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  • 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.
  • Nieminen, Tarja (Helsingin yliopisto, 2015)
    Social capital has been widely discussed in research. An increasing amount of literature has linked social capital to various health outcomes and well-being. However, both health and social capital are complex phenomena, and there is still inconsistency in the research findings. The general aim of this study was to examine the associations between social capital, health behaviour and health among adult Finnish population. The conceptualization and operationalization of social capital varies according to discipline and level. In this study, social capital is measured at the individual level assuming that an individual s investment in group activity reflects social capital seen as a resource related to social networks and group membership. Individual benefits are accessed through social connections in varied groups and society. Thus the resources do not reside within the individual but rather in the structure of person s social networks. Social capital was measured on three dimensions in this study: 1) social support, 2) social networks and participation and 3) trust and reciprocity. The association between these dimensions and health were examined. Health was investigated as self-rated health, psychological well-being and mortality. This study utilised the data of the Health 2000 Survey conducted in 2000−2001. Of people aged 30 and over, 89% participated in the home interview and 80% in the general health examination. The study material presents the whole population unusually well. The National Institute for Health and Welfare (THL; formerly the National Public Health Institute, KTL) had the overall responsibility for the project. In addition, the project organization involved a wide range of research and funding agencies. This survey contains a rich armoury of questions about health and illnesses, health behaviour, capacity for work, functional capacity and use of health services. Furthermore, it includes a broad selection of questions used in measuring social capital. The results found an accumulation of social capital and general welfare for the same groups: the highest levels of social capital were found among the young, well-educated and married people. However, all socio-demographic subgroups seem to benefit from social capital. Regardless of all socio-demographic characteristics, high levels of social capital were associated with good health, associations which varied among different health-related behaviours, but social participation had a strong statistical association with all components of health and all health behaviours. Regardless of chronic diseases people with high levels of social capital felt healthier than those with low levels. The positive association between social capital and survival was statistically significant among men and suggestive among women. These findings indicate that social capital contributes to health. Health inequalities between population sub-groups are still substantial. Health could be promoted and health inequalities reduced by developing tools for increasing social participation especially in those groups lacking social capital−and who often also suffer from several health problems.
  • 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.
  • 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.
  • Haapala, Markus (Helsingin yliopisto, 2010)
    Miniaturized analytical devices, such as heated nebulizer (HN) microchips studied in this work, are of increasing interest owing to benefits like faster operation, better performance, and lower cost relative to conventional systems. HN microchips are microfabricated devices that vaporize liquid and mix it with gas. They are used with low liquid flow rates, typically a few µL/min, and have previously been utilized as ion sources for mass spectrometry (MS). Conventional ion sources are seldom feasible at such low flow rates. In this work HN chips were developed further and new applications were introduced. First, a new method for thermal and fluidic characterization of the HN microchips was developed and used to study the chips. Thermal behavior of the chips was also studied by temperature measurements and infrared imaging. An HN chip was applied to the analysis of crude oil – an extremely complex sample – by microchip atmospheric pressure photoionization (APPI) high resolution mass spectrometry. With the chip, the sample flow rate could be reduced significantly without loss of performance and with greatly reduced contamination of the MS instrument. Thanks to its suitability to high temperature, microchip APPI provided efficient vaporization of nonvolatile compounds in crude oil. The first microchip version of sonic spray ionization (SSI) was presented. Ionization was achieved by applying only high (sonic) speed nebulizer gas to an HN microchip. SSI significantly broadens the range of analytes ionizable with the HN chips, from small stable molecules to labile biomolecules. The analytical performance of the microchip SSI source was confirmed to be acceptable. The HN microchips were also used to connect gas chromatography (GC) and capillary liquid chromatography (LC) to MS, using APPI for ionization. Microchip APPI allows efficient ionization of both polar and nonpolar compounds whereas with the most popular electrospray ionization (ESI) only polar and ionic molecules are ionized efficiently. The combination of GC with MS showed that, with HN microchips, GCs can easily be used with MS instruments designed for LC-MS. The presented analytical methods showed good performance. The first integrated LC–HN microchip was developed and presented. In a single microdevice, there were structures for a packed LC column and a heated nebulizer. Nonpolar and polar analytes were efficiently ionized by APPI. Ionization of nonpolar and polar analytes is not possible with previously presented chips for LC–MS since they rely on ESI. Preliminary quantitative performance of the new chip was evaluated and the chip was also demonstrated with optical detection. A new ambient ionization technique for mass spectrometry, desorption atmospheric pressure photoionization (DAPPI), was presented. The DAPPI technique is based on an HN microchip providing desorption of analytes from a surface. Photons from a photoionization lamp ionize the analytes via gas-phase chemical reactions, and the ions are directed into an MS. Rapid analysis of pharmaceuticals from tablets was successfully demonstrated as an application of DAPPI.
  • Saarinen, Sampo (2014)
    Nanofluids are a new class of colloids that is generally classified as solid particle suspensions such that the particle diameter is less than 100 nm. In the last decade they have exhibited anomalously high thermal conductivity compared to classical models. Additionally, nanoscale emulsions have shown similar behavior but have gathered less attention than solid particle nanofluids. The optimal preparation of nanoemulsions is not straightforward. Multiple factors have an effect on the final size distribution and therefore optimization is required. Models for the anomalous behavior include effects of the Brownian motion, formation of particle clusters and ordering of liquid into a layer of high conductivity around the particles. In our measurements for nanoscale emulsions, we however observed no significant deviation from the classical models. Besides conduction, nanofluids could also be utilized in convective heat transfer applications. The research on this field is more limited but indicates that increases in heat transfer exist also in convective transport. We perform heat transfer experiments on several n-decane in water nanoemulsions and nanoscale micelle colloids in the transition and turbulent flow regime. Our results indicate that while the thermal properties of the samples were usually worse for convective applications than the reference, the heat transfer properties were similar or better especially at high Reynolds numbers.
  • Sajavaara, Timo (Helsingin yliopisto, 2002)
  • Koponen, Jonna (Helsingin yliopisto, 2009)
    Several excited states of Ds and Bs mesons have been discovered in the last six years: BaBar, Cleo and Belle discovered the very narrow states D(s0)*(2317)+- and D(s1)(2460)+- in 2003, and CDF and DO Collaborations reported the observation of two narrow Bs resonances, B(s1)(5830)0 and B*(s2)(5840)0 in 2007. To keep up with experiment, meson excited states should be studied from the theoretical aspect as well. The theory that describes the interaction between quarks and gluons is quantum chromodynamics (QCD). In this thesis the properties of the meson states are studied using the discretized version of the theory - lattice QCD. This allows us to perform QCD calculations from first principles, and "measure" not just energies but also the radial distributions of the states on the lattice. This gives valuable theoretical information on the excited states, as we can extract the energy spectrum of a static-light meson up to D wave states (states with orbital angular momentum L=2). We are thus able to predict where some of the excited meson states should lie. We also pay special attention to the order of the states, to detect possible inverted spin multiplets in the meson spectrum, as predicted by H. Schnitzer in 1978. This inversion is connected to the confining potential of the strong interaction. The lattice simulations can also help us understand the strong interaction better, as the lattice data can be treated as "experimental" data and used in testing potential models. In this thesis an attempt is made to explain the energies and radial distributions in terms of a potential model based on a one-body Dirac equation. The aim is to get more information about the nature of the confining potential, as well as to test how well the one-gluon exchange potential explains the short range part of the interaction.
  • Nihtilä, Annamari (Helsingin yliopisto, 2014)
    A reform to Dental Care legislation in 2002 abolished age limits restricting adults use of public dental services in Finland. This Dental Reform aimed to increase equity by improving adults´ access to care and reducing cost barriers. The adult population´s increased demand for dental care put pressure on the Public Dental Service (PDS). The aim of this study was to compare heavy and low use of dental services in the PDS of Espoo in order to identify reasons for heavy use and to suggest improvements to care provision. This study is based on register data. All patients who had visited the PDS of Espoo in 2004 (n=63 850) were divided into two groups: children and adolescents and adults. Within each group, all patients who had made six or more dental visits to the PDS in 2004 were defined as heavy users of oral health services and all the patients who had had three or fewer visits as low users. A random sample of 320 adult patients and a 245 children and adolescent patients was drawn from each group. All adult heavy and low consumers of dental services identified in 2004, were followed for five years. Information on age, sex, number and types of visits, oral health status and treatment provided was collected from treatment records. Seven per cent of the children and adolescents in 2004 could be classified as heavy users and the main reasons of heavy use were high numbers of orthodontic treatment occasions provided by dentists and high numbers of decayed teeth in a small number of children. For adults, 10% were heavy users. A need for complicated treatment, dentists´ and dental hygienists´ lack of experience of adult dental care and lack of specialist resulted in high numbers of visits for these patients. The adult heavy users were older and had lower social status than low users. Of these baseline adult heavy users 11% persisted as chronic frequent users during 2005-2009. Typical for adult heavy use in the baseline and the follow-up study was a lack of proper examinations, poor quality of periodontal diagnosis, lack of preventive care, and a cycle of repetitive repair or replacement of restorations, often as emergency treatment. Fixed prosthetic treatment was seldom used in the PDS of Espoo. The PDS should seek to early identify possible heavy users and they should be offered a comprehensive approach to treatment and a responsible team of a dentist and dental hygienist. In order to manage adult dental health effectively, the PDS should encourage regular examinations, treatment plans and recall visits based on patients´ oral health and risk factors.