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  • Teivonen, Satu (2010)
    Havupuiden erikoismuotoja on käytetty koristekasveina jo vuosisatoja ympäri maailmaa. Niitä on lisätty pääsääntöisesti pistokkaista ja varttamalla. Suomessa kotimaisten metsäpuidemme erikois-muotoja on kartoitettu ja kerätty kokoelmiin järjestelmällisemmin 1960-luvulta alkaen. Taimisto-viljelijät, puutarhasuunnittelijat ja kotipuutarhurit ovat olleet enenevässä määrin kiinnostuneita näistä kotimaisista kestävistä havukasveista. Yli 90 prosenttia markkinoillamme olevista havukas-veista tuodaan ulkomailta, joten on selvää, että niiden talvenkestävyydessä on ongelmia. Tämän tutkimuksen tavoitteena oli selvittää kotimaisille erikoismuodoille sopivia lisäysmene-telmiä ja siten edistää kotimaisen havukasvituotannon mahdollisuuksia. Aineistona kokeissa oli kotimaisia erikoismuotoja metsäkuusesta (Picea abies (L.) Karsten) ja kotikatajasta (Juniperus communis L.), tavallisia metsäkuusia sekä kahdeksan ulkomaista havupuutaksonia. Lisäysmene-telmistä tutkittiin varttamista ja pistokaslisäystä ja kokeet suoritettiin Metsäntutkimuslaitoksen toimipaikoissa Lopen Haapastensyrjässä sekä Punkaharjulla. Varttamiskokeessa vertailtiin koti-maisen kuusen erikoismuotokloonien varttamisen onnistumista. Pistokaskokeissa tutkittiin geno-tyypin, emopuun iän, pistokasoksan sijainnin sekä hormonikäsittelyn vaikutusta havukasvien pis-tokkaiden juurtumiseen. Tavalliset metsäkuuset toimivat kontrolleina. Tutkimus osoitti, että varttaminen onnistui erinomaisesti kaikilla erikoismuotoklooneilla. Ovat-ko vartteet esteettisesti katsottuna koristekäyttöön sopivia, jää vielä seurattavaksi. Pistokaskokeis-sa havaittiin, että juveniilisuus vaikutti pistokkaiden juurtumiseen, mutta iäkkäistäkin puista lisää-minen onnistuu, kunhan genotyyppi on sopiva. Keskimäärin alaoksat juurtuivat paremmin kuin latvuksen yläosista otetut pistokasoksat, mutta vain yhdellä kloonilla ero oli tilastollisesti merkit-sevä. Hormonikäsittely heikensi selvästi kotimaisen kuusen ja katajan pistokkaiden juurtumista, mutta ulkomaisiin havupuulajeihin käsittelyllä ei ollut vaikutusta. Kotimaisen havukasvituotannon pohjaksi pitäisi tehdä kloonivalintaa, jossa koristearvon lisäksi otettaisiin huomioon myös kloonin lisättävyys. Taimien tuottaminen pistokkaista on selvästi edul-lisempaa kuin vartteiden tuottaminen, joskin varte kasvaa myyntikuntoon nopeammin kuin pisto-kastaimi. Pistokastaimi on kuitenkin omajuurinen ja stabiilimpi kasvutavaltaan kuin varte. Tämä korostuu etenkin kääpiömuotoja tuotettaessa.
  • Söderlund, Sanni (2011)
    AIMS An independent, powerful coronary heart disease (CHD) predictor is a low level of high-density lipoprotein cholesterol (HDL-C). Discoidal preβ-HDL particles and large HDL2 particles are the primary cholesterol acceptors in reverse cholesterol transport, a key anti-atherogenic HDL mechanism. The quality of HDL subspecies may provide better markers of HDL functionality than does HDL-C alone. We aimed I) to study whether alterations in the HDL subspecies profile exist in low-HDL-C subjects II) to explore the relationship of any changes in HDL subspecies profile in relation to atherosclerosis and metabolic syndrome; III) to elucidate the impact of genetics and acquired obesity on HDL subspecies distribution. SUBJECTS The study consisted of 3 cohorts: A) Finnish families with low HDL-C and premature CHD (Study I: 67 subjects with familial low HDL-C and 64 controls; Study II: 83 subjects with familial low HDL-C, 65 family members with normal HDL-C, and 133 controls); B) a cohort of 113 low- and 133 high-HDL-C subjects from the Health 2000 Health Examination Survey carried out in Finland (Study III); and C) a Finnish cohort of healthy young adult twins (52 monozygotic and 89 dizygotic pairs) (Study IV). RESULTS AND CONCLUSIONS The subjects with familial low HDL-C had a lower preβ-HDL concentration than did controls, and the low-HDL-C subjects displayed a dramatic reduction (50-70%) in the proportion of large HDL2b particles. The subjects with familial low HDL-C had increased carotid atherosclerosis measured as intima-media-thickness (IMT), and HDL2b particles correlated negatively with IMT. The reduction in both key cholesterol acceptors, preβ-HDL and HDL2 particles, supports the concept of impaired reverse cholesterol transport contributing to the higher CHD risk in low-HDL-C subjects. The family members with normal HDL-C and the young adult twins with acquired obesity showed a reduction in large HDL2 particles and an increase in small HDL3 particles, which may be the first changes leading to the lowering of HDL-C. The low-HDL-C subjects had a higher serum apolipoprotein E (apoE) concentration, which correlated positively with the metabolic syndrome components (waist circumference, TG, and glucose), highlighting the need for a better understanding of apoE metabolism in human atherosclerosis. In the twin study, the increase in small HDL3b particles was associated with obesity independent of genetic effects. The heritability estimate, of 73% for HDL-C and 46 to 63% for HDL subspecies, however, demonstrated a strong genetic influence. These results suggest that the relationship between obesity and lipoproteins depends on different elements in each subject. Finally, instead of merely elevating HDL-C, large HDL2 particles and discoidal preβ-HDL particles may provide beneficial targets for HDL-targeted therapy.
  • Anttonen, Minna (2013)
    This Master's thesis examines the current status of head of state immunity in international law. The emphasis is on head of state immunity as a customary law rule. The aim of this thesis is to examine whether the removal of personal immunities of incumbent heads of state is possible in international criminal courts, with the authorization of the Security Council.
  • Korpela, Antti (Helsingin yliopisto, 2000)
  • Palosuo, Hannele (2003)
    Työssä vertailtiin 18-64-vuotiaitten moskovalaisten(n=545) ja suomenkielisten helsinkiläisten (n=824) terveyttä, elintapoja ja asenteita. Aineisto kerättiin postikyselynä Neuvostoliiton hajoamisvuonna 1991. Helsingissä vastausprosentti oli 71, mutta Moskovassa 29 osin poikkeuksellisen keruuajankohdan vuoksi. Aineistojen sukupuoli-, ikä- ja siviilisäätyjakaumat vastasivat perusväestön jakaumia, mutta Moskovassa korkeastikoulutetut olivat yliedustettuina. Väitöskirja koostuu perusraportista, kolmesta artikkelista ja yhteenvedosta. Moskovalaiset asuivat ahtaammin kuin helsinkiläiset ja heidän perheissään oli useammin kolme sukupolvea ja muita sukulaisia. Moskovalaisten heikompi kokonaishyvinvointi näkyi yleisempänä tyytymättömyytenä ja vieraantuneisuutena. Heille oli myös kertynyt enemmän rasittavia elämänmuutoksia edellisten viiden vuoden aikana ja he kokivat työnsä useammin rasittavaksi ja terveydelle haitalliseksi kuin helsinkiläiset. Helsinkiläisten koettu terveys oli merkitsevästi parempi. Huonoin terveys oli moskovalaisilla naisilla. Terveydentila oli selkeimmin yhteydessä sosiaaliseen asemaan Helsingin naisilla ja heikoimmin Moskovan naisilla. Moskovalaisten kunto oli huonompi ja he harrastivat huomattavasti vähemmän liikuntaa kuin helsinkiläiset. Moskovassa miehet tupakoivat yleisemmin, mutta naiset harvemmin kuin Helsingissä. Miesten ja naisten erot terveydessä ja terveyskäyttäytymisessä olivat yleensä suurempia Moskovassa kuin Helsingissä. Terveellinen elämäntyyli (ei tupakointia eikä runsasta humalajuontia, terveellinen ruokavalio ja liikuntaa) oli Helsingin miehistä 29%:lla ja naisista 39%:lla, mutta Moskovassa 7%:lla miehistä ja 6%:lla naisista. Moskovalaisten terveyskäyttäytymistä rajoittivat monet materiaaliset tekijät. He uskoivat vähemmän omiin mahdollisuuksiinsa vaikuttaa terveyteensä ja olivat useammin fatalistisia ja onneen uskovia kuin helsinkiläiset, jotka luottivat useammin mm. kykyihin, luonteenlujuuteen ja koulutukseen elämässä menestymisen ehtoina. Vieraantuneisuus liittyi selkeämmin epäterveellisiin elintapoihin Helsingissä, varsinkin miehillä. Terveyttä arvostivat eniten helsinkiläisnaiset, mutta se oli myös moskovalaisten tärkeimpiä arvoalueita. Moskovalaiset painottivat kuitenkin enemmän perheen, elintason ja uskonnon merkitystä kuin helsinkiläiset, joille taas hedonistiset ja individualistiset arvot olivat tärkeämpiä (itsensätoteuttaminen, mielenrauha, elämästä nauttiminen). Tuloksia tarkasteltiin hyvinvointitutkimuksen ja elämäntyylitutkimuksen viitekehyksissä. Vertailututkimuksen metodologisia ongelmia selvitettiin erikseen erityisesti mittauksen identtisyyden ja ekvivalenssin näkökulmasta. Tuloksia suhteutettiin myös terveydentilan muutoksiin Venäjällä ja Suomessa 1950-luvulta 2000-luvun taitteeseen erityisesti kuolleisuus- ja elinaikatietojen valossa. Venäjän kansanterveydessä tapahtui epäsuotuisa käänne 1960-luvun puolivälissä, jolloin Venäjän ja Suomen elinajanodotteet olivat jokseenkin samat. 1990-luvulla Venäjän kansanterveys huononi jyrkästi, kun Suomen terveysindikaattorit kehittyivät melko tasaisesti parempaan suuntaan. Venäjän terveyskriisin selityksiksi tarjotaan yleisimmin elämäntyylin epäterveellisyyttä, psykososiaalista stressiä ja sosiaalisen eriarvoisuuden kasvua, joita myös selviteltiin Moskovan ja Helsingin aineistoissa vuodelta 1991.
  • Palosuo, Hannele (2003)
    This thesis examined health, health-related behaviour and attitudes of adults aged 18-64 on the basis of a postal survey, conducted in Moscow (n=545, response rate 29%) and Helsinki (Finnish-speaking population, n=824, response rate 71%) in 1991, the year when the Soviet Union was dissolved. The data represented sufficiently the sex, age, and marital status distributions of the cities. The Moscow sample was biased towards higher education, which was taken into account by various methodological solutions in the analysis and the interpretations. Well-being was lower in Moscow and was shown as greater discontet with central life spheres, greater alienation and more experience of stress. Muscovite women had the worst health on most indicators. In view of notions of a ‘classless’ or homogenous social structure in socialist societies, weaker social gradients on health were expected in Moscow compared to Helsinki. This was so among women, but less clearly among men. Health was a highly salient value in both cities. The Muscovites valued traditional and private spheres of life more than the Finns and were more external and fatalistic in their causal attributions. Finnish respondents were more individualistic and hedonistic in their value ratings and internal in their causal attributions, believing more in the significance of talent and strength of character. Men and women in Helsinki were more ‘egalitarian’ in their health-related habits. An ‘all-healthy’ lifestyle (no smoking, no frequent drunkenness, healthy diet, physical exercise) was found among 39% of women and 29% of men in Helsinki, but only 6% and 7% in Moscow. Alienation was expected to undermine the motivation to lead a healthy life. This proved more clearly true in Helsinki than in Moscow. Methodological problems of comparison between different societies were addressed in terms of identity and equivalence of measurement. Explanations for the Russian health crisis of the 1990s, and the long-term fluctuations since the mid-1960s, are suggested on the basis of research literature. They range from general modernisation approaches to more specific suggestions (e.g. generation lag hypothesis), while the main models propose explanations concerning lifestyle, psychosocial stress and social inequalities, which were all relevant to the present study.
  • Sarvikivi, Emmi (Helsingin yliopisto, 2008)
    Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery. The studies were carried out at the Hospital for Children and Adolescents of Helsinki University Central Hospital. Epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined and they were genotyped. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for the patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs in these patients. During 1999-2006, the overall annual BSI rate was 1.6/1,000 patient days (range by year, 1.2–2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. The NICU was overcrowded during the S. marcescens clusters. A negative correlation between C. parapsilosis BSIs and fluconazole use in the NICU was detected, and the isolates derived from a single initially susceptible strain became less susceptible to fluconazole over time. Eighty postoperative HAIs, including all severe infections, were detected during hospitalization after open-heart surgery; 34% of those HAIs were SSIs and 25% were BSIs. The postdischarge study found 65 infections that were likely to be associated with hospitalization. The majority (89%) of them were viral respiratory or gastrointestinal infections, and these often led to rehospitalizations. The annual hospital-wide BSI rates were stable, and the significant variation detected in some units could not be seen in overall rates. Further studies with data adequately adjusted for risk factors are needed to assess BSI rates in the patient groups with the highest rates (hematology, neonatology). The outbreak investigations showed that horizontal transmission was common in the NICU. Overcrowding and lapses in hand hygiene probably contributed to the spreading of the pathogens. Following long-term use of fluconazole in the NICU, resistance to fluconazole developed in C. parapsilosis. Almost one-fourth of the patients who underwent open-heart surgery acquired at least one HAI. All severe HAIs were detected during hospitalization. The postdischarge study found numerous viral infections, which often caused rehospitalization.
  • Koivunen, Kristiina (1999)
    Tutkimuksessa arvioidaan Pohjois-Kurdistanin, eli Kaakkois-Turkin, terveystilannetta 1990-luvulla. Alueella on ollut vuodesta 1984 lukien aseellinen konflikti Turkin armeijan ja Kurdistanin Työväenpuolueen PKK:N välillä. Vuodesta 1992 lähtien Turkin armeija on käyttänyt näkymättömän sodan (low-intensity warfare) taktiikkaa ja tyhjentänyt noin kolme tuhatta kurdikylää PKK:N huoltoreittien katkaisemiseksi. Noin kolme miljoonaa kurdia on Turkissa maan sisäisinä pakolaisina (intemally displaced persons). Turkin valtio perustettiin vuonna 1923 Lausannen rauhansopimuksella, joka määritteli Turkin vähemmistöiksi vain ei-islamilaisia ryhmiä. Vuodelta 1982 olevan Turkin perustuslain mukaan maassa ei ole vähemmistöjä, ja kaikkien sen kansalaisten äidinkieli on turkki, joten vähemmistöjen oikeuksista ei tarvitse edes keskustella. Turkin valtion toteuttama assimilaatiopolitiikka täyttää kulttuurisen kansanmurhan (cultural genocide) kriteerit. Tutkimuksen teoreettisena viitekehyksenä on kulttuurisen kansanmurhan ja näkymättömän sodan teoriat. Tutkimusaineisto koostuu alueelta olevista tilastoista ja raporteista, joita ovat laatineet mm. Turkin Tilastokeskus, Human Rights Foundation of Turkey, Turkin Lääkäriliitto, terveysalan ammattiliitto Saglik Sen, ja alueella vierailleet delegaatiot. Olen myös haastatellut alueella käyneitä kurdeja. Olen itse kerännyt tutkimusaineistoa Turkissa vuosina 1997-1999 neljän matkan aikana, yhteensä viisi viikkoa. Poikkeustila-alueella (State of Emergency Region) kaikki sairaudet, joista on saatavissa tietoja, ovat lisääntyneet 1990-luvulla. Ilmoitettujen malariatapausten määrä on kymmenkertaistunut muutaman vuoden aikana, mutta malarian torjuntaa on vähennetty samaan aikaan. Vuonna 1998 alueelta löytyi 19 poliotapausta, lokakuussa 1998 WHO järjesti Turkin, Irakin, Iranin ja Syyrian kurdialueilla 2,3 miljoonan lapsen rokottamisen poliota vastaan. Myös koleran, tuberkuloosin, b-hepatiitin ja trakooman määrät ovat moninkertaistuneet 1990 -luvulla. Turkin Lääkäriliitto arvioi kurdialueen lapsikuolleisuuden olevan kaksin- tai kolminkertainen muuhun maahan verrattuna. Samaan aikaan kun sairaudet ovat lisääntyneet, suuri osa terveysasemista on suljettu työvoimapulan takia tai otettu sotilaskäyttöön. Tilanteesta ei ole saatavilla tarkkoja, luotettavia tietoja. Turkki on estänyt kansainvälisiä järjestöjä, kuten Punaista Ristiä, tekemästä alueella terveyskartoituksia tai toimittamasta humanitaarista apua kodittomille ihmisille. Se, että tilanteen tutkiminen on hyvin vaikeaa, on kulttuurisen kansanmurhan yksi aspekti: kurdeilta on kielletty oma identiteetti, kieli ja kulttuuri, mutta heidät on myös häivytetty tilastoista ja tutkimuksesta.
  • Koivunen, Kristiina (1999)
    The aim of this research is to study the health situation in the Turkish part of Kurdistan (Southeast Turkey) during the 1990s. Since 1984 there has been going on an armed conflict between the Turkish army and Kurdistan Labour Party, the PKK. Since 1984 the army has used the strategy of low-intensity war towards the guerillas. To cut the supply routes of the guerillas, the army has forced people from three thousand villages to leave their homes. About three million Kurds live in Turkey as internally displaced persons. The Republic of Turkey was founded in 1923 with the Treaty of Lausanne, according. to which the only minorities in Turkey are some non-muslim ones. According to the Constitution from 1982, there are no minorities in Turkey, and the mother language of all citizens' is Turkish, so there is no need even to discuss about the rights of minorities. The assimilation policy run by the state fills the criteria of cultural genocide. The theoretical framework of this research is theories connected to cultural genocide and low-intensity warfare. The information is collected for example from statistics of the State Institute of Statistics of Turkey; from reports given out by the U.S. Department of State, Human Rights Foundation of Turkey, Turkish Medical Association and the Labour Union of Health Care Saglik Sen; from travel reports and by interviewing Kurds who have visited the region. I have myself collected information in Turkey five weeks, during four journeys in 1997-1999. In the State of Emergency Region the amount of all diseases, of which there is any information available, has increased during the 1990s. The number of reported cases of malaria has became tenfold during some years, but the prevention of malaria has decreased during the same period. 19 polio cases were reported in 1998 in the region. In October 1998 the WHO arranged in the Kurdish region in Iran, Iraq, Turkey and Syria a campaign during which 2,3 million children were vaccinated towards polio. Also the amount of cholera, tuberculosis, hepatitis B and trachoma has increased during the 1990s. The Turkish Medical Associal estimates that infant mortality rate in the Kurdish provinces is two or three times as high as in other parts of Turkey. While the amount of diseases has increased, many of health centers have been closed due to lack of labour, or they have been taken into military use. No exact, thrustworthy information about the situation is available. Turkey has prevented international humanitarian organisations, like the Red Cross and Médecin Sans Frontières, to make any surveys about the situation, and to deliver aid to the homeless people. The denial of doing research is one aspect of cultural genocide: in Turkey Kurdish language, culture and identity are forbidden, but in addition to that, it is impossible to find information about the Kurds in statistics and research.
  • Nurmi, Anna (Helsingin yliopisto, 2008)
    High dietary intake of fruits and vegetables has been linked to protection against chronic diseases, of which cardiovascular diseases (CVD) are the major cause of death in Finland. One of the hypotheses underlying the mechanism behind this effect is the antioxidant action of several dietary factors, including vitamins C and E, carotenoids and polyphenolic compounds. Polyphenols are consumed in large quantities in plant rich diets and observations on their antioxidant potency in vitro have made them a hot research topic during the past twenty years. The present study deals with the antioxidant activity of selected members of the plant family Lamiaceae sage (Salvia officinalis L.), thyme (Thymus vulgaris L.), rosemary (Rosmarinus officinalis L.) and two oregano species (Origanum vulgare L., Origanum onites L.). Due to the abundance of various phenolic compounds in these herbs, they are considered as a potential source of health-beneficial natural components with usage as health-promoting dietary supplements. The applicability of hydrodistillation, methanolic and ethanolic extraction, and pressurised hot-water extraction (PHWE) to extract phenolic antioxidants from sage was studied. Based on the 1,1-diphenyl-2-picrylhydrazyl radical (DPPH ) scavenging activity of the different extracts, PHWE was the most effective technique. The hydrodistillation method was chosen for the further production of study extracts due to sensory properties of the extracts suitable for human consumption. The technique was also easily applicable in a larger scale production. The in vitro antioxidant properties of water extracts from sage, rosemary, thyme and oregano (O. vulgare) were characterised using three radical scavenging assays, a reductive capacity assay and a human low-density lipoprotein (LDL) oxidation assay. The total phenolic content of these extracts was determined. Depending on the method used, the extracts showed varying degrees of antioxidant activity. The absorption and metabolism of oregano (O. onites) extract in humans was evaluated by analysing the urinary excretion of phenolic metabolites using liquid chromatographic methods. The excretion of phenolic metabolites in urine was markedly increased following a single ingestion of O. onites extract, and the pattern of urinary metabolites suggested effective metabolism to take place. The in vitro antioxidant activity of phenolic constituents and human metabolites of O. onites were studied in DPPH and LDL oxidation assays. The phenolic acids from O. onites showed a range of antioxidant activity in the assays used, and some degree of activity was observed for many of the aglycone forms of their human metabolites. In a double-blinded, placebo-controlled clinical trial, the effects of oregano (O. vulgare) extract consumption on different biomarkers of antioxidant capacity and lipid peroxidation were studied in healthy men. No short- or long term effects on the antioxidant parameters followed were observed. This work revealed several aspects on the problematic nature of studies on antioxidants. Even though these extracts and their constituents seem promising antioxidant candidates in vitro and are at least to some extent available in the body, they lack effects on an array of lipid peroxidation and antioxidant capacity parameters in vivo. The findings suggest that their potential health-beneficial effects on humans are not mediated via direct antioxidant action. However, the epidemiologically observd association between the high intake of polyphenol rich fruits and vegetables and the decreased risk of CVD, as well as accumulating in vitro evidence on several bioactivities of polyphenols support the theory that polyphenols may have favourable effects on human health mediated via some other mechanisms.
  • Salo, Sirpa (2008)
    This is a study of people’s eclectic understanding of illnesses and inconsistence in illness management in a Nepali village called Bholung. The aim of the discussion is to illustrate and explain how the villagers and local healers make cultural sense of their illnesses which are thought to have a supernatural origin. I aim to explain what kinds of personal and socio-cultural meanings the villagers and the village healers give to experiences of being ill – and why. By analysing how the local Hindu culture and society shape the villagers’ ways of seeing and being in the world I aim to explain how these matters contribute to culturally recognised forms of being ill and getting well in Bholung. I did village based research for seven months in 2003. My fieldwork was focused on the village of thirty-five households and some 180 people. My material consists of structured and unstructured, informal interviews and participant observation. I interviewed fourteen villagers of whom five were women. The interviewees were between forty-five and sixty-six years old. Structured direct observation I practiced during healing sessions, daily puja rituals, purification rituals and for example during annual offering rituals. Hindu rules and restrictions and local household rites and rituals influence how the villagers know and understand their holistic cosmology and their hierarchical social system. Also, they influence how the villagers know and experience their own bodies, how they explain and interpret - depending on their personal motives and needs, social pressure and constant socio cultural changes - the causes and consequences of some of their illnesses, and how they further deal with them at the village level. I suggest that the hierarchical Hindu order is constructed and maintained in Bholung household rites and rituals, and in healing rituals, not only because the maintenance of the holistic social system is believed to require such created differences between people and places, but also because the hierarchical order stands for purity, the ideal order of relations and of being related in Bholung.
  • Simonsen, Nina (Helsingin yliopisto, 2013)
    Municipalities are important arenas in health promotion as many of the determinants of health relate to, and exert their influence in, local contexts. Accordingly, one key question in public-health work is how to support health promotion on the local level. The present study explores and compares health promotion actions in four medium-sized municipalities, with an emphasis on factors influencing engagement. The point of departure is the health promotion strategies described in the Ottawa Charter (WHO 1986) – the focus being on community action for health, health-promoting health services and healthy public policy – and the multilevel health promotion model (Rütten et al. 2000). The overall aim is to further enhance understanding of health promotion action in local contexts. The specific aims are to explore the role of local voluntary associations in health promotion, to compare the emphasis on health promotion in four municipalities with different forms of primary healthcare service production, and, especially, to identify factors associated with comprehensive health promotion action and with health policy impact (effective health promotion actions). The study – part of an evaluation of the production model of primary healthcare in four municipalities in the southern part of Finland – is based on cross-sectional surveys conducted in the four municipalities in 2000, 2002 and 2004 and including all registered local voluntary associations (LVAs), primary healthcare (PHC) personnel (including services for older people) and local politicians. The data were analysed by means of descriptive statistics as well as logistic and linear regression analysis. The findings suggest that a fair proportion of LVAs are interested in action for community health and could be seen as a resource for health promotion in local contexts. There was agreement that the promotion of residents’ health requires cooperation between municipal agencies and LVAs, although cooperation was not particularly strongly emphasized in municipal budget and action plans according to the politicians. Cooperation with municipal agencies was independently associated with LVA engagement in health promotion. PHC personnel appear to be engaged in health promotion primarily on an individual basis. On all three levels (individual, group and population) it was most prevalent in ambulatory care. This was also true in the case of comprehensive action, as well as when health promotion was conceptualized as addressing risk behaviour. There were some differences between the municipalities in terms of level of engagement; the respondents' focus in health promotion and varying opportunities for cooperation are two potential explanations for these differences. Moreover, variables reflecting all the proposed determinants (organizational values, competence and opportunities) were independently associated with the PHC personnel’s engagement in comprehensive health promotion action. These included working conditions that are conducive to health promotion such as being able to use one’s skills and knowledge, and having possibilities for reflection and learning as well as collegial support; knowledge about residents’ health and living conditions; and opportunities to cooperate with partners outside the organization. Similarly, perceived competence and a value orientation towards health as well as opportunities for community participation were independently associated with LVA engagement in comprehensive health promotion action. In addition to the determinants in the theoretical model, the municipality had an influence. There were no inter-municipality differences in the politicians’ evaluations of health promotion actions and their effectiveness (health policy impact). In terms of impact, an emphasis on promoting health and quality of life among older people and the resources (in the form of capacity of PHC and care for older people) were among the most significant elements of health promotion policy on the local level. Contrary to expectations, opportunities for community participation were not associated with the evaluations. The findings reinforce the value of empowerment, community participation and intersectoral cooperation – in other words the principles of health promotion – in the context of Finnish municipalities, providing further evidence as well as highlighting their significance for engagement in health promotion action. The study also provides novel empirical confirmation concerning the applicability of the multilevel health promotion model to the actions of different actors in municipalities, in other words in local contexts. In support of action on the local level, the findings – the equally strong associations of organizational values, competence and opportunities with engagement in health promotion – suggest the need for a multilevel approach. However, local policy makers may need more evidence concerning the impact of cooperation and community participation.
  • Saarni, Samuli (Helsingin yliopisto, 2008)
    Quality of life (QoL) and Health-related quality of life (HRQoL) are becoming one of the key outcomes of health care due to increased respect for the subjective valuations and well-being of patients and an increasing part of the ageing population living with chronic, non-fatal conditions. Preference-based HRQoL measures enable estimation of health utility, which can be useful for rational rationing, evidence-based medicine and health policy. This study aimed to compare the individual severity and public health burden of major chronic conditions in Finland, including and focusing on reliably diagnosed psychiatric conditions. The study is based on the Health 2000 survey, a representative general population survey of 8028 Finns aged 30 and over. Depressive, anxiety and alcohol use disorders were diagnosed with the Composite International Diagnostic Interview (M-CIDI). HRQoL was measured with the 15D and the EQ-5D, with 83% response rate. This study found that people with psychiatric disorders had the lowest 15D HRQoL scores at all ages, in comparison to other main groups of chronic conditions. Considering 29 individual conditions, three of the four most severe (on 15D) were psychiatric disorders; the most severe was Parkinson s disease. Of the psychiatric disorders, chronic conditions that have sometimes been considered relatively mild - dysthymia, agoraphobia, generalized anxiety disorder and social phobia - were found to be the most severe. This was explained both by the severity of the impact of these disorders on mental health domains of HRQoL, and also by the fact that decreases were widespread on most dimensions of HRQoL. Considering the public health burden of conditions, musculoskeletal disorders were associated with the largest burden, followed by psychiatric disorders. Psychiatric disorders were associated with the largest burden at younger ages. Of individual conditions, the largest burden found was for depressive disorders, followed by urinary incontinence and arthrosis of the hip and knee. The public health burden increased greatly with age, so the ageing of the Finnish population will mean that the disease burden caused by chronic conditions will increase by a quarter up to year 2040, if morbidity patterns do not change. Investigating alcohol consumption and HRQoL revealed that although abstainers had poorer HRQoL than moderate drinkers, this was mainly due to many abstainers being former drinkers and having the poorest HRQoL. Moderate drinkers did not have significantly better HRQoL than abstainers who were not former drinkers. Psychiatric disorders are associated with a large part of the non-fatal disease burden in Finland. In particular anxiety disorders appear to be more severe and have a larger public health burden than previously thought.
  • Laas, Karin (Helsingin yliopisto, 2009)
    Rheumatoid arthritis (RA) and other chronic inflammatory joint diseases already begin to affect patients health-related quality of life (HRQoL) in the earliest phases of these diseases. In treatment of inflammatory joint diseases, the last two decades have seen new strategies and treatment options introduced. Treatment is started at an earlier phase; combinations of disease-modifying anti-rheumatic drugs (DMARDs) and corticosteroids are used; and in refractory cases new drugs such as tumour necrosis factor (TNF) inhibitors or other biologicals can be started. In patients with new referrals to the Department of Rheumatology of the Helsinki University Central Hospital, we evaluated the 15D and the Stanford Health Assessment Questionnaire (HAQ) results at baseline and approximately 8 months after their first visit. Altogether the analysis included 295 patients with various rheumatic diseases. The mean baseline 15D score (0.822, SD 0.114) was significantly lower than for the age-matched general population (0.903, SD 0.098). Patients with osteoarthritis (OA) and spondyloarthropathies (SPA) reported the poorest HRQoL. In patients with RA and reactive arthritis (ReA) the HRQoL improved in a statistically significant manner during the 8-month follow-up. In addition, a clinically important change appeared in patients with systemic rheumatic diseases. HAQ score improved significantly in patients with RA, arthralgia and fibromyalgia, and ReA. In a study of 97 RA patients treated either with etanercept or adalimumab, we assessed their HRQoL with the RAND 36-Item Health Survey 1.0 (RAND-36) questionnaire. We also analysed changes in clinical parameters and the HAQ. With etanercept and adalimumab, the values of all domains in the RAND-36 questionnaire increased during the first 3 months. The efficacy of each in improving HRQoL was statistically significant, and the drug effects were comparable. Compared to Finnish age- and sex-matched general population values, the HRQoL of the RA patients was significantly lower at baseline and, despite the improvement, remained lower also at follow-up. Our RA patients had long-standing and severe disease that can explain the low HRQoL also at follow-up. In a pharmacoeconomic study of patients treated with infliximab we evaluated medical and work disability costs for patients with chronic inflammatory joint disease during one year before and one year after institution of infliximab treatment. Clinical and economic data for 96 patients with different arthritis diagnoses showed, in all patients, significantly improved clinical and laboratory variables. However, the medical costs increased significantly during the second period by 12 015 (95% confidence interval, 6 496 to 18 076). Only a minimal decrease in work disability costs occurred mean decrease 130 (-1 268 to 1 072). In a study involving a switch from infliximab to etanercept, we investigated the clinical outcome in 49 patients with RA. Reasons for switching were in 42% failure to respond by American College of Rheumatology (ACR) 50% criteria; in 12% adverse event; and in 46% non-medical reasons although the patients had responded to infliximab. The Disease Activity Score with 28 joints examined (DAS28) allowed us to measure patients disease activity and compare outcome between groups based on the reason for switching. In the patients in whom infliximab was switched to etanercept for nonmedical reasons, etanercept continued to suppress disease activity effectively, and 1-year drug survival for etanercept was 77% (95% CI, 62 to 97). In patients in the infliximab failure and adverse event groups, DAS28 values improved significantly during etanercept therapy. However, the 1-year drug survival of etanercept was only 43% (95% CI, 26 to 70) and 50% (95% CI, 33 to 100), respectively. Although the HRQoL of patients with inflammatory joint diseases is significantly lower than that of the general population, use of early and aggressive treatment strategies including TNF-inhibitors can improve patients HRQoL effectively. Further research is needed in finding new treatment strategies for those patients who fail to respond or lose their response to TNF-inhibitors.
  • Kaukua, Jarmo (Helsingin yliopisto, 2004)
  • Haapamäki, Johanna (Helsingin yliopisto, 2011)
    Health-related quality of life (HRQoL) measurement has become an important outcome in treatment trials and in health policy decisions. HRQoL can be measured by using generic or disease-specific tools. Generic instruments can be used for comparing health status among patients in different health states and conditions but they do not focus specifically on the issues relevant in a particular disease. Disease-specific tools may be more responsive to changes within a specific condition. In earlier studies, impairment of HRQoL has been evident in patients with inflammatory bowel disease (IBD), especially when the disease is active. Data about the impact of comorbidity or demographic characteristics of the patients on HRQoL are partly controversial. This study, which comprised 2913 adult IBD patients, examined HRQoL using the disease-specific IBDQ and the general 15D instruments. The 15D scores of IBD patients were compared with scores of a gender and age matched general population sample. Frequency of IBD symptoms and arrangement of therapy were studied and compared with those of IBD patients in an earlier European study. Furthermore, data of other chronic diseases of the patients were obtained from the Social Insurance Institution s reimbursement register and comorbidity of IBD patients was compared with that of age and gender matched controls. --- Of the respondents, 37% reported that they suffered from disturbing IBD symptoms weekly. In 17% of the patients, the symptoms greatly affected the ability to enjoy leisure activities, and 14% stated that these symptoms greatly affected their capacity to work. Despite that, the great majority (93%) of patients expressed satisfaction with their current treatment, which exceeded the rate observed in the other European patients. The mean IBDQ score was 163, as the possible range is 32-224, and disease activity was strongly correlated with HRQoL. Older age, comorbid diseases, and female gender were also related to impairment of HRQoL. Lower HRQoL scores were seen also in newly-diagnosed patients and in those with a history of surgery, especially after stoma or ileal pouch-anal anastomosis (IPAA) operation. The range of 15D scores was 0.30-1.00, with mean of 0.87. As with the IBDQ, disease activity, older age and history of surgery were correlated with the score. Both the newly-diagnosed patients and patients with a long-lasting disease had lower scores than average even after adjusting for age. The 15D scores of IBD patients were significantly lower than those of the control group. A strong correlation was seen between the 15D and the IBDQ scores. Comorbidity with other chronic diseases was observed in 29% of IBD patients. Connective tissue diseases, chronic obstructive pulmonary diseases, pernicious anaemia, and coronary heart disease (CHD) were significantly increased in patients with IBD. Especially female IBD patients appeared to be at increased risk for CHD, and patients who reported weekly IBD symptoms had a higher risk for having other chronic diseases in addition to IBD. Comorbidity impaired HRQoL, as measured with both generic and disease-specific tools. In conclusion, HRQoL is impaired in IBD patients. An understanding of predictors of HRQoL will help to recognise patients who will need special support.
  • Karppinen, Noora (2014)
    Heart rate variability (HRV) is a noninvasive tool for investigating cardiac autonomic nervous system, especially its parasympathetic branch. HRV is known to be reduced for example in cardiovascular autonomic neuropathy and after myocardial infarction. Several studies have reported reduced HRV in type 1 diabetes patients. Regular exercise is known to increase parasympathetic tone but the effect of training on HRV is somewhat unclear. This study examined HRV during 48 hours after incremental cycling until volitional fatigue in type 1 diabetes patients without cardiac autonomic neuropathy and in healthy controls. HRV was analyzed both at day and night. Subjects’ aerobic capacity was measured. Part of the subjects underwent 6-12 months training intervention, after which the same measurements were repeated. Time-domain, frequency-domain and nonlinear methods were used in HRV analysis. Aerobic capacity was significantly higher in healthy controls than in type 1 diabetes patients (p=0.036). No differences in HRV were found between type 1 diabetes patients and healthy controls. In healthy controls aerobic capacity correlated with LF/HF-ratio (r=-0.711, p=0.014). In type 1 diabetes patients glycosylated hemoglobin (HbA1c) correlated with SDNN (r=-0.645, p=0.023), absolute VLF power (r=-0.648, p=0.023) and SD2 of Poincare plot (r=-0.646, p=0.023). There was a significant increase in aerobic capacity in both groups after training intervention (p<0.05). Training intervention did not cause a significant change in HRV.