Abstract This work was aimed at studying speech perception and auditory performance in the everyday lives of Finnish-speaking postlingually severely or profoundly hearing-impaired adults before and after receiving a multichannel cochlear implant. The association between the formal speech perception results and auditory performance in everyday life was also determined, and an effort was made to define how well a smaller sample represents the nationwide results. The patient series comprised a nationwide retrospective survey (N = 67), in which data on hearing level and word recognition were requested from the hospitals, and a prospective sample from the city of Oulu (N = 20), in whom hearing level, sentence, word and phoneme recognition and phoneme confusions were examined using standardised audiometric measures and formal speech perception tests in a study with a prospective repeated measure design. Categories of auditory performance in everyday life were assessed in both samples. The median sound field hearing level at frequencies of 0.5, 1, 2 and 4 kHz for the subjects in the nationwide survey one year after the switch-on of the implant was comparable to the level of mild hearing impairment. All the subjects achieved at least some open-set word recognition auditorily only (mean 71%, 95% CI 61-81%). The results in the Oulu sample were in line with the nationwide survey. A majority of the subjects (31/40) was able to understand conversation without speechreading one year after switch-on. Sentence recognition by the subjects in the Oulu sample improved most during the initial six months after the switch-on of the implant, whereas word and phoneme recognition improved steadily during the two-year follow-up period. Estimated average sentence recognition after two years was 89% (95% CI 71 to 106%), word recognition 73% (95% CI 58 to 87%), syllable recognition 53% (95% CI 42 to 63%), vowel recognition 80% (95% CI 68 to 92%) and consonant recognition 67% (95% CI 57 to 76%). Confusion of phonemes took place more in the direction a spectral energy distribution at higher frequencies. The association between auditory performance in everyday life and the formal speech perception tests was high (rs > 0.81, p < 0.0001). Systematic prospective assessment of speech perception with tests of differing difficulty is recommended for the follow-up of adult cochlear implant users. / Tiivistelmä Tämän työn tarkoituksena oli tutkia suomenkielisten, kielen oppimisen jälkeen vaikean tai erittäin vaikean kuulovian saaneiden aikuisten kuulon tasoa, puheen vastaanottoa ja kuulon toiminnallista tasoa monikanavaisen sisäkorvaistutteen avulla. Tutkimuksessa selvitettiin myös, miten puheen vastaanottoa mittaavat testit kuvaavat selviytymistä arkipäivän elämässä sisäkorvaistutteen mahdollistaman kuulon avulla. Tarkoituksena oli myös määrittää, millä tavalla pieni otos edustaa kansallisia tuloksia. Tutkimuksessa on retrospektiivinen kansallinen otos (N=67) ja prospektiivinen Oulun otos (N=20). Kansallisessa otoksessa tiedot kuulon tasosta ja sanojen tunnistuskyvystä kerättiin yliopistosairaaloista koehenkilöiden sairauskertomuksista. Oulun otoksessa kuulon tasoa, sekä lauseiden, sanojen ja äänteiden tunnistuskykyä ja äänteiden sekoittuvuuksia tutkittiin audiometrian ja puheenvastaanottoa mittaavien testien avulla kahden vuoden seurannan aikana. Kuulon toiminnallista tasoa arvioitiin kuulon toiminnallisen tason luokituksella molemmissa otoksissa. Kansallisen otoksen koehenkilöiden kuulokynnysten mediaani äänikentässä sisäkorvaistutteella taajuuksilla 0,5, 1, 2 ja 4 kHz oli verrattavissa lievän kuulovian tasoon vuosi sisäkorvaistutteen käyttöönoton jälkeen. Kaikki koehenkilöt kykenivät tunnistamaan vähintään joitain sanoja pelkästään kuulonvaraisesti (keskiarvo 71 %, 95 %:n luottamusväli 61-81 %). Oulun otoksen ja kansallisen otoksen tulokset olivat yhteneväiset. Vuosi sisäkorvaistutteen käyttöönoton jälkeen suurin osa (31/40) koehenkilöistä pystyi keskustelemaan ilman huulioluvun tukea hiljaisessa ympäristössä. Oulun otoksen koehenkilöiden lauseiden tunnistuskyky parani eniten ensimmäisten kuuden kuukauden aikana. Sanojen ja äänteiden tunnistuskyky parani koko kahden vuoden seurannan ajan. Kaksi vuotta sisäkorvaistutteen käyttöönoton jälkeen, estimoitu keskimääräinen lauseiden tunnistusprosentti oli 89 % (95 %:n luottamusväli 71-106 %), sanojen tunnistusprosentti oli 73 % (95 %:n luottamusväli 58-87 %), tavujen tunnistusprosentti oli 53 % (95 %:n luottamusväli 42-63 %), vokaalien tunnistusprosentti oli 80 % (95 %:n luottamusväli 68-92 %) ja konsonanttien tunnistusprosentti oli 67 % (95 %:n luottamusväli 57-76 %). Koehenkilöt sekoittivat vokaaleja ja konsonantteja useimmiten spektraaliselta energialtaan läheisimpään suuremmille taajuuksille sijoittuvaan äänteeseen. Kuulon toiminnallisen tason luokituksen ja puheen vastaanottoa mittaavien testien välinen korrelaatio oli korkea (rs > 0.81, p < 0.0001). Sisäkorvaistutteen saavien aikuisten kuulon tason ja puheen vastaanottokyvyn systemaattinen seuranta vaikeudeltaan eritasoisten testien avulla on tärkeää monipuolisen kuntoutuksen suunnittelun tueksi.

A quantitative study was conducted to determine the socio-economic outcomes for the beneficiaries of the Expanded Child Survival Initiative in Uganda. The population comprised of all orphans and vulnerable children who were trained under the Expanded Child Survival Initiative of which a sample of 102 respondents were included in the structured data collection process. The outcomes that were explored were employment, income, assets and family support to siblings and other dependants by the primary beneficiaries. The findings show that the outcomes of the Expanded Child Survival Initiative were positive and benefited socio economic lives of the respondents and their family members. The majority of the respondents were using the skills obtained from the training and were employed. The employment provided a source of income and the income earned facilitates the respondents in providing the basic needs of the family members. They were able to provide adequately for most of their basic needs. The findings also show that the respondents had accumulated some assets. A number of factors influenced the utilisation of the newly acquired skills including having tool kits, start-up capital and business management skills. It is recommended that training providers should provide start-up support to the apprentices in order to facilitate them to utilise the skills obtained from apprenticeship trainings. / Public Health / Thesis (M.A. (Public Health))

A quantitative study was conducted to determine the socio-economic outcomes for the beneficiaries of the Expanded Child Survival Initiative in Uganda. The population comprised of all orphans and vulnerable children who were trained under the Expanded Child Survival Initiative of which a sample of 102 respondents were included in the structured data collection process. The outcomes that were explored were employment, income, assets and family support to siblings and other dependants by the primary beneficiaries. The findings show that the outcomes of the Expanded Child Survival Initiative were positive and benefited socio economic lives of the respondents and their family members. The majority of the respondents were using the skills obtained from the training and were employed. The employment provided a source of income and the income earned facilitates the respondents in providing the basic needs of the family members. They were able to provide adequately for most of their basic needs. The findings also show that the respondents had accumulated some assets. A number of factors influenced the utilisation of the newly acquired skills including having tool kits, start-up capital and business management skills. It is recommended that training providers should provide start-up support to the apprentices in order to facilitate them to utilise the skills obtained from apprenticeship trainings. / Public Health / Thesis (M.A. (Public Health))

The focused of this study is the role of capacity building in Community Home Based Care (CHBC) for HIV/AIDS patients. The study forms part of my Master's in Development Administration programme, undertaken through UNISA. The dissertation was accomplished by studying the TASO community initiative in Sseeta-Nazigo, Mukono District, Uganda. It explores the concept of capacity building and its applicability to CHBC. The primacy data was gathered by conducting Key Infonnant Interviews (KIIs) and Focus Group Discussions (FGD). The secondary data was gathered by reviewing literature to augment the primary data. In addition, data was gathered through observations within the community. The fmdings have identified seven critical components of capacity building: community mobilisation, skills development, Information, Education and Communication (IEC) Voluntary Counselling and Testing (VCT), networking and collaboration, support and supervision, Monitoring and Evaluation (M&E). The study observed that capacity built in the above areas resulted in three outcomes: skills development, improvement in procedures, and institutional development. Informed recommendations were subsequently made related to the seven componentsof capacity building in CHBC / Development Studies / M. A. (Development Studies)

The focused of this study is the role of capacity building in Community Home Based Care (CHBC) for HIV/AIDS patients. The study forms part of my Master's in Development Administration programme, undertaken through UNISA. The dissertation was accomplished by studying the TASO community initiative in Sseeta-Nazigo, Mukono District, Uganda. It explores the concept of capacity building and its applicability to CHBC. The primacy data was gathered by conducting Key Infonnant Interviews (KIIs) and Focus Group Discussions (FGD). The secondary data was gathered by reviewing literature to augment the primary data. In addition, data was gathered through observations within the community. The fmdings have identified seven critical components of capacity building: community mobilisation, skills development, Information, Education and Communication (IEC) Voluntary Counselling and Testing (VCT), networking and collaboration, support and supervision, Monitoring and Evaluation (M&E). The study observed that capacity built in the above areas resulted in three outcomes: skills development, improvement in procedures, and institutional development. Informed recommendations were subsequently made related to the seven componentsof capacity building in CHBC / Development Studies / M. A. (Development Studies)

This study focuses on the psycho-social challenges faced by HIV/AIDS lay counsellors at a Voluntary Counselling and Testing (VCT) site in Tshwane, South Africa. A qualitative approach was employed by using semi-structured interviews with open-ended questions to obtain information from four lay counsellors, who provide pre- and post-test counselling at a VCT site. The results indicate that the management of clients’ emotions and needs pose enormous challenges to HIV/AIDS lay counsellors who do not receive any formal psycho-social support at VCT sites. The research participants in this study resort to their own coping mechanisms to deal with the challenges – with varying degrees of success. The recommendation is made that a formal support programme should be put in place at VCT sites, which will allow HIV/AIDS lay counsellors to respond to the many demands placed on them. Such a programme can help prevent burnout and a high turnover in lay counsellors. / Social Work / M. A. (Social Behaviour Studies in HIV/AIDS)

This study focuses on the psycho-social challenges faced by HIV/AIDS lay counsellors at a Voluntary Counselling and Testing (VCT) site in Tshwane, South Africa. A qualitative approach was employed by using semi-structured interviews with open-ended questions to obtain information from four lay counsellors, who provide pre- and post-test counselling at a VCT site. The results indicate that the management of clients’ emotions and needs pose enormous challenges to HIV/AIDS lay counsellors who do not receive any formal psycho-social support at VCT sites. The research participants in this study resort to their own coping mechanisms to deal with the challenges – with varying degrees of success. The recommendation is made that a formal support programme should be put in place at VCT sites, which will allow HIV/AIDS lay counsellors to respond to the many demands placed on them. Such a programme can help prevent burnout and a high turnover in lay counsellors. / Social Work / M. A. (Social Behaviour Studies in HIV/AIDS)