Työkyvyn hallinta, seuranta ja varhainen tuki : Tutkimus sairausvakuutuslain vuoden 2011 muutoksen vaikutuksista työpaikkojen toimintaan

Tutkimuksessa selvitettiin vuoden 2011 sairausvakuutuslain muutoksen vaikutuksia työkyvyn hallintaan, seurantaan ja varhaiseen tukeen. Sairausvakuutuslakimuutos (L 1056/2010) edellyttää, että ”työpaikalla on yhteistyössä työterveyshuollon kanssa sovitut käytännöt siitä, miten työkyvyn hallintaa, seurantaa ja varhaista tukea toteutetaan työpaikan ja työterveyshuollon yhteisenä toimintana”, jotta työterveyshuollon korvausluokkaan 1 kuuluvista palveluista aiheutuvista kustannuksista korvattaisiin 50 %:n sijaan 60 %. Tutkimus toteutettiin kahdessa vaiheessa. Ensimmäisessä vaiheessa tehtiin laaja, sähköinen kyselytutkimus, johon osallistui yli 1 000 työnantajaa. Toisessa vaiheessa kartoitettiin syvemmin työnantajien hyviksi kokemia työkyvyn hallinnan käytäntöjä sekä kehitysehdotuksia case-tutkimuksen menetelmin suppeammasta 22 työnantajan otoksesta. Tämän lisäksi haastateltiin viittä eri työterveyshuollon palveluntuottajaa. Yli 85 % kyselytutkimukseen osallistuneista ilmoitti sopineensa toimintakäytännöistä tai laatineensa toimenpideohjelman yhteistyössä työterveyshuollon kanssa, mikä on noin 10 prosenttiyksikköä enemmän kuin ennen vuotta 2011. Erilaisille toimintamalleille on laadittu suunnitelmia melko kattavasti, mutta suunnitelmien seuranta ei ole vielä systemaattista: suunnitelmiin ei ole kytketty tavoitteita, ja seurattavat mittarit puolestaan eivät välttämättä kytkeydy suunnitelmiin. Suurin osa tutkimuksen toiseen vaiheeseen osallistuneista organisaatioista koki lakimuutoksen onnistuneeksi tavaksi edistää työkyvyn hallintaa. Osallistuneissa organisaatioissa työkyvyn hallinta ja varhainen tuki on tullut viime vuosina keskimäärin systemaattisemmaksi ja tavoitteellisemmaksi. Haastateltavat kuitenkin korostivat organisaation omaa toimintaa ja valmiutta tärkeämmäksi työkyvyn hallinnassa. Haastateltavat pitivät suunnitelmien tekoa melko hyödyllisenä työkyvyn hallinnan kannalta ja osasivat mainita esimerkkejä hyvistä työkykykäytännöistä. Tavoitteiden seuranta ja mittaaminen ei kuitenkaan ole niin systemaattista kuin laajat suunnitelmat antaisivat olettaa. Tavoitteet on suunnitelmissa ilmaistu tyypillisesti yleisellä tasolla, jolloin niitä on vaikea mitata tai asettaa tavoitetasoja. Työpaikoilla seurataankin tyypillisesti helposti mitattavia asioita, kuten työtapaturmia, sairauspoissaoloja ja ennenaikaisia eläköitymisiä. Nämä kuvastavat myöhäisen vaiheen ongelmia. Varhaisen vaiheen tunnistamista tai ennaltaehkäisyn toteutumista ei seurata, oletettavasti niiden vaikean mitattavuuden vuoksi, vaikka tavoitteista nämä teemat löytyvät. Työkyvyn hallinnan kehittäminen on monivaiheinen prosessi, joka lähteäkseen käyntiin edellyttää yleistä tietoisuutta työkyvyn hallinnasta sekä henkilöstöasioista vastaavien tahojen kykyä kommunikoida muun johdon kanssa työkyvyn hallinnan kustannusvaikuttavuudesta. Onnistunut työkyvyn hallinta edellyttää lisäksi, että johto on sitoutunut siihen, sisäinen viestintä esimiehille ja työntekijöille toimii ja että henkilöstö osallistuu prosessiin

Interactions between the Aggregatibacter actinomycetemcomitans secretin HofQ and host cytokines indicate a link between natural competence and interleukin-8 uptake

Naturally competent bacteria acquire DNA from their surroundings to survive in nutrient-poor environments and incorporate DNA into their genomes as new genes for improved survival. The secretin HofQ from the oral pathogen Aggregatibacter actinomycetemcomitans has been associated with DNA uptake. Cytokine sequestering is a potential virulence mechanism in various bacteria and may modulate both host defense and bacterial physiology. The objective of this study was to elucidate a possible connection between natural competence and cytokine uptake in A. actinomycetemcomitans. The extramembranous domain of HofQ (emHofQ) was shown to interact with various cytokines, of which IL-8 exhibited the strongest interaction. The dissociation constant between emHofQ and IL-8 was 43 nM in static settings and 2.4 μM in dynamic settings. The moderate binding affinity is consistent with the hypothesis that emHofQ recognizes cytokines before transporting them into the cells. The interaction site was identified via crosslinking and mutational analysis. By structural comparison, relateda type I KH domain with a similar interaction site was detected in the Neisseria meningitidis secretin PilQ, which has been shown to participate in IL-8 uptake. Deletion of hofQ from the A. actinomycetemcomitans genome decreased the overall biofilm formation of this organism, abolished the response to cytokines, i.e., decreased eDNA levels in the presence of cytokines, and increased the susceptibility of the biofilm to tested β-lactams. Moreover, we showed that recombinant IL-8 interacted with DNA. These results can be used in further studies on the specific role of cytokine uptake in bacterial virulence without interfering with natural-competence-related DNA uptake

In the Shadow of Celebrity? World-Class University Policies and Public Value in Higher Education

The growing popularity of the concept of world-class universities raises the question of whether investing in such universities is a worthwhile use of public resources. Does concentrating public resources on the most excellent universities improve the overall quality of a higher education system, especially if definitions of excellence and world-class are made by external ranking organizations? This paper addresses that question by developing a framework for weighing up trade-offs between institutional and system performance, focusing on the potential system-wide improvements which world-class university programmes (WCUPs) may bring. Because WCUPs are in a relatively early stage of their development, systemic effects are not yet clear. We therefore analyse the ex ante reasons that policy makers have for adopting WCUPs to see if they at least seek to create these systemic benefit

Collaboration and knowledge exchange between scholars in Britain and the empire, 1830–1914

In recent years there has been a growing interest among historians in the British Empire as a space of knowledge production and circulation. Much of this work assumes that scholarly cooperation and collaboration between individuals and institutions within the Empire had the effect (and often also the aim) of strengthening both imperial ties and the idea of empire. This chapter argues, however, that many examples of scholarly travel, exchange, and collaboration were undertaken with very different goals in mind. In particular, it highlights the continuing importance of an ideal of scientific internationalism, which stressed the benefits of scholarship for the whole of humanity and prioritized the needs and goals of individual academic and scientific disciplines. As the chapter shows, some scholars even went on to develop nuanced critiques of the imperial project while using the very structures of empire to further their own individual, disciplinary and institutional goals

Healthcare-associated viral and bacterial infections in dentistry

Infection prevention in dentistry is an important topic that has gained more interest in recent years and guidelines for the prevention of cross-transmission are common practice in many countries. However, little is known about the real risks of cross-transmission, specifically in the dental healthcare setting. This paper evaluated the literature to determine the risk of cross-transmission and infection of viruses and bacteria that are of particular relevance in the dental practice environment. Facts from the literature on HSV, VZV, HIV, Hepatitis B, C and D viruses, Mycobacterium spp., Pseudomonas spp., Legionella spp. and multi-resistant bacteria are presented. There is evidence that Hepatitis B virus is a real threat for cross-infection in dentistry. Data for the transmission of, and infection with, other viruses or bacteria in dental practice are scarce. However, a number of cases are probably not acknowledged by patients, healthcare workers and authorities. Furthermore, cross-transmission in dentistry is under-reported in the literature. For the above reasons, the real risks of cross-transmission are likely to be higher. There is therefore a need for prospective longitudinal research in this area, to determine the real risks of cross-infection in dentistry. This will assist the adoption of effective hygiene procedures in dental practice

The World-Class Multiversity: Global commonalities and national characteristics

World-Class Universities (WCUs) are nationally embedded comprehensive higher education institutions (HEIs) that are closely engaged in the global knowledge system. The article reviews the conditions of possibility and evolution of WCUs. Three interpretations are used to explain worldwide higher education: neoliberal theory, institutional theory, and critical political economy, which give greater recognition than the other theories to the role of the state and variations between states. World higher education is evolving under conditions of globalization, organizational modernization (the New Public Management), and in some countries, marketization. These larger conditions have become manifest in higher education in three widespread tendencies: massification, the WCU movement, and organizational expansion. The last includes the strengthening of the role of the large multi-disciplinary multi-purpose HEIs ("multiversities"), in the form of both research-intensive WCUs with significant global presence, and other HEIs. The role of binary sector and specialist HEIs has declined. Elite WCUs gain status and strategic advantage in both quantity and quality: through growth and the expansion of scope, and through selectivity and research concentration. The balance between quantity and quality is now resolved at larger average size and broader scope than before. The final section of the article reviews WCUs in China and considers whether they might constitute a distinctive university model

Co-creation with Companies: A Means to Enhance Societal Impact of University Researchers?

In this chapter, we explore co-creation as a form of societal interaction of science. We approach co-creation as a goal-oriented form of dynamic interaction aiming at mutual benefit of all parties. As such, we exclude technology transfer and other linear societal interaction forms that follow a closed-model innovation format. We argue that focusing solely on tapping the needs of researchers and ‘pure’ science would lead to ignoring the broader context in which researchers work. An excessive focus on meeting the needs of external stakeholders could jeopardize the preconditions of science. Hence, this chapter explores how researcher-company co-creation can be nurtured in a heavily institutionalized setting, where established rules govern the process of knowledge production and protect research integrity. The co-creation process is analyzed by combining Nonaka’s SECI model and Strober’s interdisciplinary interaction model for knowledge creation. We find that the core of this process lies facilitated dialogue, which is seen as open knowledge sharing between equal participants