Browsing by Subject " rehabilitation"

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  • Petersen, Bjorn; Weed, Ethan; Sandmann, Pascale; Brattico, Elvira; Hansen, Mads; Sorensen, Stine Derdau; Vuust, Peter (2015)
    Cochlear implants (CIs) are primarily designed to assist deaf individuals in perception of speech, although possibilities for music fruition have also been documented. Previous studies have indicated the existence of neural correlates of residual music skills in postlingually deaf adults and children. However, little is known about the behavioral and neural correlates of music perception in the new generation of prelingually deaf adolescents who grew up with CIs. With electroencephalography (EEG), we recorded the mismatch negativity (MMN) of the auditory event-related potential to changes in musical features in adolescent CI users and in normal-hearing (NH) age mates. EEG recordings and behavioral testing were carried out before (T1) and after (T2) a 2-week music training program for the CI users and in two sessions equally separated in time for NH controls. We found significant MMNs in adolescent CI users for deviations in timbre, intensity, and rhythm, indicating residual neural prerequisites for musical feature processing. By contrast, only one of the two pitch deviants elicited an MMN in CI users. This pitch discrimination deficit was supported by behavioral measures, in which CI users scored significantly below the NH level. Overall, MMN amplitudes were significantly smaller in CI users than in NH controls, suggesting poorer music discrimination ability. Despite compliance from the CI participants, we found no effect of the music training, likely resulting from the brevity of the program. This is the first study showing significant brain responses to musical feature changes in prelingually deaf adolescent CI users and their associations with behavioral measures, implying neural predispositions for at least some aspects of music processing. Future studies should test any beneficial effects of a longer lasting music intervention in adolescent CI users.
  • Wallin, M (Kela, 2009)
    Sosiaali- ja terveysturvan tutkimuksia 103
    Tutkimuksen tarkoitus oli selvittää kotona asuvien vanhusten laitoskuntoutuksen liikunnallisen osuuden toteutumista fysioterapeuttien ja vanhusten näkökulmasta. Tutkimuksen aineisto kerättiin vuosina 2002 ja 2003 Kelan IKÄ-hankkeen kuntoutusryhmistä. Tutkimukseen haastateltiin 31 iältään 66–93-vuotiasta kuntoutujaa ja 11 fysioterapeuttia. Lisäksi videoitiin seitsemän ryhmäliikuntatilannetta, joihin osallistui yhteensä 52 vanhusta ja 9 ammattilaista. Vanhukset kuvailivat kuntoutuskokemustaan joko arjessa selviytymisen välineeksi tai lomaksi arjesta. Osa oli pettynyt saamaansa kuntoutukseen. Fysioterapeutit pitivät vanhuksia joko kuntoutuksen vastaanottajina, jolloin keskityttiin vanhuksen fyysisen toimintakyvyn ongelmiin tai sosiaalisiin tarpeisiin, tai kumppaneina harjoitteluinterventiossa kotona selviytymisen edistämiseksi. Ryhmäliikuntatilanteet etenivät fysioterapeuttijohtoisesti, joko strukturoidusti ilman kuntoutujille annettua yksilöllistä palautetta tai yksilöllisen ohjauksen ja palautteen mahdollistaen. Ns. kiertoharjoittelussa vanhuksilla oli mahdollisuus osallistua aktiivisesti liikuntaryhmän toteuttamiseen. Vanhukset osallistuivat hiljaisesti harjoittelemalla, vastentahtoisesti suostumalla, sitkeästi yrittämällä tai kaveria auttamalla. Heterogeeninen vanhusryhmä haastaa nykyisiä kuntoutuskäytäntöjä, joissa on sekä toimivia että kehitettäviä alueita. Vanhusten kotona asumista heidän yksilölliset tarpeensa huomioon ottaen voidaan tukea, kun vanhukset saavat osallistua muiden ryhmäläisten kanssa yhteiseen ongelmanratkaisuun ja heille mielekkäiden, arjen askareita tukevien harjoitusten tekemiseen. – Suomenkielinen yhteenveto s. 52–56.
  • Sipilä, Raija; Mikkelsson, Marja; Honkanen, Mari; Malmivaara, Antti; Komulainen, Jorma (2019)
    Objective: To describe a project to develop guideline implementation tools (GItools) for rehabilitation guidelines, and a collaboration between a guideline producer and a healthcare organization to implement guidelines into care pathways. Design: Descriptive case study. Methods: A national guideline organization in Finland launched a 3-year project in 2015 to implement rehabilitation recommendations. Usability of the GItools was evaluated and improved, based on literature, workshops and surveys. An implementation plan guided the production of the GItools. An implementation plan was developed to integrate the shoulder disorders guideline into a care pathway at Paijat-Hame district rehabilitation unit. The implementation plan was produced in 3 facilitated workshops, which included brainstorming, snowballing, prioritizing and short lectures. Results: Twenty implementation plans and 119 different GItools for 22 guidelines were developed. The GItools, in particular patient material, were perceived as useful for the facilitation of guideline implementation. Four seminars and 14 sessions of continuous medical education were arranged. A plan was developed and executed for the implementation of the shoulder disorders guideline. Conclusion: It is feasible for a guideline producer to systematically include GItools into rehabilitation guidelines. This implementation project was an example of a successful collaboration between a guideline producer and a healthcare organization.
  • Särkamö, Teppo; Altenmueller, Eckart; Rodriguez-Fornells, Antoni; Peretz, Isabelle (2016)
  • O’Shea, Mia (Helsingin yliopisto, 2021)
    Objectives. This study sought to investigate factors related to the elicitation of music-evoked autobiographical memories (MEAMs) in healthy aging to improve overall understanding of the phenomenon and to enhance the selection of optimal musical stimuli to be used for the neurological rehabilitation and care of elderly individuals. The characteristic contents of MEAMs of healthy older individuals were also explored. Methods. 113 healthy senior subjects (aged 60 – 86 years) listened to 70 preselected song excerpts and rated each on a 5-point Likert scale in five domains: valence, emotional intensity, arousal, familiarity and autobiographical salience. Correlational and linear mixed model analyses were conducted to discover the relationship between the rated variables. Eighty-one participants additionally chose to verbally describe their MEAMs in further detail. These submitted inserts (n = 2790) were manually categorized and labelled into non-mutually exclusive groups and sub-groups. Results and conclusions. The analyses revealed that all rating variables had statistically significant positive relationships with one another. Valence, emotional intensity, arousal and familiarity all had significant positive effects on the dependent variable autobiographical salience. Thus, in order to maximally evoke MEAMs in healthy elderly individuals, the chosen musical stimuli should be regarded by the listener as being pleasant, emotionally intense, physiologically arousing and familiar. The contents of elderly individuals’ MEAMs often involved music-related activity, such as singing, dancing or listening to music. They also frequently contained details of specific people or locations. Lastly, they often weren’t very temporally specific and memories from adolescence were more common than other life periods.
  • Honkanen, Mari; Arokoski, Jari; Sipilä, Raija; Kukkonen-Harjula, Katriina; Malmivaara, Antti; Komulainen, Jorma (2019)
    Objective: Rehabilitation is often neglected in clinical practice guidelines, even when there is evidence for its effectiveness. The Current Rehabilitation development project, documented in this article, aimed to develop processes and structures to incorporate evidence and good practice on rehabilitation and functional capacity into the Finnish national Current Care Guidelines. Design: Descriptive assessment. Methods: The 3-year Current Rehabilitation development project was launched in 2012. It began with an assessment of existing rehabilitation evidence on the Current Care Guideline database and a query to Finnish rehabilitation experts. The project group developed and compiled tools for Current Care editors and guideline panels. The editorial team continued to monitor changes in rehabilitation evidence in the guidelines. Results: During the years 2012-2014, a total of 54 guidelines were published, and rehabilitation was incorporated into 31 of them. The number of rehabilitation-related evidence summaries increased from 49 to 164. During the next 3 years an additional 41 guidelines were published. Rehabilitation was incorporated to 24 of them, and the number of rehabilitation-related evidence summaries increased from 78 to 136. Conclusion: The level of evidence criteria used for rehabilitative interventions were the same as for symptomatic or curative interventions. Evidence showing the effectiveness of rehabilitation increased substantially during the project.
  • Valkeapää, Taina Jenni Marika; Tanaka, Kimiko; Lindholm, Camilla Christina; Weiste, Elina Hannele; Stevanovic, Tuire Melisa (2019)
    This paper investigates how two ideologies of mental health rehabilitation—recovery ideology and communal approach—are realized in interactional practices associated with psychosocial rehabilitation. More spesifically, the paper discusses employee selection in the context of the Clubhouse-created Transitional Employment (TE) programme, which offers employment opportunities for rehabilitants. The paper describes how joint decisions are established during the moment-by-moment interactional processes at the Clubhouse. Drawing from the data set of 29 video-recorded rehabilitation group meetings, and Conversation Analysis as a method, the paper analyzes two questions: (1) How do the participants talk about the decision-making process associated with the TE on a “meta” level? And (2) how are the TE employees actually selected in the turn-by-turn sequential unfolding of interaction? When discussing the TE employee selection procedure on a “meta” level, the values of recovery ideology focusing on client empowerment and self-determination are prevalent. Also, the central ideals of the communal approach—openness and collaboration—are defended as decision-making guidelines. However, in the meetings where decisions on the TE employees are concretely made, there is a mismatch between the two ideological approaches to rehabilitation and the actual practices observable in the relevant interactional encounters.
  • Kela (Kela, 2019)
  • Kela (Kela, 2020)
    Suomen virallinen tilasto
  • Turunen, Kati (Helsingfors universitet, 2012)
    Objective. Hearing loss is one of the most common chronic health problems, and the number is increasing as a result of population aging. Hearing aids are regarded as the main rehabilitation method for hearing loss. The goal of this follow-up study was to review the experiences of working aged new hearing aid adopters. The focus was to map out the expectations and satisfaction towards the hearing aid, and the disability experiences caused by hearing loss. This thesis is a part of Minna Laakso, Eila Lonka, Johanna Ruusuvuori and Tarja Aaltonen's research project "Communication with Hearing Aid". Also the data was collected as a part of the project. Methods. The population consisted of 42 working age hearing aid first time users (37 64 years). 16 of them were women. Before the hearing aid fitting the participants filled up two self-assessment questionnaires: Denver Scale and Expectations towards hearing aids. Two to three weeks after implementation of the hearing aid the participants filled up the second Denver Scale questionnaire and also IOI-HA questionnaire. Thus it was possible to compare the expectations, disability experiences and satisfaction. The research also studied the construct of Denver scale by using statistical principal component analysis. The model was then utilized in the other statistical analyses. Three participants were also interviewed. Half-structured interviews provided more detailed information about the experiences towards the hearing aid and the hearing loss. The contents of the interviews were then compared to the questionnaire data. Results and conclusions. The expectations towards the hearing aid were high in the study population, although there wasn t any correlation between expectations and short-range satisfaction. Changes in the disability as the result of hearing aid intervention weren t statistically significant. Principal components of the Denver Scale didn't follow the model introduced in previous studies. The contents of the interviews were moderately consistent with the questionnaire data. In this research it was noticed, that the high disabilities due to hearing loss can also be seen after the hearing aid intervention.
  • Mattila-Holappa, Pauliina (Kela, 2018)
    Studies in social security and health 152
    Mental disorders are the leading cause of work disability among young adults. This study examined the background of young adults who were granted temporary work disability pension due to mental disorders in Finland, their clinical profile, the interventions targeted at them, and employment outcomes over five years. The data comprised people aged 18–34 (n = 1,163) who were granted a fixed-term work disability pension in 2008 due to a mental disorder (ICD-10 codes F10–69, F80–99) by an occupational pension institute. The data included patients’ pension applications and attached medical certifications, which were linked to employment data from the Finnish Centre for Pensions. The most common diagnoses were depressive mood disorders (39%), schizophrenia, schizotypal and delusional disorders (34%), and mania or bipolar disorder (14%). Half of the young adults were attached to the labour market or education prior to the granted pension. Three clinical profiles were identified: ‘Childhood (including adolescence) adversity’, associated with depressive disorders; ‘Comorbidity’, associated with bipolar disorder; and ‘Undefined’, associated with psychotic disorders. Half of the non-student young adults had received work-oriented interventions or had them in their treatment and rehabilitation plan. Forty per cent had received psychotherapy or had a plan for it. A total of 22% of the sample were employed at the end of the 5.6-year follow-up, whereas 48% had been employed at some time during this period. Having planned psychotherapeutic intervention or rehabilitative courses and training at baseline was associated with quicker entry into the labour market. Having both planned psychotherapeutic and work-oriented interventions was associated with being employed at the end of the follow-up. Both psychotherapy and work-oriented interventions are likely to be beneficial for the future employment of young adults on disability pension.
  • Castaneda, Anu E.; Cilenti, Katja; Rask, Shadia; Lilja, Eero; Skogberg, Natalia; Kuusio, Hannamaria; Salama, Essi; Lahti, Jari; Elovainio, Marko; Suvisaari, Jaana; Koskinen, Seppo; Koponen, Paivikki (2020)
    Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants.
  • Marques, Maria Jose; Schwilch, Gudrun; Lauterburg, Nina; Crittenden, Stephen; Tesfai, Mehreteab; Stolte, Jannes; Zdruli, Pandi; Zucca, Claudio; Petursdottir, Thorunn; Evelpidou, Niki; Karkani, Anna; AsliYilmazgil, Yasemen; Panagopoulos, Thomas; Yirdaw, Eshetu; Kanninen, Markku; Luis Rubio, Jose; Schmiedel, Ute; Doko, Adrian (2016)
  • Sarkamo, Teppo (2018)
    Music engages an extensive network of auditory, cognitive, motor, and emotional processing regions in the brain. Coupled with the fact that the emotional and cognitive impact of music is often well preserved in ageing and dementia, music is a powerful tool in the care and rehabilitation of many ageing-related neurological diseases. In addition to formal music therapy, there has been a growing interest in self- or caregiver-implemented musical leisure activities or hobbies as a widely applicable means to support psychological wellbeing in ageing and in neurological rehabilitation. This article reviews the currently existing evidence on the cognitive, emotional, and neural benefits of musical leisure activities in normal ageing as well as in the rehabilitation and care of two of the most common and ageing-related neurological diseases: stroke and dementia.
  • Grau-Sanchez, Jennifer; Ramos-Escobar, Neus; Sierpowska, Joanna; Rueda, Nohora; Susana, Redón; Rifà, Xavi; Veciana de las Heras, Misericordia; Pedro, Jordi; Särkämö, Teppo Tapio; Duarte, Esther; Rodríguez-Fornells, Antoni (2018)
    The effect of music-supported therapy (MST) as a tool to restore hemiparesis of the upper extremity after a stroke has not been appropriately contrasted with conventional therapy. The aim of this trial was to test the effectiveness of adding MST to a standard rehabilitation program in subacute stroke patients. A randomized controlled trial was conducted in which patients were randomized to MST or conventional therapy in addition to the rehabilitation program. The intensity and duration of the interventions were equated in both groups. Before and after 4 weeks of treatment, motor and cognitive functions, mood, and quality of life (QoL) of participants were evaluated. A follow-up at 3 months was conducted to examine the retention of motor gains. Both groups significantly improved their motor function, and no differences between groups were found. The only difference between groups was observed in the language domain for QoL. Importantly, an association was encountered between the capacity to experience pleasure from music activities and the motor improvement in the MST group. MST as an add-on treatment showed no superiority to conventional therapies for motor recovery. Importantly, patient's intrinsic motivation to engage in musical activities was associated with better motor improvement.
  • Räty, Silja; Borrmann, Carolin; Granata, Giuseppe; Cardenas-Morales, Lizbeth; Schoenfeld, Ariel; Sailer, Michael; Silvennoinen, Katri; Holopainen, Juha; De Rossi, Francesca; Antal, Andrea; Rossini, Paolo M.; Tatlisumak, Turgut; Sabel, Bernhard A. (2021)
    Background: Occipital strokes often cause permanent homonymous hemianopia leading to significant disability. In previous studies, non-invasive electrical brain stimulation (NIBS) has improved vision after optic nerve damage and in combination with training after stroke. Objective: We explored different NIBS modalities for rehabilitation of hemianopia after chronic stroke. Methods: In a randomized, double-blinded, sham-controlled, three-armed trial, altogether 56 patients with homonymous hemianopia were recruited. The three experiments were: i) repetitive transorbital alternating current stimulation (rtACS, n=8) vs. rtACS with prior cathodal transcranial direct current stimulation over the intact visual cortex (tDCS/rtACS, n=8) vs. sham (n = 8); ii) rtACS (n = 9) vs. sham (n = 9); and iii) tDCS of the visual cortex (n = 7) vs. sham (n = 7). Visual functions were evaluated before and after the intervention, and after eight weeks follow-up. The primary outcome was change in visual field assessed by high-resolution and standard perimetries. The individual modalities were compared within each experimental arm. Results: Primary outcomes in Experiments 1 and 2 were negative. Only significant between-group change was observed in Experiment 3, where tDCS increased visual field of the contralesional eye compared to sham. tDCS/rtACS improved dynamic vision, reading, and visual field of the contralesional eye, but was not superior to other groups. rtACS alone increased foveal sensitivity, but was otherwise ineffective. All trial-related procedures were tolerated well. Conclusions: This exploratory trial showed safety but no main effect of NIBS on vision restoration after stroke. However, tDCS and combined tDCS/rtACS induced improvements in visually guided performance that need to be confirmed in larger-sample trials.
  • Turkia, Mirva (Helsingin yliopisto, 2020)
    Objectives. Reform schools (RS) in Finland are foster care institutions where children and adolescents are placed when other child welfare services fail to provide adequate education and care. Former research has shown that the mental health problems of these adolescents are multiple and severe, and they often continue to adulthood. The aim of this study was to investigate how much those placed in RS participate in rehabilitation services provided by the Social Insurance Institution of Finland (Kela) and purchase psychopharmacons after RS placement, compared to their peers. Methods. This study was a part of After reform school study (ARSS), study project by the Finnish Institute for Health and Welfare (Terveyden ja hyvinvoinnin laitos, THL), the aim of which is to research adolescent’s life after RS placement. The data for the study project was acquired in the end of 2014, and included all the adolescents residing in RS in 1991, 1996, 2001, 2006, and 2011 and their matched peers. Data analyses were conducted using logistic regression, with RS placement, cohort year, and gender as independent variables. In the final analyses, dependent variables were psychotherapy and the purchases of antipsychotics, anxiolytics, drugs used for sleep disorders, antidepressants, psychostimulants used for ADHD and drugs used in alcohol dependence. Results and conclusions. First, even though the psychiatric morbidity among the persons with RS background is high, the results of this study showed that they do not participate in the Kela´s psychotherapy services more than their peers. Second, those with RS background purchase psychopharmacons remarkably more compared to their peers. In addition, women participate in Kela´s psychotherapy, and purchase psychopharmacons more than men, except stimulants used for ADHD. Also, the youngest cohorts participate in psychotherapy and purchase psychopharmacons less than the oldest cohort. In conclusion, the psychotherapy services currently available do not meet the needs of the persons placed in RS. There should be wider range of mental health services available, and it should be made as easy as possible to access them.
  • CTR-TBI Participants Investigators; Jacob, Louis; Cogne, Melanie; Tenovuo, Olli; Azouvi, Philippe; Palotie, Aarno; Piippo-Karjalainen, Anna; Pirinen, Matti; Raj, Rahul; Ripatti, Samuli (2020)
    Background Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. Objective Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. Methods Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. Results In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). Conclusions Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.
  • Ristaniemi, Teija (2005)
    The goal of this research is to describe functionality of the psychiatric rehabilitation program from the standpoint of a patient and create a client oriented work strategy. This research examines customer orientation in psychiatric rehabilitation process from the standpoint of patients' experience. The main questions are how do patients experience customer orientation, how do they define customer orientation in their experiences and expectations and, finally, what kind of role customer orientation plays in practise of professionals. This research analyzes the experiences of nine psychiatric rehabilitation patients. I interviewed four men and five women to ensure wider approach and diversity in the results. This research respects the scientific tradition of a phenomenological-hermeneutics research. Interviews were oriented according to phrasing of a question. Collected materials are analysed using method of content-based analysis. First I dissect client orientation as a principle of service in theory. I bring out some of the changes in conception of humankind, of social welfare and public health care systems as well as new structures of unfortunate life. I also examine client orientation as a foundation of values, the changes of professionalism and customer orientation as an ethical obligation. Then I focus on customer orientation as a theoretical construct in pursuance of illustrating some definitions of customer orientation. After this I process implementation of rehabilitation in the psychiatric institutional care. This section covers the structural change of mental health services and rehabilitation of a patient with mental disturbance in the forum of rehabilitation. As the result of the analysis I created four main categories. Main categories are psychiatric hospital in experience, experiencing participating, subjectivity vs. professionalism and experiencing interaction. The contentual classes of psychiatric rehabilitation are the definitions of customer, the goals of rehabilitation and the methods of the rehabilitation. According to the mental patients client oriented rehabilitation is a process including well-planned methods, individual orientation, co-operation and constant evaluation. Implementation of customer-oriented service is good nursing and a way to reach the goals set in cooperation. Customer orientation demands multi-professional cooperation and patients who partake in decision-making. The requirements for customer-oriented service are fluent flow of information between professionals and a patient, empowering co-operation, relevant agency and making time for above-mentioned. The guideline for customer-oriented service can be described with words such as explicitness, integrity, trust, individuality, solidarity, affability, supportive, empathy and discretion. The structure of rehabilitation process seemed to be unclear and without any terse structure. For the mean time the proportion of customers influence in rehabilitation plan was fringe. Customers' role was to be an informant and passive recipient. Target-orientation of rehabilitation was mostly problem-based and strengthens the conception of metal disturbance as a static and chronic phenomenon. Also integration of institutional care and treatment of outpatients appeared to be unclear. But the same token, the patients' slant on professionalism was pretty ambiguous. On the one hand patients were willing to have an influence in the rehabilitation plan, on the other hand they were willing to bow out of decision-making. Professionalism claimed patients' attention and justification regardless. The main obstacle for customer orientation, as experienced in the field of mental health care, was the dominating working culture based on the classical idea of professionalism. The obstacles to better customer orientation were related to the implementation of treatments, the attitudes of nurses and patients, setting and reaching the goals, insufficient interaction and some necessities of treatment. It was obvious that rehabilitation and the principles of customer orientation were always in contradiction in a setting where the possibility of coercive measures exists. While defining customer orientation, the rehabilitation patients do not come out with any expectations or suggestions related with the economical or administrative issues of the hospital. Expectations on decision-making in a wider societal context were also marginal. In consequence customer orientation will always be interpreted through the factual interdependence of a patient and the hospital stuff.
  • Westerholm, Kristina (2008)
    The purpose of this thesis was to gain insight into the juvenile justice systems in the United States and Finland through examining the experiences of probation officers working within the two systems. During the past three decades, the juvenile justice system in the United States has shown an increase of hardened ideologies and a decrease in rehabilitative ideals, which goes against the very foundation of the first juvenile court. David Garland suggests that the increased punitiveness of the U.S. society is a symptom of the era we are living in, which he calls “late twentieth century modernity.” This is an era which has simultaneously recognized profound economic, cultural, social and political changes, and with it creating a sense of ontological insecurity for people. However, juvenile justice policies in Finland during this time have evolved in the opposite direction, placing increased emphasis on the special consideration needed for juvenile offenders. By examining the experiences of probation officers working within the two systems, this thesis attempted to determine what the current atmosphere of the systems was. As such, this study attempted to answer the following questions: (1) are the hardening ideologies supported by the probation officers answers who work with juvenile offenders? (2) How do the probation officers experience working within their respective systems and (3) what are their views on juvenile offenders? Consequently (4) are we able to determine where the current emphasis of the respective systems studied is on a treatment – punishment axis? This thesis utilized an exploratory survey design. Approximately 165 individuals who work for the Probation Service in Finland and the Georgia Department of Juvenile Justice in the United States were selected to voluntarily respond to a survey questionnaire. The survey contained both quantitative and qualitative items and was analyzed through quantitative and qualitative methods making it a mixed-model study. The results indicate that probation officers in Finland believe in rehabilitation among juvenile offenders and support a system based on rehabilitative ideals. Probation officers in the United States still believe in rehabilitation as well, but have accepted a system which has evolved to one based on punitive ideals.