Embracing the wickedness of health care : essays on reforms, wicked problems and public deliberation

fi=vertaisarvioitu|en=peerReviewed

Taking Deliberation to the Streets : Reflections on Deliberative Walks

The focus of this article, a model that we call the Deliberative Walk, builds on the principles of Citizens’ Juries and Development Walks. Two case studies are used to explore the potential of uniting the two different participatory models, one that is based on discussion and the other that is more observation oriented. Both case studies were implemented in Finland during autumn 2014. Reviewing these case studies is important, because the issue of ‘taking deliberation to the streets’ has rarely been addressed in the academic literature on CJs and other deliberative mini-publics. Based on the case studies, our suggestion is that in place-specific deliberations, a Deliberative Walk is a suitable method when the issue that is being tackled has highly intertwined social and physical dimensions, while in more situation-specific deliberations, a Deliberative Walk adds value when the issue is such that it needs a more complete and direct learning experience.fi=vertaisarvioitu|en=peerReviewed

Disability and Deliberative Democracy: Towards Involving the Whole Human Spectrum in Public Deliberation

There is a danger that the basic assumption in deliberative democracy rests still strongly on the idea of normality. There is an image of ordinary, normal and active citizens which is supposed to capture the whole human spectrum. However, people with disabilities are traditionally excluded from societal participation. If the same exclusion takes place in deliberative democracy, the implications for its legitimacy are significant. In this article, we will examine how deliberative democracy understands and acknowledges disability and analyse how citizens' jury is suited to involve people with disabilities in order to reach the whole human spectrum for public deliberation. A citizens' jury for people with disabilities, implemented in Finland during the summer of 2011, is used as an in-depth case study. Findings of this article suggest that such citizens' jury has potential in enhancing the inclusiveness of deliberative democracy. However, challenges that need to be focused on in future research remain. These include the costs and the influence of citizens' jury for people with disabilities. Also the inclusion of people with intellectual disabilities remains a challenge.© 2013 Nordic Network on Disability Research. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.fi=vertaisarvioitu|en=peerReviewed

Co-Creating Safety and Security? Analyzing the multifaceted field of co-creation in Finland

Complexity is said to be on the rise in the security environment and co-creation has been proposed as one of the ways to respond to this situation. Through co-creation, complexity is addressed by a plurality of actors and actions, instead of by any single authority or recipe. Such an approach is the main premise of the Finnish Concept for Comprehensive Security. This article seeks to answer the question of how co-creation occurs as part of societal safety and security functions in Finland and what kind of challenges and problems are involved therein. The focus of the article is on the regional and local levels of action and on the public-sector/civil-society interface. The data informing this study are 31 small-group discussions that took place in so-called security cafés. This article uses the modified ladder of safety and security co-creation derived from previous research to provide its analytical framework. The ladder of co-creation proved to be a useful analytical tool to address the phenomenon and to illustrate the multifaceted and context-dependent nature of safety and security co-creation. Results indicate that at present co-creation within the safety and security functions in Finland seems to focus more on action-oriented co-production. Citizens as volunteers participate in the functions of producing safety and security, but talk-centered, planning-oriented co-creation seems to be less common. The data also provide clear indications of the darker sides of co-creation. Co-creation may be symbolic and tokenistic in that it remains at a rhetorical level. The data also offer examples of co-contamination (the lowest level of the ladder of co-creation). These examples were related to the roles of spontaneous volunteers and emergent citizen groups.©2021 the Authors. Published in The International Journal of Mass Emergencies and Disasters (IJMED) and published by the International Sociological Association's Research Committee on the Sociology of Disasters.fi=vertaisarvioitu|en=peerReviewed

Dying at home of cancer: whose needs are being met? The experience of family carers and healthcare professionals (a multiperspective qualitative study)

Objectives: Supporting patients to die in the place of their choosing is an important aspect of end of life care. Our study set out to answer the question: ‘How does the home environment influence perceptions of quality of death, and the experience of caring for the dying at home, for family carers and healthcare professionals (HCPs)? Methods: A qualitative approach, using multiperspective interviews with bereaved family carers (n=15) and a nominated HCP (n=13) ensured depth of insight gained into supporting a home death. The semistructured interviews were audio recorded, transcribed verbatim and analysed using Framework. Results: We found that the home environment enabled normality, a sense of control and individualised care which family carers often perceived as contributing towards a good death. However, the home environment created challenges for both family carers and HCPs, due to the differing and at times conflicting needs of the dying person and their family carers. Conclusions: We have shed light on the complexity of balancing the demands and the satisfaction of caring for someone dying at home. The ability to manage these conflicting needs influenced whether carers perceived the home setting as the best place for the person to have received care in their last days of life

Understanding the Emerging Fourth Sector and Its Governance Implications

The fourth sector has traditionally been described as encompassing families, households, neighbours, and friends, however, competing definitions have recently begun to emerge. Three different strands can be observed in the fourth-sector literature. The first strand centres on the notion of one-to-one aid. The second strand centres on self-organizing civic activism. The third strand focuses on hybrid organizations. In this paper we will analyse the main commonalities and differences in the understanding of the fourth sector. Our conclusion is that despite differences, there is enough ‘family resemblance’ between the three different streams of fourth-sector discussion to warrant a synthetic reflection of the governance issues related to this novel phenomenon. As a result of that analysis, we distinguish five specific governance issues that are related to 1) the ability of the public sector to work upon shared values, 2) the empowering nature of self-organizing, 3) the need for new operational rules under the ‘sharing economy’, 4) the transitory but structuration-oriented nature of fourth-sector processes and 5) the notion that fourth-sector involvement does not necessarily improve the quality of participation.fi=vertaisarvioitu|en=peerReviewed

Pesticide load in agriculture, (MATYVA-project)

Tämä selvitys on osa vuonna 1993 käynnistynyttä 'Maatalouden tuotantovaihtoehtojen ympäristötaloudelliset vaikutukset'(MATYVA) -projektia (Osa 4.2: 'Tavanomaisen viljelyn torjunta-ainepäästöt'). Sen tarkoituksena on kuvata torjunta-aineiden käyttäytymistä ja huuhtoutumista viljelymaassa ja arvioida huuhtoutumisen suuruusluokkaa ja käytön alueellista ja tuotantoalakohtaista jakautumista. Toriunta-ainepäästöt vesistöihin vaihtelevat aineesta ja olosuhteista riippuen ja lienevät meillä 0,1-1,0 % aineiden käytöstä. Ajoittain pintavesien torjunta-ainepitoisuudet ylittävät talousvedelle asetetut raja-arvot. Mikäli torjunta-aineilta joudutaan poistamaan raakavedestä, siitä aiheutuu yhteiskunnalle suuria kustannuksia. Torjunta-aineiden kulkeutuminen ja hajoaminen maassa riippuu monista aineen ja maaperän fysikaalisista ja kemiallisista ominaisuuksista, säätilasta ja viljelymenetelmistä. Torjunta-ainepäästöjen arvioimiseksi on tunnettava paikalliset maaperä- ja ilmasto-olosuhteet ainakin pääpiirteissään. Koska aineet liikkuvat veden mukana, päästöjen aluetasoinen ennustaminen on mahdollista matemaattisten mallien avulla, mikäli maalajit pystytään luokittelemaan ja paikantamaan hydrologisten ominaisuuksiensa mukaan. Valuma-aluetasoinen tietojärjestelmä on erityisen tärkeä silloin, kun pintavettä käytetään talousveden raakavetenä tai pohjavesien saastumisvaara on olemassa. Torjunta-aineiden myyntiä on meillä tilastoitu ja julkaistu vuodesta 1953 lähtien. Suurimmillaan myynti oli 1980. Maataloudessa -käytettävien torjunta-aineiden myynti oli silloin tehoaineina n. 2400 tonnia. Sen jälkeen myynti on vähentynyt ja oli vuonna 1994 1272 tonnia. Teoreettinen, myyntimäärästä laskettu keskimääräinen käyttö viljeltyä peltohehtaaria kohti vuonna 1994 oli 0,71 kg/ha. 0,2 kg/ha). Kainuun ja Lapin alueelta ei torjunta-aineiden käyttöä arvioitu. Suurin osa torjunta-aineista käytettiin kevätviljojen viljelyssä (62 %). Seuraavina olivat peruna (13 %), sokerijuurikas (12 %) ja kesanto (7 %). Syysviljoilla, nurmi- heinä- ja öljykasveilla käyttö oli n. 2,5 % kokonaiskäytöstä. Alueellisen torjunta-aineiden käytön arvioimiseksi on meillä eri tahoilta saatavilla tarvittavia tietoja pitkältäkin aikaväliltä. Kohtalaisen luotettavien arvioiden laatiminen on mahdollista. Takautuvalla arvioinnilla on merkitystä, koska torjunta-aineita voi ilmaantua pohjavesiin vuosien kuluttua käsittelystä. Tärkeää olisi luoda jatkuva seurantajärjestelmä mahdollisten riskien arvioimiseksi.This publication is a part of the project "The economical effects of the environmental impacts of agricultural production alternatives" launched in 1993. The aim is to examine the fate of pesticides in arable soils and to estimate the use of pesticides by region and the production sector. Pesticide run-off depends on the pesticide used and the environmental conditions. In Finland run-off is thought to vary from 0.1% to 1.0% calculated from the total pesticide used. Pesticide contents in surface water occasionally exceed the limits set for drinking water. The removal of pesticides from raw water would he very expensive for society. Pesticide transport and degradation in the soil depend on many physical and chemical properties of the pesticide and the soil environment. The climate and soil management systems also influence the misration and degradation of pesticides. Local soil and climate conditions need to be known (at least approximately) if we are to be able to evaluate pesticide run-offs into the environment. If the soil type can be classified and its hydrological properties evaluated, pesticide run-offs can be estimated at local level with mathematical models. A data base on the local run-off area is important when surface water is used as a source of raw water for drinking water or if there is a dangerof the groundwater being polluted. Pesticide sales have been recorded and published in Finland since 1953. Sales were highest in 1980, when approximately 2400 tonnes (calculated as active ingredients) of pesticides were used in agriculture. Since then sales have declined; in 1994 the figure was 1272 tonnes. In theory this makes for 0.71 kg of pesticides per cultivated hectare. Regionally (based on an evaluation made by Rural Centres 1994) total use of pesticides was greatest in the coastal area of Finland, where the percentage of fields is also highest. Pesticide use was greatest (10.92 kg/ha) in Turku region and smallest in North Karelia (0.2 kg/ha). Pesticide use was not evaluated in Kainuu or Lapland. The highest proportion of pesticides was used for the cultivation of spring crops (62%). Next came potatoes (13%), sugar beet (12%) and fallow (7%). Total pesticide use for autumn crops, grasses, hay and rape for oilseed was approximately 2.5%. Regional pesticide use can be evaluated with information available over long period in Finland. With this information it is then possible to make predictions. It is important to estimate the previous use of pesticide because pesticides may appear in the groundwater even years after they have been used. It would be important to create a procedure for evaluate possible risks.vokMyynti MTT tietopalveluyksikkö. Yksikön huom.: Kirjasto Aj-

#StrongTogether? Qualitative Sentiment Analysis of Social Media Reactions to Disaster Volunteering during a Forest Fire in Finland

The transformation of disaster volunteering has been highlighted in academic literature. This study examined that transformation via a big data approach. The context for the study was provided by a forest fire in Finland, which sparked a debate on volunteering. The data (806 social media messages) were analyzed using qualitative sentiment analysis to (1) identify the sentiments relating to a variety of volunteers and (2) understand the context of and tensions behind those sentiments. The data suggested that the prevailing view of disaster volunteering is a rather traditional one, while the observations on the transformation remain largely latent. The positive sentiments reflected a view of the co-production of extinguishing forest fires as an activity of formal governmental and nonprofit emergency management organizations and volunteers from expanding and extending organizations. Unaffiliated volunteers were seen as extra pairs of hands that could be invited to help in an organized way and with limited tasks, only if required. Sentiments with a more negative tone raised concerns about having sufficient numbers of affiliated volunteers in the future and the rhetorical level of appreciation of them. The data revealed a dichotomous relationship between “professionals” and “amateurs” and the politicization of the debate between different actor groups.© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).fi=vertaisarvioitu|en=peerReviewed

The security environment has always been complex! : the views of Finnish military officers on complexity

The theoretical framework of complexity is beginning to attract wider attention in research on the armed forces, and consequently the views of those who face complexity on the ground should be explored in more detail. Failure to do so risks complexity remaining only a top-level theory lacking adequate connection to practice. This article seeks to address this issue through analyzing the views of Finnish military officers. Data for the research were gathered using a deliberation and data collection method called a security café. A total of 74 people, most of them holding the rank of captain in the army or air force or lieutenant senior grade in the navy, attended the security café. The data used in this research were elicited from 47 idea rating sheets, evaluated during the security café, and include both quantitative and qualitative data. The article analyzes those data to address the following questions in relation to the theoretical framework of the article: What kind of perceptions of the complexity of the security environment do officers hold? What kind of practices do officers consider fit the presumed complexity of the security environment?© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.fi=vertaisarvioitu|en=peerReviewed

Elintapojen vaikutus lisääntymisterveyteen ja sitä edistävä neuvonta

Opinnäytetyön tarkoituksena oli kartoittaa kirjallisuuskatsauksen avulla jo olemassa olevaa tietoa elintapojen vaikutuksia lisääntymisterveyteen ja miten lisääntymisterveyttä voidaan edistää. Opinnäytetyön tavoitteena oli löytää uutta tietoa aiheesta. Työssä keskityttiin lisääntymisikäisiin naisiin ja miehiin. Tutkimuksista kävi ilmi, että elintavoilla on suuri merkitys lisääntymisterveyteen ja hedelmällisyyteen. Monessa tutkimuksessa todettiin, että painonhallinta on tärkeä osa raskauden suunnittelua ja sillä on suuri vaikutus sekä sikiön että äidin terveyteen. Lisääntymisterveyttä edistävälle elintapaneuvonnalle on tarvetta ja sitä tulisi tarjota laajalti kaikille lisääntymisikäisille henkilöille. Käytettyjen tutkimusten perusteella lisääntymisikäisillä naisilla ja miehillä on vähän tietoa raskautta edeltävistä tekijöistä, jotka vaikuttavat raskaaksi tulemiseen. Tästä voidaan päätellä, että neuvontaa tarjotaan liian vähän, tai se on vaikeasti saatavilla. Tutkimustuloksista voidaan myös päätellä, että lisääntymisikäiset naiset ja miehet olisivat valmiita muuttamaan elintapojaan raskautta ajatellen terveellisimmiksi, jos lisääntymisterveyttä edistävää neuvontaa tarjottaisiin enemmän ja se olisi helpommin saatavilla.The thesis explains the impact of lifestyle choices to reproductive health and how it can be promoted. This thesis is a literature review. The purpose of this study was to identify the already existing information on the promotion of reproductive health and the effects of lifestyle choices on fertility and reproductive health. The aim of the thesis was to find new information about the topic. Work focused on reproductive aged women and men. Studies showed that lifestyle choices play an important role in reproductive health and fertility. Many studies found that for example weight control is an important part of family planning and it has a great health impact on both the fetus and the mother. Reproductive health-promoting lifestyle counseling was much needed and it should be offered widely to all individuals of reproductive age. According to the studies used in this thesis reproductive aged women and men had little knowledge of pre-pregnancy factors that affect the ability to become pregnant. It could be concluded that the advice is offered too little, or it is not easily accessible. The study results could also be concluded that in hope for pregnancy, reproductive aged women and men would be willing to change their lifestyles if promoting reproductive health counseling was offered more and it would be more easily availabl