Abstract The study aimed to assess the Stability of Communication Deviance of 166 adoptive families recruited into the Finnish adoptive family study, including 76 high-risk children and 90 controls. The biological mothers of the high- risk children had been schizophrenic at some stage. The Communication Deviance shown by the adoptive parents and the adopted children was evaluated on the individual and family Rorschach Communication Deviance (CD) scales and, in the case of the parents, also the couple Rorschach tests. The thought disorders of the adopted children were evaluated on the Thought Disorder scale. The following statistical tests were used: χ2 -compatibility test, Spearman correlation test and Mann - Whitney U -test, logistic regression analysis and Mantel - Haenzel stratified χ2 test to compare the cross-tabulations. Communication Deviance was notably permanent in a variety of interactive situations. The parents showed most permanence between individual and couple Rorschach tasks and spouse and the family tasks. The presence of the children altered parental communication and the presence of the parents altered the children's communication: the impact was circular, and its magnitude depended on the clarity of communication by both parties. A high risk adoptee did not affect of Communication Deviance shown by the adoptive parents, except in family situations. The adoptive parents of high-risk children were more sensitive to the child's presence and showed abundant family CD more often than the control parents. Most of the adoptive parents of high-risk children produced a lot of CD in all situations studied, which implies that Communication Deviance is a circular phenomenon, whereby the child further enhances the basically incoherent communication between the parents.The control children's thought disorders were related to the compatibility of the adoptive parents' Communication Deviance, and to the degree of parental CD in couple and family tasks while those of the high-risk children were not. Part of the adopted children's thought disorders were more closely related to genetic vulnerability, being predicted by parental Communication Deviance in individual situations, but not in couple or family situations. Communication Deviance is so permanent as to be largely resistant to therapy. Constantly ambiguous parental communication is an environmental factor in a child's life and interferes with the development of his or her thinking. By behavioral therapy we can learn to make family communication less ambiguous.

Abstract Unemployed are known to be in poorer health and to use less health care services compared to those employed. However, evidence on the work ability of the unemployed remains scarce. The methods of assessing work ability are very divergent, not least because a shared understanding on the concept of work ability is lacking. Furthermore, the aspect of marginalization gives rise to further challenges when assessing work ability among the unemployed. This study explored the work ability of long-term unemployed, their needs for medical care and rehabilitation as well as the methods of assessing work ability. The aims were to find out to which amount and how the work ability was restricted among the unemployed and to clarify the needs for medical care and rehabilitation among them. Additionally, differences between the methods for assessing the disease-oriented and multidimensional work ability, as well as the need for rehabilitation were analysed. Both qualitative and quantitative methods were used in this multi-method research in three different studies. The multidimensional work ability assessments were conducted among long term unemployed individuals in three Labour Force Service Centres (Oulu, Raahe region and Kainuu) and in one municipality (Paltamo). Furthermore, an illustrated case study was conducted to compare the materials and background theories of disease-oriented and multidimensional work ability assessment methods. The work ability was significantly decreased for a great proportion of long term unemployed, mostly because of mental disorders. In one municipality, 27% of the long term unemployed were found disabled for open labour market, in addition 20% of them were considered to need medical care and rehabilitation to enable return to work. By using multidimensional work ability assessment method, restrictions in work ability as well as the needs for rehabilitation appeared to get identified more accurately than by using the disease-oriented method. The latter had missed potential rehabilitation avenues and had led to under-rehabilitation, misrehabilitation and over-rehabilitation. The results indicate that the practices of assessing work ability should be based on biopsychosocial and not only on biomedical approach of health and therefore existing information from the multidisciplinary network concerning the clients’ functioning should be routinely collected and used. The health care services as well as the work ability assessment procedures should be tailored to meet the special needs of the long term unemployed to support their work ability and potential of returning to work. / Tiivistelmä Työttömien terveydentila on heikompi ja he käyttävät vähemmän terveyspalveluja kuin muu samanikäinen väestö. Sen sijaan työttömien työkyvystä ei ole olemassa kattavaa tutkimustietoa. Toisaalta työkyvyn arvioinnin menetelmät ovat epäyhtenäiset, koska työkyvyn käsitteestäkään ei ole yhtenäistä ymmärrystä. Syrjäytymiseen liittyvät ilmiöt aiheuttavat työttömien työkyvyn arviointiin omat erityishaasteensa. Tämän tutkimuksen kohteena olivat pitkäaikaistyöttömien työkyky, sairauksien hoitoon ja kuntoutukseen liittyvät tarpeet sekä työkyvyn arvioinnin menetelmät. Tavoitteena oli selvittää, kuinka suurella osalla ja millä tavoin pitkäaikaistyöttömien työkyky on heikentynyt sekä minkälaista hoidon ja kuntoutuksen tarvetta heillä on. Lisäksi selvitettiin sairauslähtöisen ja monialaisen työkyvyn ja kuntoutustarpeen arvioinnin eroja. Monimenetelmätutkimuksen kolmessa osatutkimuksessa käytettiin sekä laadullisia että määrällisiä menetelmiä. Aineistoina olivat kolmen työvoiman palvelukeskuksen (Oulu, Raahen seutukunta ja Kainuu) ja yhden kunnan (Paltamo) alueella asuville vaikeasti työllistyville henkilöille monialaisesti toteutetut työkyvyn arvioinnit. Lisäksi aineistona analysoitiin sairauslähtöisessä ja monialaisessa työkyvyn arvioinnissa käytettävät tietoaineistot ja tulokset yhdellä esimerkkiasiakkaalla havainnollistaen. Suurella osalla pitkäaikaistyöttömistä työkyky oli merkittävästi heikentynyt, sairausluokista eniten mielenterveyden häiriöiden takia. Yhden kunnan kaikista pitkäaikaistyöttömistä todettiin avoimille työmarkkinoille työkyvyttömiksi 27 % ja näiden lisäksi 20 %:lla todettiin työkykyä kohentavan hoidon ja kuntoutuksen tarvetta. Monialaisen arviointimallin avulla tunnistettiin työkyvyn heikkeneminen ja kuntoutustarve osuvammin kuin perinteisellä sairauslähtöisellä toimintatavalla, joka hukkaa kuntoutuksen potentiaalia ja johtaa alikuntoutukseen, väärinkuntoutukseen tai ylikuntoutukseen. Tulosten perusteella työkyvyn arvioinnin käytännöt tulisi perustaa biopsykososiaaliseen eikä vain biomedikaaliseen terveyskäsitykseen ja niissä tulisi nykyistä enemmän hyödyntää monialaisessa verkostossa olevaa informaatiota tutkittavan toimintakyvystä. Työkyvyn tukemiseksi työttömien terveyspalvelut sekä työkyvyn ja kuntoutustarpeen arvioinnit tulisi aiempaa enemmän suunnitella ja kohdentaa pitkäaikaistyöttömien erityistarpeet huomioiden.