"Oma entinen on palannut takaisin elämään" : Kuntoutuksen vaikuttavuus aikuisena kuuroutuneiden henkilöiden elämänhallintaan ja psykososiaaliseen hyvinvointiin

Objective The objective of this study was to learn about the psychosocial well-being and life management of Finnish adults with late deafness or hearing loss and to observe the effectiveness of the rehabilitation courses they participated in. Methods For my study I used indicators which were suitable for the evaluation of life management and psychosocial well-being of late-deafened adults. The first part of the study was conducted during 2009 as a questionnaire on three rehabilitation courses in Kopola, a course center of the Finnish Federation of Hard of Hearing. The follow-up study was done at the third period of the courses during 2009 2010. The questionnaire contained both open and structured questions. The questionnaire consisted of five areas concerning life management and psychosocial well-being: sense of coherence (life management), human relations and social support, mood, self-esteem and satisfaction with life. I also asked the participants to reflect on their experiences of group rehabilitation. Results and conclusions The participants consisted of seven women and three men. They were approximately 63 years old and were all retired. Loss of hearing was described to have affected their social life, free time, and in general made their lives more difficult. From the course the participants hoped to gain new skills such as signed speech and lip-reading, uplift their mood, accept their loss of hearing and experience peer support. After the courses they replied that they had more close relations with whom they also were a little more in contact with. More participants were satisfied with e.g. their ability to take care of themselves, their free time, financial situation, family life, mental resources and physical shape. Majority of the participants showed symptoms of depression when the courses started, but at the end of the courses these signs had moderated or disappeared for most of them. The participants felt that during the rehabilitation they had been heard, respected, accepted and been taken care of. The course provided the possibility for confiding, and the discussions gave the participants support and consolidation. In conclusion, the course affected positively on the acclimatization to the hearing loss and the empowerment of the participants. The results of this study can be utilized in disability services, the development of rehabilitation and in the social- and health services of senior citizens.

Maidontuottajatila ja ravinnepolitiikka: Tilan toimintamekanismit, politiikan tarve ja ohjauskeinojen vaikuttavuus

Tutkielman tarkoituksena on rakentaa malli, jolla voidaan arvioida maitotilan toimintaa monipuolisesti ravinnehuuhtouman kannalta. Tavoitteena on ennen muuta analyyttinen tarkastelu siten, että kuitenkin huomioiden maidontuotannon ominaispiirteet, keskeisinä esimerkkeinä ravinnon, maidontuotannon ja lannan ominaisuuksien väliset riippuvuudet. Analyysissa tarkastellaan tilanomistajan yksityisen hyödynmaksimoinnin ja yhteiskunnan tavoitteiden eroavaisuutta. Lisäksi johdetaan optimaaliset ohjauskeinot ja arvioidaan eräiden yksinkertaisten ohjauskeinojen vaikuttavuutta. Mallin analysoinnin perusteella yksityinen ja yhteiskunnallinen optimiratkaisu eroavat toisistaan kaikkien päätösmuuttujien osalta. Ei voida kuitenkaan yleispätevästi sanoa muutosten merkittävyyttä tai suuntaa ottamatta kantaa mallin funktiomuotoihin ja parametriarvoihin. Optimaaliset ohjauskeinot tulisi asettaa keinolannoitteen ja lannan levitykselle, väkirehuruokinnalle ja säilörehun viljelylle, mutta ei eläinten määrälle. Toisaalta optimaaliset ohjauskeinot ovat hyvin monimutkaisia. Tarkasteltujen yksinkertaisempien ohjauskeinojen vaikuttavuutta ei voida tarkasti arvioida analyyttisella tasolla. Numeeristen tulosten perusteella yhteiskunnallisessa optimissa eläinmäärä olisi hieman yksityistä optimia pienempi, väkirehun käyttö vähäisempää, enemmän peltoa allokoitaisiin säilörehun viljelyyn ja lannoitustasot olisivat kautta linjan hieman pienemmät. Lannanlevitykset eroavat etäisyyden suhteen: molemmissa tapauksissa lannanlevityksen intensiteetti kasvaa kohti tilan keskusta kuljettaessa, mutta yksityisessä optimissa lähimmälle pellolle dumpataan kaikki ylimääräinen lanta, kun taas yhteiskunnallisessa optimissa lanta levitetään tasaisemmin eri pelloille. Ero kokonaishyvinvoinnissa jää pieneksi, mutta eläinmäärän kasvu kärjistäisi lannan dumppauksen aiheuttamia huuhtoumahaittoja. Yksinkertaisista ohjauskeinoista lannoitusrajoitus sekä ravinne- ja keinolannoitevero osoittautuivat kohtalaisen käyttökelpoisiksi numeeristen tulosten perusteella. Sen sijaan eläinmäärän rajoittaminen ja lannan kuljetuskustannuksia kompensoivat tuet vaikuttavat tulosten perusteella huonoilta ratkaisuilta.

Matti Laurila : Jääkäriupseeri, suojeluskuntapäällikkö, rintamakomentaja

Matti Laurila (1895 1983) This is a biographical research of a Jaeger officer, a Civil Guard Chief, a Field Commander Matti Laurila. A broader practice of qualitative methods was utilized in the research. The main aim is a permanent reconstruction and reinterpretation of past events through the experiences of the study object. The life and times of Laurila are intertwined with the crucial events that led to the Finnish Declaration of Independence. Afterwards he helped to ensure that the young republic also stayed independent. As a Jaeger in the winter of 1917 Laurila witnessed an incident he would never forget. After disobeying a direct order, Sven Saarikoski from Lapua was shot dead by his commanding officer, K. A. Ståhlberg, on the ice of the river Aa. Laurila faced the horrors of war at closer quarters, for he lost his father and his brother in the battle of Länkipohja on 16th March 1918. This battle was a major turning point for Laurila and profoundly influenced the rest of his life. The relationship between Laurila and his superiors was problematic almost throughout his military career, haunted as he was by the memory of Sven Saarikoski's execution and the losses in Länkipohja The position of Laurila as an authority in South Ostrobothnia was a key factor in preventing the extreme right from rallying enough Civil Guard troops to escalate the embryonic Mäntsälä rebellion of 1932. After the rebellion Laurila routinely opposed anything he saw as a threat to the independence of the Civil Guard. He would flatly refuse to even consider the integration of the Civil Guard into the national defence force. His uncompromising stand in this matter annoyed some among the higher ranking officers. After the Winter War Laurila got himself into a dispute with Jaeger Colonel H. E. Hannuksela that would have long-lasting consequences. The conflicts between them became widely known in the attack phase of the Continuation War in 1941 at the latest. Laurila had to give up his military career at the end of 1944. In the years that followed he did what he could to ensure that the South Ostrobothnia Civil Guard patrimony remained in the province. Laurila's position as a respected authority in South Ostrobothnia remained unchanged until his death.

Teacher Education, School Effectiveness and Improvement : A Study of Academic and Professional Qualification on Teachers' Job Effectiveness in Nigerian Secondary Schools

This academic work begins with a compact presentation of the general background to the study, which also includes an autobiography for the interest in this research. The presentation provides readers who know little of the topic of this research and of the structure of the educational system as well as of the value given to education in Nigeria. It further concentrates on the dynamic interplay of the effect of academic and professional qualification and teachers' job effectiveness in secondary schools in Nigeria in particular, and in Africa in general. The aim of this study is to produce a systematic analysis and rich theoretical and empirical description of teachers' teaching competencies. The theoretical part comprises a comprehensive literature review that focuses on research conducted in the areas of academic and professional qualification and teachers' job effectiveness, teaching competencies, and the role of teacher education with particular emphasis on school effectiveness and improvement. This research benefits greatly from the functionalist conception of education, which is built upon two emphases: the application of the scientific method to the objective social world, and the use of an analogy between the individual 'organism' and 'society'. To this end, it offers us an opportunity to define terms systematically and to view problems as always being interrelated with other components of society. The empirical part involves describing and interpreting what educational objectives can be achieved with the help of teachers' teaching competencies in close connection to educational planning, teacher training and development, and achieving them without waste. The data used in this study were collected between 2002 and 2003 from teachers, principals, supervisors of education from the Ministry of Education and Post Primary Schools Board in the Rivers State of Nigeria (N=300). The data were collected from interviews, documents, observation, and questionnaires and were analyzed using both qualitative and quantitative methods to strengthen the validity of the findings. The data collected were analyzed to answer the specific research questions and hypotheses posited in this study. The data analysis involved the use of multiple statistical procedures: Percentages Mean Point Value, T-test of Significance, One-Way Analysis of Variance (ANOVA), and Cross Tabulation. The results obtained from the data analysis show that teachers require professional knowledge and professional teaching skills, as well as a broad base of general knowledge (e.g., morality, service, cultural capital, institutional survey). Above all, in order to carry out instructional processes effectively, teachers should be both academically and professionally trained. This study revealed that teachers are not however expected to have an extraordinary memory, but rather looked upon as persons capable of thinking in the right direction. This study may provide a solution to the problem of teacher education and school effectiveness in Nigeria. For this reason, I offer this treatise to anyone seriously committed in improving schools in developing countries in general and in Nigeria in particular to improve the lives of all its citizens. In particular, I write this to encourage educational planners, education policy makers, curriculum developers, principals, teachers, and students of education interested in empirical information and methods to conceptualize the issue this study has raised and to provide them with useful suggestions to help them improve secondary schooling in Nigeria. Though, multiple audiences exist for any text. For this reason, I trust that the academic community will find this piece of work a useful addition to the existing literature on school effectiveness and school improvement. Through integrating concepts from a number of disciplines, I aim to describe as holistic a representation as space could allow of the components of school effectiveness and quality improvement. A new perspective on teachers' professional competencies, which not only take into consideration the unique characteristics of the variables used in this study, but also recommend their environmental and cultural derivation. In addition, researchers should focus their attention on the ways in which both professional and non-professional teachers construct and apply their methodological competencies, such as their grouping procedures and behaviors to the schooling of students. Keywords: Professional Training, Academic Training, Professionally Qualified, Academically Qualified, Professional Qualification, Academic Qualification, Job Effectiveness, Job Efficiency, Educational Planning, Teacher Training and Development, Nigeria.

Evidence-based perspective on CP rehabilitation : Reviews on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices

This thesis utilises an evidence-based approach to critically evaluate and summarize effectiveness research on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices in children and adolescents with cerebral palsy (CP). It aims to assess the methodological challenges of the systematic reviews and trials, to evaluate the effectiveness of interventions in current use, and to make suggestions for future trials Methods: Systematic reviews were searched from computerized bibliographic databases up to August 2007 for physiotherapy and physiotherapy-related interventions, and up to May 2003 for orthotic devices. Two reviewers independently identified, selected, and assessed the quality of the reviews using the Overview Quality Assessment Questionnaire complemented with decision rules. From a sample of 14 randomized controlled trials (RCT) published between January 1990 and June 2003 we analysed the methods of sampling, recruitment, and comparability of groups; defined the components of a complex intervention; identified outcome measures based on the International Classification of Functioning, Disability and Health (ICF); analysed the clinical interpretation of score changes; and analysed trial reporting using a modified 33-item CONSORT (Consolidated Standards of Reporting Trials) checklist. The effectiveness of physiotherapy and physiotherapy-related interventions in children with diagnosed CP was evaluated in a systematic review of randomised controlled trials that were searched from computerized databases from January 1990 up to February 2007. Two reviewers independently assessed the methodological quality, extracted the data, classified the outcomes using the ICF, and considered the level of evidence according to van Tulder et al. (2003). Results: We identified 21 reviews on physiotherapy and physiotherapy-related interventions and five on orthotic devices. These reviews summarized 23 or 5 randomised controlled trials and 104 or 27 observational studies, respectively. Only six reviews were of high quality. These found some evidence supporting strength training, constraint-induced movement therapy or hippotherapy, and insufficient evidence on comprehensive interventions. Based on the original studies included in the reviews on orthotic devices we found some short-term effects of lower limb casting on passive range of movement, and of ankle-foot orthoses on equinus walk. Long term effects of lower limb orthoses have not been studied. Evidence of upper limb casting or orthoses is conflicting. In the sample of 14 RCTs, most trials used simple randomisation, complemented with matching or stratification, but only three specified the concealed allocation. Numerous studies provided sufficient details on the components of a complex intervention, but the overlap of outcome measures across studies was poor and the clinical interpretation of observed score changes was mostly missing. Almost half (48%) of the applicable CONSORT-based items (range 28 32) were reported adequately. Most reporting inadequacies were in outcome measures, sample size determination, details of the sequence generation, allocation concealment and implementation of the randomization, success of assessor blinding, recruitment and follow-up dates, intention-to-treat analysis, precision of the effect size, co-interventions, and adverse events. The systematic review identified 22 trials on eight intervention categories. Four trials were of high quality. Moderate evidence of effectiveness was established for upper extremity treatments on attained goals, active supination and developmental status, and of constraint-induced therapy on the amount and quality of hand use and new emerging behaviours. Moderate evidence of ineffectiveness was found for strength training's effect on walking speed and stride length. Conflicting evidence was found for strength training's effect on gross motor function. For the other intervention categories the evidence was limited due to the low methodological quality and the statistically insignificant results of the studies. Conclusions: The high-quality reviews provide both supportive and insufficient evidence on some physiotherapy interventions. The poor quality of most reviews calls for caution, although most reviews drew no conclusions on effectiveness due to the poor quality of the primary studies. A considerable number of RCTs of good to fair methodological and reporting quality indicate that informative and well-reported RCTs on complex interventions in children and adolescents with CP are feasible. Nevertheless, methodological improvement is needed in certain areas of the trial design and performance, and the trial authors are encouraged to follow the CONSORT criteria. Based on RCTs we established moderate evidence for some effectiveness of upper extremity training. Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most physiotherapy interventions is available to guide clinical practice. Well-designed trials are needed, especially for focused physiotherapy interventions.

The incidence and outcome of severe sepsis in Finland : The Finnsepsis Study

Severe sepsis is associated with common occurrence, high costs of care and significant mortality. The incidence of severe sepsis has been reported to vary between 0.5/1000 and 3/1000 in different studies. The worldwide Severe Sepsis Campaign, guidelines and treatment protocols aim at decreasing severe sepsis associated high morbidity and mortality. Various mediators of inflammation, such as high mobility group box-1 protein (HMGB1) and vascular endothelial growth factor (VEGF), have been tested for severity of illness and outcome in severe sepsis. Long-term survival with quality of life (QOL) assessment is important outcome after severe sepsis. The objective of this study was to evaluate the incidence, severity of organ dysfunction and outcome of severe sepsis in intensive care treated patients in Finland (study I)). HMGB1 and VEGF were studied in predicting severity of illness, development and type of organ dysfunction and hospital mortality (studies II and III). The long-term outcome and quality of life were assessed and quality-adjusted life years and cost per one QALY were estimated (study IV). A total of 470 patients with severe sepsis were included in the Finnsepsis Study. Patients were treated in 24 Finnish intensive care units in a 4-month period from 1 November 2004 to 28 February 2005. The incidence of severe sepsis was 0.38 /1,000 in the adult population (95% confidence interval 0.34-0.41). Septic shock (77%), severe oxygenation impairment (71.4%) and acute renal failure (23.2%) were the most common organ failures. The ICU, hospital, one-year and two-year mortalities were 15.5%, 28.3%, 40.9% and 44.9% respectively. HMGB1 and VEGF were elevated in patients with severe sepsis. VEGF concentrations were lower in non-survivors than in survivors, but HMGB1 levels did not differ between patients. Neither HMGB1 nor VEGF were predictive of hospital mortality. The QOL was measured median 17 months after severe sepsis and QOL was lower than in reference population. The mean QALY was 15.2 years for a surviving patient and the cost for one QALY was 2,139 . The study showed that the incidence of severe sepsis is lower in Finland than in other countries. The short-term outcome is comparable with that in other countries, but long-term outcome is poor. HMGB1 and VEGF are not useful in predicting mortality in severe sepsis. The mean QALY for a surviving patient is 15.2 and as the cost for one QALY is reasonably low, the intensive care is cost-effective in patients with severe sepsis.

Vaikuttavuusyhteiskunta : Sosiaalisten olojen arvostelusta vaikutusten todentamiseen

Evaluation practices have pervaded the Finnish society and welfare state. At the same time the term effectiveness has become a powerful organising concept in welfare state activities. The aim of the study is to analyse how the outcome-oriented society came into being through historical processes, to answer the question of how social policy and welfare state practices were brought under the governance of the concept of effectiveness . Discussions about social imagination, Michel Foucault s conceptions of the history of the present and of governmentality, genealogy and archaeology, along with Ian Hacking s notions of dynamic nominalism and styles of reasoning, are used as the conceptual and methodological starting points for the study. In addition, Luc Boltanski s and Laurent Thévenot s ideas of orders of worth , regimes of evaluation in everyday life, are employed. Usually, evaluation is conceptualised as an autonomous epistemic culture and practice (evaluation as epistemic practice), but evaluation is here understood as knowledge-creation processes elementary to different epistemic practices (evaluation in epistemic practices). The emergence of epistemic cultures and styles of reasoning about the effectiveness or impacts of welfare state activities are analysed through Finnish social policy and social work research. The study uses case studies which represent debates and empirical research dealing with the effectiveness and quality of social services and social work. While uncertainty and doubts over the effects and consequences of welfare policies have always been present in discourses about social policy, the theme has not been acknowledged much in social policy research. To resolve these uncertainties, eight styles of reasoning about such effects have emerged over time. These are the statistical, goal-based, needs-based, experimental, interaction-based, performance measurement, auditing and evidence-based styles of reasoning. Social policy research has contributed in various ways to the creation of these epistemic practices. The transformation of the welfare state, starting at the end of 1980s, increased market-orientation and trimmed public welfare responsibilities, and led to the adoption of the New Public Management (NPM) style of leadership. Due to these developments the concept of effectiveness made a breakthrough, and new accountabilities with their knowledge tools for performance measurement and auditing and evidence-based styles of reasoning became more dominant in the ruling of the welfare state. Social sciences and evaluation have developed a heteronomous relation with each other, although there still remain divergent tendencies between them. Key words: evaluation, effectiveness, social policy, welfare state, public services, sociology of knowledge

Kuntien vaikuttavuustavoitteet lasten ja nuorten hyvinvointityössä

Tämä pro gradu –tutkielma tarkastelee kuntien itselleen asettamia vaikuttavuustavoitteita lasten ja nuorten hyvinvointityössä. Kirjallisuuskatsauksessa selvitetään, mitä tulos- ja tavoiteohjaus, tuloksellisuus ja vaikuttavuus tarkoittavat kuntien lasten ja nuorten hyvinvointityössä. Julkishallinnon New Public Management-reformin pohjalta syntynyt kuntalaki painottaa organisaatioiden tehokkuutta ja tuloksellisuutta. Tuloksellisuudella tarkoitetaan toimintojen taloudellisuutta ja vaikuttavuutta. Tällaiseen tulos- ja tavoiteohjaukseen siirtyminen on edellyttänyt arvioinnin kehittämistä. Keskeisiä käsitteitä tässä tutkimuksessa ovat: toiminta-ajatus, päämäärä, tavoite, vaikuttavuus, vaikuttavuustavoite, vaikutus ja arviointi. Teoreettista kirjallisuutta konkretisoidaan lasten ja nuorten hyvinvointityön arkipäivään liittyvin sovelluksin ja esimerkein. Tutkielman aineistona on 12 kuntien tuottamaa, vuoden 2008 alussa lakisääteiseksi tullutta lasten ja nuorten hyvinvointisuunnitelmaa, joiden tehtävänä on toimia lasten ja nuorten hyvinvoinnin edistämiseksi sekä lastensuojelun järjestämiseksi ja kehittämiseksi kunnissa. Aineiston kvalitatiivisen eli laadullisen analyysin menetelmänä käytetään teemoittelua. Tarkastelu paljastaa, että kunnat ovat asettaneet varsin vähän konkreettisia ja mitattavissa olevia vaikuttavuustavoitteita laatiessaan lasten ja nuorten hyvinvointisuunnitelmia. Kuntien asettamat tavoitteet voidaan jakaa seuraaviin teemoihin: määrälliset ja ”joko tai” –tavoitteet, ehdotusmuotoiset tavoitteet, ”kehitetään, edistetään, panostetaan, vahvistetaan” –tavoitteet, tavoitteet jatkuvana resurssitaisteluna sekä ”oikein vai väärin” –tyyppiset tavoitteet. Edellä esitetyt tavoitetyypit voidaan jakaa vielä karkeasti kahdenlaisiin kategorioihin: kunnallisen lasten ja nuorten palvelujärjestelmän kehittämiseen keskittyvät tavoitteet ja oikeaa ja väärää kuvaavat, moraalis-eettiset tavoitteet. Koko aineiston kattavana havaintona esitetään, että kunnat tuntuvat välttelevän täsmällisten, konkreettisten ja mitattavissa olevien tavoitteiden esittämistä lasten ja nuorten hyvinvointisuunnitelmissa ja ilmaisevan tavoitteiden sijaan mielellään palvelujärjestelmää kuvaavia ja kehittäviä päämääriä.

Suomen kaivosalan aluetaloudelliset vaikutukset elinkeinorakenteeseen ja työllisyyteen

Tutkimuksen kohteena oli Suomen kaivosala. Tavoitteena oli analysoida yhdeksän vasta käynnistyneen tai valmisteilla olevan kaivoksen aluetaloudelliset vaikutukset elinkeinorakenteeseen ja työllisyyteen. Tutkimukseen valitut kaivoshankkeet olivat Kevitsa, Kylylahti, Laivakangas, Länttä, Pajala–Kolari, Pampalo, Sokli, Suurikuusikko ja Talvivaara. Aluetaloudelliset vaikutukset laskettiin kaivosten vaatimiin investointeihin ja tulevaan liikevaihtoon perustuen. Laskelmat tehtiin Ruralia-instituutissa kehitetyllä CGE RegFinDyn -aluemallilla periodille 2007–2020. Tulokset sisältävät aluetalouden täyden sopeutumisen ja kerroinvaikutukset. Tutkimuksen rahoittaja on Työ- ja elinkeinoministeriö. Kaivoksen investointi- eli rakentamisvaihe on kiihkeä, mutta suhteellisen lyhytaikainen. Toimintavaihe on puolestaan vakaa ja pitkäaikainen riippuen metallien maailmanmarkkinahintojen kehityksestä. Vaiheet voivat olla limittäisiä kuten Pajala–Kolarin ja Talvivaaran tapauksessa tai peräkkäisiä kuten Soklissa. Tulosten mukaan limittäisyys on aluetaloudellisen vaikuttavuuden kannalta parempi vaihtoehto. Kaivoksen rakentaminen ja kasvava malmin tuotanto luovat työllisyyttä ja kulutusmahdollisuuksia yhtä aikaa, jolloin vaiheiden yhteinen aluetaloudellinen vaikutus muodostuu suuremmaksi. Peräkkäisessä tapauksessa uuden tulovirran muodostuminen on selvästi tasaisempaa. Molemmissa tapauksissa työtulot jäävät toimintavaiheessa omaan maakuntaan. Ongelmaksi alueen kannalta muodostuu, kuinka saada ainakin osa pääomatuloista jäämään aluetta hyödyttämään. Tulosten perusteella kaivoshankkeista erottuu selvästi kolme taloudellisen kasvun kannalta vaikuttavinta: Pajala–Kolari, Sokli ja Talvivaara. Näiden kumulatiivinen pitkän tähtäimen vaikutus talouskasvuun olisi 1–3 prosenttia yli sijaintimaakuntiensa ennakoidun normaalikehityksen. Toinen ryhmä olisi Kevitsa ja Kylylahti, joiden vaikuttavuus olisi tasoa 0.7 prosenttia. Pampalo, Suurikuusikko, Laivakangas ja Länttä lisäisivät talouskasvua pitkällä tähtäimellä kumulatiivisesti tarkasteltuna 0.1–0.3 prosenttia yli maakuntiensa ennakoidun normaalikehityksen. Kaivokset loisivat huomattavan määrän uusia työmahdollisuuksia. Pajala–Kolarin ja Soklin kaivoshankkeissa suurimman työvoimatarpeen aikana vuonna 2014 työllisyys olisi parantunut viiden vuoden aikana yhteensä 4600–6000 henkilötyövuodella normaalikehitykseen verrattuna. Talvivaaran kaivoksella työllisyysvaikutuksen huippuvuosi on jo 2010, jolloin kaivos olisi luonut neljän vuoden aikana yhteensä 6000 uutta työpaikkaa. Kevitsan, Kylylahden ja Suurikuusikon kohdalla vastaavat korkeimmat kumulatiiviset luvut olisivat 1300, 1000 ja 800. Muiden hankkeiden vastaava työllisyysvaikutus olisi pienempi ja vaihtelisi 60–250 henkilötyövuoden välillä. Vuositasolla työvoimatarpeet olisivat Pajala–Kolarin ja Soklin tapauksessa keskimäärin 900–1200 ja Talvivaarassa 1200. Kaivoshankkeiden vaikutus elinkeinorakenteeseen näkyisi eri toimialojen tuotannon muutosten kautta. Kaivoksilla olisi luonnollisesti suora ja suuri vaikutus mineraalien kaivuuseen. Myös rakentamisen toimialaan kaivosten vaikutus olisi erittäin merkittävä, mutta väliaikainen ja rajoittuisi investointivaiheeseen. Rakentamisen ja mineraalien kaivuun tuotannon kasvu heijastuisivat muille aloille. Tuotanto nousisi muun muassa ei-metallisten mineraalituotteiden valmistuksen, koneiden ja laitteiden valmistuksen ja kuljetuksen, varastoinnin ja tietoliikenteen toimialoilla. Yleinen elintaso nousisi, jolloin palvelutoimialoista koulutus ja terveydenhuolto- ja sosiaalipalvelut vahvistuisivat. Kaivosten vuoksi resursseja luovuttamaan joutuvia toimialoja olisi useita ja ne olisivat pääasiassa samoja kaivoksesta ja maakunnasta riippumatta. Pitkällä tähtäimellä tuotanto laskisi alkutuotannossa kuten myös metallien jalostuksen ja metallituotteiden, elintarvikkeiden, tekstiilien, massan ja paperin sekä puutavaran ja puutuotteiden valmistuksen toimialoilla. Kaivosalan voimakas kasvu Pohjois- ja Itä-Suomessa ei ratkaisisi kokonaan maakuntien taloudellisia ongelmia. Hankkeet tukisivat kuitenkin merkittävästi taantumasta nousua. Lisäksi suotuisa talouskehitys syntyisi käytännössä seutukunta- ja työssäkäyntialueilla eli maakuntaa pienemmissä aluetalouden yksiköissä, jolloin vaikutukset olisivat paljon vahvemmat. Kaivosalasta on mahdollisuus kehittyä pysyvä uusi toimiala tarkastelluissa viidessä maakunnassa, mikäli metallien hinnat eivät vaihtele liikaa.

Henkilöstöjohtamisen tehostaminen valtionhallinnossa henkilöstötilinpäätös-informaation avulla. Empiirinen tutkimus Suomen valtionhallinnossa tuotettavan henkilöstötilinpäätösinformaation arvosta johtamisessa

Tutkimuksessa selvitetään, edistääkö Suomen valtionhallinnossa tuotettava henkilöstötilinpäätösinformaatio henkilöstöprosesseihin perustuvan henkilöstöstrategian tehokasta toteuttamista. Tutkimuksen uutuusarvo alan kansainvälisen tutkimuksen kentässä perustuu laaja-alaiseen tarkastelunäkökulmaan. Tämän mahdollisti tutkimuskohteena olevasta ilmiöstä käytössä oleva monipuolinen, yhtenäisiin käsitteisiin perustuva ja useita vuosia koskeva henkilöstötilinpäätöksen tunnuslukuaineisto. Aikaisempien tutkimusten usein yksittäisiin tekijöihin perustuvasta analyysistä poiketen, tutkimuksella selvitettiin henkilöstön johtamiseen ja tuloksellisuuteen sidoksissa olevien tekijöiden vaikutuksia laajoina kokonaisuuksina, koskien kaikkia henkilöstön johtamisprosesseja. Tutkimus avaa uusia näköaloja henkilöstöinformaation hyväksikäytölle henkilöstön eri johtamisprosesseissa, jotka liittyvät saumattomasti organisaation toimintaan ja kokonaisjohtamiseen. Käytetty henkilöstön johtamisprosessikeskeinen tarkastelukulma auttaa ymmärtämään henkilöstön osaamisen, motivaation, työhyvinvoinnin, johtamisen ja palkinnan yhteyksiä sekä toisiinsa että organisaation pitkäjänteiseen toimintaan ja tuloksellisuuteen. Tutkimuksen keskeinen tavoite on motivoida johtoa, esimiehiä ja HR -ammattilaisia entistä enemmän hyväksikäyttämään henkilöstöön liittyvää analysoitua tietoa henkilöstöstrategioiden teon ja käytäntöön viennin, johtamisen ja henkilöstösuunnittelun apuvälineenä.

Hyvän hallinnon muunnelmat : Julkisoikeudellinen tutkimus

This doctoral thesis analyses the concepts of good governance and good administration. The hypothesis is that the concepts are radically indeterminate and over-inclusive. In the study the mechanisms of this indeterminacy are examined: why are the concepts indeterminate; how does the indeterminacy work and, indeed, is it by any means plausible to try to define the concepts in a closed way? Therefore, the study focuses on various current perspectives, from which the concepts of good governance and good administration are relevant and what kind of discursive contents they may include. The approach is both legal (a right to good administration) and one of moral philosophy and discourse analysis. It appears that under the meta-discourse of good governance and good administration there are different sub-discourses: at least a legal sub-discourse, a moral/ethical sub-discourse and sub-discourses concerning economic effectiveness and the promotion of societal and economic development. The main claim is that the various sub-discourses do not necessarily identify each other s value premises and conceptual underpinnings: for which value could the attribute good be substituted in different discourses (for example, good as legal, good as ethical and so on)? The underlying presumption is, of course, that values are ultimately subjective and incommensurable. One possible way of trying to resolve the dynamics of possible discourse collisions is to employ the systems theory approach. Can the different discourses be interpreted as autopoietic systems, which create and change themselves according to their own criteria and are formed around a binary code? Can the different discourses be reconciled or are they indifferent or hostile towards each other? Is there a hegemonic super discourse or is the construction of a correct meaning purely contextual? The questions come back to the notions of administration and governance themselves the terms the good in its polymorphic ways is attempting to define. Do they engage different political rationalities? It can be suggested that administration is labelled by instrumental reason, governance by teleological reason. In the final analysis, the most crucial factor is that of power. It is about a Schmittian battle of concepts; how meanings are constructed in the interplay between conceptual ambiguity and social power. Thus, the study deals with administrative law, legal theory and the limits of law from the perspective of revealing critique.

The Effects of Reduction Mammaplasty

Symptomatic hypertrophic breasts cause a health burden with physical and psychosocial morbidity. The value of reduction mammaplasty in the treatment of symptomatic breast hypertrophy has been consistently reported by patients and has been well recognised by plastic surgeons for a long time. However, the scientific evidence of the effects of reduction mammaplasty has been weak or lacking. During the design of this study most of the previous studies were retrospective and the few prospective studies had methodological limitations. Therefore, an obvious need for prospective randomised studies was present. Nevertheless, practical and ethical considerations seemed to make this study design impossible, because the waiting time for the operation was several years. The legislation and subsequent introduction of the uniform criteria for access to non-emergency treatment in Finland removed these obstacles, as all patients received their treatment within a reasonable time. As a result, a randomised controlled trial with a six-month follow-up time was designed and conducted. In addition, a follow-up study with two to five years follow-up was also carried out later. The effects of reduction mammaplasty on the patients breast-related symptoms, psychological symptoms, pain and quality of life was assessed. In addition, factors affecting the outcome were investigated. This study was carried out in the Hospital District of Helsinki and Uusimaa, Finland. Eighty-two out of the approximately 300 patients on the waiting list in 2004 agreed to participate in the study. Patients were randomised either to be operated (40 patients) on or to be followed up (42 patients). The follow-up time for both groups was six months. The patients were operated on by plastic surgeons or trainees at the Department of Plastic Surgery at Helsinki University Central Hospital or at the Department of Surgery at Hyvinkää Hospital. The patients completed five questionnaires: the SF-36 and the 15D quality of life questionnaires, the Finnish Breast-Associated Symptoms questionnaire (FBAS), a mood questionnaire (Raitasalo s modification of the short form of the Beck Depression Inventory, RBDI), and a pain questionnaire (The Finnish Pain Questionnaire, FPQ). Sixty-two out of the original 82 patients agreed to participate in the prospective follow-up study. In this study, patients completed the 15D quality of life questionnaire, the Finnish Breast-Associated Symptoms questionnaire, and the RBDI mood questionnaire. After six months follow-up, patients who had undergone reduction mammaplasty had a significantly better quality of life, fewer breast-associated symptoms and less pain, and they were less depressed or anxious when compared to patients who had not undergone surgery. The change in quality of life was more than two times the minimal clinically important difference. The patients preoperative quality of life was significantly inferior when compared to the age-standardised general population. This health burden was removed with reduction mammaplasty. The health loss related to symptomatic breast hypertrophy was comparable to that of patients with major joint arthrosis. In terms of change in quality of life, the intervention effect of reduction mammaplasty was comparable to that of hip joint replacement and more pronounced than that of knee joint replacement surgery. The outcome of reduction mammaplasty was affected more by preoperative psychosocial factors than by changes in breast dimensions. The effects of reduction mammaplasty remained stable at two to five years follow-up. In terms of quality of life, symptomatic breast hypertrophy causes a considerable health loss comparable to that of major joint arthrosis. Patients who undergo surgery have fewer breast-associated symptoms and less pain, and they are less depressed or anxious and have an improved quality of life. The intervention effect is comparable to that of major joint replacement surgery, and it remains stable at two to five years follow-up. The outcome of reduction mammaplasty is affected by preoperative psychosocial factors.

PERFECT Stroke : PERFormance, Effectiveness, and Costs of treatment episodes in Stroke

Stroke is a major cause of death and disability, incurs significant costs to healthcare systems, and inflicts severe burden to the whole society. Stroke care in Finland has been described in several population-based studies between 1967 and 1998, but not since. In the PERFECT Stroke study presented here, a system for monitoring the Performance, Effectiveness, and Costs of Treatment episodes in Stroke was developed in Finland. Existing nationwide administrative registries were linked at individual patient level with personal identification numbers to depict whole episodes of care, from acute stroke, through rehabilitation, until the patients went home, were admitted to permanent institutional care, or died. For comparisons in time and between providers, patient case-mix was adjusted for. The PERFECT Stroke database includes 104 899 first-ever stroke patients over the years 1999 to 2008, of whom 79% had ischemic stroke (IS), 14% intracerebral hemorrhage (ICH), and 7% subarachnoid hemorrhage (SAH). A 18% decrease in the age and sex adjusted incidence of stroke was observed over the study period, 1.8% improvement annually. All-cause 1-year case-fatality rate improved from 28.6% to 24.6%, or 0.5% annually. The expected median lifetime after stroke increased by 2 years for IS patients, to 7 years and 7 months, and by 1 year for ICH patients, to 4 years 5 months. No change could be seen in median SAH patient survival, >10 years. Stroke prevalence was 82 000, 1.5% of total population of Finland, in 2008. Modern stroke center care was shown to be associated with a decrease in both death and risk of institutional care of stroke patients. Number needed to treat to prevent these poor outcomes at one year from stroke was 32 (95% confidence intervals 26 to 42). Despite improvements over the study period, more than a third of Finnish stroke patients did not have access to stroke center care. The mean first-year healthcare cost of a stroke patient was ~20 000 , and among survivors ~10 000 annually thereafter. Only part of this cost was incurred by stroke, as the same patients cost ~5000 over the year prior to stroke. Total lifetime costs after first-ever stroke were ~85 000 . A total of 1.1 Billion , 7% of all healthcare expenditure, is used in the treatment of stroke patients annually. Despite a rapidly aging population, the number of new stroke patients is decreasing, and the patients are more likely to survive. This is explained in part by stroke center care, which is effective, and should be made available for all stroke patients. It is possible, in a suitable setting with high-quality administrative registries and a common identifier, to avoid the huge workload and associated costs of setting up a conventional stroke registry, and still acquire a fairly comprehensive dataset on stroke care and outcome.

Nationalism Circumscribed : Transnational Governance of Minority Rights in Post-Cold War Europe

For the past two centuries, nationalism has been among the most influential legitimizing principles of political organization. According to its simple definition, nationalism is a principle or a way of thinking and acting which holds that the world is divided into nations, and that national and political units should be congruent. Nationalism can thus be divided into two aspects: internal and external. Internally, the political units, i.e., states, should be made up of only one nation. Externally each nation-state should be sovereign. Transnational national governance of rights of national minorities violates both these principles. This study explores the formation, operation, and effectiveness of the European post-Cold War minorities system. The study identifies two basic approaches to minority rights: security and justice. These approaches have been used to legitimize international minority politics and they also inform the practice of transnational governance. The security approach is based on the recognition that the norm of national self-determination cannot be fulfilled in all relevant cases, and so minority rights are offered as a compensation to the dissatisfied national groups, reducing their aspiration to challenge the status quo. From the justice perspective, minority rights are justified as a compensatory strategy against discrimination caused by majority nation-building. The research concludes that the post-Cold War minorities system was justified on the basis of a particular version of the security approach, according to which only Eastern European minority situations are threatening because of the ethnic variant of nationalism that exists in that region. This security frame was essential in internationalising minority issues and justifying the swift development of norms and institutions to deal with these issues. However, from the justice perspective this approach is problematic, since it justified double standards in European minority politics. Even though majority nation-building is often detrimental to minorities also in Western Europe, Western countries can treat their minorities more or less however they choose. One of the main contributions of this thesis is the detailed investigation of the operation of the post-Cold War minorities system. For the first decade since its creation in the early 1990s, the system operated mainly through its security track, which is based on the field activities of the OSCE that are supported by the EU. The study shows how the effectiveness of this track was based on inter-organizational cooperation in which various transnational actors compensate for each other s weaknesses. After the enlargement of the EU and dissolution of the membership conditionality this track, which was limited to Eastern Europe from the start, has become increasingly ineffective. Since the EU enlargement, the focus minorities system has shifted more and more towards its legal track, which is based on the Framework Convention for the Protection of National Minorities (Council of Europe). The study presents in detail how a network of like-minded representatives of governments, international organizations, and independent experts was able strengthen the framework convention s (originally weak) monitoring system considerably. The development of the legal track allows for a more universal and consistent, justice-based approach to minority rights in contemporary Europe, but the nationalist principle of organization still severely hinders the materialization of this possibility.

Numeroiden harhaa vai toteutuksen työkaluja? -indikaattorien käyttö maatalouden ympäristöpoliittisessa suunnittelussa

This research focused on indicators with the aim of recognizing the main characters of this particular tool. The planning and use of Finnish sustainability indicators for natural resource management was examined as well as the experiences about the international sets of agri-environmental indicators were described. In both cases, the actual utilization of information was found to be quite minimal. Indicators have succeeded in bringing more of environmental information into the processes of decision making, but information has not been directly shifted into the actions of natural resource management. The concept of technical use of indicators was presented and considered as a possible explanation for the failures of information transfer and communication. Traditionally indicators have been used in order to recognize and describe the performance of certain system; to provide clear operative message for the actors. In policy planning, the situation is essentially different. We may lack both the jointly shared and accepted objectives of development as well the reliable and representative methods for measuring the issue under attention. Therefore, the technical orientation of using indicators may cause several problems at the policy forum. The study identified the risks of 1) reduced informative basis of decision-making, 2) narrowed approach of interpreting the data, 3) the focus on the issues that already are best documented and provides the most representative data series, and 4) the risks of losing the systemic viewpoints while focusing on measurable details of the system. Technical use of indicators may also result the excessive focus on information while being detached from the actions. With sustainability indicators, the major emphasis was indeed paid with producing information while the reality of agricultural practices was left mostly unaffected. Therefore, the essential process of social learning, where actions and producing of relevant information are alternating was neither realized. This study underlines the complexity of information transfer, mutual communication and the learning of new practices. Besides the information and measurable number people also need personal experiences and interesting stories, which make them to understand the meaning of information in their own lives. Particularly important this is for thechildren, who are studying for to be the future decision-makers of food system; in production as well as the in consumption of food. Numbers will be useful tools of management as soon there exists the awareness of the direction, where to strive for.