Suchergebnisse

This paper aims at defining the concept of "geopolitical space of the geopolitics of the Sea" and it analyses the way it is constructed. Given that the notion of geopolitical space in the general sense has been largely neglected in contemporary geopolitical theory, this is not a simple task. The paper deals with a physical space of the World Sea and utilizes the theory of modern human geography in which space is understood as a product of human activity. We argue that there is a significant connection between geopolitics of the Sea and the academic discipline of the International Law of the Sea. This link is taken as the basis for the discussion regarding geopolitical space, which encompasses three teleological elements: the fulfillment of the paper's main objective; the argument regarding the connection of Geopolitics of the Sea with the International Law; and, finally, presenting the political science context of the codification of the modern International Law of the Sea. By using earlier studies, the paper analyses the geopolitical space through ideas of construction within dichotomy, as well as through the process of establishing a community within the international framework. The paper also offers our own theory according to which the geopolitical space is the space of manifestation of geopolitical phenomena. ; Temeljni je cilj rada prikazati na koji način nastaje i šta zapravo jeste "geopolitički prostor geopolitike mora". Argumentacija nije bila jednostavna jer je geopolitički prostor kao pojam u općem smislu zanemaren u recentnoj geopolitičkoj teoriji. U diskusiji smo se bavili fizičkim prostorom Svjetskog mora te koristili teorijom suvremene humanističke geografije u kojoj je prostor proizvod društvene djelatnosti. Iznijeli smo stav da je geopolitika mora posebno disciplinarno povezana s međunarodnim pravom mora. To smo, dalje, iskoristili kao poligon za raspravu o geopolitičkom prostoru, i to s tri teleološka elementa: ispunjenje osnovnog cilja rada; argumentacija veze s pravom; te prikaz politološkog konteksta procesa kodifikacije suvremenog međunarodnog prava mora. Geopolitički prostor smo ispitali kroz postojeće ideje konstrukcije unutar dihotomije, te pri uspostavi zajednice u međunarodnom okviru. Ponudili smo i vlastitu teoriju po kojoj je geopolitički prostor prostor manifestacije geopolitičkih fenomena.

زمینه و هدف: کمبود مواد غذایی، تغییرات اقلیمی و دیگر عوامل سبب شده تا تولید گیاهان تغییر شکل‌یافته ژنتیکی (محصولات تراریخته) از دهه 90 میلادی مورد توجه قرار گیرد. تولید این گیاهان همان‌گونه که موجب امیدواری در رفع گرسنگی بود، به دلیل تأثیر احتمالی بر محیط زیست موج نگرانی را نیز برانگیخت. هدف از این تحقیق، بررسی تعهدات زیست‌محیطی دولت‌ها در حوزه محصولات تراریخته در پرتو اصول حقوق بین‌الملل محیط زیست، اتحادیه اروپا و ایران است. مواد و روش‌ها: نوشتار حاضر به شیوه توصیفی ـ تحلیلی ابتدا اصول پیش‌گفته حاکم در حقوق بین‌الملل محیط زیست را بررسی می‌کند تا دریابد تعهدات زیست‌محیطی دولت‌ها درباره محصولات تراریخته از نظر اصول حقوق بین‌الملل چگونه است و سپس رویکرد اختصاصی اتحادیه اروپا را بررسی و تطبیق داده و بالاخره گذرا این وضعیت را در ایران مرور می‌کند. یافته‌ها: اتحادیه اروپا برخلاف ایالات متحده دیدگاهی احتیاط‌آمیز توأم با سخت‌گیری در حمایت از مصرف‌کننده و محیط زیست پیش گرفته که ریشه در اصول کلی حقوق بین‌الملل محیط زیست دارد. اصولی مانند توسعه پایدار، اقدام احتیاطی، ارزیابی و اطلاع‌رسانی که به جمع رعایت مصالح دولت‌ها در دستیابی به توسعه و پیشرفت و حفظ محیط زیست می‌انجامد، در حالی که در ایران از سویی قوانین حمایتی از محیط زیست به صورت کارآمد تصویب نشده است و یا این‌که در برخی موارد محیط زیست و حمایت از آن مغفول مانده است. ملاحظات اخلاقی: در تمام مراحل نگارش پژوهش حاضر، ضمن رعایت اصالت متون، صداقت و امانتداری، رعایت شده است. نتیجه‌گیری: نتایج این جستار نشان می‌دهد که دولت‌ها در خصوص محصولات تراریخته متعهد به رعایت اصول کلی یا عرفی توسعه پایدار، اقدام احتیاطی، ارزیابی و اطلاع‌رسانی بوده و رعایت اصول مزبور بهترین راهکار جهت صیانت از حقوق مصرف‌کننده و حمایت از محیط زیست است. ; Background and Aim: Food scarcity, climate change and other factors have led to the production of genetically modified crops (transgenic crops) since the 1990s. The production of these plants, as they had hoped to eliminate hunger, also raised concerns about the potential impact on the environment. The purpose of this study is to examine the Governments' Environmental Obligations on Genetically Modified Organism (GMO) in the light of the International Environmetal Law, European Union and Iran. Materials and Methods: The present paper is descriptive-analytical paper and firstly examines the aforementioned principles of international environmental law in order to understand what is the environmental commitment and obligation of governments in the process of cultivation and supply for transgenic products from the perspective of international law. Then, it examines and applies the EU-specific approach and finally reviews this situation in Iran. Findings: The European Union, unlike United States, has taken a cautious approach to consumer and environmental protection. This approach is rooted in the general principles of international environmental law. Principles such as sustainable development, precautionary principle and the principle of notification that bring together the interests of governments in achieving development, improvement and environmental protection, while in Iran,It has not been enacted environmental laws effectively on the GMO or in some cases the environment and its protection have been neglected. Ethical Considerations: In order to organize this research, while observing the authenticity of the texts, honesty and fidelity have been observed. Conclusion: The results show that governments are committed to adhering to the general or customary principles of sustainable development, precautionary principle and the principle of notification in the process of cultivating and supplying for Genetically Modified Organism (GMO), and adhering to these principles is the best way to safeguard consumer rights. Cite this article as: Pouresmaeili A, keykhosravi M, Vaezi Kakhki MR. The Studying of Governments' Environmental Obligations on Genetically Modified Organism (GMO) in the light of the International Environmetal Law, European Union and Iran. Bioethics Journal 2020; 10(35): e16.

Raportissa tarkastellaan sotilaallisen t&k-panostuksen ja kilpailukyvyn välisiä yhteyksiä. Aineistona käytetään brittiläisen International Institute for Strategic Studies -laitoksen (IISS) "The Military Balance" -raportin tietoja länsimaiden sotilaallisen t&kpanostuksen kehityksestä. Julkisen vallan sotilaallisia t&k-panostuksia verrataan maiden julkisiin siviilipuolen t&k-menoihin, sotilaallisiin hankintamenoihin, sekä suhteessa maiden BKT:hen ja puolustusbudjetteihin. Raportissa on mukana myös tiivis katsaus sotilaallisen t&k-panostuksen ja tuottavuuden välistä yhteyttä kuvaavista kansainvälisistä tutkimuksista. Raportin tulosten mukaan sotilaallisella t&k-panostuksella ja kilpailukyvyllä ei ole suoraa yhteyttä. ; This study discusses the relationship between military R&D and competitiveness. The study is based mainly on a British International Institute for Strategic Studies -institutes publication "The Military Balance", and furthermore its information about the development of Western countrye´s military R&D-stakes for the years 1994 -2001. Government military R&D is compared for government R&D, defence expenditure and also to the countries gross domestic product and defence budgets. The study also includes tight review about the previous international studies, which are focused to study the relationship between military R&D and productiveness. The study concludes, that there are no direct connection between military R&D and competitiveness.

The article discusses the status, rights and perspectives of the minorities and "non-constituent" peoples in Bosnia and Herzegovina. The status of the "constituent minorities" (the "Others") is very specific and different from the minorities' status in neighbouring countries. The article argues that in Bosnia and Herzegovina "traditional" attitudes like ethno-nationalism, discrimination, violation of minorities rights and freedoms are still very dominant. A direct consequence of this socio-political atmosphere is ethno-particularisation of society and destabilization of the state in domestic and international contexts. This short review of the status of minorities in Bosnia and Herzegovina is an insight into the international and national instruments that regulate the status and rights of the national minorities in Bosnia and Herzegovina. The authors highlight the specificity of the country, i.e. the institutional discrimination of citizens that belong to the "others", but are still citizens of Bosnia and Herzegovina. The authors claim that the citizenship of Bosnia and Herzegovina should be an efficient protection against the observed discrimination. ; Tema ovog članka je položaj, prava i perspektiva manjina i "nekonstitutivnih" naroda u Bosni i Hercegovini. Položaj posebne grupe "konstitutivnih manjina" (tzv. ostalih) Bosnu i Hercegovinu čini specifičnom i po mnogim faktorima razlikuje od drugih država u okruženju. Članak se fokusira na tezu da u Bosni i Hercegovini još uvijek dominiraju određene "tradicionalne" političke i društvene projekcije koje se iskazuju u formi etnonacionalizma, diskriminacije, kršenja manjinskih prava i sloboda, odnosno demokraciji neprimjerenih supstrata i supstituta. Izravan produkt ovakvog socio-političkog ambijenta jeste etno-partikularizacija društva i destabilizacija države na unutarnjem i međunarodnom planu. Ovaj kratki ogled o položaju manjina u Bosni i Hercegovini, sem pregleda međunarodnih i nacionalnih instrumenata koji reguliraju status i prava nacionalnih manjina, nudi uvid u pomenutu specifičnost Bosne i Hercegovine: institucionaliziranu diskriminaciju građana koji pripadaju kategoriji "ostali", koji su žrtve diskriminacije, iako bi njihovo bosanskohercegovačko državljanstvo per se, i po prirodi stvari, trebalo predstavljati učinkovitu smetnju ovakvoj diskriminaciji.

Considering that in the spectrum of juvenile criminal sanctions punishment of deprivation of liberty is the most severe criminal sanction, international documents related to juveniles in conflict with the law proclaim standards that this sanction has to be imposed only as a measure of last resort and for the shortest period. Issues like possible duration of subject sanction and scope of its imposition, represents some of the basic features of the legal and judicial policy of sanctioning of juveniles, and represent the subject of this paper. The author analyzes how these issues are regulated in Bosnia and Herzegovina"s and comparative law, and how aforementioned standards are applied in practice. Applying the comparative analysis it was determined that there are certain indicators that Bosnia and Herzegovina is one of the countries that has in its heritage "humane" sanctioning policy of juvenile offenderes, and that the aforementioned international standards are consistently accepted in domestic law as well as in the jurisprudence. ; Imajući u vidu da u spektru maloljetničkih krivičnih sankcija kazna lišenja slobode predstavlja najstrožiju krivičnu sankciju, međunarodni dokumenti iz oblasti postupanja sa maloljetnicima u sukobu sa zakonom proklamiraju standard da se ona ima izricati samo kao krajnje sredstvo (ultima ratio) i u što kraćem trajanju. Upravo pitanja mogućeg trajanja predmetne sankcije, te obima njenog izricanja predstavljaju neka od osnovnih obilježja zakonske i sudske politike sankcioniranja maloljetnika, te čine predmet istraživanja ovog rada. Autor je analizirao kako su ova pitanja uređena u bosanskohercegovačkom i uporednom pravu, te kako su spomenuti standardi oživotvoreni u praksi. Primjenom komparativnopravne analize utvrđeno je kako postoje određeni pokazatelji da Bosna i Hercegovina spada u red zemalja koje baštine "humanu" politiku sankcioniranja maloljetnih učinitelja krivičnih djela, te da su spomenuti međunarodni standardi dosljedno prihvaćeni kako u pravu, tako i u sudskoj praksi ove zemlje.

This paper is an analysis of the foreign Aid Policies of two OECD Development Assistance Committee member countries – Finland and Ireland. The analysis reveals that both Finland and Ireland share high principles on their relations with the developing world, although their current policy outlooks appear to differ significantly. Despite Finland's good economic performance and prosperity largely generated by the global demand and market access, the government has so far failed to include the increasing of ODA on its priority agenda. In addition to the declining commitment, the selection criteria for Finnish aid recipients appears to be partially commercially motivated. Ireland on the other hand has a solid record of targeting the poorest of the poor with its development assistance and has recently increased development country focus in national policies. The challenge for Ireland is the effective utilisation of these funds and even more importantly keeping the government's public, international commitment to the 0,7 percent recommendation level despite the possible future slowdown of the economy.

Ex ante assessment of regulatory impact upon businesses: A neo-institutional study on the context, international influences, and Finnish experiences Regulatory impact assessment (RIA) has an established place in the European Union and its member states. This article considers evolving Finnish ex ante RIA concerning certain regulatory costs to firms. Drawing upon a neo-institutional theoretical framework and proposing three generally oriented hypotheses we received the following results. (1) The rationality of theevolving Finnish ex ante RIA of selected administrativeregulatory costs to firms gives rise issuesgiven the low implementation rate of thegeneral natonal RIA guidelines. (2) Reference to the ex ante RIA of regulatory costs to firmsin other countries has served the legitimation of preferred procedures in Finland rather than offerssolid evidence on the rationality of the foreign procedures. (3) Without a stronger contextualization of the evolving Finnish ex ante RIAmof regulatory costs to firms its procedures risk adverse effects because of their confined scope, the uneven quality of their input data, and their weak connections to the general national ex ante RIA. These results suggest the redesign of the Finnish RIA to take better into account the institutional, political, historical and cultural characteristicsof governance in this country. Keywords: regulatory impact assessment, public policy evaluation, public policymaking, lawmaking, legal policy, deregulation ; Peer reviewed

Intentional and Unintentional Injuries;Healthy ApproachReferences Haddon WJr, Suchman E, Klein D. Accident Research: Methods and Approaches. Harper & Row Publishers, Chicago, IL, USA. 1964.Global Burden of Diseases, World Health Organization, http://www.who.int/topics/global_burden_of_disease/en/ Date of access, Sept. 2012.Iranian Census Center. http://www.amar.org.ir/, Date of Access August 2012.Iranian Legal Medicine Organization, www: lmo.ir/ Date of access, Sept. 2012.Hargarten, J.W.R.a.S.W. (2002). Principles of the Disease of Injury. Rosen's Emergency Medicine. J.A. Marx. St. Louis, Missouri, Mosby Inc. 1:821-828.Jones BH, Canham-Chervak M, Sleet DA .An evidence-based public health approach to injury priorities and prevention recommendations for the U.S Military. Am J Prev Med. 2010 Jan; 38(1 Suppl):S1-10.Khorasani-Zavareh D. System versus traditional approach in road traffic injury prevention: a call for action. J Inj Violence Res. 2011 J; 3(2): 61.Peden M, Scurfield R, Sleet D, Mohan D, Hyder A, Jarawan E, MathersC: World Report on Road Traffic Injury Prevention Geneva: World Health Organization; 2004.H. Soori, S.J. Hussain and J.A. Razzak.Road safety in the Eastern Mediterranean Region – findings from the Global Road Safety Status Report. EMHJ 2011; 17 (10): 770-76.World Health Organization. Data systems- A road safety manual for decision-makers and practitioners. World Health Organization. Geneva 2010.Margie Peden, Richard Scurfield, David Sleet, Dinesh Mohan, Adnan A. Hyder, Eva Jarawan Colin Mathers. World report on road traffic injury prevention: summary .World Health Organization Geneva 2004. Economic Commission for Europe. Glossary of transport statistics, 3rd Ed. New York, NY, United Nations Economic and Social Council, 2003 (TRANS/WP.6/2003/6) (http:// www.unece.org/trans/main/wp6/pdfdocs/glossen3.pdf, accessed 16 September 2012. 2008). World Health Statistics 2008. Geneva, World Health Organization, 2008 (http://www.who.int/whosis/ whostat/2008/en/index.htm, accessed 16 September 2012.Mathers C, Loncar D. Updated projections of global mortality and burden of disease, 2002–2030: data sources, methods and results. Geneva, World Health Organization, 2005.Kopits E, Cropper M. Traffic fatalities and income growth. Accident Analysis and Prevention, 2005, 37:169–178.Vincenten J, Michalsen A. Priorities for child safety in the European Union: agenda for action. Injury Control and Safety Promotion, 2003, 9:1–8.WHO mortality database: tables. Geneva, World Health Organization (http://www.who.int/healthinfo/morttables/en/index.html, accessed 21 September 2012).Rahman A. Bangladesh health and injury survey: report on children. Dhaka, Government of the People's Republic of Bangladesh, ICMH, UNICEF and TASC, 2005.Sitthi-amorn C. Child injury in Thailand: a report on the national injury survey. Bangkok, Institute of Health Research, TASC and UNICEF, 2006 (http://www.tasc- gcipf.org/downloads/Thai%20child%20report.pdf,accessed 22 August 2012).Bener A. The neglected epidemic: road traffic accidents in a developing country. State of Qatar. International Journal of Injury Control and Safety Promotion, 2005, 12:45–47.Pedem M, Oyegbite K,Ozanne-Smit J, Hyder AA, Branche c, Rahman AKMF and et al. Mortality due to injuries in Maputo city, Mozambique. International Journal of Injury Control and Safety Promotion, 2006, 13:1–6.Hyder AA, Labinjo M, Muzaff ar SSF. A new challenge to child and adolescent survival in urban Africa: an increasing burden of road traffic injuries. Traffic Injury Prevention 2006, 7:381–388.World Health Organization. Global status report on road safety: time for action. Geneva. 2009.World Health Organization. TEACH-VIP curriculum [electronic resource]. Users' manual. 2005.David R. Meddings, MHSc, FRCP(C), Lyndee M. Knox, Matilde Maddaleno, Alberto Concha-Eastman, Joan Serra Hoffman. World Health Organization's TEACH-VIP Contributing to Capacity Building for Youth Violence Prevention. Am J Prev Med 2005; 29(5S2):259–265.Akbari M, Naghavi M, Soori H. Epidemiology of Deaths from injuries in the Islamic Republic of Iran. Eastern Medietr Health J 2006; 12(3/4): 50-58.Falls. Geneva, World Health Organization, Violence and Injury Prevention and Disability Department (http:// www.who.int/violence_injury_prevention/other_injury/falls/en/index.html, accessed Sept 2012.Christoffel KK, Scheidt PC, Agran PF, Kraus JF, McLoughlin E, Paulson JA. Standard definitions for childhood injury research: excerpts of a conference report. Pediatrics, 1992, 89:1027–1034.Khambalia A, Josh P, Brussoni M, Raina factors for unintentional injuries due to falls in children aged 0–6 years: a systematic review. Injury Prevention, 2006, 12:378–385.Bartlett SN. The problem of children's injuries in low income countries: a review. Health Policy and Planning, 2002, 17:1–13.Morrison A, Stone DH. Unintentional childhood injury mortality in Europe 1984–93: a report from the EURORISC Working Group. Injury Prevention, 1999, 5:171–176.A league table of child deaths by injury in rich countries (Innocenti Report Card No. 2). Florence, UNICEF Innocenti Research Centre, 2001 (http://www.unicef-icdc. org/publications/pdf/repcard2e.pdf, accessed Sept 2012.Hyder AA, Sugerman D, Ameratunga S, Callaghan J A, Falls among children in the developing world: a gap in child health burden estimations? Acta Paediatrica, 2007, 96:1394–1398.Bangdiwala SI, Anzola-Pérez E, Romer CC, Schmidt B, Valdez-Lazo F, Toro J, D'Suze C. The incidence of injuries in young people: I. Methodology and results of a collaborative study in Brazil, Chile, Cuba and Venezuela. International Journal of Epidemiology, 1990, 19:115–124.Del Ciampo LA, Ricco RG, De Almeida CA, Mucillo G. Incidence of childhood accidents determined in a study of home surveys. Annals of Tropical Paediatrics, 2001, 21:239–243.Savitsky B, Aharonson-Daniel L, Giveon A. Variability in pediatric injury patterns by age and ethnic groups in Israel. Ethnicity and Health, 2007, 12:129–139. Bener A, Hyder AA, Schenk E. Trends in childhood injury mortality in a developing country: United Arab Emirates.Accident and Emergency Nursing, 2007, 15:228–233.Facts about injuries: burns. Geneva, World Health Organization and International Society for Burn Injuries, 2006 (http://www.who.int/entity/violence_injury_prevention/publications/other_injury/en/burns_factsheet.pdf, accessed Sept 2012.Davies JW. Toxic chemicals versus lung tissue: an aspect of inhalation injury revisited. Journal of Burn Care and Rehabilitation, 1986, 7:213–222.Saffle JR, Davis B, Williams P. Recent outcomes in the treatment of burn injury in the United States: a report from the American Burn Association patient registry. Journal of Burn Care and Rehabilitation, 1995, 16:219–232.Moritz AR, Henriques FC. Studies of thermal injury II: the relative importance of time and surface temperature in the causation of cutaneous burns. American Journal of Pathology, 1947, 23:695–720. Lund C, Browder N. The estimation of areas of burns. Surgical Gynecology and Obstetrics, 1944, 79:352–358.MacLennan N, Heimbach D, Cullen FB. Anesthesia for major thermal injury. Anesthesiology, 1998, 89:749–770. Walton J, Mandara AR. Burns and smoke inhalation. Anesthesia and Intensive Care Medicine, 2005, 6:317–321. WHO mortality database: tables. Geneva, World Health Organization (http://www.who.int/healthinfo/ morttables/en/index.html, accessed 21 April 2012). Barrow RE, Spies M, Barrow L N, Herndon D N. Influence of demographics and inhalation injury on burn mortality in children. Burns, 2004, 30:72–77. Achebe UJ, Akpuaka FC. Chemical burns in Enugu. West African Journal of Medicine, 1989, 8:205–208. Chuang SS, Yang JY, Tsai FC. Electric water heaters: a new hazard for pediatric burns. Burns, 2003, 29:589–591. Nursal, T Z, Yildirim S, Tarim A, Caliskan K, Ezer A, Noyan T. Burns in southern Turkey: electrical burns remain a major problem. Journal of Burn Care and Rehabilitation, 2003, 24:309–314.

Energy as one of the most important factors of production, today has a great contribution to the economic growth and development of countries and has played the greatest role in the development of recent human civilization. This role, from transportation to food production and the provision of medical and health services, is becoming more prominent day by day. In order to continue the supply of energy in order to continue to use it, a lot of investment must be made. That is why energy security has been so much the focus of energy policymakers around the world. In this book, we first address the issue of defining and examining the importance of energy security then we talk about fossil fuels. In the following, we will discuss the effects of fossil fuels on the Earth's climate and biosphere. The issue of international agreements, including the Paris Agreement, will also be considered, as well as providing solutions to fossil fuel damage by introducing renewable energy sources, which will be one of the chapters of this book. Finally, we will examine the disadvantages and disadvantages of renewable energy to realize that these energies are not perfect in themselves! Instead of fearing, or sitting and calculating, that there are a few years left until the end of the life of oil reserves, the world needs a policy that thinks about the available alternatives. Much more and better alternatives to the fossil fuels that have driven the world and industry for years. Renewable energy sources are another proposition facing human societies. A way to overcome the energy crisis and the time bomb that seems to be tuned to announce the end of energy at any moment. In fact, we should listen to the proposal of the Saudi Minister of Energy in the 1970s, who said: "The Stone Age did not end because the stone ran out. The age of oil must end much sooner than the end of oil."

Abstract The present study concerns the recruitment of foreign workforce in municipalities and private enterprises which provide local services. We scrutinize in which professions the workforce is required in the future. This research also focuses on ways how the employer can hire the best suitable foreign employees in the organization. As the final step the aim is to develop a model for recruitment of foreign workforce. This topic is currently interesting because of the increase of the share of older population and the decrease of available workforce in Finland in the near future. It is estimated that for example there will be 185 000-210 000 new jobs available in social and health care sectors during 2005-2020. The purpose of this dissertation is to increase the knowledge regarding the recruitment of foreign workforce in the municipality sector. The research was carried out using questionnaires for ten different organizations in Northern Ostrobothnia. These are Pudasjärvi, Kempele, Liminka, Muhos, Hailuoto, Sievi, Lumijoki and Tyrnävä municipalities, Mäntykoti ry in Oulu and the Family home Ojantakanen in Pulkkila. The main research question of this dissertation is: How the recruitment of foreign workforce can be carried out in the municipality sector? The theoretical background of the analysis is based on international human resource management and multicultural literature, knowledge about the quantities of foreigners, and demographic prognosis of population statistics. Methodologically the study is a qualitative study. The research method is content analysis based on research data. The data were collected during 2011-2013 using three questionnaires to municipality and business managers. According to the results of this research the organizations need further information on how to organize the recruitment of foreign workforce the best way. There is need for the recruitment of foreign workforce in the Northern Ostrobotnia, but there are no strategies of how to carry out work-based immigration, or the strategies are inadequate. The personnel and the managers need further education to learn how to meet and orientate foreign employees. ; Tiivistelmä Tutkimus käsittelee ulkomaisen työvoiman rekrytointia kuntiin ja kunnallisia palveluja tuottaviin yksityisiin yrityksiin. Työssä selvitetään, mille aloille työvoimaa tulevaisuudessa tarvitaan ja millä keinoilla työnantaja voi palkata sopivimmat ulkomaiset työntekijät organisaatioonsa. Lisäksi tutkimuksessa on tavoitteena kehittää ulkomaisen työvoiman rekrytointimalli. Aihe on ajankohtainen, sillä väestön ikääntyminen ja työvoiman tarjonnan väheneminen vaikuttavat lähivuosina Suomen työvoiman määrään. On arvioitu, että muun muassa sosiaali- ja terveyssektorilla avautuu 185 000–210 000 työpaikkaa vuosina 2005–2020. Väitöskirjatyön tarkoituksena on lisätä tietoa ulkomaisen työvoiman rekrytoinnista kuntasektorilla. Tutkimusaineisto kerättiin Pohjois-Pohjanmaalta kymmenestä eri organisaatiosta. Nämä ovat Pudasjärven, Kempeleen, Lumijoen, Limingan, Muhoksen, Hailuodon, Tyrnävän ja Sievin kunnat, Oulun Seudun Mäntykoti ry ja Ojantakasen perhekoti Pulkkilassa. Väitöskirjan keskeinen tutkimuskysymys on: Miten ulkomaisen työvoiman rekrytointi voidaan toteuttaa kuntasektorilla? Tutkimuksen teoreettinen tausta perustuu kansainvälisen henkilöstöjohtamisen sekä monikulttuurisuuden kirjallisuuteen ja väestötilastoihin liittyviin demografisiin ennusteisiin. Tutkimusote on laadullinen. Tutkimusmenetelmänä käytettiin aineistolähtöistä sisällönanalyysiä. Tutkimusaineisto kerättiin vuosina 2011–2013 kolmella kunta- ja yritysjohtajille suunnatulla kyselyllä. Tutkimustulosten mukaan organisaatiot tarvitsevat lisätietoa siitä, mikä on paras tapa toteuttaa ulkomaisen työvoiman rekrytointi. Pohjois-Pohjanmaalla on tarvetta ulkomaisen työvoiman rekrytoinnille, mutta suunnitelmia työperäisen maahanmuuton toteuttamiseksi ei ole tai ne ovat puutteellisia. Henkilöstö ja esimiehet tarvitsevat koulutusta ulkomaalaisten työntekijöiden kohtaamiseen ja perehdyttämiseen.

Tutkimuksessa selvitetään, missä määrin työpaikkojen työsuojeluvalvontaa toteutetaan alueellisesti eri tavalla eli toteutuuko valvonta työpaikoilla yhtenäisesti eri puolilla Suomea. Tutkimuksen ennakko-oletuksena on, että merkittävä syy työsuojeluvalvonnan alueelliseen erilaisuuteen on valvonnan organisointi viiden itsenäisen aluehallintoviraston työsuojelun vastuualueen tehtäväksi. Työsuojeluhallintoa ja työsuojeluvalvonnan toteutumisen yhtenäisyyttä työpaikoilla ei ole tutkittu tieteellisesti 2000-luvulla. Tämä tutkimus arvioi työsuojeluhallinnon rakennetta ja valvonnan toteutumista sekä hallinnon että työpaikkojen näkökulmasta. Tutkimus antaa sekä tieteellisesti perusteltuja teoreettisia että hallinnon asiakkaiden näkökulmia työsuojeluhallinnossa käynnissä olevaan valvonnan yhtenäistämiskehitykseen. Tutkimuksen teoreettisena viitekehyksenä on hallinnon evaluaatiotutkimus, joka tarkoittaa hallinnon toimivuuden arviointia käyttäjä- ja asiakasnäkökulmasta. Työsuojeluhallinto toteuttaa työpaikoille kohdistuvaa työsuojeluvalvontaa työsuojelutarkastuksina, jolloin hallinnon asiakkaita ovat työpaikat ja niiden työnantajat ja työntekijät. Pääasiallisena tutkimusaineistona ovat valvontatietojärjestelmä Veran raportit ja niistä tehdyt 27 valvonnan alueellista vertailua sekä henkilöhaastattelut, jotka kohdistuvat 52:een työsuojeluhallinnon, työmarkkinajärjestöjen ja työpaikkojen työsuojeluhenkilöön. Tutkimuksessa on kolme päälukua: työsuojeluhallituksen aika 1973-1993, itsenäisten alueellisten työsuojeluviranomaisten aika vuodesta 1993 lähtien sisältäen työmarkkinajärjestöjen roolin työsuojeluvalvonnassa ja valvonnan alueellinen vertailu. Tutkimusmatkani kohti yhtenäistä työpaikkojen työsuojeluvalvontaa alkoi työsuojeluhallituksesta, joka perustettiin vuonna 1973 osana hyvinvointivaltion rakentamista ja valtiojohtoista suunnitteluoptimismia. Valtiollinen työsuojelu koottiin yhden ministeriön alaisuuteen. Työsuojeluhallituksen aikana oli keskusjohtoinen, ainakin osittain yhtenäinen työsuojeluvalvonta, mutta keskusviraston toiminta ei onnistunut, koska työnantajat vastustivat sitä koko ajan pitäen sen toimintaa konspiratiivisena, vehkeilevänä. Työsuojeluhallitus lakkautettiin vuonna 1993 osana keskusvirastojärjestelmän purkamista 1990-luvun alun taloudellisen laman seurauksena. Valtion harjoittamaa sääntelyä purettiin hallinnon kaikilla sektoreilla, ja hallintoa madallettiin lähemmäksi asiakasta. Valtion merkitystä vähennettiin koko yhteiskunnassa ja hyvinvointivaltiosta tehtiin kilpailuvaltio, jolloin markkinaliberalismi ja New Public Management voimistuivat. Työsuojeluhallituksen lakkautuksessa tehtiin ehkä muutakin politiikkaa; pirstaloimalla valvovaa hallintoa heikennettiin samalla työpaikoille kohdistuvaa keskitettyä valvonnan voimaa. Itsenäisten alueellisten työsuojeluviranomaisten aikana vuodesta 1993 lähtien entisten työsuojelupiirien ja nykyisten aluehallintoviraston työsuojelun vastuualueiden toiminnallinen itsenäisyys korostui. Hallinnon toiminnassa näkyy, ettei työsuojeluvalvonnalla ole yhteistä keskusjohtoa. Sosiaali- ja terveysministeriön työ- ja tasa-arvo-osasto, jonka alaisuuteen työsuojelu keskushallinnossa kuuluu, toteuttaa Kansainvälisen työjärjestön ILO:n (International Labour Organization) sopimusten tulkintaa, että työsuojeluhallinto on riippumaton valvontatehtävää suorittaessaan eikä ministeriö siten puutu valvonnan alueellisiin menettelytapoihin. Tutkimus käsittelee myös työsuojeluhallinnon laajaa yhteistyötä työmarkkinajärjestöjen kanssa. Järjestöt osallistuvat kaikkeen päätöksentekoon, jossa käsitellään hallinnon tavoitteita, painopisteitä, valvontaohjeita ja resursseja. Tutkimuksessa arvioidaan edustuksellisen demokratian näkökulmasta korporatiivisen etujärjestövaikutuksen ja hallinnon suhdetta riippumattoman työsuojeluvalvonnan päätöksenteossa ja toimeenpanossa. Tarkastuskertomuksiin perustuva alueellisen valvonnan vertailu osoittaa, että työsuojeluvalvonta on eriytynyt vastuualueittain. Työpaikkojen kunnossaolo määritellään usein eri tavalla, joten tarkastajien valvoma työturvallisuuden minimitaso ei toteudu yhdenmukaisesti koko maassa. Siten velvoitteita korjata tai poistaa työturvallisuusepäkohtia annetaan eri tavalla ja lopputuloksena on se, ettei työnantajia kohdella tasapuolisesti. Tutkimuksen johtopäätöksenä on, että työsuojeluvalvonta on osa kansallista hallintotoimintaa ja laillisuusvalvontaa, ei alueellista tai paikallista hallintoa. Työsuojelu ei eroa toimialoittain maantieteellisesti, koska eri ammattialojen työ on pääpiirteissään samanlaista koko maassa ja niiden työturvallisuus ei juurikaan eroa maantieteellisesti. Tämän vuoksi myös työsuojeluvalvonnan pitäisi olla yhdenmukaista koko maassa. Suomeen pitäisi perustaa Pohjoismaiden mallin mukainen työsuojelun keskusorganisaatio, joka koordinoisi yhtenäistä laillisuusvalvontaa samalla tavalla kuin Poliisihallitus, Syyttäjälaitos ja uusi Tuomioistuinvirasto koordinoivat toimialojensa laillisuusvalvontaa ja toiminnan menettelytapoja. ; This study examines the extent to which workplace occupational safety and health (OSH) enforcing is carried out differently across the Finnish regions, in other words whether workplace enforcing is uniform across Finland. The presupposition of the study is that an important reason for the regional disparity in labour inspection is the decentralized organization of the inspection to by the five independent divisions of occupational health and safety of the regional state administrative agency. The OSH administration and the uniformity of the implementation of OSH in the workplace have not been scientifically studied in the 21st century. This study assesses the structure and implementation of the OSH administration from the perspective of both the administration and the workplace. The study provides a scientifically justified analysis covering both theoretical and customers' perspectives on OSH management and the ongoing integration of health and safety enforcement. The chosen theoretical approach of the study is the administrative evaluation framework, which means assessing the functionality of administration from the user and customer perspective. The Labour Inspectorate carries out workplace safety inspections in the form of occupational safety inspections, whereby the customers of the administration are the workplaces and their employers and employees. The main research material are OSH inspection database Vera reports and personal interviews carried out with 52 persons in the job protection administration, labour organizations and employment OSH personnel. The study consists of three main empirical chapters: the Labour Protection Board, the Central Office 1973-1993, the independent Regional Labour Inspectorate since 1993, including the role of labour organizations in labour inspection and the regional comparison of labour inspection. Shift towards an integrated job labour inspection started with the Labour Protection Board which was established in 1973 as part of the construction of the welfare state during the era of optimism in state-directed planning State labour protection was brought together under one ministry. The Labour Protection Board the system was center-led, at least regarding uniform occupational health and safety enforcing, but the Board's operations were not successful, mainly because the employers were opposed to it throughout its existence. The Labour Protection Board was abolished in 1993 as part of the dismantling of the central office system that followed the economic recession in the early 1990s. State regulation in all sectors of government was decentralized and administration was brought closer to the customers. The role of the state was diminished in society as a whole and the welfare state became a competitive state, with neoliberalism and New Public Management becoming stronger. Other objectives were also part of the decision to abolish the Labour Protection Board; at the same time, the fragmentation of supervisory authorities weakened the efficiency of workplace control. The era of the independent regional labour inspectorates since 1993 underlines the functional independence of the former OSH Inspectorate and the current division of occupational health and safety of the regional state administrative agency. The operation shows that there is no common central management for labour enforcement. The Department for Work and Gender Equality of the Social and Health Ministry, which is responsible for occupational safety in central administration, interprets International Labour Organization (ILO) conventions as meaning that the labour administration is independent in carrying out its supervisory function. Thus, the Ministry does not interfere with regional control procedures. The study also deals with the extensive co-operation between the labour protection administration and the labour market organizations. Trade unions are involved in all decision-making concerning management objectives, priorities, control guidelines and resources. The study examines the influence of corporatist interest groups and the governance of occupational health and safety enforcing decision-making and implementation from the perspective of representative democracy. A comparison of regional control based on inspection reports shows that OSH control of occupational health and safety has varied between the regional divisions. The condition of workplaces is often defined differently, so the minimum level of occupational safety supervised by inspectors is not uniformly applied throughout the country. Thus, obligations to remedy or eliminate occupational safety deficiencies in workplaces are given different treatment and the result is that employees are not treated equally. The conclusion of the study is that health and safety control should be in the competence of national administration and judicial review, not regional or local administration. Occupational safety and health does not differ geographically by industry, as the work of the various occupations is broadly similar throughout the country and there is little geographical variation in occupational safety. For this reason, labour inspection should also be uniform throughout the country. Finland should set up the Nordic model of a more centralized OSH system, which would coordinate an integrated review of legality in the same way as the National Police Board, the Prosecutor's Office and the Court of Justice co- ordinate the law enforcement and operational procedures of their respective sectors.

Backgrounds and Aims: Using Geographical Information System (GIS) can decreases the burden of road traffic injuries effectively by identification of hot spot to modification in hazardous areas. The aim of the study was determining geographical distribution of human risk factors associated with road traffic injuries by using Geographical Information System (GIS) in Iran. Materials and Methods: The national database of road traffic injuries registered by the Iranian traffic Police (Rahvar NAJA) was used. The human risk factors were investigated by recognition of the hazardous points and geographical distribution of associated risk factors. The Hot Spot Analysis and Map clustering approaches were employed to meet the objectives. Results: The mean age of injured subjects was 34 years and the most affected age group was 20-39 years. Death and injury occurrence within out of cities ways were 0.3 % and 28% respectively. Geographical distribution of risk factors also showed that roads of Northern provinces i.e. (Gilaan and Mazandaran) were the hazardous rising as well as Qazvin to Rasht and Qom to Tehran roads. Sistan and Balochestan Provinces and Tehran had the highest (4.8%) and the lowest (0.1%) rates of road traffic injuries leading to death in the country. Conclusions: Northern provinces and its leading axes by hazardous rising and Sistan and Balochestan province with fatal injuries need to identify the cause of injuries' and, if necessary, more tighten regulations and more controls by the traffic police must be applied. REFERENCESPeden M, Scurfield R, Sleet D, Mohan D Hyder A A, Jarawan E . (2004).World report on road traffic injury prevention: World Health Organization Geneva. 2004.Kopits E, Cropper M. Traffic fatalities and economic growth. Accid Anal Prev 2005;37(1): 169-78.Channa R, Jaffrani H A, Khan A J, Hasan T, Razzak J A. Transport time to trauma facilities in Karachi: an exploratory study. Int J Emerg Med 2008; 1(3): 201–4. Soori H, Hussain S, Razzak J. Road safety in the Eastern Mediterranean Region–findings from the Global Road Safety Status Report. East Mediterr Health J 2011;17(10):770-6.Soori H. Descriptive study (Chapter 8) in Basic applied epidemiology. Percian text book 2nd edition.Tehran: Arjmand publisher; 2008.Gesler W. The uses of spatial analysis in medical geography: a review. Social Science & Medicine 1986; 23(10): 963-73.Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to address a global-health problem. The Lancet 2006;367(9521): 1533-40.Akbari M, Naghavi M, Soori H. Epidemiology of deaths from injuries in the Islamic Republic of Iran. East Mediterr health J 2006;12(3/4): 382-90.Rasouli M R, Nouri M, Zarei M R. Saadat S, Rahimi-Movaghar V. Comparison of road traffic fatalities and injuries in Iran with other countries. Chin J Traumatol 2008;11(3): 131-4.Ainy E, Soori H, Mahfozphoor S, Movahedinejad AA. Presenting a practical model for governmental political mapping on road traffic injuries in Iran in 2008: a qualitative study. J R Soc Med Sh Rep 2011; 2(10):79.Khorasani-Zavareh D, Mohammadi R., Khankeh H R, Laflamme L, Bikmoradi A, Haglund B J A. The requirements and challenges in preventing of road traffic injury in Iran. A qualitative study. BMC Public Health 2009; 23(9): 486-91.Nantulya V M, Reich M R. The neglected epidemic: road traffic injuries in developing countries. BMJ 2002; 324(7346): 1139-41. Elvik R. Road safety management by objectives: A critical analysis of the Norwegian approach. Accid Anal Prev 2008;40(3): 1115-22.Liang L Y, Mo'soem D, Hua L T. Traffic accident application using geographic information system. Journal of the Eastern Asia Society for Transportation Studies 2005;6(1): 3574–89.Braddock M, Lapidus G, Cromley E, Cromley R., Burke G, Banco L. Using a geographic information system to understand child pedestrian injury. Am J Public Health. 1994;84(7): 1158-61. Lascala E A, Gerbe D, Gruenewald P J. Demographic and environmental correlates of pedestrian injury collisions: a spatial analysis. Accid Anal Prev 2000;32(5): 651-8.Lightstone A, Dhillon P, Peek-Asa C, Kraus J. A geographic analysis of motor vehicle collisions with child pedestrians in Long Beach, California: comparing intersection and midblock incident locations. Inj Prev 2001;7(2): 155-60.Daum M L, Dorsch W R. Managing Land Use and Institutional Controls with GIS . Journal of Map & Geography Libraries: Advances in Geospatial Information, Collections & Archives2008 ;4(1): 163-73.Erdogan, S, Yilmaz I, Baybura T, Gullu, M. Geographical information systems aided traffic accident analysis system case study: city of Afyonkarahisar. Accid Anal Prev 1998; 40(1): 174-81.Al-Kharusi W. Update on Road Traffic Crashes. Clinical Orthopaedics and Related Research. 2008;466(10): 2457-64.Fars news. Saturday 5th October 2012.Mwatelah J. Application of Geographical Information Systems (GIS) to Analyze causes of Road traffic Accidents (RTAs)–case Study of Kenya. International Conference on Spatial Information for Sustainable Development Nairobi, Kenya. 2–5 October 2001.Cusimano MD, Chipman M., Glazier R. H, Rinner C, Marshall S P. Geomatics in injury prevention: the science, the potential and the limitations. Inj Prev 2007;13(1): 51-6.Rezaeian M, Dunn G, St Leger S, Appleby L. Geographical epidemiology, spatial analysis and geographical information systems: a multidisciplinary glossary. J Epidemiol Community Health 2005;61(2): 98-102.

VTT Symposium 191 ; Energian ja ympäristön leikkauskohdassa on viime vuosina tapahtunut suuria mullistuksia. Energiamarkkinat ovat vapautuneet ja osana kestävään kehitykseen pyrkimystä ekologinen ajattelu on saanut jalansijaa myös perinteisessä markkinataloudessa, tyyppiesimerkkinä vihreän sähkön käsite ja kierrätys. Ympäristöproblematiikassa on siirrytty megasarjaan, esimerkiksi ilmastokysymyksessä eletään suurten päätösten aikaa. Energia- ja ympäristöteknologian myynnissä myyjältä vaaditaan yhä enemmän osaamista. Tuotteiden käytön pitkäaikaiset ympäristöominaisuudet vaikuttavat ratkaisevasti kaupan syntyyn. Perinteisen kovan teknologian rinnalle tarvitaan uutta innovatiivista pehmoteknologiaa. SIHTI-ohjelma on paneutunut näihin kysymyksiin niin sanotuilla strategisilla selvityksillään. Ympäristönsuojelun ohjaukseen tarvittavaa tietoutta on luotu lukuisissa ympäristövaikutusten arvottamiseen liittyvissä hankkeissa sekä talouden ja ympäristönsuojelun optimia hakevissa selvityksissä. Yritystasolla tehtävää ympäristölaskentaa varten on luotu uusia työkaluja ja menetelmiä ja päästöpörssien monulotteisia vaiktuksia on analysoitu. Poliittisen päätöksenteon tueksi on kehitetty kasvihuonekaasujen kehitystä kuvaavia indikaattoreita ja analysoitu vaihtoehtoisten päästörajoitustekniikoiden kustannuksia ja tehokkuutta. SIHTI-ohjelmassa savukaasujen puhdistustekniikka-alueelle on syntynyt oma vahva tutkimuskokonaisuutensa, jonka ympärille on kehittynyt kansainvälisestikin arvostettuja tutkimusryhmiä. Pienhiukkasten tärkeimpiä päästölähteitä on kartoitettu, koostumuksia ja kokojakaumia mitattu ja erilaisia keinoja vaikuttaa pesureitten ja sähkösuodattimien erotustehokkuuteen tutkittu. Tutkimusryppääseen on kuulunut sekä teoreettisia mallinnuslaskelmia, laboratoriomitan laiteteknistä kehitystyötä että täyden mitan koetoimintaa. Osoituksena onnistuneesta panostuksesta on, että tutkimustuloksia on jo voitu hyödyntää kaupallisesti ja täyden mittakaavan laitetoimituksia ulkomaille on jo toteutettu. Uusia innovatiivisia teknisiä ratkaisuja ympäristöpäästöjen mittaamisella on myös kehitetty. Metsäteollisuuden ympäristövaikutusten hallinnan parantamiseksi on ohjelman puitteissa perusteellisesti mitattu ja mallinnettu haitallisten aineiden kulkeutumista eri virroissa ja prosessiyksiköissä sekä tutkittu ja kehitetty uusia säästävän teknologian ratkaisuja mm. sellutehtaan vesikiertojen sulkemiselle, viherlipeäsakan ja tuhkan hyödyntämiselle sekä siistauslietteen ja jätepaperin poltosta syntyvän tuhkan kierrättämiselle. Turvetuotannon valumavesien sekä pöly- ja melupäästöjen paremmalle hallinnalle on kehitetty uusia menetelmiä ja ohjeita, joita on jo otettu käyttöön. Vaihtoehtoisia ratkaisuja käytettyjen turvetuotantoalueiden jälkikäytölle on niin ikään tutkittu. Poikkitieteellisen lähestymistavan takia SIHTI-ohjelma on pyrkinyt tiedottamaan tutkimustuloksistaan mahdollisimman laajasti. Ohjelman vuosiseminaari ja sen yhteydessä pidettävät istunnot energiantuotannon päästöjen ympäristövaikutuksista, pienhiukkasten erottamisesta ja kiinteiden jätteiden hyötykäytöstä suovat oivallisen tilaisuuden niin esitelmänpitäjille kuin kuulijoillekin antaa oman panoksensa meitä kaikkia hyvin läheisesti askarruttavaan kysymykseen, mikä on oikea tie ja etenemistapa kestävään energiantuotantoon. ; Great revolutions have taken place in the intersection of energy and environment in recent years. The energy market has been liberated, and in part of sustainable development, an ecological pattern of thought has gained a footing in traditional market economy, typical examples being green electricity and recycling. As regards environmental problems, we have moved towards a mega-league; for example, we are living an era of great resolutions on environmental issues. More diversified knowhow is required from the sellers of energy and environmental technology. Long-term environmental impacts of the use of products are of decisive significance in business transactions. New innovative soft-line technology is required in addition to conventional hard technology. The Finnish National SIHTI Programme has attended to these issues via so-called strategic surveys. Knowledge required for the control of environmental protection was created in a number of projects on evaluation of environmental impacts and in assessments searching an optimum for economy and environmental protection. New tools and methods were developed for environmental accounting in enterprises, and diversified impacts of emission exchange were analysed. Indicators describing the development of greenhouse gases were developed and costs and efficiency of alternative technologies for limiting emissions were analysed to support political decision-making. In the SIHTI Programme, a strong research integrity was formed in the field of flue gas cleaning technology, and research groups with a high international esteem were also formed. Most significant emission sources of particulates were surveyed, their composition and particle size distributions were measured, and different tools of improving the separation capacity of scrubbers and electrical precipitators were studied. This research integrity included both theoretical modelling calculations, laboratory-scale equipment-technical development and full-scale testing. An indicator of successful focusing is that research results have already been utilised commercially, and industrial-scale equipment commissions have been executed. New innovative technical solutions for measuring emissions to the environment have also been developed. To improve the control of environmental impacts of the pulp and paper industry, the transportation of detrimental substances in different flows and process units were measured and modelled, and new solutions of non-waste technology were developed for closed water cycles in pulp mills, for the use of green liquor sludge and ash and for the recovery of ash from the combustion of deinking sludge and waste paper. In peat production, new methods and instructions were developed and introduced for the control of drainage waters and for dust emissions and noise problems. After-use alternatives for exhausted peat production fields were also studied. Due to the interdisciplinary approach, the SIHTI Programme has disseminated information about research results as widely as possible. The Annual Seminars of the Programme, and sessions on environmental impacts of emissions from energy production, separation of particulates, and utilisation of solid wastes have offered excellent opportunities to the lecturers and to the audience to bring their own contribution to the issue occupying our mind: what would be the right way of approaching sustainable energy production.

Pro gradu ­tutkielma koostuu seuraavista osista: Rouvinen, Kaisa. Lisääntymisterveydenhuollon haasteet ja naisten hyvinvointi vähiten kehittyneissä maissa. Tampereen yliopisto. Terveystieteen laitos. Kirjallisuuskatsaus. Osasuoritus Pro gradu ­tutkielmaan. 26 s. 2003 Rouvinen, Kaisa. Quality of care in reproductive health services at health posts in Nepal. International EuroQuan Conference on Quality and Nursing Practice. Proceedings. Norsk sykepleieforbund. 1997; 224-231. Rouvinen, Kaisa. Quality of care in reproductive health services at five government health posts in Siraha District, Eastern Nepal. A dissertation submitted to the University of Liverpool (School of Tropical Medicine) in partial fulfilment of the degree of Master in Community Health. 95 pages. 1996 ; 1. JOHDANTO 6 2. LISÄÄNTYMISTERVEYS KEHITYKSEN INDIKAATTORINA 7 3. NAISEN ELÄMÄN TÄRKEÄT JA KRIITTISET VAIHEET 10 3.1. RASKAUS JA SYNNYTYS - TURVALLISEN ÄITIYDEN TAVOITE 10 3.2. PERHESUUNNITTELU JA ABORTTI 15 3.3. HIV JA MUUT SUKUPUOLITAUDIT 17 3.4. LAPSETTOMUUS JA LAPSEN SUKUPUOLI 19 3.5. SUKUPUOLIELINTEN TRADITIONAALINEN SILPOMINEN 20 3.6. KÖYHYYDEN, TRADITIOIDEN JA OLOSUHTEIDEN MERKITYS 22 4. HAASTEET JA MAHDOLLISUUDET 23 LÄHTEET 26 QUALITY OF CARE IN REPRODUCTIVE HEALTH SERVICES AT FIVE GOVERNMENT HEALTH POSTS IN SIRAHA DISTRICT, EASTERN NEPAL ACKNOWLEDGEMENTS 1 TABLE OF CONTENTS III LIST OF TABLES VI LIST OF FIGURES VII LIST OF ABBREVATIONS AND ACRONYMS VIII GLOSSARY IX EXECUTIVE SUMMARY X CHAPTER 1. INTRODUCTION 1 1.1. THE CLIENT AND THE CONCERN 1 1.1.1. Save the Children US in Nepal 1 1.1.2. Save the Children Siraha project 1 1.1.3. Problem statement 2 1.2. THE STUDY 2 1.2.1. Study question 2 1.2.2. Aim and objectives of the study 2 1.2.1. Action plan and accomplishment of the study 3 1.3. STUDY LOCATION 4 1.3.1. Nepal 4 1.3.2. Siraha District 4 CHAPTER 2. LITERATURE REVIEW 6 2.1. GLOBAL VIEWS OF WOMEN'S HEALTH 6 2.2. PRIMARY HEALTH CARE IN NEPAL 8 2.2.1. Safe Motherhood and Family Planning 8 2.3. QUALITY IN HEALTH CARE 10 2.3.1. What is quality? 10 2.3.2. Approaches to assessment of quality in health care 10 2.4. SELECTED ISSUES IN QUALITY OF HEALTH CARE 14 2.4.1. The structure of the health care and its relevance in quality assessment 14 2.4.2. Health care providers' job motivation and its impact on quality of health care 15 2.4.3. User satisfaction 16 2.5. CONCLUSION 17 CHAPTER 3. METHODOLOGY 19 3.1. EVALUATION OF HEALTH POST FACILITIES AND SERVICE ARRANGEMENTS 20 3.1.1. Study location 20 3.1.2. Selection of health posts 20 3.1.3. Issues and variables used to explore the objective 20 3.1.4. Tools and strategies of data collection 20 3.2. EXPLORING HEALTH CARE PROVIDERS' PERCEPTIONS ABOUT THE QUALITY OF CARE 21 3.2.1. Study population 21 3.2.2. Selection of informants 21 3.2.3. Issues and variables used to explore the objective 21 3.2.4. Tools and strategies of data collection 21 3.3. DESCRIBING THE LEVEL OF USERS' SATISFACTION 22 3.3.1. Study population 22 3.3.2. Selection of informants 22 3.3.3. Issues and variables used to explore the objective 22 3.3.4. Tools and strategies of data collection 23 3.4 ADDITIONAL DATA COLLECTION METHODS 24 3.5. PRE-TESTING AND TRANSLATION 24 3.6. DATA HANDLING AND STORAGE 25 3.7. DATA ANALYSIS 25 3.8. QUALITY ASSURANCE AND ENCOUNTERED CONSTRAINTS IN DATA COLLECTION 25 CHAPTER 4. RESULTS 27 4.1. EVALUATION OF HEALTH POST FACILITIES AND SERVICE ARRANGEMENTS 27 4.1.1. Location and accessibility 27 4.1.2. Target population and service statistics 27 4.1.3. Sub-health posts, outreach clinics and staffing 28 4.2.4. Waiting facilities at health posts 28 4.1.5. Rooms for counselling and MCH and FP services 28 4.1.6. Infection prevention 29 4.1.7. Equipment and instruments for use in MCH and FP 29 4.1.8. Availability of contraceptives and essential medicines 29 4.1.9. IEC material and activities 29 4.1.10. Record keeping and reporting 30 4.1.11. Health post management and supervision 30 4.1.12. Conclusion 30 4.2. HEALTH CARE PROVIDERS' PERCEPTION ABOUT THE QUALITY OF CARE 31 4.2.1. Job satisfaction and experience as a health care provider 31 4.2.2. Health workers' perception of what is good quality in health care 32 4.2.3. Health workers' perception about users' expectations 33 4.2.4. Health workers' suggestions for improvement of health care 33 4.2.5. What are the specific reasons for low utilisation of FP and AN services 34 4.2.6. Conclusion 35 4.3. QUALITY OF CARE FROM THE USERS' POINT OF VIEW 35 4.3.1. The sample 35 4.3.2. Perceptions of the quality of care 37 4.3.3. Suggestions for improvement for the quality of care at a health post 40 4.3.4. Conclusion 40 4.4. SUMMARY OF RESULTS 41 CHAPTER 5. DISCUSSION 43 5.1. IMPACTS OF STRUCTURE OF HEALTH CARE ON QUALITY OF THE SERVICE 43 5.1.1. Accessibility 43 5.1.2. Clinical settings and procedures 44 5.1.3. Service arrangements 44 5.2. HEALTH WORKERS' ROLE 47 5.2.1. Users' expectations contradicting providers' perceptions 47 5.2.2. Implications of health workers' perceptions for improvement of quality 48 5.2.3. Job motivation 48 5.2.4. Quality assurance cycle 50 5.3. CONCLUSIONS 50 5.4. COMMENTS ON METHODS USED IN THE STUDY 51 CHAPTER 6. RECOMMENDATIONS 53 REFERENCES 54 APPENDICES APPENDIX 1 PHOTPGRAPHS: WALL PAINTINGS AND TBA TRAINING 58 APPENDIX 2 MAPS OF NEPAL AND SIRAHA DISTRICT 59 APPENDIX 3 INVENTORY FORM FOR HEALTH POST FACILITIES 60 APPENDIX 4. BACKGROUND VARIABLES 70 APPENDIX 5.A STRUCTURED QUESTIONNAIRE FOR USER EXIT INTERVIEW 71 APPENDIX 5.B MAITHALI TRANSLATION OF THE QUESTIONNAIRE 75 APPENDIX 6 EVALUATION OF HEALTH POST FACILITIES AND SERVICE ARRANGEMENTS 79 APPENDIX 7. FINDINGS FROM HEALTH PERSONNEL IN-DEPTH INTERVIEWS 84 APPENDIX 8. USERS' EXPRESSIONS OF THE QUALITY OF CARE. QUOTATIONS. 85

Kunnat ovat suuren muutoksen keskellä. Kuntarakenneuudistus sekä sosiaali- ja terveydenhuollon palvelurakenneuudistus tulevat muuttamaan kuntien hallintoa merkittävästi. Kari Hakarin tutkimus tarkastelee yhden suuren kaupungin hallinnonuudistusta uuden julkisen hallinnan teorian näkökulmasta. Uusi julkinen hallinta on kunnallishallinnon uudistamisen kolmas vaihe, joka on kehittynyt perinteisestä julkishallinnosta ja tätä seuranneesta uudesta julkisjohtamisesta. Tutkimuksen tavoitteena on arvioida, onko uudesta julkisesta hallinnasta kuntien hallinnonuudistusten uudeksi suunnaksi. Tutkimuksella tuetaan myös kuntien käytännön kehittämistoimintaa. Tutkimuskohteena on Tampereen kaupungin toteuttama kokonaisvaltainen toimintamallin uudistus. Uudistus muodostuu kolmesta osasta: pormestarijärjestelmästä, tilaaja–tuottaja-mallista sekä asiakaslähtöisestä prosessiajattelusta. Tutkimustulokset osoittavat, että Tampereen muutosprosessi toteuttaa varsin hyvin uuden julkisen hallinnan mukaista ajattelua. Se ei kuitenkaan edusta tätä moderneimmillaan, vaan perustuu vahvasti sekä byrokraattisen organisaation rakenteisiin että uuden julkisjohtamisen mukaiseen markkinoistumisen tavoitteeseen. Näyttää siltä, että Tampereenkin toimintamalli kaipaa päivittämistä, jotta se pystyy vastaamaan paremmin tulevaisuuden haasteisiin. Moderni uuden julkisen hallinnan kokonaisuus kuntien hallinnon kehittämisen näkökulmasta muodostuu 1) avoimesta kumppanuudesta asukkaiden, palvelutuottajien ja muiden sidosryhmien kanssa, 2) paikallisuuden ja yhteisöllisyyden korostamisesta, 3) monimuotoisesta suorasta ja edustuksellisesta demokratiasta, 4) asiakaslähtöisestä palvelujen kehittämisestä, 5) tulosperusteisesta palveluiden hankinnasta sekä 6) monimuotoisesta palvelutuotannosta. Muutos vallankäytössä on yksi uuden julkisen hallinnan ominaispiirre. Kunnan johtaminen edellyttää monimutkaistuvassa yhteiskunnassa uusia välineitä ja toimintatapoja. Tutkimuksen mukaan moderni kunnan johtaminen perustuu onnistuneelle yhdistelmälle pehmeää ja kovaa valtaa. Tutkimuksen mukaan uusi julkinen hallinta voi kehittyä kuntien hallinnonuudistusten perustaksi. Tätä tukee se, että uudessa julkisessa hallinnassa kehittämisperiaatteet muodostavat loogisen kokonaisuuden, jota voidaan käytännössä toteuttaa monin välinein erilaisissa tilanteissa. Lisäksi on olemassa ilmeinen tarve yhteiselle visiolle, jotta välttämättä edessä oleva kuntien hallinnonuudistus pystytään toteuttamaan. Uudet, isot reformit tarvitsevat aina mallin, johon muutos voidaan perustaa. Uuden julkisen hallinnan kehittymistä tukee myös se, että hallinnon kehittämisen käytännön toteutukset sekä kansainvälisesti että Suomessa toteuttavat jo monella tavoin uuden julkisen hallinnan mukaisia hallinnonuudistuksen kehityssuuntia. Tutkimus tuo uutta tietoa uuden julkisen hallinnan käytännön toteutuksesta suuressa suomalaisessa kaupungissa. Se näyttää myös suuntaa kuntien kehittämistyölle yhdistäen käytäntöä ja teoriaa ja tuo näin tietoa sekä käytännön kuntien kehittämistehtävissä toimiville että tutkijoille. Tampereen toimintamallin päivittämiselle se tarjoaa päämäärän, jota kohti edetä. ; The subject of this dissertation is the new public governance from the perspective of the local government management reforms. The research question is: how is the new public governance reflected in local government reforms? The research ques-tion will be examined from the perspectives of theory, practice and power relations. The empirical object of the study is the management reform of the City of Tampere, Finland. The reform includes three parts: the mayoral system, the purchaser-provider model and the customer-oriented process organization. The study also aims at the development of municipal operations, and presents new public governance as a comprehensive "theory of practice", which combines theory and practice and allows municipalities to find perspectives, tools and a theoretical framework for their management reforms. The study consists of four separate published sub-studies and this summary. The first sub-study deals with the theory of new public governance within the framework of the management reform of the City of Tampere. The second and third sub-studies are concerned with a variety of practical implementations of new public governance in the City of Tampere management reform. The fourth sub-project addresses power relations. In this summary the results are presented from the perspective of a management model, networked service development and the change in the exercise of power. Questionnaires were the empirical basis of the first two sub-studies, the third examined written documents and used interviews with experts and fourth sub-study relied on theme interviews with directors. New public governance (NPG) represents the third wave of the management re-forms evolving from a traditional public administration, and that following the new public management. An essential feature of the new public governance is that it does not completely reject earlier administrative reforms, but rather complements them with new solutions. NPG is based on the view that the public administration is no longer able alone to control society, but the success of governance is based on the partnership with the private and third sectors as well as with the citizens. Within the framework of new public governance one can, at least to some extent, identify three distinct trends. The differences between the trends are mainly in emphasis placed on various matters. Discussion of the new public governance started in network governance. Next, the new public governance was discussed from the perspective of democratic decision-making and public participation. The third emphasis seems to be on the new public governance as a development of customer-focused services and co-production. The results show that the process of change of the City of Tampere can be imple-mented quite well within the new public governance paradigm. At the beginning of the process the new public management was a decided basis of the reform. In the phases of preparation and implementation constraints and international experiences of weaknesses were perceived in the new public management model. On the basis of this, the management model has been developed further so that issues of new public governance such as local democracy, participation, networks and transparency of government have become stronger. The management model of Tampere does not, however, represent the new public governance in its modern form. The Tampere model is built on a basis of democracy and regulation of traditional public administration as well as the quasi-markets of the new public management. The modern new public governance reform seems to be moving especially towards a customer-oriented service development. According to this study the change in the use of power seems to be one of the characteristics of society's growing complexity and new public governance. There is a need for new instruments for leadership and in the exercise of power in an in-creasingly complex society. The modern municipal leadership is based on a suc-cessful combination of soft and hard power. The growth of new public governance as the next paradigm of management re-forms can be justified from three different perspectives. First, the new public gov-ernance is a logical entity. It brings together coherent principles of management reform, which can be implemented in practice by a variety of techniques in different situations. Second, there is an obvious need for a common vision for local gov-ernment reforms. New, large-scale reforms always need a new paradigm in which a change can be set up. There is a need for a common vision for the municipalities and their functions in order to implement local government reform. The new public governance could be the entirety that can show the way for the necessary man-agement reform of municipalities in Finland. Third, the practical implementations of management reforms both internationally and in Finland are already realizing the trends of management reform of new public governance in a number of ways.