Väitöskirjat

Recent Submissions

  • Onodera, Henri (Helsingin yliopisto, 2015)
    This is an ethnographic study of the lived experiences of young activists during the last years of Mubarak s presidency in Egypt. Its general aim is to provide an understanding of what it was like to be involved in opposition politics during a period when the eventual end of Mubarak s rule in 2011 was little more than a collective aspiration. Drawing on different strands of qualitative social science, including anthropology, sociology and youth research, the study is based on 12 months of fieldwork in Cairo, conducted between 2007 and 2011. It makes use of political engagement as an open analytic that enables the examination of different activities that were oriented towards, but not exclusive to, public political processes and formal avenues to political participation. In this vein, the study explores the activities that the young activists regarded as meaningful in terms of challenging the status quo, and how being young in itself shaped their ways of participating in public political life. While it focuses on the experiences of young Cairenes who were predominantly male and aged in their 20s, it is acknowledged that important differences existed among them that conditioned their efforts to acquire new visibilities and political roles, including social differences such as class, gender and global connectedness. In order to explore the diversity of their political experiences, the study discusses four principal areas of analysis and related topics: namely, generational consciousness, tactical practice, friendship relations and ethical reflections. It is demonstrated that, firstly, the new forms of youth activism in the 2000s promoted a critical generational consciousness as a disenfranchised social location in the intergenerational order, while also providing reinvigorated meanings to youth as a subversive political category, and in some ways a privileged experiential realm, ready to conduct public political dissent on its own terms. The new youth movements, such as Youth for Change and April 6 Youth that emerged on the fringes of larger processes of contentious politics, assumed new roles in public political life and merged, at least temporarily, young Egyptians from different backgrounds and affiliations into collective actions: forging alliances, largely beyond the formal political institutions. Secondly, the young activists resorted to a number of tactical practices in order to reach out to wider publics via both offline and online avenues. Their operating preferences lay in organizing unlicensed street protests in the popular, lower-class residential areas and tapping into the subversive potential of the new information and communication technologies, including blogs and social media. Although these forms of public dissent expanded their otherwise narrow political opportunities, their adoption was not, however, equally available to everyone. Some either had the necessary social networks in place, including family support, or the available time and the economic means to do so, while those, who were less equipped for public dissent, could nonetheless acquire new combinations of practical skills, knowledge and social connections that enabled them to enact their sense of meaningful political action. At the same time, the efforts to build youth coalitions faced a number of challenges, one of which was internal factionalism, which, coupled with the growing use of social media, diversified the scope of youth activism in the run-up period to the 2011 uprisings. Thirdly, being a young activist in the late 2000s provided much more varied everyday experiences than merely the acts of public political dissent. It also involved absorbing pre-existing oppositional culture and adopting dissident lifestyles that were filled with shared moments of being and doing things with others on a daily basis. In the absence of representative political institutions, the experiences of having friends and being a friend to others offered intimate avenues to public political life that stretched beyond kin ties and formal organizations. Although oppositional youth activism was divided along lines of class, gender and political affiliation, the young could forge mutual grounds for friendship relations on the basis of their shared experiences and stories of contention, while frequenting downtown Cairo as the main hub of their everyday trajectories. Although friendship relations were at times volatile in the contested field of politics, safeguarding the bonds of trust, belonging and everyday solidarity represented highly relevant everyday activities. Fourthly, the young Cairenes were faced with a number of ethical reflections on the meaningfulness of their own dissent practices, not the least due to the personals risks that opposition politics involved in authoritarian settings. While the prospect of impoverishment did not generally motivate their political engagements, they shared a sense of injured patriotism that prevailed in the wider prodemocracy movement, and aspired to greater recognition as rightful citizens. At the same time, they operated on an ambivalent moral terrain that required positioning one s self and others in relation to normative claims to the common good; furthermore, they had to contend with popular suspicion about the impact of their public political dissent and about possible motives for their activism, such as the pursuit of social status and personal wellbeing. Despite the differences that existed among the activist youth in terms of class and gender, however, they could in part challenge these types of speculations by enacting the prevailing ideals of personhood in terms of bravery, righteousness and self-sacrifice. Meanwhile, although the young Cairenes were embedded in the moral worlds of prodemocracy mobilization, they were also compelled to balance their political engagements in terms of multiple life transitions, especially in terms of balancing their activism with the requirements of gaining a livelihood. While there were multiple ways of being or becoming an activist in the late Mubarak era, the young Cairenes political engagements were connected to their collective pursuit of playing a meaningful role in what happened in the present, while acknowledging that Egypt s future was intimately tied to their own life trajectories.
  • Virtanen, Laura (Helsingin yliopisto, 2015)
    Water quality in streams usually changes fast, and sensitive biological indicators are essential for monitoring these changes. Diatoms are widely used in biological stream quality assessments. However, there are temporal and spatial variations in diatom communities that may result in unreliable quality assessments. Under different kinds of environmental stressors, diatoms can produce deformed frustules. Heavy metals are among the most common causes of these teratological forms. In addition to eutrophication and organic pollution, diatoms could potentially be used for indicators of heavy metal enrichment. The aim here was to examine the interannual and intra-annual turnover of stream diatom communities. The focus of this study was on whether specific species traits and species local abundance and regional distribution affected temporal occurrence of diatom species. The study also included an examination of how stable diatom inferred stream classifications are in time and if pure spatial variation in diatoms should be considered when assessing stream water quality based on diatoms. The final aspect of the study was to determine which heavy metals, and to what extent, trigger the occurrence of deformations in diatom Achnanthidium minutissimum. Our results imply that abundant and widely distributed species with larger niches and the ability to attach to the substratum sustain persistent populations in varying environmental conditions typical for streams. The most persistent species are thus perhaps the most reliable species to be used as indicators of water quality. The stream classification based on diatoms resulted in temporally stable and statistically distinct community types. Thus, the results suggest that sampling of diatoms in every three years seems to be a reliable procedure to assess biological water quality. The investigation also revealed that study regions differ in their diatom species composition more than in their environmental features indicating that diatoms are structured not only by the local environment but also by large-scale processes, possibly related to climate, dispersal and history. As diatom species composition varies between regions, future bioassessments would benefit from regional stratification. Finally, study results indicated that two metals, copper and zinc, and a metalloid, antimony, were the most likely triggers of A. minutissimum deformations. The definition of their morphological and quantitative characteristics, along with a better taxonomic circumscription of the affected species, should allow the use of deformations as a reliable indicator of heavy metal enrichment in freshwater habitats.
  • Loman, Tina (Helsingin yliopisto, 2015)
    Health behaviours are important to prevention and public health. Health behaviours include usually food habits, physical activity, drinking, smoking and sleeping. Improving health behaviours help reduce risks for several major chronic diseases and mortality. Food habits and physical activity play a key role in reducing weight gain and related disease risk. Health behaviours are socially patterned and they vary between socioeconomic groups, and contribute to inequalities in health. In order to reduce socioeconomic differences in health, novel evidence is needed of changes in socioeconomic differences of health behaviours as well as reasons behind the socioeconomic differences. The main aim of this study was to examine socioeconomic differences in food habits, physical activity and weight gain, and their changes over time among middle-aged female and male public sector employees. Specific aims were to examine first changes in occupational class differences in food habits and second in physical inactivity and activity during a follow-up of 5-7 years, considering the effects of covariates. The third specific aim was to examine the association between weight gain and multiple socioeconomic indicators. This study is part of the Helsinki Health Study (HHS). The baseline data were collected by questionnaire surveys in 2000, 2001 and 2002 (n=8 960, response rate 67%). Mail surveys were sent to employees of the City of Helsinki aged 40-60 years. The follow-up survey data were collected in 2007 among the baseline respondents (n=7 332, response rate 83%). For data analysis general linear models, logistic regression analysis and the relative index of inequality were used. In many food habits, there was a hierarchical order according to occupational class, i.e. those in higher occupational classes used more often the studied food item than those in lower classes. In some food habits, there was a reverse hierarchical order and in some food habits there were no socioeconomic differences. Occupational class differences largely remained stable over the follow-up in the food habits. At baseline, there were no occupational class differences in leisure-time physical activity, but over the follow-up physical activity increased among women with the highest occupational class and decreased among men with the lowest occupational class, suggesting the emergence of occupational class differences at follow-up. The covariates (age, marital status, body mass index physical and mental health functioning, employment status) did not substantially affect the observed occupational class differences in leisure-time physical activity at follow-up. Among women and men, socioeconomic differences were observed in at least 5 kg weight gain, and current economic difficulties showed the strongest association with weight gain. Socioeconomic differences largely remained stable over the 5-7 year follow-up in food habits, whereas in leisure-time physical activity differences emerged. There were clear differences in weight gain by economic difficulties. Thus, there is a continuous need for reducing socioeconomic inequalities in the studied health behaviours. Healthy behaviours should be promoted in particular among those in lower occupational classes and those with economic difficulties.
  • Laaksonen, Esti (Helsingin yliopisto, 2015)
    The estimated number of heavy consumers of alcohol is about 20 percent of population, of which 10 percent suffer from alcohol dependency. Many heavy consumers of alcohol also smoke. The effectiveness of treatments can be significantly improved with medical treatment. The problems are: how medical treatment can be utilized in practical treatment, and how to ensure treatment adherence. The aim of this study was to investigate the effectiveness of pharmacotherapies combined with a brief manual-based cognitive-behavioural intervention (CBT) in treating alcohol-dependent patients. In the large-scale clinical treatment study, which ran for 2.5 years, the effectiveness and patient response to the three drugs (naltrexone, acamprosate and disulfiram) were compared. The study used a survey drawn up guidebook for patients, Winning at last defeating the drinking problem. In addition, we researched how the reduced alcohol consumption affects the quality of life, mood and smoking. In the study of sweet preference we analyzed possible associations between sweet preference and efficacy of naltrexone treatment. In addition, we researched patients treatment adherence and medication adherence to targeted naltrexone, as well as reduction of problem drinking and craving. This combined treatment (medication and CBT) significantly reduced alcohol consumption resulting in improved quality of life. Noticeable is that compared to the other study medicines, especially during the continuous medication period, supervised disulfiram appeared superior. During the targeted medication period, there were no other significant differences between the groups except for that the abstinence days were significantly more frequent in the disulfiram group. The treatment was also associated with success in quitting smoking among patients using disulfiram. The study of sweet preference, it was significantly related to treatment measures in the naltrexone group when the outcome was relapses to heavy drinking. Our study offers a possible new explanation of the clinical observation that naltrexone is not effective for every patient. Adherence to the targeted use of naltrexone added treatment compliance and efficacy of the medicine. Patients who had less symptoms of alcohol dependence, suffered from high craving for alcohol, were unemployment, young or could not keep the drinking diary were less committed to treatment. Problem drinking can be changed to abstinence or moderate drinking with the combination of medical therapy, CBT and good treatment commitment. The benefits of treatments are probably long-term, because part of the positive results lasted over two years. The treatment methods used in this study were usable and they can be implemented in all levels of Finnish health care.
  • Al-Samadi, Ahmed (Helsingin yliopisto, 2015)
    Recurrent aphthous ulcer (RAU) is an ulcerative disease of the oral mucosa characterised by the appearance of ulcerations in the oral mucosa accompanied by an erythematous halo area surrounding the ulcer and showing signs of acute inflammation. While RAU affects approximately 20% of the population globally, its pathogenesis remains poorly understood. Furthermore, most studies concentrate on treatment while few address the pathogenesis of the disease. This project aimed to determine the mechanisms of oral epithelial cell death in RAU, the role of these cells in disease pathogenesis in terms of toll-like receptor (TLR) expression, and the ability of the these cells to produce chemokines, pro-inflammatory cytokines, and antimicrobial peptides. Together these may first aggravate and, then, down-regulate the inflammation and initiate the healing process. For this purpose, we collected 13 aphthae and 11 healthy control biopsies for immunohistochemical staining, immunofluorescence staining, and quantitative PCR. For functional studies, we cultured primary oral keratinocytes and oral squamous cell carcinoma cell-line SCC-25 and tested their responses to different stimuli. Our results highlight the importance of oral epithelial cells in RAU; interestingly, oral epithelial cells in RAU tested positive for apoptosis markers caspase-3, especially at the superficial and spinous layer, and TUNEL, but negative in controls. We also found that TLRs are primarily present in the basal and suprabasal layers of control epithelium, but their expression extends to the superficial layer in RAU epithelium. Additionally, we found significally higher expressions of tumour necrosis factor-α (TNF-α), interleukin-8 (IL-8), IL-17C, and beta defensin 2 (BD-2) in RAU oral epithelium compared with control epithelium. Functional studies on cultured primary oral keratinocytes and SCC-25 supported our results from RAU biopsies since these cells responded to damage-associated molecule patterns (DAMPs), such as self-DNA and pro-inflammatory cytokines including IL-17C, TNF-α, and interferon gamma (IFN-γ), through a significant increase in the expression of selected molecules including TLR2, TNF-α, and BD-2. Based on our findings, RAU may begin with a strong initiating factor activating a self-amplificatory cycle. This cycle is characterised by the induction of epithelial cells apoptosis at the superficial layer down to the basal layer, a change in the pattern of TLR distribution, the up-regulation of several chemokines and pro-inflammatory cytokines, and, finally, the secretion of antimicrobial peptides initating the healing process. As a result of the lack of adaptive immunity in RAU, the cycle recurs when the mucosa is subjected to an initiating factor of the same sequence.
  • Kalinowski, Jaroslaw (2015)
    One of the goals of modern quantum chemistry is to simulate actual chemical experiments. In order to study species closer to real life systems and bulk environments there is a need for methodological developments. There are two ways to approach large systems with a given level of accuracy: conceptual changes to quantum chemistry methods or algorithmic developments for current methods. Many scientists believe that the conceptual changes truly increase the size of the systems one can study. With more or less advanced approximations to the method it is possible to increase the efficiency of calculations orders of magnitude. The implementation and algorithms fall down in the priority list, as advanced algorithmic developments are time consuming and usually lead to lower efficiency increases than conceptual changes. In this work it is shown that algorithmic developments cannot be neglected, and that even simple changes help in utilizing the power of modern computers and can also increase the efficiency by orders of magnitude. In this work new algorithmic developments are presented and used for solving various timely chemical problems.
  • Tuomela, Annika (Helsingin yliopisto, 2015)
    Low oral bioavailability and general delivery problems related to poorly water soluble drugs are major challenges in pharmaceutical formulation development. Nanocrystal technologies have been introduced as advantageous formulation approaches for these molecules. Nanocrystals, with greater surface to volume ratio, can effectively increase both the dissolution rate and saturation solubility of active ingredients. The aim of this thesis was to obtain detailed knowledge about the dissolution characteristics of drug nanocrystals, and to develop feasible nanocrystal applications for ocular and oral drug delivery purposes. Hence, develop-ability issues from the analytical difficulties of the drug dissolution behavior to the scale-ability of the nanocrystals were covered. A new approach in dissolution testing of nanocrystals, UV imaging, was introduced and applied in order to obtain detailed understanding of the real-time dissolution behavior of different nanosized particle fractions. Moreover, both liquid and solid nanocrystal dosage forms were formulated and studied in vitro and in vivo. High-quality nanocrystal suspensions were prepared using the rapid and industrially relevant top-down wet milling technique. Detailed, real-time dissolution analyses of the nanocrystals enabled a close level insight into the occurring phenomena. With regards to the formulation development, an in vivo effective nanocrystal suspension formulation was developed for ocular delivery, to treat elevated intraocular pressure. Furthermore, nanocrystal suspensions were converted into dry powders, by both freeze-drying and granulating technique, and further processed into tablet and capsule formulations. By screening both powder and tablet properties, optimal compositions for nanocrystalline solid formulations were indicated with regards to the higher scale process-ability. The formulations were studied both in vitro and in vivo. As a result, the great difficulty of predicting the in vivo behavior based on the in vitro results and the importance of in vivo studies in the early development phase, were addressed. It was concluded that the methods applied and studied provided valuable knowledge and important tools for the pharmaceutical formulation development in order to solve the current problems related to the delivery of poorly soluble drugs.
  • Kalu, Emmanuel Okwara (Helsingin yliopisto, 2015)
    More than half of those newly infected with HIV/AIDS are between the ages of 15 and 24 (UNICEF, UNAIDS and WHO 2002). The disease s challenge is not limited to students already diagnosed with the disease, but also to students in limbo (students who do not know their status), because about 50% of those living with HIV do not know their status (UNAIDS 2012). However, voluntary HIV screening is unpopular, probably due to fear and gross misconceptions. Based on the presumption that besides its health and educational impacts, the disease also influences the productivity and future goals of students, this study investigated and compared the conceptions of HIV-positive university students in Finland and Nigeria in search of not only the negative, but also the positive meanings of living with the disease, with the aim of bettering HIV/AIDS understandings. The study is primarily approached through phenomenography. Seven individuals participated in the study (three Finns and four Nigerians) through in-depth and e-mail interviews. The outcomes are described and compared under 7 main categories, 26 sub-categories and 300 themes based on the similarities and qualitative differences in the participants conceptions. To further illustrate the outcomes, Concept Maps were used at the end of each main category to separately show the Finnish and Nigerian participants responses within each category. In addition, tables of comparison were used in Appendixes one to seven to compare the Finnish and Nigerian participants conceptions thematically and also in relation to the results of earlier studies. Subsequently, propositions in text format were used in Appendix eight to present the concept map outcomes in a different light. The findings reveal that although the negative effects are much more noticeable, the positive impacts are increasing. They add to refuting what we already know about living with the disease, especially in the 1980s and 1990s. In view of the many benefits of living with HIV, as illuminated by this study, the current situation is unlike the past, as today living with HIV does more good than harm especially in terms of motivating positive and healthful living. The comparison of the two groups reveals no wide gap between the Finnish and Nigerian participants conceptions; nevertheless, while the Finnish participants are slightly better informed about HIV/AIDS, their Nigerian counterparts are more open and positive about their conditions. Due to the nature of its findings, the implications of this study are many; the most outstanding of which is that it may positively and healthfully transform readers. By bringing into the spotlight the unpopular positive sides of living with HIV (not AIDS), PLWHA could further be strengthened to cope with the disease, and the fears of students in limbo due to misconceptions could be reduced, which may motivate them to voluntarily participate in HIV screening. Furthermore, the study may contribute to enabling HIV/AIDS organisations to better tailor their services towards meeting the needs of their subjects. School authorities could equally be motivated to make school environments more HIV/AIDS friendly. The Finnish Ministry of Social Affairs and Health and similar ministries in other countries may also find in these outcomes reasons to push for changes in HIV/AIDS policies. Keywords: HIV/AIDS, PLWHA, students, education, health, healthful living
  • Jalava, Lotta (Helsingin yliopisto, 2015)
    The dissertation consists of four academic articles and an introductory chapter explaining the objectives, background and results of the study. It concentrates on the variation and change in predicate structures in Tundra Nenets, a Samoyedic (Uralic) language spoken in Siberia. The focus of the study is on the finite and non-finite forms and the concept of finiteness in grammatical change. The study investigates those grammatical categories that show variation in verbal and non-verbal predication or that are results of grammaticalization processes that include changes in non-finite verb forms. The topics of the articles are adjectival words, modal and evidential categories, and the essive-translative constructions in Tundra Nenets. The data consists of published texts in Tundra Nenets from different periods of time representing different genres, as well as fieldwork material recorded on the Taimyr Peninsula in 2011. The approach is functional typological, and the methodology combines synchronic linguistic description and diachronic explanation of the grammatical phenomena. The linguistic processes are analysed with relation to language use and context, and their development is explained with relation to the synchronic variation in the language and similar structural and functional paths of change in other languages. The findings of this study complement earlier research by suggesting mechanisms and paths of change for categories whose origin has been hypothesized in earlier studies. The results suggest that non-finite verb forms often serve as a basis for modal and evidential verb forms in Tundra Nenets, but they can also take part in grammaticalization processes that produce nominal categories, such as the essive-translative suffix. At the same time, the study provides syntactic analyses of lesser studied grammatical categories in Tundra Nenets. It also contributes to the more general discussion on finiteness and infiniteness as well as the division of main word classes in grammatical change.
  • Nybond, Susanna (Helsingin yliopisto, 2015)
    Due to the emergence of multidrug resistant bacteria, bacterial infections are still a major healthcare problem. Many factors have led to a discovery void of new antibacterial agents, rendering the current antibiotic pipeline inadequate for future medical needs. For example, the outcomes from pure biochemical high-throughput screening (HTS) assays have, in many cases, not led to successful clinical compounds. Therefore cell-based assays might be a better choice for primary screening. However, the antibacterial cell-based assays in the current use often require long incubation times and they are not always amenable for miniaturization and automation for HTS. In this work, two screening assays based on recombinant bioluminescent E. coli strains were optimized and implemented in the screening of chemical libraries and natural products in antibacterial drug discovery. One of the recombinant bacterial strains was a strain which is sensitive towards transcriptional and translational inhibitors. The assay based on this strain was successfully miniaturized into 384-format using automatized liquid handling and was validated with a proof-of-concept library containing known drugs. This provided a means to perform a larger scale high throughput screen of a compound library. Based on the HTS hit structures, a ligand-based in silico screening of a virtual chemical library was employed for hit enrichment. The most active hits and the in silico selected compounds were further investigated in more detail. Natural products have been an important source in drug discovery, especially in the discovery of antibiotics in the current use. However, matrix effects such as colour or turbidity of natural product extracts can potentially cause interference in conventional absorbance based microbial growth inhibition assays. Also, conventional antibacterial assays are usually not sensitive enough for detecting very small concentrations in fractionated natural product extracts. The feasibility of bioreporter -based assays in antimicrobial screening of natural products was demonstrated by screening an in-house natural product library. One of the assays was also implemented for investigating the antibacterial properties of an extract from a fungal culture filtrate, which demonstrated the sensitivity of the assay for identification of active components from fractionated samples. In conclusion, sensitive and reproducible bioassays amenable for further miniaturization and automation were developed for antibacterial drug discovery. Compared to conventional antimicrobial testing, the bioreporter-based methods offer important improvements such as simultaneous data acquirement on antimicrobial activity, first indication of mode of action and significant reduction of assay time to 2-4 h compared to 24 h in standard susceptibility assays. The developed bioluminescent assays led to the improvement of compound throughput in antimicrobial screening: from hundreds of samples (natural product extracts and fractions) in manually performed assays in 96-well plates, to thousands of test compounds (synthetic compound libraries) in 384-well format using automated liquid handling.
  • Kaukomaa, Timo (Helsingin yliopisto, 2015)
    This study examines facial expressions in naturally occurring face-to-face interaction. The focus is on how facial expressions (e.g., smiles and frowns) are part of the collaborative construction and modification of shared emotional stances between speakers and hearers. The data corpus of this study consists of five recorded dyadic Finnish conversations over lunch between individuals who were familiar with each other. The conversations were recorded with three video cameras: two cameras recorded the participants facial expressions and upper bodies and one camera the overall situation. The method of this study is conversation analysis, which makes it possible to examine how participants use their facial expression, move-by-move or turn-by-turn, in the joint negotiation processes of shared emotional stances. The dissertation consists of three original articles and an introduction. In the introduction, I lay out the central concepts and the perspective of the study, describe the data and method, and provide an overview and short examples of the results of the study. I also discuss at a more general level the ways in which my study contributes to earlier studies on embodied socio-emotional communication, and to our understanding of social interaction and social life. The analysis highlights the important role facial expressions have in construction and modification of the public emotional sphere of conversation. The emotional sphere is in continuous transformation, as the participants collaboratively negotiate their situational relationship and interpersonal (in)congruence with regard to the activity at hand. The articles 1 and 2 examine how speakers turn initial facial expression (a smile or a frown) contributes to the action of the utterance it foreshadows and to the larger sequential environment. The results show that the interactional trajectories of these turn-opening facial expressions vary substantially: smiles are first steps to a shared moment of positive or humorous stance, whereas frowns initiate a problem turn that creates momentary distance between participants. The article 3 demonstrates the ways in which recipients facial expression may shift the emotional stance of the speaker s utterance. The recipient s facial expressions play a major role in the collaborative modification of shared emotional stance. They do not simply mirror the speaker s stance or display understanding of the speaker s talk; rather, they perform well-timed systematic operations on the projected course of the talk. The contribution of the article is to show how speakers and hearers work in collaboration using subtle and well-timed facial (and other) expressions of emotion in order to negotiate, move-by-move, the emotional stance(s) that they will share. This study reveals the significance of facial expressions in communicative actions and in the regulation of situational affective relationship between speakers and hearers in mundane interactions. These processes resonate with the larger social structures and the reproduction of micro-social order.
  • Kurko, Terhi (Helsingin yliopisto, 2015)
    Nicotine Replacement Therapy (NRT) products are the most commonly used smoking cessation (SC) pharmacotherapy. This study explored the deregulation of NRT products from pharmacy-only distribution to general sales in Finland which took place in 2006. The overall aim of this study was to assess the reasons for the NRT deregulation and its reflections on SC practices in Finland. NRT deregulation was explored from three perspectives: 1) policy-making; 2) community pharmacists as health care professionals providing guidance on NRT use; and 3) NRT users perceptions of NRT in SC. The NRT deregulation from the policy-making perspective was assessed by inductive content analysis of all the publicly available documents and interviews of 12 Members of the Parliament (Study I). A nationwide representative survey to every second pharmacy owner and staff pharmacist (n=2291) was conducted a year after the deregulation in 2006-2007 (Studies II and III). The NRT users perspective was assessed by inductive content analysis of smokers and quitters postings (n=24 481) in five internet discussion areas in the national SC support Forum, STUMPPI, in 2007-2012 (Study IV). The NRT deregulation was politically communicated as a safe and evidence-informed decision promoting public health by advancing SC in Finland (I). However, two of the most important motives for the deregulation, poor NRT availability and the effectiveness of sole NRT use in SC, were largely based on assumptions instead of scientific evidence. At the time of the pharmacists survey, nearly half of the respondents reported being familiar with the Finnish SC Guideline. The familiarity with the Guideline was directly reflected in the level SC actions taken by pharmacist (II). Due to the NRT deregulation, in particular pharmacy owners , motivation towards counselling NRT customers decreased (III). The analysis of smokers and quitters internet-based discussions (IV) revealed that many Finnish smokers and quitters saw NRT as less important in SC or held negative perceptions towards NRT use. From smokers and quitters perspective, the most highlighted factors of successful quitting were quitters own psychological empowerment and peer support from the discussion community. This study found a great variety of NRT usage patterns. Of these, the most commonly emerged one was the use of lower dosage or shorter period compared with the instructions on NRT use. The findings of this study suggest that the sole increased NRT use may not be so crucial for SC as suggested during the political decision-making process. This study provided also evidence that in Finland NRT products are used in a way which may not be optimal for treatment success. Therefore many smokers and quitters could benefit from personalized support for NRT use which would include behavioural components and a plan for NRT use to optimize the treatment. In future it is important to guarantee that community pharmacist are not lost as an important public health resource to provide such individualized NRT counselling and managing personalized SC plans. In addition, there is a need to develop more advanced SC services fitting to the needs of individual quitters. These services could utilize internet-based services and peer support. The findings of this study highlight the need to further evaluate the public health benefits gained from the deregulation.
  • Mehtälä, Juha (Helsingin yliopisto, 2015)
    Continuous-time Markov processes with a finite state space can be used to model countless real world phenomena. Therefore, researchers often encounter the problem of estimating the transition rates that govern the dynamics of such processes. Ideally, the estimation of transition rates would be based on observed transition times between the states in the model, i.e., on continuous-time observation of the process. However, in many practical applications only the current status of the process can be observed on a pre-defined set of time points (discrete-time observations). The estimation of transition rates is considerably more challenging when based on discrete-time data as compared to continuous observation. The difficulty arises from missing data due to the unknown evolution of the process between the actual observation times. To be able to estimate the rates reliably, additional constraints on how they vary in time will usually be necessary. A real world application considered in this thesis involves the asymptomatic carriage state (colonisation) with the bacterium \textit{Streptococcus pneumoniae} (the pneumococcus). The pneumococcus has over 90 strains and for understanding the dynamics of the pneumococcus among humans it is important to understand within-host competition between these strains. Research questions regarding competition in this thesis are: does colonisation by one serotype protect from acquisition of other serotypes and is clearance affected by concurrent colonisation by other serotypes? A question regarding the implication of competition to pneumococcal dynamics after vaccination is also of interest. In addition, vaccine protection may be heterogeneous across individuals, leading to a question about how well such vaccine protection can be estimated from discrete-time data. When only discrete-time observations are available, the decision when to measure the current status of the process is particularly important. With measurements that are temporally apart from each other, information about the state of the process at one point does not give information about the state at the other points. When measurements are very close to each other, knowing the state at one point bears information about the state at other, temporally close points. This thesis addresses the estimation of transition rates based on repeated observations of the current status of an underlying continuous-time Markov process. Applications to actual data concern the process of pneumococcal colonisation. Optimal study designs are considered for improved future studies of similar type, applications including but not limited to pneumococcal colonisation studies.
  • Aarnio, Matti (Helsingin yliopisto, 2015)
    Today's medical education faces the challenge of developing students competencies to resolve ever more complex problems in collaboration with other professionals. Problem-based learning (PBL) has proven useful for developing many of the competencies needed in modern healthcare. In PBL students collaboratively construct knowledge to explain and solve problems related to real-life situations. In such knowledge construction, dealing with conflicting ideas and knowledge has the potential to enhance student learning while also developing teamwork and critical thinking, skills that are central to multi-professional healthcare teams. The studies that make up the present doctoral thesis explored how students deal with conflicts on knowledge and how they are facilitated to handle such conflicts in PBL tutorial discussions. In addition, the thesis focuses on how to help students learn teamwork skills and critical thinking. Study I examined how to teach teamwork skills to first-year medical students and how to motivate them to learn these skills. The teamwork skills focused on verbal communication in PBL tutorial sessions and in healthcare teams. Feedback on the teamwork skills module from three consecutive classes of first-year students was analysed. Students motivation to learn teamwork skills increased significantly when the introduction to the topic was improved by more clearly pointing out the clinical relevance of such skills. Study II focused on how conflicts on knowledge were dealt with in PBL tutorial group discussions. Four video-recorded tutorial sessions including 33 first-year medical and dental students were analysed. Conflicts on knowledge were found to be relatively rare and generally fairly brief. This was due to a lack of collaborative and thorough argumentation, as well as a lack of questions that would elicit elaboration on the issues. Study III examined tutor facilitation during tutorial discussions, and particularly how the facilitation helped students to collaboratively resolve conflicts on knowledge. The study focused on the tutors in the same video-recorded tutorial sessions as in Study II. The tutors typically intervened by confirming what the students had said or by giving explanations, but they rarely asked questions that would stimulate elaboration on knowledge. During conflicts on knowledge the tutors gave more explanations, but did little to encourage the students to elaborate on conflicting ideas. Study IV focused on medical students conceptions of critical thinking in preclinical PBL. The aim was to find out how the students defined critical thinking, how they perceived it in preclinical PBL and what they expected it to be in clinical practice. The students typically understood critical thinking as judging the reliability of sources of information. Few students understood critical thinking to mean reflecting on their own thinking or viewing things from different perspectives. Students conceptions of critical thinking may have prevented them from seeing the connection between critical thinking in preclinical PBL and critical thinking in clinical practice. The present thesis sheds light on the processes of collaborative knowledge construction related to dealing with conflicting knowledge and ideas in PBL tutorial discussions. The results confirmed prior research findings, which have shown that students rarely deal with conflicting ideas and knowledge, and they point to the central role of the tutor in facilitating students to address these matters in tutorial discussions. The findings also revealed that engaging in deep inquiry during conflicts on knowledge was challenging for both students and tutors. The results further underlined the importance of clearly pointing out to students how they will benefit from the skills learned in preclinical PBL, such as teamwork and critical thinking, in their future professions. Based on these findings, new ideas for improving learning from conflicting ideas in small-group discussions are introduced. Future studies are encouraged to continue exploring the many exciting avenues opened by the present doctoral thesis.
  • Eskelä, Elina (Helsingin yliopisto, 2015)
    Cities are striving to attract and retain talented workers in order to increase their competitiveness in the new economy, which is highly dependent on innovation and knowledge. Residential satisfaction has been identified as a key determinant of whether a person stays or moves to another location. However, given the tendency to focus on the housing of immigrant groups with a lower socio-economic status, the factors that affect the residential satisfaction of skilled migrants remain understudied. This article-based dissertation in the field of urban geography examines the determinants of residential satisfaction among skilled migrants living in the Helsinki metropolitan area (HMA), Finland. The research setting is intended to maximise the cultural and socio-economic as well as locational diversity within the limits of recognised skilled migrant groups. The analysis focuses on how the interplay between individuals norms and the situational conditions is manifested when immigrants assess a single housing market, the HMA. The study is qualitative in nature and draws on 70 semi-structured interviews with skilled migrants and with experts on migration and housing in the city region. Despite the cultural, socioeconomic and locational heterogeneity of the interviewees, their experiences of housing in the HMA were notably similar: the uppermost assessment was that it is expensive, cramped and uniform. On the other hand, they appreciated the overall safety and functionality of the city region, as well as the natural environment: the predominant influence, for them, is the family life cycle rather than the urban amenities that are often assumed to be highly important for the creative class . The results also show that homeownership is not a simple indicator of the intention to stay in or leave the region, which contradicts earlier findings on ethnic-minority housing. The study underlines the importance of the social environment in creating residential satisfaction among skilled migrants. Whereas earlier studies revealed the essential nature of social networks and personal trajectories in the location decisions of skilled workers, the results of this study indicate that the supply of local, neighbourhood-based social ties is particularly limited in the case of the HMA, and that this has a negative impact on the residential satisfaction of skilled migrants. Furthermore, the structural element of housing seemed to have an effect on local social ties: among international students the extent of such ties varied according to the housing form. Although many skilled migrants are in a good socio-economic position, they are not immune to problems related to finding suitable housing. Housing availability, quality and affordability are therefore significant factors in enhancing residential satisfaction among such groups. Furthermore, as local social ties serve a mediating role with regard to the residential area as well as to society, the formation of such ties would promote the integration of migrants. These aspects of housing should be acknowledged in the strategies of cities wishing to accommodate and retain global talent. Keywords: skilled migrants, housing, residential satisfaction, social ties, Helsinki metropolitan area