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In this paper, we discuss motivations for internationalisation and the rationalities of higher education institutions based on the APIKS survey. There are two higher education sectors in Finland. Universities of applied sciences emphasise teaching and have a close connection with regional research, development, and the innovation system. Universities emphasise research and academic competition for research resources, as well as teaching based on research. Therefore, the conditions for internationalisation in these two higher education sectors are based on different sets of factors. There are also significant differences between individual institutions within both sectors. Individuals’ career paths depend on factors related to higher education sectors and institutional strategies. International academic activities determine the factors on which career paths are built in these two higher education sectors. Both pathways lead to internationalising institutions but in different ways.

Finnish higher education consists of research-oriented universities and teaching-oriented universities of applied sciences, and both sectors have a role in research, development and innovation. This paper focuses on governance and management at the institutional and academic unit levels, based on responses to several questions in the APIKS survey regarding the influence of academics, performance targets of academic units and the influence of academics in decision making and workload. Institutions in both sectors of Finnish higher education emphasise strategies and are heavily reliant on public funding. Both sectors also have an orientation to strong performance management.

This study aims to investigate health care professionals' reflections on patient complaints in a specialized medical care organization. Studies on health care and medical education have shown that more research on triggering situations is needed to examine these reflections. In this study, the professionals' responses are evaluated using reflection theory and its strategies from a game theory perspective. The data from the cross-sectional study were analyzed using qualitative data analysis and quantitative statistical methods (N=245). Four types of patient complaints were analyzed: malpractice, communication, information, and procedures. They were evaluated as reflective targets and strategies that could be used to solve patient complaints. Information plays a central role in the choice of strategies. The results of this study may benefit the development and implementation of gamification strategies for the patient complaint process. Further research on patient complaints is needed to investigate the factors that impact the health care professionals' responses.

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In recent years, Finnish care policy has emphasised that older people should remain at home for as long as possible. Since the final stages of life and death will theoretically happen more often in the home, it is important to identify people’s experiences and needs regarding end-of-life care and dying. The aim of this article is to provide knowledge on these questions from the perspective of the Northern Finnish people (N = 294). Statistical analysis was used with data gathered from a survey of a random sample. People’s wishes for their end-of-life place and carers and their end-of-life plans and concerns, are analysed as part of a social and cultural construction of dying and end-of-life care. The results show that people do have end-of-life concerns and that they consider end-of-life planning important but that few preparations are actually made. In many instances, home is regarded as the best place for end-of-life care and dying, but care institutions are also regarded positively. Reliance on professional care is very strong, even though people hope to receive care from family members as well. The results are discussed in the light of Finnish care policy and end-of-life culture.

We set out to assess the extent to which writing modality affects recollection in children and adolescents. We examined 10- to 11-year-old children’s (N = 63) and 16-year-old adolescents’ (N = 43) handwriting, keyboarding with a laptop computer and keyboarding with a touchscreen tablet computer or mobile phone in a within-subjects experimental design. Participants were instructed to write down stories dictated to them in the three writing modalities. Recollection of the stories was assessed using free recall of details in the stories. The results indicate that the writing modality affects recollection, handwriting leading to better recollection. However, currently, digital writing tools are inundating classrooms and workplaces around the globe, making their competent use a necessity in today’s world. For example, in Finland, students are obligated to use a laptop in upper secondary education and in the national final examination. In light of the results, we highlight the importance of balancing the instruction and practice of different writing modalities. Given the limitations of this study, we suggest conducting a larger-scale study and further research on the educational and cognitive implications of using and learning to write using multiple writing modalities.

STUDY DESIGN A magnetic resonance imaging follow-up study of lumbar arteries among patients with sciatica with chronic Chlamydia pneumoniae infection. OBJECTIVE To determine whether chronic infection causes occlusion of lumbar arteries. SUMMARY OF BACKGROUND DATA C. pneumoniae infection is associated with coronary heart disease, and the infectious pathogen has also been detected in abdominal aortic aneurysms and in atherosclerotic plaques. No studies are available on the effect of this infectious agent on lumbar arteries. METHODS Chronic infection was defined as persistent high positive immunoglobulin G and/or immunoglobulin A antibodies and/or the presence of immune complexes. The lumbar arteries, evaluated with two-dimensional time-of-flight magnetic resonance angiography, were scored as normal, narrowed, or occluded. The differences in the segmental and whole lumbar spine (segments L1-L4) sum of arterial occlusion at baseline and at 3 years, and the incidence of new arterial stenosis were compared in patients with and without chronic infection using the Kolmogorov-Smirnov test. RESULTS Patients with chronic infection were more likely to be persistent smokers (P = 0.006), male (P = 0.04), and more obese (P = 0.02) compared to patients with normal antibody levels. They had significantly higher degree of arterial stenosis at L4 segment at baseline and at 3 years (P = 0.001 and 0.002, respectively), in the whole lumbar spine at baseline and at 3 years (P < 0.001 for both), and at L1 and L3 segments at 3 years (P = 0.013 for both). The incidence of new arterial stenosis was similar in both patient groups. Patients with chronic infection also had significantly higher grade of endplate degeneration at L4-L5 (P = 0.008). CONCLUSIONS The results of this study suggest that chronic C. pneumoniae infection may induce stenosis of lumbar arteries.

Medical rehabilitation arranged by the Social Insurance Institution of Finland is provided for children with severe disabilities. The study aimed to find out which service characteristics were associated with perceived outcomes of rehabilitation. Parents whose children had participated in rehabilitation ( n = 496) responded to a mail questionnaire that included questions on service characteristics and possible outcomes. Based on factor analysis, four outcome variables were formed. Logistic regression analysis was used to identify the particular service characteristics that were associated with the perceived outcomes. The family’s participation in rehabilitation planning and the child’s willingness to participate in rehabilitation activities were associated with good outcomes. Having a contact person for the rehabilitation process predicted child and family empowerment outcomes. The results emphasize the significance of establishing a good partnership between the professionals and the family; of developing the contents of the rehabilitation program, so that they motivate the child, and of organizing service coordinators for each family.

A cross-sectional study in sciatic population.To evaluate the separate roles of nerve root entrapment-based on magnetic resonance imaging-and other discogenic pain mechanisms on disability and physical signs among symptomatic sciatic patients.Data symptoms of sciatica are generally understood to be generated by nerve root compression, but other pain mechanisms of sciatica have been suggested.The authors obtained magnetic resonance scans from 160 patients with unilateral sciatic pain. The patients reported the intensity of their back and leg pain and their back-specific disability. Clinical examination and magnetic resonance imaging (1.5 T) was performed on every patient. The degree of disc displacement, neural enhancement, and nerve root compression was evaluated from magnetic resonance scans. The correlations of symptoms and signs with magnetic resonance imaging findings were calculated.The degree of disc displacement in magnetic resonance imaging did not correlate with any subjective symptoms, nor did nerve root enhancement or nerve compression. Magnetic resonance imaging classification was associated, however, with straight leg raising restriction. In regression analysis, straight leg raising restriction was best explained with a simple classification of nonherniations versus herniations.The results suggest that a discogenic pain mechanism other than the nerve root entrapment generates the subjective symptoms among sciatic patients. The findings of this study thus indicate that magnetic resonance imaging is unable to distinguish sciatic patients in terms of the severity of their symptoms.