Tensions in corporate social responsibility in Finnish small and medium sized enterprises

Abstract. This thesis studies the tensions owner-managers of Finnish SMEs face when engaging in CSR activities, as well as how those tensions are experienced and managed by the owner-managers. It takes a paradox approach to tensions, as it understands that tensions are innate to CSR and consist of competing goals between the dimensions of CSR — economic, environmental and social. The study aims to open up the understanding of paradoxical tensions in CSR and their influence on the management of SMEs. The thesis begins with a literature review of the CSR concept, introducing its chameleon nature and historical changes. The concept is then further specified to fit the Finnish and SME context, before moving to introducing tensions in CSR and their management. The thesis uses a qualitative approach and the data was gathered by interviewing owner-managers of five Finnish SMEs. As CSR is becoming critical for many companies and they find ways to integrate CSR to their businesses, it’s evident that they will also growingly face tensions in their CSR engagement. The findings of this study provide information in the different levels, change and context that paradoxical tensions manifest in as well as between the traditional CSR dimensions. The findings suggest that Finnish SMEs face tensions between the individual goals of owner-managers and the company’s or industry’s goals or requirements. Paradoxical tension further manifest in the changes that take place to introduce more responsible practices, as well as between the long-term goals and short-term needs. To manage tensions, the results suggest that SMEs integrate CSR to their core operations in order to act responsible and not to use CSR as an additional entity to maximise profits. Integration is utilised to strive for a balance between the competing goals of CSR. The study demonstrates that Finnish SMEs mainly use proactive strategies to manage paradoxical tensions where a balance is not possible, which reduce or prevent the occurrence of tensions. Contrastingly, some owner-managers are reluctant to acknowledge the tensions due to their impact to the core business, thus denying or justifying the tensions by moving it to a level that satisfies different stakeholders and shareholders. In this way, they convince themselves and others that as the company operates on a responsible basis, no tensions arise. The results further emphasise the usage of formal measurements, reporting or certificates to demonstrate CSR engagement, going against the previous understanding of SMEs informal CSR activities

Urticaria and angioedema in Estonia, Iceland and Sweden

Peer reviewe

Metabolite and lipoprotein profiles reveal sex-related oxidative stress imbalance in de novo drug-naive Parkinson's disease patients

Parkinson's disease (PD) is the neurological disorder showing the greatest rise in prevalence from 1990 to 2016. Despite clinical definition criteria and a tremendous effort to develop objective biomarkers, precise diagnosis of PD is still unavailable at early stage. In recent years, an increasing number of studies have used omic methods to unveil the molecular basis of PD, providing a detailed characterization of potentially pathological alterations in various biological specimens. Metabolomics could provide useful insights to deepen our knowledge of PD aetiopathogenesis, to identify signatures that distinguish groups of patients and uncover responsive biomarkers of PD that may be significant in early detection and in tracking the disease progression and drug treatment efficacy. The present work is the first large metabolomic study based on nuclear magnetic resonance (NMR) with an independent validation cohort aiming at the serum characterization of de novo drug-naive PD patients. Here, NMR is applied to sera from large training and independent validation cohorts of German subjects. Multivariate and univariate approaches are used to infer metabolic differences that characterize the metabolite and the lipoprotein profiles of newly diagnosed de novo drug-naive PD patients also in relation to the biological sex of the subjects in the study, evidencing a more pronounced fingerprint of the pathology in male patients. The presence of a validation cohort allowed us to confirm altered levels of acetone and cholesterol in male PD patients. By comparing the metabolites and lipoproteins levels among de novo drug-naive PD patients, age- and sex-matched healthy controls, and a group of advanced PD patients, we detected several descriptors of stronger oxidative stress

Post-mortem volatiles of vertebrate tissue

Volatile emission during vertebrate decay is a complex process that is understood incompletely. It depends on many factors. The main factor is the metabolism of the microbial species present inside and on the vertebrate. In this review, we combine the results from studies on volatile organic compounds (VOCs) detected during this decay process and those on the biochemical formation of VOCs in order to improve our understanding of the decay process. Micro-organisms are the main producers of VOCs, which are by- or end-products of microbial metabolism. Many microbes are already present inside and on a vertebrate, and these can initiate microbial decay. In addition, micro-organisms from the environment colonize the cadaver. The composition of microbial communities is complex, and communities of different species interact with each other in succession. In comparison to the complexity of the decay process, the resulting volatile pattern does show some consistency. Therefore, the possibility of an existence of a time-dependent core volatile pattern, which could be used for applications in areas such as forensics or food science, is discussed. Possible microbial interactions that might alter the process of decay are highlighted

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Heterogeneity of prodromal Parkinson symptoms in siblings of Parkinson disease patients

Abstract: A prodromal phase of Parkinson’s disease (PD) may precede motor manifestations by decades. PD patients’ siblings are at higher risk for PD, but the prevalence and distribution of prodromal symptoms are unknown. The study objectives were (1) to assess motor and non-motor features estimating prodromal PD probability in PD siblings recruited within the European PROPAG-AGEING project; (2) to compare motor and non-motor symptoms to the well-established DeNoPa cohort. 340 PD siblings from three sites (Bologna, Seville, Kassel/Goettingen) underwent clinical and neurological evaluations of PD markers. The German part of the cohort was compared with German de novo PD patients (dnPDs) and healthy controls (CTRs) from DeNoPa. Fifteen (4.4%) siblings presented with subtle signs of motor impairment, with MDS-UPDRS-III scores not clinically different from CTRs. Symptoms of orthostatic hypotension were present in 47 siblings (13.8%), no different to CTRs (p = 0.072). No differences were found for olfaction and overall cognition; German-siblings performed worse than CTRs in visuospatial-executive and language tasks. 3/147 siblings had video-polysomnography-confirmed REM sleep behavior disorder (RBD), none was positive on the RBD Screening Questionnaire. 173/300 siblings had <1% probability of having prodromal PD; 100 between 1 and 10%, 26 siblings between 10 and 80%, one fulfilled the criteria for prodromal PD. According to the current analysis, we cannot confirm the increased risk of PD siblings for prodromal PD. Siblings showed a heterogeneous distribution of prodromal PD markers and probability. Additional parameters, including strong disease markers, should be investigated to verify if these results depend on validity and sensitivity of prodromal PD criteria, or if siblings’ risk is not elevated

Equality in the Degree Programme in International Business in Oulu University of Applied Sciences

The purpose of this thesis is to look further into students’ perceptions of equality in the Degree Programme in International Business in Oulu University of Applied Sciences. A previous survey, Jouko wants to know!, conducted by Oulu University of Applied Sciences indicated that the overall situation concerning equality in the educational institution is positive, with most participants reporting they are treated equal. However, according to the survey students studying in the Degree Programme in International Business encounter more unequal treatment during their studies in comparison to the results of Oulu University of Applied Sciences in total. Due to low amount of participants from the Degree Programme in International Business and problems with the survey questions the results are not likely to give a sincere view of the situation. Despite the results indicating that students feel equal, the inherent problems with the survey are a reason for further research. The research for this thesis was conducted by targeting students with a quantitative survey as well as using qualitative, semi-structured interviews to gain deeper insight of equality in the Degree Programme in International Business. The interview participants were guaranteed anonymity. The thesis includes a theoretical part in which equality and parts of Finnish legislation have been analyzed and adopted to get a broader understanding of the research. The objective of this thesis is to understand if students feel equal and in what situations does unequal treatment happen. Results indicate that most students have been treated equal during their studies. However, unequal treatment is more common in matters such as nationality, language skills and preferential treatment by teachers. Even though students reported witnessing other students receiving preferential treatment by teachers, a greater deal of unequal treatment manifests from students themselves. Approximately one third of the students in the Degree Programme in International Business reported that they have been treated unequally. As a result, we have conducted development proposals for Oulu University of Applied Sciences that would help in understanding the inequality issues students face and how these situations can be prevented

Preventing Gender-Based Violence Post Disasters : Building the capacity of humanitarian actors in the Philippines to engage with men and boys to reduce the risks of perpetration of violence

Gender based violence (GBV) is a global public health issue and a major feature in humanitarian emergencies. However, the phenomenon is not inevitable and can be predicted and prevented. In a context such as the Philippines, where GBV is widespread and there is a constant threat of natural hazards, strengthening the capacity of humanitarian responders to reduce the risks of GBV post disasters can contribute to preventing unnecessary suffering of affected populations. Yet, no previous research has looked at factors associated with the perpetration of GBV and strategies used by humanitarian actors to engage with men and boys to prevent these types of violence post disasters in the Philippines. The aim of this study is to enhance this knowledge and investigate; how can humanitarian actors in the Philippines work with men and boys to prevent the perpetration of GBV post disasters? The study adopts a qualitative research approach and based on a literature review and 18 key-informant interviews with humanitarian actors in the Philippines, it explores the current knowledge and practice on the topic. The material was analysed in relation to gender and feminist theory, the Ecological Model of risk factors of GBV, a primary prevention approach and the Spectrum of Violence Prevention. The study identifies a number of aggravating factors that seem to be associated with an increased risk of perpetration of GBV post disasters, such as men’s loss of a livelihood and lack of coping mechanisms. However, these factors are not the causes of GBV but these violent acts are deeply rooted in gendered power imbalances and rigid gender roles in the Philippines society. Ultimately, the study concludes that to effectively prevent the perpetration of GBV post disasters, long-term and effective multi-sectoral efforts between a wide range of actors are needed. In this work, humanitarian actors can play a key role to initiate change. The study suggests that humanitarian actors, within their existing activities, should seek to increase men’s access to safe spaces, peer support networks and mental health services, and support men to develop more elastic gender roles and non-violent coping mechanisms. Programmes should simultaneously increase women’s empowerment, the broader community’s support for social change and allow for dialogue to take place between women and men to synchronise their social transformations. Finally, the study notices that a rather heteronormative and binary understanding of gender seem to be present in the shared initiatives to prevent GBV post disasters. Hence, the study suggests that humanitarian actors should strengthen the capacity of their staff to apply a gender and norm-critical analysis in their work by incorporating these aspects in internal trainings

Time Together : a nursing intervention targeting everyday life in psychiatric inpatient care : patient and staff perspectives

Background: Patient and staff descriptions of everyday life in psychiatric inpatient care are consistent, revealing a challenging environment with over-reliance on medication and, power imbalances. Patients and staff ask for the opportunity to develop relationships; however, the literature on nursing interventions targeting these issues is sparse. This thesis comprises four studies with a twofold overall aim. The first part constructs a theoretical understanding of everyday life processes in psychiatric inpatient care, and the second part evaluates a nursing intervention in psychiatric inpatient care. Methods: Studies I and II used a grounded theory design with individual interviews (I, II), dyadic interviews (II) and focus group discussions (II). Study III used mixed methods, a single system experimental design with questionnaires and a qualitative process evalu­ation with logs and participant observations. Study IV used a qualitative design with individual semi structured interviews. The participants were 16 patients with experiences of psychiatric inpatient care (I), 36 staff members who worked in psychiatric inpatient care (II), 80 patients and 50 staff members in the evaluated wards (III) and 11 patients who had taken part in the nursing intervention Time Together (IV). In studies I and II the analysis followed grounded theory. In study III data were subjected to visual analysis, per­centage of non-overlapping data and qualitative content analysis, also used in study IV. Results: Patients in psychiatric inpatient care experienced everyday life as being influenced by interactions between patients and staff, the environment and the content of care. The quality of interactions was what tied these components together. Having trustful interactions could compensate for an otherwise poor environment and a confusing care content, while adapting to absence of, or obstructive interactions contributed to experiences of the environment as stigmatizing and the care content as confusing (I). Staff had ideals regarding everyday life on the wards but obstacles hindered them from putting their ideals into practice. To cope with this, they appeared to shift their focus from the patient’s best to their own survival. This resignation made it even more difficult for them to work in a way that aligned with their ideals (II). The theoretical understanding that was constructed from study I and II revealed that what patients described as absent or obstructive interactions, or passivity, were mirrored by staff descriptions of obstacles in their everyday life on the wards. Furthermore, what patients described as trustful inter­actions and satisfying activities were mirrored by staff descriptions of having the patients’ best interest at heart. This is interpreted as when staff is able to focus on the patients’ best interests, improvements in the everyday life in psychiatric inpatient care are possible. The nursing intervention called Time Together was feasible to introduce in psychiatric inpatient care. The intervention was enabled by shared responsibility, a friendly approach and a predictable structure, whilst it was hindered by a distant approach and unpredictable structure. Measurements showed no effect on the quality of interactions between patients and staff, but questionable effects on perceived stress and stress of conscience among staff, as well as on staff satisfaction with interactions with patients (III). Patients described their experiences of taking part in the intervention as being seen as a human among other humans, that it contributed to hope for recovery but also, that feelings of distance to staff were fostered when Time Together sessions were not offered (IV). Conclusion: By implementing Time Together in psychiatric inpatient care, staff is allowed access to a nursing intervention that can meet patients’ needs for high-quality interactions in everyday life and that may have potential to decrease perceived stress and stress of conscience among staff and increase their satisfaction with interactions with patients. By using joint activities as bridging actions, this intervention could lead to the development of nurse-patient relationships built on reciprocity and engagement, something that is emphasised in recovery-oriented mental health nursing.Bakgrund: Patienters och personals beskrivningar av vardagslivet inom psykiatrisk heldygnsvård är konsekventa och avslöjar en komplex miljö med hög tilltro till medicinsk behandling och obalans i maktförhållanden. Patienter och personal efterfrågar möjligheter att utveckla relationer med varandra men omvårdnadsinterventioner med sådant fokus är sparsamt beskrivna i den vetenskapliga litteraturen. Avhandlingen har ett tvådelat syfte och omfattar fyra delstudier. Den första delen syftade till att konstruera en teoretisk förståelse för vardagliga processer inom psykiatrisk heldygnsvård och den andra delen till att utvärdera en omvårdnadsintervention inom psykiatrisk heldygnsvård. Metod: I delstudie I och II användes en grounded theory design med individuella intervjuer (I, II), dyadiska intervjuer (II) och fokusgruppsdiskussioner (II). I delstudie III användes mixade metoder, en single system experimental design med enkäter och en kvalitativ processutvärdering med loggar och deltagande observationer. I delstudie IV användes en kvalitativ design med individuella semistrukturerade intervjuer. Deltagarna var 16 patienter med erfarenhet av psykiatrisk heldygnsvård (I), 36 personal med erfarenhet av arbete inom psykiatrisk heldygnsvård (II), 80 patienter och 50 personal från de utvärderade avdelningarna (III) och 11 patienter som deltagit i omvårdnads­interventionen Tid Tillsammans (IV). I delstudie I och II följde analysen grounded theory. I delstudie III analyserades data med hjälpa av visuell analys, percentage of non-overlapping data och kvalitativ innehållsanalys som även användes i delstudie IV. Resultat: Patienter inom psykiatrisk heldygnsvård upplevde att vardagslivet på avdelningarna påverkades av interaktionerna med personalen, miljön och vårdens innehåll. Den gemensamma kärnan i dessa delar var kvaliteten i interaktionerna. Tillitsfulla interaktioner kompenserade för en annars fattig miljö och ett förvirrande vårdinnehåll medan anpassning till frånvaro av, eller hindrande interaktioner bidrog till upplevelser av en stigmatiserande miljö och ett förvirrande vårdinnehåll (I). Personal hade ideal gällande vardagslivet på avdelningarna men svårigheter hindrade dem från att omvandla idealen i praktiken. För att hantera detta verkade de skifta sitt fokus från patienternas bästa till att själva kunna överleva. Resignationen försvårade ytterligare för dem att kunna arbeta i linje med sina ideal (II). Den teoretiska förståelsen som konstruerats visar att det patienterna beskrev som frånvaro av, eller hindrande interaktioner samt passivitet reflekterades i personalens beskrivningar av hinder i vardagslivet på avdelningarna. Det patienterna beskrev som tillitsfulla interaktioner och tillfredsställande aktiviteter reflekterades i personalens beskrivningar av att fokusera på patienternas bästa. Detta tolkas som att när personal har möjlighet att fokuserar på patienternas bästa, då finns möjligheter till förbättringar av vardagslivet inom psykiatrisk heldygnsvård. Omvårdnadsinterventionen Tid Tillsammans var genomförbar inom psykiatrisk hel­dygn­svård. Delat ansvar, ett vänligt bemötande och en förutsägbar struktur möjliggjorde interventionen medan ett distanserat bemötande och en oförutsägbar struktur utgjorde hinder. Mätningarna visade inga effekter på kvaliteten i interaktionerna mellan patienter och personal samt osäkra effekter på personalens upplevda stress och samvetsstress samt på personalens nöjdhet med interaktionerna med patienterna (III). Patienterna beskrev sina erfarenheter av att ha tagit del i Tid Tillsammans som att bli sedd som en människa bland andra människor, att det bidrog till hopp om återhämtning men också att känslor av distans till personalen utvecklades när Tid Tillsammans inte genomfördes (IV). Konklusion: Genom att införa Tid Tillsammans inom psykiatrisk heldygnsvård får personal tillgång till en omvårdnadsintervention som kan möta patienternas behov av interaktioner med hög kvalitet och som kan ha potential att minska deras upplevda stress och samvetsstress samt öka deras nöjdhet med interaktionerna med patienterna. Genom att använda gemensamma aktiviteter kan relationer som bygger på ömsesidighet och engagemang mellan patienter och personal utvecklas, något som betonas inom återhämtningsinriktad psykiatrisk omvårdnad

Preventing Gender-Based Violence Post Disasters : Building the capacity of humanitarian actors in the Philippines to engage with men and boys to reduce the risks of perpetration of violence

Gender based violence (GBV) is a global public health issue and a major feature in humanitarian emergencies. However, the phenomenon is not inevitable and can be predicted and prevented. In a context such as the Philippines, where GBV is widespread and there is a constant threat of natural hazards, strengthening the capacity of humanitarian responders to reduce the risks of GBV post disasters can contribute to preventing unnecessary suffering of affected populations. Yet, no previous research has looked at factors associated with the perpetration of GBV and strategies used by humanitarian actors to engage with men and boys to prevent these types of violence post disasters in the Philippines. The aim of this study is to enhance this knowledge and investigate; how can humanitarian actors in the Philippines work with men and boys to prevent the perpetration of GBV post disasters? The study adopts a qualitative research approach and based on a literature review and 18 key-informant interviews with humanitarian actors in the Philippines, it explores the current knowledge and practice on the topic. The material was analysed in relation to gender and feminist theory, the Ecological Model of risk factors of GBV, a primary prevention approach and the Spectrum of Violence Prevention. The study identifies a number of aggravating factors that seem to be associated with an increased risk of perpetration of GBV post disasters, such as men’s loss of a livelihood and lack of coping mechanisms. However, these factors are not the causes of GBV but these violent acts are deeply rooted in gendered power imbalances and rigid gender roles in the Philippines society. Ultimately, the study concludes that to effectively prevent the perpetration of GBV post disasters, long-term and effective multi-sectoral efforts between a wide range of actors are needed. In this work, humanitarian actors can play a key role to initiate change. The study suggests that humanitarian actors, within their existing activities, should seek to increase men’s access to safe spaces, peer support networks and mental health services, and support men to develop more elastic gender roles and non-violent coping mechanisms. Programmes should simultaneously increase women’s empowerment, the broader community’s support for social change and allow for dialogue to take place between women and men to synchronise their social transformations. Finally, the study notices that a rather heteronormative and binary understanding of gender seem to be present in the shared initiatives to prevent GBV post disasters. Hence, the study suggests that humanitarian actors should strengthen the capacity of their staff to apply a gender and norm-critical analysis in their work by incorporating these aspects in internal trainings