Kelan järjestämän kuntoutuksen kohdentuminen ja vaikutukset työkykyyn kunnallisilla työpaikoilla

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

"Ei sitä ainakaan helpommaksi tehdä sairaan opiskelijan elämää" : Pitkäaikaissairaiden kokemuksia korkeakoulutuksen esteistä ja mahdollisuuksista

This study examines the experiences of students with chronic illnesses in higher education. I chose to study rheumatic and other musculoskeletal diseases because they are group of diseases that are nationally significant in Finland. From students experiences I do interpretation of their agency. My research problems are: What kind of obstacles and possibilities student with chronic illness experiences in studying? What kind of obstacles illness set up for the agency or does it set any? How agency of student with chronic illness shows in the context of the university? I collected the data by using interview and focus group method. Additionally I had different kinds of documents of accessibility and equality in the university. Interviews were like halfstructured theme and open interviews. Focus group method I have applied. All the people that participated in the study were students from the university of Helsinki. They all have rheumatic or other musculoskeletal diseases. I have five interviewees and the group consisted of two people and the researcher. In the data analysis I use categorizing by the themes. Students that participated in my study spoke about their pain related experiences of their illness which also connected to their experiences of the higher education. Students agencies were limited the more they experienced pain. Pain forces students to certain activity one actions avoidance and another s favouring. If part-time studying would have been possible economically, it would have made the life easier for a part of the students. Students were aware of the available resources of their body for some of the students illness and life control set challenge and for some it set conditions. Students thought that university education is more possible to them than vocational education. Students didn t feel their own body limited in the context of university that emphasize intellectual and knowledge connected values and some of the students had reversed their illness as a resource of studying. However students felt their illness as a private matter and they considered illness profit and disadvantage before telling about it, which I interpretated limiting students agencies. In the university terms of students agencies were bond to individuality that came up in positive and negative. Freedom of studying was positive but official and individual study accommodations made agency bounded. Majority of the students didn t see possibilities to do differently in the university s practice but some of the students had recognised values underneath the practices that made it possible to reflect them, do differently and made space for agency.

Health-Related Quality of Life and Mental Disorders in Finland

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

Parisuhdetyössä toimivien vapaaehtoisten motivaatio ja sitoutuminen : Tutkimus HNMKY:n parisuhderyhmien ryhmänjohtajista

Tutkimuksen tarkoituksena on tarkastella kristillisessä parisuhdetyössä toimivien, HNMKY:n vapaaehtoisten ryhmänjohtajien motivaatiota ja sitoutumista sekä näiden välistä yhteyttä. Tutkimuksessa selvitettiin, keitä HNMKY:n avioliittoleirin vapaaehtoiset ryhmänjohtajat ovat, mitkä ovat heidän motivaatiot ryhmänvetäjinä sekä, mihin he ovat sitoutuneet ja, mikä heitä sitouttaa. Tutkimuksessa tarkasteltiin erityisesti arvoihin ja organisaatioon sitoutumista. Tutkimuksen empiirinen aineisto koostui Paremman avioliiton perheleirien 2007 ja 2008 vapaaehtoisien parisuhderyhmien ryhmänjohtajina toimineilta kerätystä kyselyaineistosta (N=163). Tutkimusote oli kvantitatiivinen. Teoreettinen viitekehys muodostui motiivien osalta Claryn ja kumppaneiden kehittelemästä The Volunteer Functions Inventory -mallista (VFI), joka on kehitetty vapaaehtoisten motiivien mittaamiseen sekä muusta aiemmasta motiivitutkimuksesta. Sitoutumisen osalta teoreettinen viitekehys muodostui vapaaehtoisten sitoutumiseen liittyvästä teoriasta sekä aiemmasta sitoutumisen tutkimuksesta. Parisuhdetyön ryhmänvetäjiltä löydettiin faktorianalyyseilla aiemmasta tutkimuksesta osittain poiketen neljä erilaista motivaatiota: 1) Oman parisuhteen hoito, 2) Auttamisen arvot, 3) Itselle saaminen sekä 4) Toimiminen yhdessä. Merkittävin vapaaehtoisuuteen motivoiva tekijä oli Oman parisuhteen hoito, joka sisälsi oman parisuhteen hoidon lisäksi omien vaikeuksien käsittelyä sekä vertaistukeen liittyviä motivaatioita. Auttamisen arvot sisälsivät toisten auttamisen tärkeyden sekä kristilliset arvot. Itselle saaminen piti sisällä oppimismotiiveja sekä omat vaikeudet motiiveja. Toimiminen yhdessä käsittää itsetuntomotiiveja ja sosiaalisia motiiveja. Näistä Itselle saaminen ja Toimiminen yhdessä liittyivät merkittävästi toisiinsa. Ryhmänvetäjiltä löydettiin faktorianalyyseilla neljä erilaista sitotuttavaa tekijää: 1) Saatu tuki, 2) Osa identiteettiä, 3) Palkitsevuus sekä 4) Onnistuminen auttamisessa. Merkittävin syy vapaaehtoisuuteen sitoutumiseen on Saatu tuki, joka sisältää sekä HNMKY:ltä että myös muilta ryhmänjohtajilta saadun tuen. Osa identiteettiä sisältää sen, että ryhmänjohtamisesta on tullut osa minua, ja että toiminta on vahvistanut itsetuntoa sekä sopii elämäntilanteeseen. Tähän sisältyi myös toisten auttamisen tärkeys. Sitouttavista tekijöistä vahvimmin toisiinsa liittyvät Saatu tuki ja Osa identiteettiä. Motivaatio ja sitoutuminen liittyvät monella tavoin toisiinsa. Merkittävimmin toisiinsa liittyvät motivaatiossa Auttamisen arvot ja sitoutumisessa Osa identiteettiä. Näille ihmisille auttamisen arvoissa tärkeää ovat kristillisten arvojen edistäminen parisuhdetyössä sekä merkittävien asioiden tekeminen itselle tärkeässä tehtävässä. Heitä motivoi toisten auttaminen ja sama asia sitouttaa heitä myös vapaaehtoiseen parisuhdetyöhön. Niitä ryhmänjohtajia, joita motivoi vapaaehtoistoimintaan oma parisuhteen hoito, sitouttaa tähän työhön sen palkitsevuus. Niitä, joita motivoivat Auttamisen arvot tai Itselle saaminen, sitouttaa Saatu tuki, Osa identiteettiä ja Palkitsevuus. Kun motivoivana tekijänä on Toiminen yhdessä, silloin sitouttaa Saatu tuki ja Osa identiteettiä. Ryhmänjohtajat ovat erittäin sitoutuneita HNMKY:n arvoihin ja opetukseen. Vastaajille on erittäin merkittävää kristillisten arvojen edistäminen parisuhdetyössä. Kristillisyyden ja sen arvojen merkityksellisyys, auttamisen sekä oman parisuhteen ja perheen tärkeys liittyvät toisiinsa. Avainsanat – Nyckelord Vapaaehtoistyö, motiivit, sitoutuminen, parisuhde Säilytyspaikka – Förvaringställe Teologisen tiedekunnan kirjasto

Elämää syövän kanssa : Narratiivinen tutkimus henkisen ja hengellisen tuen merkityksestä syöpää sairastavalle

Cancer diseases are considered to be relatively common among the Finnish population, every fourth Finn has been affected by cancer in their lifetime. Around 24,000 new cases of cancer are diagnosed each year in Finland. According to the estimations, about half of all diseased will recover. This research examines cancer patients experiences and needs for mental and spiritual support. This paper answers questions what kind of support cancer patients were given after the diagnosis and how did they felt about it. My research was conducted by thematic interviews (N=7) with cancer patients and letters (N=13). To analyze I used narrative holistic-content analysis and holistic analysis of form. Narrative holistic-content analysis consists of reading the material and writing down common points, themes and deflections. By using holistic analysis of form, I observed changes and turning points in one s story of life. Then I could graphically show the emotional changes in the cancer patients life. By rereading the material, examining and comparing it, I was able to build different categories. After defining these categories (Longing, Supported, Individualists, Believers) I reread the interviews in terms of which category it belonged to. I chose one story from each category to represent the whole group. This so-called central story was complemented by other stories from the same group. Analysis enables to define a type story from each group, they were examples of the various ways of reacting about support that they were giving or not having the support that were needed. The stories reflect the participants feelings about support they were given but some cases feeling rejected.

Työkykyarviokokous moniammatillisen työryhmän päätöksentekotilanteena : Tutkimus vuorovaikutuksesta ja potilaan osallisuudesta

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

Vaikeavammaisen nuoren aikuistuminen : Yksilöllinen ja erilainen elämänkulku

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

Sosiaalialan ammattilaiset kunnian, häpeän ja kunniaväkivallan jäljillä

Pro gradu -tutkielmassani tarkastelen kunnian ja häpeän käsitteitä sekä kunniaväkivallan ilmiötä sosiaalialan ammattilaisten näkökulmasta käsin. Samalla vertailen suomalaisen ja kunniakulttuurin eroja suhtautumisessa kunnian ja häpeän käsitteisiin. Tutkielmani empiirinen aineisto koostuu kymmenestä sosiaalialan ammattilaisen puolistrukturoidusta teemahaastattelusta. Haastatelluista kuusi työskenteli sosiaalityöntekijänä, kaksi perhetyöntekijänä, yksi ohjaajana ja yksi maahanmuuttajatyöntekijänä. Kolme haastateltavista on maahanmuuttajataustaisia. Haastatteluiden rakenne on kaksijakoinen: alkuosuus keskittyi kunnian ja kunniallisuuden sekä häpeän ja kunniattomuuden käsitteisiin, kun taas loppuosuuksissa painottui kunniaväkivallan ja maahanmuuttajien kanssa tehtävän yhteistyön teema. Laadullisena tutkimusmenetelmänä olen käyttänyt haastatteluiden sisällönanalyysia. Tutkielmassani avaan ja vertailen kunnian ja häpeän käsitteiden merkityksiä, paikannuksia ja sisältöjä suomalaisessa ja kunniakeskeisessä kulttuurissa. Haastatteluaineistoni analyysin pohjalta syntyi kunnian ja häpeän nelikenttä, jota halkaisevat horisontaalinen valta-akseli ja vertikaalinen vaikutusakseli. Nelikentän neljä vyöhykettä kuvaavat kunnian ja häpeän teemoja yksilöllisyyden ja yhteisöllisyyden, yksityisyyden ja julkisuuden sekä vallan ja vaikutuksen ulottuvuuksien kautta. Tutkielmassani avaan sitä, miten nämä nelikentän vyöhykkeet näyttäytyivät haastatteluissa sisällöllisesti sekä suhteessa toisiinsa. Samalla vertailen löydöksiä kunniakulttuurin käsityksiin kunniasta ja häpeästä. Kunnian ja häpeän kysymysten kautta lähestyn kunniaväkivaltateemaa ja suomalaisen monikulttuurisuustyön haasteita ja mahdollisuuksia. Sosiaalialan työ maahanmuuttajien parissa sisältää erityispiirteitä ja elementtejä, jotka lisäävät käytännön työn haastavuutta ja luovat mahdollisia karikkoja ja esteitä toimivalle ja asiakaslähtöiselle yhteistyölle. Kulttuurituntemus, yhteisöjen sisältä tuleva tuki ja kulttuuritulkkien käyttö koettiin haastateltavien parissa tarpeellisena kunniaväkivaltatyöskentelyssä. Kunniaväkivaltatyöskentely tarvitsee myös monien toimijatahojen yhteistyötä, joka tuo mukanaan omia ulottuvuuksia, sekä mahdollisten toiminta- ja yhteistyömallien hahmottamista että vastuun koordinoinnin kysymyksiä. Haastatteluissa tuli esille toiveita ja tarvetta kunniaväkivaltakysymyksiin liittyvän yhteistyön koordinoinnin parantamisesta ja työskentelyn mallintamisesta. Naiset voidaan nähdä kunnian ja perheen ytimessä, mutta myös yksityisyyden ja julkisuuden rajojen rikkojina. Kunniakulttuurissa naisten tasavertaisuuden yhtenä riskitekijänä ja hidasteena voidaan nähdä myös yksilöllisyyden ja yhteisöllisyyden välisen rajan huokoisuus; erityisesti tyttöjen ja naisten kunniaan ja samalla integriteettiin puuttuminen ja sen hallitseminen vaarantaa pyrkimykset tasa-arvoisempaan yhteiskunnalliseen kehitykseen. Naisten yhteiskunnallinen asema ja oikeudet ovatkin kunniaväkivallan torjumisen kulmakiviä sekä länsimaissa että perinteisissä kunniakulttuureissa.

Työttömien työnhakumotivaatio ja motivointi: sosiaalitoimen työvalmentajien näkökulmia

Tutkimuksessa tarkastellaan sosiaalitoimen työvalmentajien käsitysten ja kokemusten valossa sosiaalitoimen ja työ- ja elinkeinotoimiston työttömien asiakkaiden työnhakumotivaatiota ja motivointia. Tutkimuksen taustalla ovat havainnot siitä, että asiakkaan oletettu motivaatio näyttää enenevässä määrin määrittävän sosiaalitoimen, työhallinnon ja muihin hyvinvointipalveluihin pääsyä, niissä palvelua ja asiakkaan etuuksia. Tutkimukseen sisältyy yhteiskunta- ja käyttäytymistieteellisiin tutkimuksiin pohjautuva katsaus työttömien työnhakukäyttäytymisestä. Työnhakumotivaatioon liitetään R.M. Ryanin ja E. Decin itsemääräämisteoria. Tutkimusta varten haastateltiin kuutta kunnallisessa sosiaalialan yksikössä toimivaa työvalmentajaa ja havainnoitiin kolmea työvalmennuksen asiakastapaamista. Työvalmentajien teemahaastattelut analysoitiin pääosin teema-analyysia käyttäen ja havainnointiaineistoa käytettiin haastatteluaineiston analyysin tukena. Työnhakukäyttäytyminen näyttäytyy moniulotteisena psykososiaalisena ilmiönä, johon vaikuttavat työnhakijan valmiudet, elämäntilanne, sosiaalinen tuki ja työttömyyden kokeminen. Työnhakijoilla nähdään olevan erilaisia motivaatiotiloja, joihin katsotaan vaikuttavan palkkatyöhön liittyvien motiivien henkilökohtainen merkitys ja henkilön elämänhallinnan luonne. Motivaatiotilat nimetään joustavaksi, lukkiutuneeksi, riippumattomaksi ja hajanaiseksi motivaatio-orientaatioksi. Motivointia tarkastellaan prosessina, joka kohdistuu erityisesti työnhaussaan esteellisiin työttömiin. Motivoinnissa käsitellään työnhaun psyykkisiä esteitä, ja asiakkaan voimavarat ja unelmat valjastetaan tukemaan tavoitteellista työnhakua. Työntekijän vuorovaikutustaidoilla ja motivaatiolla on oleellinen merkitys asiakkaan mentaalisen prosessin edistäjinä. Motivoituminen ilmenee asiakkaan toimintana, elämäntilanteen kohentumisena ja ilon tai tyytyväisyyden tunteena. Työvalmentajien käsityksissä työnhaussaan esteellinen työ- ja elinkeinotoimiston asiakas välttyy sanktioilta, jos on pystyvä, osaa taistella etuuksistaan tai osallistuu toistuvasti samoihin aktivointitoimenpiteisiin. Ammatinvalinnanohjauksen keinoin nähdään mahdolliseksi edistää työttömien motivoitumista. Työvalmentajat pitävät tärkeänä sosiaalityön roolia työnhaun vaikeiden esteiden purkamisessa, joskaan sosiaalityössä ei kokonaisuutena katsota riittävästi tuettavan asiakkaiden työllistymistä. Johtopäätöksenä esitetään, että sosiaalityön rooli työttömien motivoinnissa sijoittuu sosiaalityön asiakkaiden valmistamiseen työmarkkinoille, tukeen työhön kiinnittymisessä ja hyvinvointia lisäävän yhteiskuntaosallisuuden vahvistamiseen. Avainsanat: työnhaku, motivaatio, motivointi, työttömyys, työvalmennus, aikuissosiaalityö, aktivointi

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.

Psychological resources, their social antecedents, and association with well-being and health behaviour in early adulthood

The success of entering work life, young people s psychological resources and self-reported well-being were studied in a longitudinal setting from a life-span developmental-contextual perspective in early adulthood. The aim was to analyse how psychosocial characteristics in early childhood and adolescence predict successful entrance into work life, how this is associated with well-being, and to assess the level of psychological resources such as dispositional optimism, personal meaning of work and coping in early adulthood. The role of these and social support, in the relationship between regional factors (such as place of residence and migration), self-reported health and life satisfaction was studied. The association between a specific coping strategy, i.e. eating and drinking in a stressful situation and eating habits, was studied to demonstrate how coping is associated with health behaviour. Multivariate methods, including binary logistic regression analyses and ANOVA, were used for statistical analyses. The subjects were members of the Northern Finland 1966 Birth Cohort, which consists of all women and men born in 1966 in the two northernmost provinces of Finland (n= 12,058). The most recent follow-up, at the age of 31 years when 11,637 subjects were alive, took place in 1997-1998. The results show, first, that social resources in the childhood family and adolescence school achievement predict entrance into the labour market. Secondly, psychosocial resources were found to mediate the relationship between migration from rural to urban areas, and subjective well-being. Thirdly, psychological resources at entrance into the labour market were found to develop from early infancy on. They are, however, influenced later by work history. Fourthly, stress-related eating and drinking, as a way of coping, was found to be directly associated with unhealthy eating habits and alcohol use. Gender differences were found in psychosocial resources predicting, and being associated with success in entering the labour market. For men, the role of attitudinal and psychological factors seems to be especially important in entrance into work life and in the development of psychological resources. For women, academic attainment was more important for successfully entering work life, and lack of emotional social support was a risk factor for stress-related eating only among women. Stress-related eating and drinking habits were predicted by a long history of unemployment as well as a low level of education among both genders, but not excluding an academic degree among men. The results emphasize the role of childhood psychosocial factors in preventing long-term unemployment and in enhancing psychological well-being in early adulthood. Success in entering work life, in terms of continuous work history, plays a crucial role for well-being and the amount of psychological resources in early adulthood. The results emphasize the crucial role of enhancing psychological resources for promoting positive health behaviour and diminishing regional differences in subjective well-being.

Social-class inequalities in ill health - the contribution of physical workload

Tutkimuksen aiheita olivat yhteiskuntaluokkien väliset erot sairastavuudessa ja alentuneessa toimintakyvyssä, sekä fyysisen työkuormituksen ja joidenkin muiden työolojen vaikutus sairastavuuteen. Empiirisestä työstä on raportoitu myös neljässä kansainvälisissä tieteellisissä aikakauskirjoissa julkaistussa artikkelissa. Tässä julkaistu yhteenveto sisältää tulosten yhteenvedon lisäksi myös tutkimusta koskevien käsitteellisten ja teoreettisten kysymysten sekä tutkimustradition kriittisen katsauksen. Työn päätavoitteita olivat 1) tutkia fyysisesti kuormittavan työn, ja jossain määrin muiden työolojen osuutta yhteiskuntaluokkien välisiin eroihin sairaudessa ja toimintakyvyn alentuneisuudessa; 2) tutkia työn fyysisen kuormittavuuden, työhön liittyvien vaikutusmahdollisuuksien ja hallinnan (decision latitude), luokka-aseman, iän ja sukupuolen yhteisvaikutuksia heikentyneeseen terveydentilaan; sekä 3) tutkia missä määrin mekaanisten työaltisteiden ja tuki- ja liikuntaelinsairastavuuden välinen yhteys voi selittää yhteiskuntaluokkien välisiä eroja heikentyneessä yleisessä terveydentilassa. Tutkittavat olivat keski-ikäisiä Helsingin kaupungin työntekijöitä. Analyysit perustuivat poikittaisasetelmaan, ja käytetty aineisto oli Helsinki Health Studyn vuosien 2000 ja 2002 välillä kerättyä aineistoa. Analyyseihin käytetyssä aineistossa oli 3740:stä 8002:een tutkittavaa. Tulosten perusteella fyysisillä (sekä fysikaalisilla) työoloilla on merkittävä vaikutus yhteiskuntaluokkien välisiin eroihin yleisessä sairastavuudessa, toimintakyvyn heikentymisessä, tuki- ja liikuntaelinsairastavuudessa sekä itsearvioidussa terveydentilassa. Naisilla lähes puolet heikentyneen toimintakyvyn ja koetun terveydentilan luokkaeroista vaikutti olevan selitettävissä fyysisellä työkuormituksella. Hallintamahdollisuuksien ei havaittu merkittävästi muuttavan fyysisen kuormituksen vaikutusta toimintakykyyn. Fyysisen kuormittavuuden terveysvaikutus voimistui kasvavan iän mukaan enemmän naisilla kuin miehillä. Osa, mutta ei koko fyysisen kuormituksen vaikutus yhteiskuntaluokkien eroihin heikentyneessä terveydessä vaikutti välittyvän tuki- ja liikuntaelinsairastavuuden kautta. Terveys ja sairaus eivät ole yhtenäisiä tiloja, ja siksi monet eri sosiaalisesti ja rakenteellisesti määräytyvät olosuhteet todennäköisesti vaikuttavat yhteiskunnallisten terveyserojen syntymiseen. Fyysis-materiaalisten olojen vaikutusta terveyserojen syntyyn nyky-yhteiskunnassa on mahdollisesti aliarvioitu. Yhteiskuntaluokkien väliset erot fyysis-materiaalisissa olosuhteissa eivät ole kadonneet, ja nämä erot todennäköisesti vaikuttavat terveyserojen syntyyn.

Campylobacter Infections of Domestic Origin in Finland

Campylobacter jejuni and C. coli are the leading causes of human bacterial gastroenteritis in developed countries. Most human Campylobacter infections are sporadic and a seasonal peak in the distribution of infections can be seen in the summer months in several countries, including Finland. A variety of risk factors for Campylobacter infections have been identified; handling and eating poultry, drinking unpasteurized milk, contact with domestic animals, and travelling abroad. However, the relative importance of the different risk factors in sporadic cases of Campylobacter infection remains unknown. In most cases, the infection is self-limiting and no specific treatment is required. Campylobacter enteritis can cause a wide range of complications, including reactive arthritis (ReA) that is reported in 1-5% of the cases. Seven clinical microbiology laboratories serving different geographical areas of Finland, participated in this multi-centre study, conducted during a seasonal peak in 2002. In a matched case-control study, domestically-acquired sporadic Campylobacter infections from three geographical areas were collected. The final study comprised 100 cases and 137 controls. Risk factors for sporadic domestically-acquired Campylobacter infections were identified on the basis of a questionnaire; swimming in natural waters was found to be a novel risk factor for Campylobacter infection. Other independent risk factors were tasting or eating raw or undercooked meat and drinking untreated water from a dug well. The role of bacterial strain and host characteristics are not fully understood in Campylobacter infections. Exposure factors, demographical characteristics, and the serotype of the Campylobacter isolate may affect the severity of the enteritis. This cross-sectional study comprised 114 patients with C. jejuni enteritis, diagnosed in three clinical microbiology laboratories; most of the patients had participated in the previous case-control study. Swimming was associated with age ≤ 5 years and serotype Pen 6,7 was found significantly more often among patients reporting swimming. The geographical distribution among serotypes varied; serotype Pen 4-complex appeared more often in patients from urban areas and serotype Pen 21 among patients from more rural areas. Thus, risk factors and sources of infection for C. jejuni infection may vary among individuals depending on age and geographical location. The in vitro susceptibilities of C. jejuni and C. coli strains isolated from patients infected abroad (85 strains) or domestically (393 strains) revealed that susceptibility to erythromycin is still high, even among isolates of foreign origin. However, the novel antimicrobial agent telithromycin did not offer any advantage over erythromycin; isolates with high minimal inhibitory concentrations (MICs) for erythromycin also showed reduced susceptibility to telithromycin. Reduced susceptibility to fluoroquinolones was detected almost exclusively among isolates of foreign origin and half of these isolates with high MICs for fluoroquinolones also showed elevated MICs for doxycycline. Questionnaires concerning complications associated with C. jejuni enteritis were sent to patients two months after becoming ill; 201 patients from seven different geographical areas were included in the study. Musculoskeletal complications after C. jejuni infection were commonly reported by patients (39%). The incidence of classical ReA was 4% and that of Achilles enthesopathy and/or heel pain 9%. Other C. jejuni-associated reactive joint symptoms were commonly reported, however, due to their milder nature seldom seen and diagnosed by a physician. The severity of the enteritis may predict further complications; stomach ache during enteritis was connected to the development of later joint pain. Early antimicrobial treatment, within two days from the start of symptoms, shortened the duration of diarrhoea by two days but did not prevent later musculoskeletal complications. Campylobacter is an important human enteropathogen and causes a significant burden of illness. As the incidence of Campylobacter infections is high, the importance of the infection and the occurrence of complications will increase. This stresses the importance of understanding the risk factors for acquiring Campylobacter infection and how bacterial strain and host characteristics may affect the risk for infection. The role of antimicrobial treatment for acute Campylobacter enteritis seems to be marginal and should be used restrictively.

Work-related well-being of Finnish anesthesiologists

Anesthesiologists, according to some studies, are highly stressed, die at a significantly earlier age than their colleagues and the general population,and are among the leaders in physicians' suicide records. Data are,however, sparse and contradictory. The aim of this study was to discover details of the work-related well-being of Finnish anesthesiologists. In 2004, a cross-sectional postal survey including all 550 working Finnish anesthesiologists produced a total of 328 responses (60%); 53% were men. The anesthesiologists had the greatest on-call workload among Finnish physicians. Their average in-hospital on-call period lasted 24 hours (range 14 to 38). Over two-thirds felt stressed. The most important causes of stress were work and combining work with family. Their main worries at work were: excessive workload and time constraints, especially being on call, organizational problems, and fear of harming patients. On-call workload correlated with burnout. Being frequently on call was correlated with severe stress symptoms--symptoms associated with sick leaves. Women were more affected by stress than men. High job control and organizational justice seemed to mitigate hospital-on-call stress symptoms. The respondents enjoyed fairly high job and life satisfaction. Job control and organizational justice were the most important correlates of these wellness indicators. Work-related factors were more important in males, whereas family life played a larger role in the well-being of female anesthesiologists. Women had less job control, fewer permanent job contracts, and a higher domestic workload. Of the respondents, 31% were willing to consider changing to another physician's specialty and 43% to a profession other than medicine. The most important correlates for these job turnover attitudes were conflicts at the workplace, low job control, organizational injustice, stress, and job dissatisfaction. One in four had at some time considered suicide. Respondents with poor health, low social support, and family problems were at the highest risk for suicidality. The highest risks at work were conflicts with co-workers and superiors, on-call-related stress symptoms, and low organizational justice. If a respondent had several risk factors, the risk for suicidality doubled with each additional factor. On-call work-burden, job control, fairness of decision-making procedures,and workplace relationships should be the focus in attempts to increase the work-related well-being of anesthesiologists.

Kahdestaan kotona : Tutkimus vanhoista pariskunnista

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