Browsing by Subject "Institutionalization"

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  • Heikkilä, Elisa; Salminen, Marika; Viljanen, Anna; Katajamäki, Taina; Koivula, Marja-Kaisa; Pulkki, Kari; Isoaho, Raimo; Kivelä, Sirkka-Liisa; Viitanen, Matti; Löppönen, Minna; Vahlberg, Tero; Viikari, Laura; Irjala, Kerttu (2021)
    BackgroundPreviously, several indexes based on a large number of clinical and laboratory tests to predict mortality and frailty have been produced. However, there is still a need for an easily applicable screening tool for every-day clinical practice.MethodsA prospective study with 10- and 18-year follow-ups. Fourteen common laboratory tests were combined to an index. Cox regression model was used to analyse the association of the laboratory index with institutionalization and mortality.ResultsThe mean age of the participants (n =1153) was 73.6 (SD 6.8, range 64.0-100.0) years. Altogether, 151 (14.8%) and 305 (29.9%) subjects were institutionalized and 422 (36.6%) and 806 (69.9%) subjects deceased during the 10- and 18-year follow-ups, respectively. Higher LI (laboratory index) scores predicted increased mortality. Mortality rates increased as LI scores increased both in unadjusted and in age- and gender-adjusted models during both follow-ups. The LI did not significantly predict institutionalization either during the 10- or 18-year follow-ups.ConclusionsA practical index based on routine laboratory tests can be used to predict mortality among older people. An LI could be automatically counted from routine laboratory results and thus an easily applicable screening instrument in clinical settings.
  • Heikkilä, Elisa; Salminen, Marika; Viljanen, Anna; Katajamäki, Taina; Koivula, Marja-Kaisa; Pulkki, Kari; Isoaho, Raimo; Kivelä, Sirkka-Liisa; Viitanen, Matti; Löppönen, Minna; Vahlberg, Tero; Viikari, Laura; Irjala, Kerttu (BioMed Central, 2021)
    Abstract Background Previously, several indexes based on a large number of clinical and laboratory tests to predict mortality and frailty have been produced. However, there is still a need for an easily applicable screening tool for every-day clinical practice. Methods A prospective study with 10- and 18-year follow-ups. Fourteen common laboratory tests were combined to an index. Cox regression model was used to analyse the association of the laboratory index with institutionalization and mortality. Results The mean age of the participants (n = 1153) was 73.6 (SD 6.8, range 64.0–100.0) years. Altogether, 151 (14.8%) and 305 (29.9%) subjects were institutionalized and 422 (36.6%) and 806 (69.9%) subjects deceased during the 10- and 18-year follow-ups, respectively. Higher LI (laboratory index) scores predicted increased mortality. Mortality rates increased as LI scores increased both in unadjusted and in age- and gender-adjusted models during both follow-ups. The LI did not significantly predict institutionalization either during the 10- or 18-year follow-ups. Conclusions A practical index based on routine laboratory tests can be used to predict mortality among older people. An LI could be automatically counted from routine laboratory results and thus an easily applicable screening instrument in clinical settings.
  • Reynolds, Bradley (Helsingin yliopisto, 2018)
    With ongoing war in Eastern Ukraine and previously perceived collective norms of post-Cold War Europe damaged, questions of cooperation continually plague stability. With the Organization of Security and Cooperation in Europe (OSCE– Conference of Security and Cooperation in Europe or CSCE prior to 1994) being one of the only actors able to facilitate minimal conflict mediation, a research focus on the institution raises questions of historical reconciliation and subsequently, interpretation of European security. This thesis adds to the existing body of knowledge by looking at implications of CSCE/OSCE institutionalization in relation to the Nagorno-Karabakh (NK) conflict, the possible application of a peacekeeping operation (PKO) in the region, and the subsequent narratives actors attempted to write through this process. As shown by recent OSCE Network Projects, contemplating narrative is critical when placing the CSCE/OSCE within a larger post-Cold War debate on historiography (Nünlist 2014; Nünlist, Aunesluoma, Zogg 2017; Zellner 2017). This study then tracks various actors’ interests in constructing new European conflict management structures and hence, a new meaning of European security after the Cold War. Politics in various participating states changed during the 1990’s and their new commitments to a common CSCE/OSCE narrative became complicated. Within this volatile period, former N+N (Neutral and Non-Allied) states, and momentarily former Warsaw Pact (WP) states, were the most noticeable supporters of new collective European security ideas through their advocacy for CSCE/OSCE institutional evolution. Though Russian and America also supported these visions, their interest in an institutionalized OSCE needed to be encouraged by numerous small states’ stalwart commitments to the ideas and norms of the early 1990’s. This helped institutionally solidify what are today critical aspects of the European security order. However, as none of these actors are monoliths and can be neatly grouped into strict analytical containers for long periods of time, institutionalization and norms became points of contention as political winds continued to shift. This story will be viewed from three different perspectives: sub-regional (South Caucasus), regional (greater European), and institutional (CSCE/OSCE). This research stems from an interdisciplinary background in political history, using archival materials, informal interviews, accounts of practitioners associated with the conflict, as well as an array of secondary sources. Constructivist theory on structural security from the Copenhagen School, Regional Security Complex Theory (RSCT) (Buzan and Waever 2003), will be applied. In regards to narrative, strategic culture, salience of norms (Hecht 2016), and memory will be briefly employed to discuss how ideas may have influenced actors’ perception of a new ‘Europe’ in relation to security. This allows for an additional lens when attempting to represent small states’ perspectives and hence, narrative construction, of security providers in the post-Soviet space.
  • Viljanen, Anna; Salminen, Marika; Irjala, Kerttu; Heikkilä, Elisa; Isoaho, Raimo; Kivelä, Sirkka-Liisa; Korhonen, Päivi; Vahlberg, Tero; Viitanen, Matti; Wuorela, Maarit; Löppönen, Minna; Viikari, Laura (BioMed Central, 2021)
    Abstract Background Objective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults. Also, self-reported assessment of health by simple self-rated health (SRH) has been shown to predict mortality and institutionalization. The aim of this study was to assess the association of objective and subjective health with mortality and institutionalization in Finnish community-dwelling older adults. Methods In this prospective study with 10- and 18-year follow-ups, objective health was measured by registered illnesses and subjective health was evaluated by simple SRH, self-reported walking ability (400 m) and self-reported satisfaction in life. The participants were categorized into four groups according to their objective and subjective health: 1. subjectively and objectively healthy, 2. subjectively healthy and objectively unhealthy, 3. subjectively unhealthy and objectively healthy and 4. subjectively and objectively unhealthy. Cox regression model was used in the analyses. Death was used as a competing factor in the institutionalization analyses. Results The mean age of the participants (n = 1259) was 73.5 years (range 64.0–100.0). During the 10- and 18-year follow-ups, 466 (37%) and 877 (70%) died, respectively. In the institutionalization analyses (n = 1106), 162 (15%) and 328 (30%) participants were institutionalized during the 10- and 18-year follow-ups, respectively. In both follow-ups, being subjectively and objectively unhealthy, compared to being subjectively and objectively healthy, was significantly associated with a higher risk of institutionalization in unadjusted models and with death both in unadjusted and adjusted models. Conclusions The categorization of objective and subjective health into four health groups was good at predicting the risk of death during 10- and 18-year follow-ups, and seemed to also predict the risk of institutionalization in the unadjusted models during both follow-ups. Poor subjective health had an additive effect on poor objective health in predicting mortality and could therefore be used as part of an older individual’s health evaluation when screening for future adverse outcomes.
  • Viljanen, Anna; Salminen, Marika; Irjala, Kerttu; Heikkilä, Elisa; Isoaho, Raimo; Kivelä, Sirkka-Liisa; Korhonen, Päivi; Vahlberg, Tero; Viitanen, Matti; Wuorela, Maarit; Löppönen, Minna; Viikari, Laura (2021)
    Background Objective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults. Also, self-reported assessment of health by simple self-rated health (SRH) has been shown to predict mortality and institutionalization. The aim of this study was to assess the association of objective and subjective health with mortality and institutionalization in Finnish community-dwelling older adults. Methods In this prospective study with 10- and 18-year follow-ups, objective health was measured by registered illnesses and subjective health was evaluated by simple SRH, self-reported walking ability (400 m) and self-reported satisfaction in life. The participants were categorized into four groups according to their objective and subjective health: 1. subjectively and objectively healthy, 2. subjectively healthy and objectively unhealthy, 3. subjectively unhealthy and objectively healthy and 4. subjectively and objectively unhealthy. Cox regression model was used in the analyses. Death was used as a competing factor in the institutionalization analyses. Results The mean age of the participants (n = 1259) was 73.5 years (range 64.0-100.0). During the 10- and 18-year follow-ups, 466 (37%) and 877 (70%) died, respectively. In the institutionalization analyses (n = 1106), 162 (15%) and 328 (30%) participants were institutionalized during the 10- and 18-year follow-ups, respectively. In both follow-ups, being subjectively and objectively unhealthy, compared to being subjectively and objectively healthy, was significantly associated with a higher risk of institutionalization in unadjusted models and with death both in unadjusted and adjusted models. Conclusions The categorization of objective and subjective health into four health groups was good at predicting the risk of death during 10- and 18-year follow-ups, and seemed to also predict the risk of institutionalization in the unadjusted models during both follow-ups. Poor subjective health had an additive effect on poor objective health in predicting mortality and could therefore be used as part of an older individual's health evaluation when screening for future adverse outcomes.