Terveydenhuollon palveluvalikoiman priorisointi

Selvityksen tavoitteena on terveydenhuollon priorisoinnin kansallinen kehittäminen. Priorisoinnilla tarkoitetaan tässä yhteydessä kaikkia niitä toimintoja, jotka pyrkivät terveydenhuollon resurssien kohdentamiseen. Selvityksessä on kuvattu terveydenhuollon priorisoinnin oikeudellisia reunaehtoja sekä haettu tietoa eri maiden priorisoinnin kehittämisestä ja niiden vaikutuksista. Hankkeessa tehtiin myös kyselyjä ja työpajoja eri sidosryhmille. Suomessa toivotaan kansallisia avoimia ja läpinäkyviä periaatteita priorisoinnin tueksi. Tällä hetkellä kansalaiset ja ammattilaiset eivät hahmota terveyspalvelujen kokonaisuutta ja todellisia kustannuksia. Jotta priorisoinnista tulisi hyväksyttyä, on 1) alettava toteuttaa systemaattista viestintästrategiaa osallistamisen mahdollistamiseksi ja 2) osallistettava eri sidosryhmiä priorisoinnin periaatteiden kehittämiseen. Tämä vaatii myös 3) kansallisten rakenteiden ja prosessien luomista periaatteiden muodostamiseen sekä niiden jalostamiseksi kriteereiksi ja menetelmiksi sekä 4) lainsäädännön kehittämistä. Perustuslain tulkinnassa on painotettu yksilön oikeuksia. Perustuslaki jättää kuitenkin liikkumavaraa kehittää priorisoinnin oikeudellista ohjausta myös väestöterveyden ja yhteiskunnan taloudelliset voimavarat nykyistä selvemmin huomioon ottavaan suuntaan.Sivua 18 on päivitetty 29.8.2022 ja aineisto korvaa aikaisemmin, 24.8.2022 julkaistun version. Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa (tietokayttoon.fi). Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Redefining innovation processes: The digital designers at work

As design in digital innovation has become a thing, we highlight the inconclusive concepts that describe design activity in innovation processes. Proposing an alternative theoretical lens - a sociomaterial practice lens - we claim that this view can reveal the contribution of digital designers to the work of innovation. This paper draws on a research study with digital designers in the UK. At the same time as we begin to reconceptualise the ways digital design activity can be described, we also illustrate a theoretical framework based on 1) action and knowing as ordered by collectively produced objects, 2) sociomateriality and the configuration of human bodies and materials in action, 3) the co-emergence of objects and sociomaterial configurations where each is the condition of the other. This alternative way of looking at design activity may pose some challenges to the theoretical traditions in the field. We however believe that it contains immense potential too

Consumers, Producers and Practices Understanding the invention and reinvention of Nordic walking.

The idea that artifacts are acquired and used in the course of accomplishing social practices has important implications for theories of consumption and innovation. From this point of view, it is not enough to show that goods are symbolically and materially positioned, mediated and filtered through existing cultures and conventions. Twisting the problem around, the further challenge is to explain how practices change and with what consequence for the forms of consumption they entail. In this article, we suggest that new practices like Nordic walking, a form of ‘speed walking’ with two sticks, arise through the active and ongoing integration of images, artifacts and forms of competence, a process in which both consumers and producers are involved. While it makes sense to see Nordic walking as a situated social practice, such a view makes it difficult to explain its growing popularity in countries as varied as Japan, Norway and the USA. In addressing this issue, we conclude that practices and associated cultures of consumption are always ‘homegrown’. Necessary and sometimes novel ingredients (including images and artifacts) may circulate widely, but they are always pieced together in a manner that is informed by previous and related practice. What looks like the diffusion of Nordic walking is therefore better understood as its successive, but necessarily localized, (re)invention. In developing this argument, we explore some of the consequences of conceptualizing consumption and consumer culture as the outcome of meaningful social practice

Cognitive deficits in unipolar old-age depression: a population-based study

There is substantial variability in the degree of cognitive impairment among older depressed persons. Inconsistencies in previous findings may be due to differences in clinical and demographic characteristics across study samples. We assessed the influence of unipolar depression and severity of depression on cognitive performance in a population-based sample of elderly persons aged \u2a7e60 years. Eighty-nine persons fulfilled ICD-10 criteria for unipolar depression (mild, n = 48; moderate, n = 38; severe, n = 3) after thorough screening for dementia (DSM-IV criteria), psychiatric co-morbidities and antidepressant pharmacotherapy. Participants (n = 2486) were administered an extensive cognitive test battery. Moderate/severe unipolar depression was associated with poorer performance on tasks assessing processing speed, attention, executive function, verbal fluency, episodic memory and vocabulary. Mild depression was associated with poorer performance in processing speed, and few differences between mild and moderate/severe depression were observed. No association between depression and short-term memory, general knowledge or spatial ability was observed. Increasing age did not exacerbate the depression-related cognitive deficits, and the deficits remained largely unchanged after excluding persons in a preclinical phase of dementia. Furthermore, depression-related cognitive deficits were not associated with other pharmacological treatments that may affect cognitive performance. Cognitive deficits in unipolar old-age depression involve a range of domains and the cognitive deficits seem to follow the spectrum of depression severity. The finding that mild depression was also associated with poorer cognitive functioning underscores the importance of detecting mild depression in elderly persons

Interactive effects of KIBRA and CLSTN2 polymorphisms on episodic memory in old-age unipolar depression

The KIBRA (rs17070145) C-allele and the CLSTN2 (rs6439886) T-allele have both been associated with poorer episodic memory performance. Given that episodic memory is affected in depression, we hypothesized that the combination of these risk alleles would be particularly detrimental to episodic memory performance in depressed persons. In the population-based SNAC-K study, 2170 participants ( 65 60 years) without dementia (DSM-IV criteria) and antidepressant pharmacotherapy were clinically examined and diagnosed following ICD-10 criteria for unipolar depression, and genotyped for KIBRA and CLSTN2. Participants were categorized according to unipolar depression status (yes, no) and genotype combinations (KIBRA: CC, any T; CLSTN2: TT, any C). Critically, a three-way interaction effect showed that the CC/TT genotype combination was associated with poorer episodic recall and recognition performance only in depressed elderly persons, with depressed CC/TT carriers consistently performing at the lowest level. This finding supports the view that effects of genetic polymorphisms on cognitive functioning may be most easily disclosed at suboptimal levels of cognitive ability, such as in old-age depression