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  • Song, Xin (Helsingin yliopisto, 2015)
    Background and aims: Obesity has become the sixth most important risk factor contributing to the overall burden of a variety of diseases worldwide. The association of anthropometric measures of obesity with mortality from various causes and incidence of cancers of various sites has been investigated, but it remains controversial. The aims of this study were to: 1) evaluate the epidemiological nature of the association of anthropometric measures of obesity with mortality from various causes, and to detect a potential threshold in this association; 2) study the epidemiological nature of the association between body mass index and incidence of cancer of different sites, and to detect a potential threshold in the association; 3) compare the strengths of different anthropometric measures of obesity in relation to cardiovascular disease (CVD) mortality; 4) assess the risk of CVD mortality in relation to obesity and sex in the general population, and also separately for those with or without diabetes at baseline. Study population and Methods: This study was based on data subsets of the Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe (DECODE) study and the National FINRISK study, including 72 947 European men and 62 798 women (I), 26 636 Finnish men and 28 089 women (II), 24 686 European men and 21 965 women (III/IV), and 23 629 European men and 21 965 women (V) aged 24 years or above at baseline. Hazard ratios (HRs) corresponding to categorical or continuous body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) or waist-to-stature ratio (WSR), a body shape index (ABSI) and waist-to-hip-to-height ratio (WHHR) were estimated by the Cox proportional hazards model adjusting for several potential confounding factors measured at baseline. The non-parametric smooth functions of several anthropometric measures of obesity were fitted to health outcomes in order to explore the potential curvilinear relationship using the spline regression model, with a threshold detected by a piecewise regression model (II/III). HR per standard deviation increment of each anthropometric measure of obesity in relation to CVD mortality was compared using the paired homogeneity test (IV). Results: BMI, WC and WHtR had a U- or J-shaped relationship with all-cause mortality (I/III), whereas WHR, ABSI and WHHR had a linear positive relationship with all-cause mortality (III). BMI had a J-shaped relationship with CVD mortality (I/III), whereas anthropometric measures of abdominal obesity (WC, WHR, WHtR and ABSI) had a linear positive relationship with CVD mortality (III). BMI had a U-shaped relationship with cancer mortality in both men and women but disappeared among non-smokers, which showed no association (I). BMI had a linear positive association with incidence of cancers of the colon, liver, kidney, bladder and all sites combined in men, and of cancers of the stomach, colon, gallbladder and ovary in women, an inverse association with incidence of cancers of the lung in men and the lung and breast in women, and a J-shaped association with incidence of all cancers combined in women (II). A one-standard-deviation increase in all obesity indicators were significantly associated with a more than 19% increase of CVD mortality risk in both men and women, and the prediction for CVD mortality was stronger with anthropometric measures of abdominal obesity than that with BMI and ABSI, and most strongly with the WHtR/WSR (IV). Men had higher CVD mortality rates and higher HRs across BMI categories, and categories of abdominal obesity than women (V). The sex difference in CVD mortality was slightly smaller in obese than in non-obese individuals; the negative interactions were statistically significant between sex and WC (p =0.02), and sex and WHtR (p =0.01). None of the interaction terms was significant when the analyses were carried out among non-diabetic or diabetic individuals separately (V). Conclusions: This study confirmed the deleterious effect of obesity on mortality from various causes and incidence of cancers of certain sites. The prediction for CVD mortality with anthropometric measures of abdominal obesity was stronger than that with BMI, which may imply a more important role of fat distribution than fat accumulation and suggest that an effective obesity prevention strategy should emphasize the importance of abdominal obesity. Men had higher CVD mortality than women across all categories of anthropometric measures of obesity, which further supports the view of higher intra-abdominal fat accumulation in men than in women, even in non-obese individuals. Obesity seems slightly to diminish the female advantage in CVD mortality, irrespective of diabetes status. This may indicate that women may gradually lose their cardiovascular advantage when they are obese, probably due to a more pronounced clustering of CVD risk factors among obese women.
  • Aaltonen, Kalle (Helsingin yliopisto, 2015)
    Rheumatoid Arthritis (RA) is an autoimmune disease, which is treated with anti-inflammatory and immunosuppressive medication comprising synthetic disease-modifying anti-rheumatic (sDMARDs) and biologic drugs. In this thesis all published randomized controlled trials studying the efficacy and safety of biologic drugs based on the inhibition of tumor necrosis factor (TNF) were identified, evaluated and pooled in using a systematic review including a meta-analysis. Then we pursued a cross-sectional overview on disease activity and medical treatment of patients with RA treated wthin the Finnish specialized healthcare. Finally, we executed two cohort studies in which we combined longitudinal patient data with information on the incidence of serious infections, malignancies and joint replacement operations retrieved from national registers. Forty-one articles reporting on 26 RCTs of TNF-inhibitors were included in the systematic review and meta-analysis. TNF-inhibitors as a monotherapy were more efficacious than placebo but comparable to methotrexate (MTX). TNF-inhibitor and MTX combination was superior to either MTX or TNF-inhibitor alone. TNF-inhibitors were relatively safe as compared to either MTX or placebo. The cross-sectional study revealed 91%, 58% and 21% of patients as concurrent users of (sDMARDs), glucocorticoids and biologics, respectively. The cohort studies showed that the adjusted incidence rate ratios (aIRRs) of infections compared to sDMARD users were 0.9 (95% CI 0.6-1.4) and 1.1 (95% CI 0.59-1.9) for the users of TNF-inhibitors and rituximab, respectively. The aIRRs of malignancies were similar between the sDMARD and biologics users. There were more primary joint replacement operations per 100 patient years among the users of biologic drugs (3.89, 95% CI 3.41 4.41) vs. DMARD (2.63, 2.35 2.94) users but slightly fewer revisions (0.65, 0.46 0.88 vs. 0.83, 0.68 1.01). Efficacy and safety of TNF-inhibitors are comparable to MTX and only few differences were observed between individual agents. Currently, more than 20% of Finnish RA patients are using biologic drugs, with a majority of them in combination therapy with sDMARDs. The incidence of serious infections and malignancies is comparable between the users of sDMARDs, TNF-inhibitors and rituximab. Compared to sDMARD users, biologic drugs users had a higher incidence of joint replacement operations while the durability of the prostheses were similar.
  • Kaprio, Tuomas (Helsingin yliopisto, 2015)
    Background and aims Colorectal cancer (CRC) is one of the world s three most common cancers, and its incidence is rising. Novel biomarkers are essential for diagnostic and prognostic tools and to identify patients for targeted and individualized therapy. Covering all human cells, the carbohydrate units of glycoproteins, glycolipids, and proteoglycans are glycans. Carcinoma-related glycan structures are potential cancer biomarkers, since glycosylation evolves during carcinogenesis. Suggested to play a role in carcinogenesis are glycoproteins podocalyxin (PODXL) and regenerating islet-derived gene (REG) 4. PODXL s aberrant expression or allelic variation or both associate in different cancers with poor prognosis and unfavourable clinicopathological characteristics. Up-regulated REG4 expression occurs in inflammatory bowel diseases and also in gastrointestinal cancers. Reports on the association of REG4 expression with CRC prognosis have been mixed, however. Material and Methods Comparison of the N-glycan profiles of 5 rectal adenomas and 18 rectal carcinomas of different stages was by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry. Tumour expression of REG4 and PODXL was evaluated by immunohistochemistry in 840 consecutive CRC patients surgically treated between 1983 and 2001. In addition we evaluated in a subgroup of 220 consecutively surgically treated CRC patients the tumour expression of MUC1, MUC2, MUC5AC, synapthophysin, chromogranin, sialyl Lewis a (sLea), and pauci-mannose. All patients were treated at Helsinki University Hospital (HUH). Results Rectal adenomas and carcinomas can be distinguished from one another based on their N-glycosylation profile. Differences in N-glycosylation existed also between carcinomas of different stages. Based on these results pauci-mannose and sLea were chosen for immunohistochemical analysis: in CRC sLea correlated with poor prognosis, and in advanced CRC, pauci-mannose expression correlated with poor prognosis. PODXL was an independent marker of poor prognosis in CRC. The two antibodies showed similar prognostic profiles, but their staining patterns differed, and they recognized different groups of patients with a poor prognosis. Combination of the two PODXL antibodies identified a group of patients with even worse prognosis. REG4 expression associated with MUC1, MUC2, and MUC5AC expression in CRC and was a marker of favourable prognosis in non-mucinous CRC. Conclusion Mass spectrometry identified several carcinoma-related glycans and a method of transforming these results into immunohistochemistry was demonstrated. PODXL was a marker of poor prognosis in CRC, whereas REG4 expression predicted a favourable prognosis in non-mucinous CRC.
  • Stewart, Timo (Helsingin yliopisto, 2015)
    This study analyses Finnish Christian Zionism from the end of the 19th century to the 1960s using the methodology of the history of ideas. It evaluates previous interpretations and investigates how Finns and in particular Finnish Christians related to Zionism and the State of Israel and why many Finnish Christians gave Zionism and the State of Israel a religious significance. The study points to three significant sources of growing Finnish Christian interest in Palestine, Jews and prophecy before Israeli independence. The first was through early visits to Palestine and the travel accounts that ensued. Pastors and theologians were particularly active in seeking out the lands of the Bible and the Fifth Gospel that they saw in it. The second was missionary work, which created a small but influential group of Finnish experts on Palestine. Of the people they encountered in Palestine, the missionaries clearly identified most with the Zionists and conveyed their worldview to their Finnish audiences. The third source was the increasingly prevalent prophecy literature that more frequently and confidently linked Zionism with the fulfilment of Biblical prophecies. This was most common amongst Pentecostals, but soon Lutheran missionaries and Evangelical revivalist followed suit. With the creation of the State of Israel even broadly read Lutheran papers made use of the same interpretive traditions. Interpretations varied in detail, but general allusions to an unspecified connection between Bible prophecy and the State of Israel founded in 1948 become common to the point of not requiring explanations. Even bolder forms of Christian Zionism were never challenged. These interpretations were facilitated until the middle of the 1960s by very favourable popular impressions of Zionism and Israel, in which the national experiences of Finland and Israel were seen to have much in common. In contrast, the voice of the Palestinians was not heard at all. Many Finnish Christians saw the State of Israel as a sign of the times and a miracle from year to year. Zionism and the State of Israel seemed to offer an answer to the question of God s continuing involvement with the world and the significance of the Bible. They were constantly relevant signs, but also seen as proof that settled the question of whether the Bible could be trusted. In the eyes of many Finnish Christians this gave the State of Israel a very special significance indeed.
  • Santala, Susanna (Helsingin yliopisto, 2015)
    In this historiographical study I evaluate the placement of Eero Saarinen s airport terminals in the history of modern architecture. His Trans World Airlines Terminal (1956-62) and Dulles International Airport (1958-63) were the first airport terminals to enter the annals of modern architecture. I hypothesize that the airport terminal was previously excluded as a building type from historiography since it was seen as infrastructure, not architecture. Furthermore, its modernity did not coincide with the aims of historians, who could not utilize an emergent building type to demonstrate how modernism revolutionized architectural vocabularies. Discussing the related histories of aviation and technologies, the typological instability of the airport terminal, and Saarinen s architectural practice, I utilize genealogy, microhistory, and Science and Technology Studies to intervene in the historiography of modern architecture. Specifically, I question the assumption that architecture follows technological developments, the narrow interpretation of modernity dominating the writing of architectural history, and the resulting myopia in the classification of emerging building types. I view Saarinen s architectural practice as one of the many laboratories for a new architecture. Mapping such laboratories reveals a multifaceted view of postwar architecture, where modernism is explained by individual actors laboring at their localized sites to mediate a particular kind of modernity. I argue that Saarinen s engagement with technology and his laboratory-like working methods reconciled the contradictions between modern architecture and its blind spot, the airport terminal. This synthesis allowed the terminal building to transcend its utilitarian-technological nature as transportation infrastructure and led to its inclusion in the history of modern architecture as a building type that has its own history and parameters for design. This study makes three contributions. It outlines the history of the airport terminal emphasizing buildings that could have easily found their place in the canon of modern architecture. It explains the reasons for their exclusion and suggests ways to reduce the canon s myopia towards variants of modernism. More broadly, this study contributes to our understanding of the historiography of modern architecture and its logic of including emergent buildings by acknowledging the airport terminal as an emblematic building type of the twentieth century.
  • Wahlström, Max (Helsingin yliopiston nykykielten laitos, 2015)
    Case inflection, which is characteristic of Slavic languages, was lost in Bulgarian and Macedonian between approximately the 11th and 16th centuries. My doctoral dissertation examines the process of this linguistic change and sets out to find its causes and evaluate its consequences. In the earlier research literature, the case loss has been attributed either to language contacts or to language-internal developments such as sound changes, yet none of the theories based on a single explanatory factor has proven satisfactory. In this study, I argue that previous researchers into Late Medieval manuscripts often tried to date the language changes earlier than is plausible in light of the textual evidence. I also propose that the high number of second-language speakers is among the key factors reducing the number of morphological categories in a language; meanwhile, several minor developments related to the case loss for instance, in the marking of possession are likely to have resulted from a specific contact mechanism known as the Balkan linguistic area. My main methodological claim is that the study of language contacts must take into account a general typological perspective. Furthermore, quantitative typological methods are also helpful in assessing whether the shared linguistic features within a linguistic area emerged independently of each other. This dissertation is divided into three parts, each representing a different methodological approach. Through corpus methods, among other approaches, the first part examines the process of the loss of case inflection within the manuscript tradition stemming from Old Church Slavonic. The second approach is based on the study of language contacts. I compare the development of the Bulgarian and Macedonian case systems with the Albanian, Balkan Romance, and Greek case systems and their evolution. In addition, using the Romani language as an example, I analyze the effect of the sociolinguistic setting on the type of contact-induced language change. The third approach examines the case systems of Bulgarian and Macedonian and the rest of the Balkan linguistic area in a cross-linguistic connection to evaluate the extent to which the phenomena related to the case loss can be attributed to universal tendencies observed in the languages of the world.
  • Henriksson, Laura (Suomen Musiikkitieteellinen Seura, 2015)
    Summary Vocal humour and critique in the couplet recordings by J. Alfred Tanner, Matti Jurva, Reino Helismaa, Juha Vainio and Veikko Lavi The aim of this study is to research the lyrics and singing styles of five Finnish couplet singers who are connected to the Finnish schlager tradition. The material-oriented study is performed by analyzing altogether 160 couplet recordings sung by J. Alfred Tanner, Matti Jurva, Reino Helismaa, Juha Vainio, and Veikko Lavi. The study examines the singers humoristic and critical approaches to the lyrics and investigates how the attitudes are performed orally by the singers. The aim of the study is to analyze the singing styles of the songs together with the content of the songs lyrics. The history of the couplet and the previous studies of the subject are reviewed in the beginning of the first part of the work, which also contains the methodological background of the work, which is divided into cultural models and attitudes and to textual and musical conventions. The methodological section introduces a viewpoint which takes into account the couplet songs musical and textual practices alongside with the general cultural views such as attitudes advocating the culture of contestation and hegemonic masculinity. A detailed analysis of Juha Vainio s couplet song Käyn ahon laitaa demonstrates in practice how the couplet recordings can be analyzed. In the articles the couplets themes are examined by using scientific concepts and by analysing couplet recordings. In the first article couplets and their critical attitudes towards persons in power are examined by using the term of carnivalism. The second article deals with self-irony of the couplets characters which is investigated by using the concept of incongruity and the relief theory previously used in humour studies. The subject of the third article is female characters in the couplet songs. The subjects of the fourth article are masculinity and its vocal interpretation in the songs. The theoretical framework of the study is based on the Judith Butler s concept of performativity and Zygmunt Bauman s categories of the postmodern pilgrim and its followers. Keywords: Couplet, humour, carnivalism, culture of contestation, performativity
  • Koskela, Elina (2015)
    Intracranial aneurysms (IAs) affect 2-3% of the population. In Finland, their rupture rate has been exceptionally high. This study aims to evaluate the prevalence and risk factors affecting neuro-ophthalmic findings in patients undergoing treatment for IAs. We also investigate the utility of conventional head computed tomography (CT) in the diagnosis of Terson´s syndrome (TS, vitreous hemorrhage in association with aneurysmal subarachnoid hemorrhage (aSAH)). Patients treated endovascularly or microsurgically for their IAs at the Department of Neurosurgery, Helsinki University Central Hospital, in 2011 prospectively underwent a neuro-ophthalmic examination preoperatively and at 3 days, 14 days, 2 to 4 months, and 6 months postoperatively. Findings suggestive of TS, as independently reviewed by two radiologists, on conventional CT head scans were compared with dilated fundoscopic findings. Participants comprised 121 patients with a ruptured aneurysm and 142 patients with an unruptured intracranial aneurysm (UIA). TS was present on fundoscopy in 13 patients (11%); the overall observed agreement between the two radiologists was 96% (116/121), with a substantial κ of 0.69 (95% CI 0.56-0.82). On average, CT demonstrated sensitivity of 42% and specificity of 97%. Factors independently predicting TS were female gender (OR 5.34, 95% CI 1.05-27.17) and World Federation of Neurosurgical Societies (WFNS) grade (OR 15.05 for grades IV-V vs. I-III, 95% CI 3.07-73.89). For patients with aSAH, the frequencies of a third, fourth, or sixth nerve palsy were 11 (9%; preoperatively), 16 (13%; immediately postoperatively), and 3 (3%; at the last follow-up), compared with corresponding frequencies of 6 (4%), 15 (11%), and 7 (5%) for patients with UIAs. Significant risk factors for postoperative eye movement disorders (EMDs) among patients with UIAs were aneurysm location in the posterior circulation (OR 142.02, 95% CI 20.13-1002.22) and aneurysm size (OR 1.28, for each 1-mm increase in diameter, 95% CI 1.12-1.47). After a follow-up time of 6 months, patients with aSAH presenting with visual field defects (VFDs) for aneurysm- or operation-related reasons numbered 20 (19%); homonymous VFDs were the most prevalent finding, and in logistic regression analysis, they were significantly associated with the Hunt and Hess (H and H) grade (OR 4.45 for grades IV-V vs. I-III, 95% CI 1.21-16.39) and presence of intracranial hemorrhage (OR 8.93, 95% CI 2.14-37.28). By contrast, seven patients (5%) treated for a UIA had VFDs. Poor-grade aSAH (H and H or WFNS grade IV-V) appears to be a strong predictive factor for TS and VFDs. With a high specificity value, conventional head CT scan might prove a useful tool in the diagnosis of TS. Although a common finding in the acute postoperative stage of ruptured and unruptured IAs, EMDs show marked improvement during follow-up.
  • Turunen, Harri (Helsingin yliopisto, 2015)
    I study the importance of variation in the higher moments of macroeconomic and financial quantities. The first essay considers the effects of uncertainty on the fiscal multiplier when the economy has hit the zero lower bound (ZLB) on the nominal rate in a relatively standard New Keynesian Dynamic Stochastic General Equilibrium (DSGE) model. As the ZLB is a very strong form of nonlinearity, the model is solved using a numerical method. Uncertainty in government spending and productivity are modeled as stochastic volatility. Confirming previous research (e.g. Christiano, Eichenbaum and Rebelo, 2011), the multiplier is found to be higher when at the bound, and the effects of volatility shocks are found to be noticeable (e.g. Basu and Bundick, 2015). Uncertainty is found to have an impact on the multiplier: when future spending is uncertain, the multiplier is high, but when future productivity is uncertain, the multiplier is low. The second essay studies whether or not DSGEs are able to generate simulated realizations with realistic third and fourth moments. Many time series in macroeconomics and finance exhibit either excess kurtosis or skewness or both. However, as was shown by Ascari et al (2013), standard DSGEs such as the neoclassical growth model or the model of Smets and Wouters (2007) are unable to produce realizations with reasonable moments, regardless of shock distribution or the order of the Taylor approximation applied. My results however indicate that this is mostly due to lack of nonlinearity in the models, since especially a model with a very strong form of nonlinearity, such as the ZLB, is able to generate non-Gaussian realizations. The third essay considers the pricing of macroeconomic risk. The theory of Merton (1973) implies that there can be other sources of priced risk than the risk associated with the return on the market portfolio and that an appropriate measure for sensitivity of a stock to this risk is the covariance of the return of that stock with the source of that risk. I apply the multivariate volatility model of Engle (2002) to estimate time-varying covariances of US stock portfolios with a variety of US macro time series. The finding is that inflation and unemployment are priced in the market and earn a negative premium, while the growth rate of industrial production and the Case-Shiller house price index are not priced.
  • Juuri, Juuso (Helsingin yliopisto, 2015)
    Kainate-type of ionotropic glutamate (KA) receptors are associated with the modulation of neuronal excitability, synaptic transmission, and activity of neuronal networks. They are believed to have an important role in the development of neuronal connections. In this thesis, the role of KA receptors in the early brain development was assessed by conducting in vitro electrophysiological recordings from individual neurons at CA3 region in acute slices of neonatal rodent hippocampi. It was found that activation of separate KA receptor populations promoted action potential firing in both glutamatergic pyramidal neurons and GABAergic interneurons. The receptors in pyramidal neurons displayed a high affinity for agonist kainate, appeared to lack subunit GluK1, and promoted spontaneous firing of pyramidal neurons without depolarizing them. The receptors in interneurons contained subunit GluK1 and their activation suppressed afterhyperpolarizing current of medium duration (ImAHP). Receptors in both neuron types appeared to be activated tonically by ambient glutamate, suggesting that their physiological role may be to act as a modulatory mechanism sensitive to changes in extracellular glutamate concentration. Changes in activity of neurons at CA3 by activation of KA receptors were reflected on the network level. Promotion of pyramidal cell firing by pharmacological activation of high-affinity KA receptors lead to enhanced glutamatergic drive and generation of network bursts in the CA3 region. The ImAHP in interneurons was also suppressed by apamin, a blocker of SK potassium channels that mediate majority of this current, and apamin enhanced generation of network bursts. This suggests that also KA receptor mediated regulation of ImAHP may modulate network activity. It was also found that there was an interaction between KA receptors and ethanol in the modulation of hippocampal network: ethanol decreased the occurrence of the network bursts at postnatal days 1 (P1) and P10, whereas it increased bursting at P5. The network effects of ethanol were partially or completely counteracted by specific pharmacological block of GluK1 subunit-containing KA receptors. The findings disclose that via regulation of activity of individual neurons, KA receptors are capable of robust modulation of network activity in immature hippocampus. Additionally, exogenous agents affecting KA receptors may perturb activity dependent developmental processes that are central for the synaptic development. The results shed light on the mechanisms underlying development of hippocampal connectivity, and may help to understand early pathologies of the brain that have developmental origins.
  • Koskela, Elina (2015)
    Intracranial aneurysms (IAs) affect 2-3% of the population. In Finland, their rupture rate has been exceptionally high. This study aims to evaluate the prevalence and risk factors affecting neuro-ophthalmic findings in patients undergoing treatment for IAs. We also investigate the utility of conventional head computed tomography (CT) in the diagnosis of Terson´s syndrome (TS, vitreous hemorrhage in association with aneurysmal subarachnoid hemorrhage (aSAH)). Patients treated endovascularly or microsurgically for their IAs at the Department of Neurosurgery, Helsinki University Central Hospital, in 2011 prospectively underwent a neuro-ophthalmic examination preoperatively and at 3 days, 14 days, 2 to 4 months, and 6 months postoperatively. Findings suggestive of TS, as independently reviewed by two radiologists, on conventional CT head scans were compared with dilated fundoscopic findings. Participants comprised 121 patients with a ruptured aneurysm and 142 patients with an unruptured intracranial aneurysm (UIA). TS was present on fundoscopy in 13 patients (11%); the overall observed agreement between the two radiologists was 96% (116/121), with a substantial κ of 0.69 (95% CI 0.56-0.82). On average, CT demonstrated sensitivity of 42% and specificity of 97%. Factors independently predicting TS were female gender (OR 5.34, 95% CI 1.05-27.17) and World Federation of Neurosurgical Societies (WFNS) grade (OR 15.05 for grades IV-V vs. I-III, 95% CI 3.07-73.89). For patients with aSAH, the frequencies of a third, fourth, or sixth nerve palsy were 11 (9%; preoperatively), 16 (13%; immediately postoperatively), and 3 (3%; at the last follow-up), compared with corresponding frequencies of 6 (4%), 15 (11%), and 7 (5%) for patients with UIAs. Significant risk factors for postoperative eye movement disorders (EMDs) among patients with UIAs were aneurysm location in the posterior circulation (OR 142.02, 95% CI 20.13-1002.22) and aneurysm size (OR 1.28, for each 1-mm increase in diameter, 95% CI 1.12-1.47). After a follow-up time of 6 months, patients with aSAH presenting with visual field defects (VFDs) for aneurysm- or operation-related reasons numbered 20 (19%); homonymous VFDs were the most prevalent finding, and in logistic regression analysis, they were significantly associated with the Hunt and Hess (H and H) grade (OR 4.45 for grades IV-V vs. I-III, 95% CI 1.21-16.39) and presence of intracranial hemorrhage (OR 8.93, 95% CI 2.14-37.28). By contrast, seven patients (5%) treated for a UIA had VFDs. Poor-grade aSAH (H and H or WFNS grade IV-V) appears to be a strong predictive factor for TS and VFDs. With a high specificity value, conventional head CT scan might prove a useful tool in the diagnosis of TS. Although a common finding in the acute postoperative stage of ruptured and unruptured IAs, EMDs show marked improvement during follow-up.
  • Pierides, Georgios (Helsingin yliopisto, 2015)
    Repair of Inguinal hernia ranks among the most common surgical procedures worldwide. Large patient numbers necessitate efficacy and sophistication in the procedure. A novel self-attaching composite mesh (Parietene ProGrip , Covidien, Dublin, Ireland) and a sutured light-weight mesh (Parietene Light , Covidien) were compared double-blinded in 394 randomized patients. Outcomes were collected with a symptom diary and telephone contact during immediate convalescence and by clinical assessment one year after the operation. Outcomes up to 5 years after application of either a sutureless bilayer mesh (Prolene® Hernia System, Ethicon Endo-Surgery, Somerville, MA, USA) or standard tension-free repair (Surgipro , AutoSuture, Norwalk, CT, USA) were collected with a postal questionnaire, telephone contact, and clinical assessment in 300 patients. Health-related quality of life before and after open inguinal hernia repair was measured by RAND 36-Item Health Survey 1.0 (RAND Corporation, Santa Monica, CA, USA) in altogether 159 patients aged at least 65 years and 373 patients aged under 65 years. The results were compared within and between age groups as well as with the values from the general population. A database of 932 open mesh-based hernia repairs was subjected to regression analyses for factors predicting the presence of chronic posthernioplasty pain or more intensive postoperative inguinal pain. Outcomes between the self-attaching mesh and sutured light-weight mesh were equivalent. Applying the self-fixating mesh was faster (34 min vs. 42 min, p less than 0.001). Median sick leave was 2 weeks. At one year, 4.7% of patients perceived pain while resting, 2.0% had pain interfering with every-day life, 25.4% experienced discomfort, and 9.5% had losses in sensation in the operated groin. One recurrence (0.3%) was encountered. Sensory dysfunction of groin skin was rarer 5 years after the operation with the bilayer device than after tension-free repair (5.0% vs. 13.9%, p = 0.022). Other long-term outcomes did not differ. Occurrence of chronic pain diminished from 6.8% at 2 years to 1.3% at 5 years. Cumulative recurrence rate was 1.3%. Discomfort was present in 25.2% of patients, but 92.7% of patients were satisfied with the operation. RAND-36 showed similar improvement in both the elderly and younger patients after open inguinal hernia repair. Complication rates between the age groups did not differ. Higher preoperative VAS score (p less than 0.006), mid-weight mesh (p = 0.012), complications (p = 0.002), recurrence (p = 0.005), and younger age (p = 0.027) predicted chronic pain after open inguinal hernia repair. Higher VAS scores for inguinal pain were predicted by higher preoperative VAS scores (p less than 0.001), heavyweight meshes (p = 0.046), complications (p = 0.016) and recurrence (p = 0.001).
  • Moustgaard, Heta (Helsingin yliopisto, 2015)
    Depression is a leading cause of disability worldwide. At worst, it may lead to frequent hospitalisation and even premature death. The risk of suicide is particularly high among the depressed. This study assessed whether social and economic resources protect depressed patients from psychiatric hospital admission and premature mortality. The study also aimed to establish the role of alcohol and the rapidly increased antidepressant treatment of depression in these outcomes. The study used large, longitudinal register samples of the Finnish adult population, combining information from various administrative registers. Depression was assessed from psychiatric hospital care and antidepressant purchases. Treatment and depression outcomes were assessed in 1-10-year follow-ups. The results indicate that at least in a population already in contact with the healthcare system, antidepressant treatment and depression outcomes vary only modestly according to social factors. However, material aspects of socioeconomic position such as a low income, not owning a home and being unemployed increased the risk of hospital admission for depression by 20-40 per cent among those with previous depression treatment, even after controlling for baseline depression severity and psychiatric comorbidity, whereas education and occupational social class were unrelated to admission risk. Having no partner and living without co-resident children also increased the admission risk. None of the social factors studied buffered against excess mortality among the depressed. Educational differences in the prevalence of antidepressant use before and after hospital care for depression were small and mostly limited to the period after discharge. Antidepressant use immediately after discharge was slightly less common among those with a low level of education, but educational differences increased thereafter as antidepressant use decreased more rapidly among this group. Differences in daily antidepressant use that met treatment guidelines were more pronounced than those for any antidepressant use, suggesting a need for improving treatment adequacy and adherence particularly among patients with a low level of education. The study established the central role of excessive alcohol consumption as a pathway to depression mortality. Alcohol-related causes accounted for about half of the excess mortality of depressed men and around a third of depressed women. Improving the detection and management of substance use problems would thus be critical for reducing depression mortality. Increased antidepressant sales do not seem to have prevented female suicides. However, among men an increase in the proportion of antidepressant users receiving minimally adequate treatment reduced non-alcohol-related suicides. The results suggest that increased adequacy of antidepressant treatment has been more central in reducing suicide rates than the mere increase in per-capita antidepressant sales or prevalence of antidepressant use.
  • Fields, Marek (Helsingin yliopisto, 2015)
    The study examines British and American propaganda and cultural diplomacy in Finland during the first decades of the Cold War. As the Cold War intensified in the late 1940s, both Britain and the United States sharpened their informational and cultural activities throughout the world. The general goal of these operations was not only the promotion of culture and the Western way of life , but also the containment of communism. For the distribution of anti-communist propaganda and the projection of culture, the British used printed material prepared by a special Foreign Office unit, BBC broadcasts and operations executed by the British Council, while the Americans relied on material produced by the United States Information Agency (USIA), including Voice of America (VOA) broadcasts. The United States also emphasised the importance of the exchange of people through, for example, the Fulbright Programme. The two Western powers operations were also conducted in exceptional environments such as Finland, in which the country s complex relationship with the Soviet Union meant that the distribution of anti-communist propaganda, for example, through Finnish newspapers was always going to be a sensitive affair. Although the British and Americans knew that the majority of Finns resented communism, they were constantly worried about finding the appropriate methods to promote their message to the broader masses. In addition to informational and cultural activities, Britain, and in particular the United States, through the CIA, also supported the anti-communist work of some Finnish organisations. The general objective of this study is to discover the nature of British and American propaganda and cultural diplomacy operations in Finland. The focus lies on their breadth, closer traits and the channels used in their execution. Furthermore, the aim is to discuss how certain characteristics of Finnish society, such as the widely accepted practice of self-censorship, affected the Western powers operational methods. Some emphasis is also placed on examining the effects of these activities and comparing the two campaigns with each other. The study is predominantly based on archived documents of the British Foreign Office, the British Council, the BBC, the US State Department and the USIA. Furthermore, records filed at numerous Finnish archives provide valuable information about the Western operations' distribution processes, while certain Finnish newspapers and magazines make up essential sources for the examination of propaganda content. This study comes to the conclusion that both Britain and the United States carried out reasonably extensive propaganda and cultural diplomacy operations in Finland in the first Cold War decades, and as a consequence supported the country's independence and attachment to the West to a greater extent than has been previously recognised. The placement of British anti-communist articles in Finnish newspapers was especially successful in the early 1950s. The BBC Finnish Service broadcasts, which included anti-communist output, were also rather warmly welcomed by the Finns as were the operations of the British Council, despite its fairly slim resources. In addition to press operations, the Americans were able to influence a considerable number of Finns especially through USIA films, television programmes, the exchange of people and other cultural operations. The Finnish political crises of the late 1950s and early 1960s restricted Western activities and forced the countries to find new methods of operation. Despite this, the impact British and American informational and cultural activities had on Finnish society can be regarded as substantial.
  • Mogensen, Ditte (Helsingin yliopisto, 2015)
    Forests emit biogenic volatile organic compounds (BVOCs) that, together with e.g. sulfuric acid, can operate as aerosol precursor compounds when oxidised. Aerosol particles affect both air visibility, human health and the Earth s radiative budget, thus making the emission inputs and oxidation mechanisms of VOCs absolutely crucial to understand. This thesis discusses the life cycle of compounds in the atmosphere. Specifically, we studied the representations of emission of BVOCs, the atmosphere s oxidation ability along with the sources and sinks of sulfuric acid. The main tool to achieve this was numerical modelling, often compared to field observations. Additionally, we performed computational chemistry simulations in order to calculate transitions in sulfuric acid. The main findings of this thesis can be summarised into the following: (1) Biological understanding of VOC emission processes needs to be enhanced in order to predict VOC concentrations with a high precision. (2) The unexplained fraction of the total OH reactivity in the boreal forest is larger than the known fraction and known secondary organic oxidation products of primary emitted terpenes cannot explain the missing reactivity. (3) OH is the main oxidation agent of organic compounds in the boreal atmosphere. (4) Criegee Intermediates, produced from unsaturated hydrocarbons, can oxidise SO2 effectively in order to provide as an essential source of sulfuric acid in areas with high VOC concentrations. (5) Two-photon electronic excitation did not turn out to be a significant sink of gaseous sulfuric acid in the stratosphere. This thesis closes a large part of the sulfuric acid concentration gap in VOC rich environments. Further, this thesis raises awareness of the fact that we still do not fully comprehend the mechanisms leading to BVOC emissions nor the organic atmospheric chemistry in the boreal forest. Finally, this work encourage to study alternative BVOC emission sources as well as alternative atmospheric oxidants.
  • Juvonen, Tarja (Nuorisotutkimusverkosto/Nuorisotutkimusseura, 2015)
    This doctoral dissertation examines the construction of agency among young people on the threshold of adulthood who are, or risk being, socially excluded. Adolescence involves many choices and decisions that impact later life, such as leaving the parental home and transitioning to independent living, establishing financial independence, making decisions about education and careers, and starting a family. An essential part of adolescence is the pursuit of autonomy and finding one s place in the adult world and its social order. Adolescents who cannot attain these goals are easily rejected as non-adults who fail to meet social expectations for different age groups and life stages. This rejection has the effect of excluding them from full citizenship. Emerging adulthood is particularly challenging for adolescents living in vulnerable circumstances who feel they are not yet ready or able to make decisions about their life. The choices they must make may also involve options that adolescents find dissatisfactory or difficult to handle. This dissertation explores young people s agency from a relational perspective, emphasising the social and contextual basis of agency rather than its individualist foundation. The relational perspective relates to autonomous agency primarily because the construction of autonomy can require the context of human relationships and mutual dependency. In contrast, an emphasis on agency that stresses individuality and independence may engender feelings of loneliness and insecurity as well as of going through the motions of a life with no true sense of meaning. People who work with and support adolescents should also bear in mind that wellbeing depends substantially on the ability of individuals to connect with others. A lack of relationships and a feeling of loneliness characterise the lives of many socially excluded and disadvantaged people. The relational perspective is particularly obvious among those without relationships. This dissertation employs a constructionist philosophy and a relational viewpoint. It focuses on outreach work and, more broadly, the service network that strives to help young people. The research data comprise documents from 2001 on street-based youth work, recordings from the development seminar of a working group, interviews with young people encountered during outreach work in 2010 and 2011, the working group s focus group discussions and recorded client visits. The four scientific articles included in the dissertation use content analysis and the voice-centred relational method to consider the themes of control, the construction of autonomous agency and the concept of having-to as it pertains to young people. The first of the articles discusses elements of control in outreach work. The three other articles explore the theme of agency and the associated relational perspective. The second and third articles examine the construction of young people s autonomous agency, first in tense meetings with outreach workers and the authorities, and then from the perspective of the challenges of independent living. The fourth article analyses the construction of adolescents agency from the viewpoint of cultural expectations, particularly the concept of having-to. The results of the articles inform the concluding section, which addresses the two research questions: How is the autonomous agency of young people constructed in the tense relationship of social control, professional support and having-to, and how is the relational approach connected to the construction of young people s autonomous agency? The results demonstrate that various social structures and service systems provide a framework for the construction of agency, particularly among young people who are or risk being socially excluded. Even the most autonomous individual must deal with certain have-to s and is the subject of control through both societal and social relationships. Both control and culturally defined having-to are factors that define the limits of agency based on freedom and choices. As clients of outreach work, adolescents who are or risk being socially excluded must negotiate with various societal representatives about the limits of their autonomy and range of choices and must respond to the expectation of stronger agency. Young people s experience of their agency and place in the world depends partly on social ties, relationships and the various resources available to them. Strengthening the agency of young people encountered through outreach work requires long-term partnership and support to help them succeed in the challenging transition to adulthood, which is limited by having-to. Interaction in outreach work, the parties meetings or failures to meet each other, plays an important role. Those involved in such work have the power to profoundly affect young people s lives as well as their ideas of themselves and their significance. External compulsion or decisions made without the adolescents contribution do not improve their self-understanding or autonomous agency, which are important to any definition of a good life.
  • Hämäläinen, Saara (Helsingin yliopisto, 2015)
    Our thesis has three individual papers and an introduction. It contributes to dynamic price and search theory. The first paper deals with the classic problem of trading under asymmetric information. The other two analyze retailing strategies that help lock in buyers by creating in-store frictions. In the first paper, we investigate welfare and equilibrium trading in a decentralized search market with asymmetric information and bilateral communication opportunities. Sellers and buyers meet randomly and pairwise and view a shared signal of the seller's quality. In the following signaling game, the sellers can either rely on this costless signal (pool) or costly signaling (separate). We observe that, although the average market quality is high, additional information is not generally welfare improving. All equilibria are inefficient. Contrary to the usual tradeoff between price and liquidity, we find that the signals can help sustaining stationary Markovian equilibria where higher quality is traded faster. In the second paper, we construct a novel search model that features in-store frictions and equilibrium price dispersion both within and across stores. The frictions originate from the gradual arrival of price information within stores and the existence of deadlines for buyers. We show that sellers have an incentive carry several similar items and generate price variation among these items to amplify the existing search frictions and create barriers to switching in an environment where none exist initially. It also helps them to discriminate better between buyers, who end with diverse degrees of price information. As the number of items in stock expands, sellers can extract more profits. In our third paper, we develop a price search model that features endogenous frictions in a duopolistic environment. These frictions originate from the gradual arrival or price information within stores and the existence of deadlines for buyers. We show that both sellers have a strategic incentive to generate frictions. There exists exactly two equilibria with a unique asymmetric pattern: a prominent seller, whose expected price is higher but the in-store frictions lower, and a non-prominent seller. The buyers are divided exactly equally into informed and uninformed consumers, and into those who fail to find anything. Under the Poisson process, this surplus loss is about 6 %.
  • Ahlqvist, Kati (Helsingin yliopisto, 2015)
    Somatic stem cell (SSC) dysfunction is a common feature of mouse models of premature ageing, most of which are created by disturbing nuclear DNA repair, damage recognition or ROS defence. The SSC dysfunction leads to decline in SSCs ability to maintain tissue homeostasis resulting in degeneration and ageing. The role of mitochondria or mitochondrial DNA (mtDNA) integrity in SSC homeostasis is unknown. Mutator mice, which harbour proof-reading deficient mitochondrial DNA polymerase gamma, accumulate mtDNA point mutations and develop a premature ageing phenotype, whereas Deletor mice, a model for adult-onset mitochondrial myopathy, accumulate mtDNA deletions and have a normal lifespan. Accumulation of mtDNA mutations and respiratory chain (RC) defect are thought to contribute to ageing process, and the Mutator mouse was the first experimental evidence supporting this theory. The aim of this thesis work was to elucidate somatic stem cell function in both Mutator and Deletor models, to investigate whether SSC dysfunction might explain the premature ageing phenotype. Our results show that the Mutator mouse accumulates mtDNA point mutations in SSC compartments, leading to changes in SSC function already during embryonal development. Deletors do not accumulate mtDNA deletions in SSCs and have normal SSC function. This suggests that premature ageing of Mutators is due to disrupted SSC homeostasis. Hematopoietic progenitors are especially sensitive to mtDNA mutagenesis, which may partly explain the high prevalence of anemia without iron deficiency seen in elderly humans. In this thesis, a novel mechanism for mitochondrial anemias is presented. MtDNA mutagenesis in hematopoietic precursors modifies signaling which causes aberrant iron loading and delayed mitochondrial clearance from maturing erythrocytes. In consequence, Mutator mice have abnormal circulating erythrocytes carrying mitochondria, which are prematurely captured and destructed by splenic macrophages, leading to iron accumulation in spleen. Enhanced destruction of newly-born erythrocytes and concurrently depleted iron stores in the bone marrow make compensatory reticulocytosis inefficient. Delayed mitochondrial clearance was also detected in a human patient with Pearson s syndrome, a rare disorder caused by a sporadic single large mtDNA deletion and causing life-threatening anemia. Treatment with N-acetyl-L-cysteine (NAC), a glutathione precursor and a ROS scavenger, was able to rescue the SSC phenotype during embryogenesis and to normalize iron loading in vitro, suggesting that mtDNA mutagenesis affects ROS signaling. However, NAC could not prevent anemia in vivo, nor rescue delayed mitochondrial clearance in vitro. This indicates that signaling in the SSC compartment is different during embryogenesis than in adulthood. This thesis shows that mtDNA integrity is essential for SSC function. Further, a new and essential role is proposed for mitochondria in regulating their own removal from maturing reticulocytes.
  • Anttila, Erkko (Helsingin yliopisto, 2015)
    Suburban century: Local community in the working-class suburbs of Helsinki in the twentieth century. The study discusses working-class suburbs that sprang up outside Helsinki in the early twentieth century and their change into affluent middle-class suburbs in the second half of the century. The focus of the study is on local community life and its change in the studied suburbs. Moreover, the study discusses how the suburbanites' ways of life and their relationship to their social and physical surroundings changed due to modernization in the latter half of the century. The research data consist of historical documents and personal reminiscences of residents that deal with topics such as neighbourhood life, practices of everyday life and local clubs and associations. In the first half of the twentieth century the working-class suburbs under study (e.g. Malmi, Pakila, Tapanila and Leppävaara) were fairly rural communities, which were characterized by their close-knit community life, widely practiced subsistence gardening and animal husbandry and numerous local small businesses. Another important characteristic of these suburbs was the central role played by local formal and informal organizations in solving problems of everyday life and in organizing leisure activities for local residents. This manifested itself, for example, in the form of local road maintenance associations, voluntary fire brigades and community festivals. Such practices indicated that the residents of these suburbs were in many ways functionally dependent on their local suburban community. Soon after the Second World War the way of life in the suburbs under study began to change towards a more privatized way of life. Behind this change was the growing prosperity of the post-war era, technological progress and the strengthening of extra-local networks and organizations. These factors diminished the suburban residents' dependence on local community networks and widened their horizons beyond narrow local circles. The suburbanites actively contributed to this change by lobbying state and municipal authorities to hasten the modernization of local infrastructure and public services. By the late twentieth century the working-class suburbs under study had changed into modern middle-class suburbs which were characterized by a high standard of living, a privatized way of life and the residents' dependence on extra-local networks and organizations. The local social and economic practices that were typical of the first half of the century had by now mostly disappeared. Instead, local community action now focused on maintaining the peace and quiet of the residential area. There were also aspirations to revive some aspects of the old community life. However, unlike in the local community networks of the early twentieth century, participation in these new forms of community building was entirely voluntary.
  • Maanavilja, Liisa (Finnish Society of Forest Science, Natural Resources Institute Finland, Faculty of Agriculture and Forestry of the University of Helsinki, School of Forest Sciences of the University of Eastern Finland, 2015)
    Drainage to increase timber production has drastically decreased the area of undrained spruce swamp forests in northern Europe. In restoration by rewetting, drainage ditches are blocked to restore the original hydrology and, ultimately, the structure, function and ecosystem services of undrained boreal spruce swamp forests. This study quantifies the restoration success of rewetting regarding plant community composition, moss community carbon assimilation potential, Sphagnum biomass production and surface peat biogeochemistry, and aims to determine the main controls of success. The study sites comprised 18 rewetted, nine undrained and nine drained spruce swamp forests in southern Finland, complemented by sites in the umava Mountains, Czech Republic. Drainage had taken place decades prior; the rewetted sites varied in their rewetting age from 1 to 15 years. The results show that rewetting has to raise the water table above a threshold to initiate any changes in the drained ecosystem. If the threshold is crossed, the changes that occur will be rapid. Two strands of development emerged throughout the different components of the ecosystem: development towards the undrained reference state and development towards a new direction, different from both the undrained and the drained state. Rewetting created favourable conditions for Sphagnum photosynthesis. Sphagnum mosses recovered in cover and biomass production rapidly. The new growth started the accumulation of the porous surface organic matter layer characteristic of mires, which increased microbial decomposition activity in the surface organic layer towards undrained levels. Meanwhile, rewetting applied on the compacted, physicochemically altered peat created wet, unstable hydrological conditions, which increased the cover of opportunistic plant species in the understory and caused high NH4 mobilization and CH4 production in the surface organic layer. Demanding spruce swamp forest species were lacking at the rewetted sites, but rewetting was successful in restoring the common species and directing the ecosystem towards mire-like functioning.