulmana. Asiakkaiden näkökulmasta suhteen voimavarana oli hänen kokema kehollinen vieraus, mikä ohjasi asiakas-asiantuntijasuhdetta neljänlaiseen asiakkaan muutossuhteeseen. Fysioterapian asiantuntijoiden näkökulmasta asiaosaamisena oli asiakkaan parantaminen liikkeen tai toiminnan avulla, mikä ohjasi asiakas-asiantuntijasuhdetta asiantuntijan näkökulmasta erilaisiin ohjaussuhteisiin. Samassa tilanteessa asiakkaiden ja asiantuntijan yhteisenä kokemat aukeamat etenivät spontaaneista turvallisuuden ja luottavaisuuden aukeamista aktiivisiin yhteisymmärryksen ja yhteissanoituksen aukeamiin. Pedagoginen suhde avautui merkityskokonaisuuksina joko vain asiakkaalle tai asiantuntijalle tai yhteisenä koettuina pedagogisina aukeamina. Edellä mainituista kolmesta (asiakkaan, asiantuntijan, yhteisenä koettu) näkökulmasta asiakas-asiantuntijasuhde osoittautui tässä tutkimuksessa neljäksi erilaiseksi asiakkaan, asiantuntijan ja yhteytenä koetun näkökulmia yhdistäväksi pedagogiseksi prosessiksi. Tutkimuksen tulosten synteesi osoitti, että pedagogisen prosessin suuntaa muuttavat yhteytenä koettujen aukeamien väliset dialogit, joissa spontaani, yhdessä näkyvä ja yhdessä koettua sanoittava dialogihetket osoittautuivat pedagogista prosessia kääntäviksi mahdollisuuksiksi. Tämän tutkimuksen mukaan vasta aktiivinen yhteistä kieltä tuottava pedagoginen suhde mahdollistaa asiakkaan kokeman kehollisen vierauden ymmärtämisen ja yhteissanoittamisen. Sanoittamalla kokemaansa asiakas voi jakaa kokemaansa toimimattomuutta tutulla kielellä myös muiden kun tilanteessa olleiden kanssa ja siten oppia itsenäisesti ohjaamaan omaa hyvinvointiaan. Tämän tutkimusten tulosten mukaan vain yhdessä (Pentin ja Sarin) tilanteessa pedagoginen prosessi eteni yhteiseksi kieleksi. Tutkimustulokset haastavat kehittämään asiakas-asiantuntijasuhdetta siten, että pedagoginen prosessi voisi toteutua kokonaisuudessaan. Avainsanat: asiakas-asiantuntijasuhde, pedagoginen suhde, fenomenologia, kokemus, merkitysanalyysi, dialogi, fysioterapia

Occupational burnout and health

Occupational burnout and heath Occupational burnout is assumed to be a negative consequence of chronic work stress. In this study, it was explored in the framework of occupational health psychology, which focusses on psychologically mediated processes between work and health. The objectives were to examine the overlap between burnout and ill health in relation to mental disorders, musculoskeletal disorders, and cardiovascular diseases, which are the three commonest disease groups causing work disability in Finland; to study whether burnout can be distinguished from ill health by its relation to work characteristics and work disability; and to determine the socio-demographic correlates of burnout at the population level. A nationally representative sample of the Finnish working population aged 30 to 64 years (n = 3151-3424) from the multidisciplinary epidemiological Health 2000 Study was used. Burnout was measured with the Maslach Burnout Inventory - General Survey. The diagnoses of common mental disorders were based on the standardized mental health interview (the Composite International Diagnostic Interview), and physical illnesses were determined in a comprehensive clinical health examination by a research physician. Medically certified sickness absences exceeding 9 work days during a 2-year period were extracted from a register of The Social Insurance Institution of Finland. Work stress was operationalized according to the job strain model. Gender, age, education, occupational status, and marital status were recorded as socio-demographic factors. Occupational burnout was related to an increased prevalence of depressive and anxiety disorders and alcohol dependence among the men and women. Burnout was also related to musculoskeletal disorders among the women and cardiovascular diseases among the men independently of socio-demographic factors, physical strenuousness of work, health behaviour, and depressive symptoms. The odds of having at least one long, medically-certified sickness absence were higher for employees with burnout than for their colleagues without burnout. For severe burnout, this association was independent of co-occurring common mental disorders and physical illnesses for both genders, as was also the case for mild burnout among the women. In a subgroup of the men with absences, severe burnout was related to a greater number of absence days than among the women with absences. High job strain was associated with a higher occurrence of burnout and depressive disorders than low job strain was. Of these, the association between job strain and burnout was stronger, and it persisted after control for socio-demographic factors, health behaviour, physical illnesses, and various indicators of mental health. In contrast, job strain was not related to depressive disorders after burnout was accounted for. Among the working population over 30 years of age, burnout was positively associated with age. There was also a tendency towards higher levels of burnout among the women with low educational attainment and occupational status and among the unmarried men. In conclusion, a considerable overlap was found between burnout, mental disorders, and physical illnesses. Still, burnout did not seem to be totally redundant with respect to ill health. Burnout may be more strongly related to stressful work characteristics than depressive disorders are. In addition, burnout seems to be an independent risk factor for work disability, and it could possibly be used as a marker of health-impairing work stress. However, burnout may represent a different kind of risk factor for men and women, and this possibility needs to be taken into account in the promotion of occupational health.

On the environmental genetics of depressive symptoms : Focus on two serotonergic genes

Depression is a complex psychiatric disorder influenced by several genes, environmental factors, and their interplay. Serotonin receptor 2A (HTR2A) and tryptophan hydroxylase 1 (TPH1) genes have been implicated in vulnerability to depression and other psychiatric disorders, but the results have been inconsistent. The present study examined whether these two genes moderated the influence of different depressogenic environmental factors on subthreshold depressive symptoms (assessed on a modified version of Beck s Depression Inventory, BDI) and depression-related temperament, i.e., harm avoidance (assessed on the Temperament and Character Inventory, TCI). The environmental factors included measures of childhood and adolescence exposure, i.e., maternal nurturance and parental socioeconomic status, and adulthood social circumstances, i.e., perceived social support and urban/rural residence. The participants were two randomly selected subsamples (n = 1246, n = 341) from the longitudinal population-based Cardiovascular Risk in Young Finns study (n = 3596). Childhood environmental factors were assessed when the participants were 3 to 18 years of age, and three years after the baseline. Adulthood environmental factors and outcome measures were assessed 17 and 21 years later when the participants were 21 to 39 years of age. The T102C polymorphism of the HTR2A gene moderated the association between childhood maternal nurturance and adulthood depressive symptoms, such that exposure to high maternal nurturance predicted low depressive symptoms among individuals carrying the T/T or T/C genotypes, but not among those carrying the C/C genotype. Likewise, high parental SES predicted low adulthood harm avoidance in individuals carrying the T/T or T/C genotype, but not in C/C-genotype carriers. Individuals carrying the T/T or T/C genotype were also sensitive to urban/rural residence, such that they had lower depressive symptoms in urban than in rural areas, whereas those carrying the C/C genotype were not sensitive to urban/rural residence difference. HTR2A did not moderate the influence of social support. TheA779C/A218C haplotype of the TPH1 gene was not involved in the association between childhood environment and adulthood outcomes. However, individuals carrying A alleles of the TPH1 haplotype were more vulnerable to the lack of adulthood social support in terms of high depressive symptoms than their counterparts carrying no A alleles. Furthermore, individuals living in remote rural areas and carrying the A/A haplotype had higher depressive symptoms than those carrying other genotypes of the TPH1. The findings suggest that the HTR2A and TPH1 genes may be involved in the development of depression by influencing individual s sensitivity to depressogenic environmental influences.