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  • Tiippana-Kinnunen, Tarja (Helsingin yliopisto, 2014)
    This 15-year follow-up focused on radiographic outcome, functional capacity, work disability and comorbidity in 86 patients (age 18-65 years), with early (≤ 12 months of disease duration) rheumatoid arthritis (RA) collected in 1986-1989 in Helsinki area and treated with early initiated DMARD therapy. The outcome was determined in relation to DMARD continuity, early disease activity, early radiographic remission (ERR) and baseline comorbidity. Of the 70 patients evaluated at 15-year examination, 50 (71%) needed continuous DMARD therapy (group A). In 20 patients (29%) DMARDs were discontinued due to clinical remission. Of these disease flared up and DMARDs were reintroduced in 9 patients (45%, group B) and 11 (55%) remained in remission (group C). The 15-year outcome was most favourable in group C: 64% of patients being in remission, according to American Collage of Rheumatology criteria, compared with 0% in B and 6% in A. Final functional capacity [mean Health Assessment Questionnaire (HAQ)] was 0.24 in C, 0.38 in B and 0.60 in A and radiographic outcome assessed with mean Larsen score (LS) 12, 25 and 54, respectively. As conclusion, patients whose DMARDs are discontinued due to remission, should be followed up closely for a flare-up of the disease. For those whose disease flares up, DMARDs should be reintroduced immediately. The 15-year LS of 69 patients determined in relation to ERR [an increase of LS ≤ 1 Larsen unit (LU) between two sequential sets of small joint radiographs during the first 2 years]. Mean 15-year LS of the small joints (14) and LS of the large joints (0.8) were lower in patients with sustained ERR (both year 1 and year 2), compared with 33 and 1.9 in patients with temporary ERR (either year 1 or year 2) or with 67 and 6.3 in patients with radiographic progression ≥ 2 LU during both first years. Considering these findings, radiographic remission should be a treatment goal in RA and early progression in small joints should be taken as a warning sign for later damage of large joints. Of 80 patients with adequate data, 20% had at least one comorbid condition at baseline and 60 % had comorbidities at the 15-year visit or at time od death, most commonly hypertension (30%), cardiovascular diseases (14%), malignancies (11%) or osteoporosis (11%). Elderly patients with baseline comorbidity showed higher disease activity both during first year of RA and at endpoint than younger patients without comorbidities. Of the 86 patients, 42 (49%) retired due to work disability (WD) during 15 years or before death, most of these due to RA. The Kaplan-Meier estimated cumulative RA-related WD was less frequent in patients with low disease activity during first 12 months (3% at year 5, 10% at year 10 and 22% at year 15) than in those with moderate or high disease activity (28%, 55% and 64%, respectively). The results of this study showed that most patients with RA need continuous DMARD treatment and emphasize the importance of targeting to clinical remission and to radiographic remission in early phase of the disease for the long-term outcome in RA.
  • Pelttari, Hanna (Helsingin yliopisto, 2012)
    The goal of initial therapy in differentiated thyroid cancer (DTC) is to minimize disease related mortality and morbidity by surgically removing the primary tumour and all metastasized tumour tissue. A second goal is to minimize risk of recurrence and metastatic spread by facilitating post-operative radio-iodine ablation (RRA), permitting accurate long-term surveillance. Recurrences are relatively common even in patient population at low-risk for cancer-specific death, occurring in 10-40% of cases. The treatment and follow-up schemes have varied between centres and there is ongoing debate about appropriate methods for primary therapy and surveillance. With the increasing incidence of DTC, the need for new factors prognostic of disease recurrence is growing; most of the prognostic systems have been validated with cancer-specific death as outcome. We designed an observational retrospective study to assess the outcome of a large cohort of patients with low-risk thyroid carcinoma and with a uniform primary therapy. All patients belong to TNM stage I or II and were considered disease-free after initial therapy. We evaluated the safety and efficacy of a surveillance paradigm, comprising yearly thyroglobulin (TG) measurements on L-T4 therapy and neck ultrasonography (US) every second year, with an increase in TG to a detectable level being an indication for further investigations. We examined the health-related quality of life (HRQoL) of the patient cohort after long-term follow-up using a validated multidimensional method (15D®). We studied factors correlating with disease recurrence, including patient demographics, tumour characteristics and parameters with primary therapy, in 495 low-risk patients treated at Helsinki University Central Hospital over a 15-year period. Post-operative and post-ablative TG concentrations, age, tumour size, local infiltration and nodal metastasis at primary surgery, number of neck US, fine-needle aspiration biopsies (FNABs) and operations performed, presence of BRAF mutation in papillary tumour tissue, disease recurrences and cancer-specific deaths were evaluated. The majority of patients had total thyroidectomy and radio-active iodine remnant ablation as initial treatment. The median follow-up was 16 (range 10 24) years. Fifty-one patients (10.3%) experienced disease recurrence during follow-up. A combination of neck US and high TG revealed most recurrences. In multiple logistic regression analysis, post-ablative measurable TG concentrations (odds ratio (OR) 3.72, confidence interval (CI) 1.71 8.05, P = 0.0009) and presence of local infiltration on primary surgery (OR 2.66, CI 1.03 6.90, P = 0.04) were the only independent predictors of recurrence. BRAF V600E mutation is common (prevalence 67%) in this low-risk papillary thyroid cancer patient group but does not predict recurrence after long-term follow-up after initial treatment with total thyroidectomy (TTE) and RRA. HRQoL was preserved in DTC patients compared to a large age- and gender-standardized sample of the general Finnish population (n = 6001). After long-term follow-up, overall HRQoL is comparable with that of the general population. DTC patients demonstrate an age-related decline in HRQoL, similar to that seen in the population in general. We conclude that post-ablative TG concentration is a strong predictor of disease recurrence in DTC. Although longer follow-up is needed, monitoring low-risk differentiated thyroid carcinoma patients with neck US and TG measured on L-T4 appears safe and effective.The same principles have now been adapted also by many international centres.
  • Kosola, Silja (Helsingin yliopisto, 2013)
    Since survival rates after pediatric liver transplantation (LT) have improved, the focus of interest has shifted to gradually evolving histological changes, long-term complications, and quality of life. Histological changes and complications are closely associated with each other and the immunosuppressive medication used, and may in turn affect the LT recipient s perception of quality of life. This thesis investigates the survival and complication rates, usefulness of protocol liver biopsies and long-term histological status of the liver graft, and cholesterol metabolism profile after pediatric LT. The effect of immunosuppression on biopsy-proven changes and cholesterol metabolism is also evaluated. In the quality of life assessment, the effects of different complications are explored. The study population includes all 99 children less than 18 years who underwent LT in Finland between 1987 and 2007. Retrospective data on LT indications, surgical procedures, surgical and medical complications, immunosuppression, and annual follow-up visits were collected from patient records and the national LT registry. For 12 patients transplanted for hepatoblastoma (HB) or hepatocellular carcinoma (HCC), also relevant cancer treatment details were gathered. Cross-sectional data included liver biopsies of 54 LT recipients (82% of survivors), serum levels of noncholesterol sterols (surrogate markers of cholesterol metabolism) and fibroblast growth factor 21 (FGF21) in 49 LT recipients (74%), and health-related quality of life (HRQoL) assessment of 57 LT recipients (86%) at median 10-11 years posttransplant. Serum levels of noncholesterol sterols and FGF21 were compared to 93 controls matched for age and gender, and the HRQoL measurements to 141 randomly picked controls matched for age, gender, and place of residence. Of the 12 patients with liver malignancies, six had HB and six HCC. All patients received neoadjuvant chemotherapy, but no routine chemotherapy was administered after LT. Median time from diagnosis to LT was 7 (2-133) months. At LT, none of the patients had radiological evidence of extrahepatic disease. The overall survival rates at one, five, and ten years after LT were 100%, 80%, and 67%, respectively. Survival was similar between the tumor types, and two deaths occurred secondary to tumor recurrence, one of each type. Biopsies of 18 patients (33%) showed near-normal histology with minimal changes. Portal inflammation was present in 14 samples (26%), and was less frequent in patients whose immunosuppression included steroids (14% vs. 47%; p = 0.008). Fibrosis was found in 21 biopsies (39%), and fibrosis staging correlated negatively with serum prealbumin levels (r = -0.364, p = 0.007) and positively with portal inflammation (r = 0.350, p = 0.010) and periportal cytokeratin 7 staining (r = 0.529, p less than 0.001). Microvesicular steatosis was detected in 23 biopsies (43%; 5-80% of hepatocytes), and correlated with the patients body-mass-index (r = 0.458, p less than 0.001) but not with steroid use. The histological findings were mainly mild and led to treatment changes in ten patients (19%), while only one minor complication was encountered. Serum lipid levels were similar in LT recipients and controls. LT recipients, however, displayed increased whole-body synthesis and decreased absorption of cholesterol compared to controls (lathosterol to cholesterol ratio 129 ± 55 vs. 96 ± 41, respectively, p less than 0.001; campesterol to cholesterol ratio 233 ± 91 vs. 316 ± 107, respectively, p less than 0.001). Low-dose methylprednisolone and azathioprine were negatively associated with the lathosterol/sitosterol ratio (r = -0.492, p less than 0.001 and r = -0.383, p = 0.007, respectively) reflecting a favorable effect on cholesterol metabolism. FGF21 levels were higher in LT recipients than in controls (248 pg/mL vs. 77 pg/mL, p less than 0.001). Under school-aged LT recipients and controls had similar HRQoL, and 54% of LT recipients aged over 7 scored within the controls normal range on all HRQoL domains. Biliary complications, reoperations, and obesity were independently associated with decreased HRQoL (p less than 0.05 for all). For those LT recipients already attending adult health care, physical functioning and general health yielded reduced scores (p less than 0.05). Still 64% of adults considered their health excellent. Sexual health was similar to controls although LT recipients may experience problems with their orgasm strength (p = 0.050). In conclusion, continued use of low-dose steroids seems to be associated with milder changes of both liver graft histology and cholesterol metabolism. Normal HRQoL and sexual health are achievable in long-term survivors of pediatric LT.
  • Sistonen, Saara (2010)
    Esophageal atresia (EA), a common congenital anomaly comprising interrupted esophagus with or without a tracheoesophageal fistula (TEF), affects one in 2840 newborns. Over half have associated anomalies. After EA repair in infancy, gastroesophageal reflux (GER) and esophageal dysmotility and respiratory problems are common. As there exist no previous population-based long-term follow-up-studies on EA, its long-term sequelae are unclear. The aims of this study were to assess the cancer incidence (I), esophageal morbidity and function (II), respiratory morbidity (III), and the spinal defects (IV) in adults with repaired EA. All patients treated for EA at the Hospital for Children and Adolescents, University of Helsinki, from 1947 to 1985 were identified, and those alive with their native esophagus were contacted, and the first hundred who replied made up the study group. The patients were interviewed, they filled in symptom questionnaires, and they underwent esophageal endoscopy and manometry, pulmonary function tests, and a full orthopedic evaluation was performed with radiographs of the spine. The questionnaire was also sent by mail to adults with repaired EA not attending the clinical study, and to 287 general population-derived controls matched for age, gender, and municipality of residence. Incidence of cancer among the study population was evaluated from the population-based countrywide cancer registry. 169 (72%) adults with repaired EA replied; 101 (42%) (58 male) participated in the clinical studies at a median age of 36 years (range, 22-56). Symptomatic GER occurred in 34% and dysphagia in 85% of the patients and in 8% and 2% of the controls (P<0.001 for both). The main endoscopic findings included hiatal hernia (28%), Barrett´s esophagus (11%), esophagitis (8%), and stenotic anastomosis (8%). Histology revealed esophagitis in 25 individuals, and epithelial metaplasia in another 21. At immunohistochemistry, CDX2-positive columnar epithelial metaplasia was present in all 21 individuals, and 6 of these also demonstrated goblet cells and MUC2 positivity. In all histological groups, GER and dysphagia were equally common (P=ns). Esophageal manometry demonstrated non-propagating peristalsis in most of the patients, and low ineffective pressure of the distal esophageal body in all. The changes were significantly worse in those with epithelial metaplasia (P≤0.022). Anastomotic complications (OR 8.6-24, 95%CI 1.7-260, P=0.011-0.008), age (OR 20, 95%CI 1.3-310, P=0.034), low distal esophageal body pressure (OR 2.6, 95%CI 0.7-10, P=0.002), and defective esophageal peristalsis (OR 2.2, 95%CI 0.4-11, P=0.014) all predicted development of epithelial metaplasia. Despite the high incidence of esophageal metaplasia, none of the EA patients had suffered esophageal cancer, according to the Finnish Cancer Registry. Although three had had cancer (SIR, 1.0; 95% CI, 0.20-2.8). The overall cancer incidence among adults with repaired EA did not differ from that of the general Finnish population. Current respiratory symptoms occurred in 11% of the patients and 2% of the controls (P<0.001). Of the patients, 16%, and 6% of the controls had doctor-diagnosed asthma (P<0.001). A total of 56% and 70% of the patients and 20% and 50% of the controls had a history of pneumonia and of bronchitis (P<0.001 for both). Respiratory-related impaired quality of life was observable in 11% of the patients in contrast to 6% of the controls (P<0.001). PFT revealed obstruction in 21 of the patients, restriction in 21, and both in 36. A total of 41 had bronchial hyper-responsiveness (BHR) in HCT, and 15 others had an asthma-like response. Thoracotomy-induced rib fusion (OR 3.4, 95%CI 1.3-8.7, P=0.01) and GER-associated epithelial metaplasia in adulthood (OR 3.0, 95%CI 1.0-8.9, P=0.05) were the most significant risk factors for restrictive ventilatory defect. Vertebral anomalies were evident in 45 patients, predominating in the cervical spine in 38. The most significant risk factor for the occurrence of vertebral anomalies was any additional anomaly (OR 27, 95%C I8-100). Scoliosis (over 10 degrees) was observable in 56 patients, over 20 degrees in 11, and over 45 degrees in one. In the EA patients, risk for scoliosis over 10 degrees was 13-fold (OR 13, 95%CI 8.3-21) and over 20 degrees, 38-fold (OR 38, 95%CI 14-106) when compared to that of the general population. Thoracotomy-induced rib fusion (OR 3.6, 95%CI 0.7-19) and other associated anomalies (OR 2.1, 95%CI 0.9-2.9) were the strongest predictive factors for scoliosis. Significant esophageal morbidity associated with EA extends into adulthood. No association existed between the esophageal symptoms and histological findings. Surgical complications, increasing age, and impaired esophageal motility predicted development of epithelial metaplasia after repair of EA. According to our data, the risk for esophageal cancer is less than 500-fold that of the general population. However, the overall cancer incidence among adults with repaired EA did not differ from that of the general population. Adults with repaired EA have had significantly more respiratory symptoms and infections, as well as more asthma, and allergies than does the general population. Thoracotomy-induced rib fusion and GER-associated columnar epithelial metaplasia were the most significant risk factors for the restrictive ventilatory defect that occurred in over half the patients. Over half the patients with repaired EA are likely to develop scoliosis. Risk for scoliosis is 13-fold after repair of EA in relation to that of the general population. Nearly half the patients had vertebral anomalies. Most of these deformities were diagnosed neither in infancy nor during growth. The natural history of spinal deformities seems, however, rather benign, with spinal surgery rarely indicated.
  • Palmu, Sauli (Helsingin yliopisto, 2013)
    Every fourth injured child seeking medical aid has sustained a fracture. Tibial fracture (annual incidence in less than 17 year old citizens in Finland is 1/1000) is the third most common fracture in children and femoral fracture (0.3/1000) among the most common pediatric injuries leading to hospitalization. Long-term treatment result of these fractures is not well known and there are no studies of treatment injuries in this pediatric patient population. Altogether 94 tibial and 74 femoral fractures were treated under anesthesia in Aurora Hospital, Helsinki between 1980-89. All but 5 of the tibial fractures were manipulated under anesthesia and casted. A remanipulation was performed in 41 patients. Femoral fractures were treated with skeletal traction in 62 patients, with internal fixation in 8 patients and by cast-immobilization 4 patients. A patients assessment form and an invitation to participate in a clinical and radiological examination at a mean follow-up of more than 20 years (16-32) was sent to all 168 patients. Six of the 58 tibial fracture patients that responded reported pain as their only memory of treatment. Results of tibial fracture treatment were satisfactory with few exceptions: functionally significant axial malalignment, limb length discrepancies nor arthritis was not found excluding four patients with >20° rotational deformity of the tibia. On the contrary 21/52 of the femoral fracture patients examined had angular malalignment of the femur exceeding 10°. Ten patients walked with a limp and leg-length discrepancy of more than 15 mm was measured in 8 patients. Knee arthritis had developed in 6/15 patients who were older than 10 years at the time of the injury. There was a positive correlation between angular deformity and knee arthritis. Treatment injuries were evaluated using patient compensation data from the Finnish Patient Insurance Centre (PIC): 50 claims involving tibial fracture treatment, 30 involving femoral fracture treatment were filed during the study period between 1997-2004. Compensation was granted in 35/50 claims after tibial fracture treatment and in 16/30 after femoral fracture treatment. The most common reasons for compensations in tibial fractures were missed diagnosis and inappropriate casting technique and delay in treatment, unnecessary or inappropriate treatment in femoral fractures. Most of the treatment injuries were regarded in retrospect as avoidable. Satisfactory long-term results in pediatric tibial fractures treated with closed manipulation and cast-immobilization can be expected. Many children require remanipulation to maintain satisfactory alignment, however. Over 10 year old patients with femoral malunion run a high risk of early knee arthritis. Most treatment injuries in pediatric tibial and femoral fractures can be avoided by accurate primary diagnostics, correct casting techniques and appropriate surgery.
  • Kirjavainen , Mikko (Helsingin yliopisto, 2010)
    Background: Brachial plexus birth palsy (BPBP) most often occurs as a result of foetal-maternal disproportion. The C5 and C6 nerve roots of the brachial plexus are most frequently affected. In contrast, roots from the C7 to Th1 that result in total injury together with C5 and C6 injury, are affected in fewer than half of the patients. BPBP was first described by Smellie in 1764. Erb published his classical description of the injury in 1874 and his name became linked with the paralysis that is associated with upper root injury. Since then, early results of brachial plexus surgery have been reasonably well documented. However, from a clinical point of view not all primary results are maintained and there is also a need for later follow-up results. In addition most of the studies that are published emanate from highly specialized clinics and no nation wide epidemiological reports are available. One of the plexus injuries is the avulsion type, in which the nerve root or roots are ruptured at the neural cord. It has been speculated whether this might cause injury to the whole neural system or whether shoulder asymmetry and upper limb inequality results in postural deformities of the spine. Alternatively, avulsion could manifest as other signs and symptoms of the whole musculoskeletal system. In addition, there is no available information covering activities of daily living after obstetric brachial plexus surgery. Patients and methods: This was a population-based cross-sectional study on all patients who had undergone brachial plexus surgery with at least 5 years of follow-up. An incidence of 3.05/1000 for BPBP was obtained from the registers for this study period. A total of 1706 BPBP patients needing hospital treatment out of 1 717 057 newborns were registered in Finland between 1971 and 1997 inclusive. Of these BPBP patients, 124 (7.3%) underwent brachial plexus surgery at a mean age of 2.8 months (range: 0.4―13.2 months). Surgery was most often performed by direct neuroraphy after neuroma resection (53%). Depending on the phase of the study, 105 to 112 patients (85-90%) participated in a clinical and radiological follow-up assessment. The mean follow up time exceeded 13 years (range: 5.0―31.5 years). Functional status of the upper extremity was evaluated using Mallet, Gilbert and Raimondi scales. Isometric strength of the upper limb, sensation of the hand and stereognosis were evaluated for both the affected and unaffected sides then the differences and their ratios were calculated and recorded. In addition to the upper extremity, assessment of the spine and lower extremities were performed. Activities of daily living (ADL), participation in normal physical activities, and the use of physiotherapy and occupational therapy were recorded in a questionnaire. Results: The unaffected limb functioned as the dominant hand in all, except four patients. The mean length of the affected upper limb was 6 cm (range: 1-13.5 cm) shorter in 106 (95%) patients. Shoulder function was recorded as a mean Mallet score of 3 (range: 2―4) which was moderate. Both elbow function and hand function were good. The mean Gilbert elbow scale value was 3 (range: -1―5) and the mean Raimondi hand scale was 4 (range:1―5). One-third of the patients experienced pain in the affected limb including all those patients (n=9) who had clavicular non-union resulting from surgery. A total of 61 patients (57%) had an active shoulder external rotation of less than 0° and an active elbow extension deficiency was noted in 82 patients (77%) giving a mean of 26° (range: 5°―80°). In all, expect two patients, shoulder external rotation strength at a mean ratio 35% (range: 0―83%) and in all patients elbow flexion strength at a mean ratio of 41% (range: 0―79%) were impaired compared to the unaffected side. According to radiographs, incongruence of the glenohumeral joint was noted in 15 (16%) patients, whereas incongruence of the radiohumeral joint was found in 20 (21%) patients. Fine sensation was normal for 34/49 (69%) patients with C5-6 injury, for 15/31 (48%) with C5-7 and for only 8/25 (32%) of patients with total injury. Loss of protective sensation or absent sensation was noted in some palmar areas of the hand for 12/105 patients (11%). Normal stereognosis was recorded for 88/105 patients (84%). No significant inequalities in leg length were found and the incidence of structural scoliosis (1.7%) did not differ from that of the reference population. Nearly half of the patients (43%) had asynchronous motion of the upper limbs during gait, which was associated with impaired upper limb function. Data obtained from the completed questionnaires indicated that two thirds (63%) of the patients were satisfied with the functional outcome of the affected hand although one third of all patients needed help with ADL. Only a few patients were unable to participate in physical activities such as: bicycling, cross-country skiing or swimming. However, 71% of the patients reported problems related to the affected upper limb, such as muscle weakness and/or joint stiffness during the aforementioned activities. Incongruity of the radiohumeral joints, extent of the injury, avulsion type injury, age less than three months of age at the time of plexus surgery and inexperience of the surgeon was related to poor results as determined by multivariate analyses. Conclusions: Most of the patients had persistent sequelae, especially of shoulder function. Almost all measurements for the total injury group were poorer compared with those of the C5-6 type injury group. Most of the patients had asymmetry of the shoulder region and a shorter affected upper limb, which is a probable reason for having an abnormal gait. However, BPBP did not have an effect on normal growth of the lower extremities or the spine. Although, participation in physical activities was similar to that of the normal population, two-thirds of the patients reported problems. One-third of the patients needed help with ADL. During the period covered by this study, 7.3% BPBP of patients that needed hospital treatment had a brachial plexus operation, which amounts to fewer than 10 operations per year in Finland. It seems that better results of obstetric plexus surgery and more careful follow-up including opportunities for late reconstructive procedures will be expected, if the treatment is solely concentrated on by a few specialised teams.
  • Heikkinen, Marja (Helsingin yliopisto, 2008)
    The aim of the study was to evaluate long-term results of operative treatment for Hirschsprung's disease(HD) and internal anal sphincter achalasia. Fecal continence and quality of life were evaluated by a questionnaire in 100 adult patients who had undergone surgery for HD, during 1950-75. Fecal continence was evaluated using a numerical scoring described by Holschneider. Fifty-four of the 100 patients underwent clinical examination, rigid sigmoidoscopy and manometric evaluation. In anorectal manometry basal resting pressure(BRP)and maximal squeeze pressure(MSP) were measured and voluntary sphincter force(VSF) was calculated by subtracting the BRP from MSP. The results of operative treatment for adult HD were compared with the results of the patients operated in childhood. In adult HD the symptoms are such mild that the patients attain adolescence or even adulthood. The patients with HD and cartilage-hair-hypoplasia were specifically evaluated. The outcome of the patients with internal anal sphincter achalasia operated on by myectomy was evaluated by a questionnaire and continence was evaluated using a numerical scoring described by Holschneider. Of the 100 patients operated on for HD 38 patients had completely normal bowel habits. A normal or good continence score was found in 91 our of 100 patients. Nine patients had fair continence. One of the patients with fair continence had Down's syndrome and two were mentally retarded for other reasons. Only one patient suffered from constipation. In anorectal manometry the difference in BRP between patients with normal and good continence was statistically significant, whereas the difference between good and fair continence groups was not statistically significant. The differences on MSP and VSF between patient groups with different continence outcome were not statistically significant. The differences between patient groups and normal controls were statistically significant in BRP and MSP. In VSF there was not statistically significant difference between the patients and the normal controls. The VSF reflects the working power of the muscles including external sphincter, levator ani and gluteal muscles. The patients operated at adult age had as good continence as patients operated in childhood. The patients with HD and cartilage-hair-hypoplasia had much more morbidity and mortality than non-cartilage-hair-hypoplasia HD patients. The mortality was as high as 38%. In patients with internal anal sphincter achalasia the constipation was cured or alleviated by myectomy whereas a significant number suffered from soiling-related social problems.
  • Nieminen, Tuomo (Helsingin yliopisto, 2014)
    Atmospheric aerosol particles affect our lives in various ways. One of the largest sources of aerosols is their formation in the atmosphere via nucleation from precursor vapours. These new particle formation (NPF) events have been observed to occur globally. The climatic effects of secondary aerosol are among the largest uncertainties limiting our scientific understanding of future and past climate changes. Characterizing the processes controlling the formation and growth of aerosols is crucial in order to estimate their effects on air quality, human health, and eventually, global climate. The work presented in this thesis is based on measurements of aerosol formation under various conditions at 12 field sites across Europe, as well as long-term, comprehensive observations of aerosol properties at a boreal forest site in Finland. The results show that new particle formation is a frequent phenomenon at both clean background and polluted Central European sites. On the sites where measurements of both charged and neutral particles were performed, the total particle formation rates at 2 nm size varied in the range 0.9 32 cm-3 s-1, whereas the charged particle formation rates were on the order of 0.05 0.16 cm-3 s-1. Further evidence of the minor role of ions in continental boundary layer particle formation was obtained from the long-term observations, which did not show any connection between variation in the galactic- cosmic-ray-induced ionization and new particle formation. In confirmation of earlier observations, sulphuric acid was found to be closely connected to particle formation rates, but to have only a minor role in their subsequent growth. At the boreal forest site, a long-term decreasing trend in the concentrations of sulphuric acid and aerosol particles was observed, whereas the particle formation and growth rates had a slight increasing trend. Finally, a proxy for the global distribution of nucleation-mode particle concentrations based on satellite data was developed. The results of this thesis give tools to quantify the source rate of atmospheric aerosol from new particle formation in various environments. The characteristics of particle formation determined in this thesis can be used in global models to evaluate the climatic effects of NPF events. The results support previous observations of atmospheric NPF, and give significant new results in particular about the role of ions in NPF in various environments, and the long-term changes in NPF.
  • Hyytinen, Heidi (Helsingin yliopisto, 2015)
    The central purpose of this doctoral thesis has been to deepen our understanding of the nature of critical thinking by combining theoretical, empirical and methodological perspectives. The concept of critical thinking has a central role both in research on the philosophy of education and in empirical research on learning and teaching in higher education. Although it is true that the philosophical and empirical analyses of critical thinking and knowledge differ fundamentally, the present thesis argues that there are shared concerns between these two scholarly traditions. The thesis consists of four studies, each of which approached this aim from different viewpoints. The methods involved both a philosophical approach and an empirical multi-method approach. The dialogue between the empirical and theoretical analyses offers new insights into conceptualising critical thinking and its prerequisites and extends our understanding of variations in critical thinking. Based on the theoretical findings of these studies, I argue that normative elements (how things ought to be) and descriptive elements (how things are) are fundamentally intertwined in the research on critical thinking. Therefore, educational research on critical thinking requires both philosophical and empirical approaches and also dialogue between these two approaches. The theoretical part of the doctoral thesis further demonstrates how philosophical research can contribute to the normative elements of the prevailing empirically-based theorisation of critical thinking, particularly by revealing some conceptual inconsistencies within this framework. The research further introduces the notion of fallibilism (human knowledge is uncertain) as a way out. Epistemological fallibilism fits the presumption of critical thinking better than relativism from the theoretical and pedagogical points of view. The empirical results revealed variation in (a) students skills and dispositions to think critically, (b) students ability to adapt their thinking and performance flexibility, (c) the nature of knowledge students consider to be relevant, (d) the knowledge that students use in problem-solving situations, as well as (e) the way students process that knowledge. Based on these variations two profiles were identified: (1) superficial processing or (2) thorough processing. Superficial processing students reproduced information in the problem-solving situation. These students did not analyse, interpret, evaluate or synthesise knowledge, and their reasoning was very poor. They palmed off justification for knowing on authorities and testimonies. In contrast to previous research, the results show that these students did not share the belief that knowledge is absolutely certain or unquestionable. Nor did these students share the view that beliefs accurately represent or correspond to reality. These students emphasised the uncertain nature of knowledge. The thorough processing students, by contrast, evaluated the quality of the information and considered its premises, as well as the implications of different conclusions. They weighed different options, analysed connections between claims, connected related ideas and gave mainly well-reasoned explanations and convincing arguments. The findings also show that the thorough processing students believed knowledge to be tentative and fallible. However, these students did not argue that all knowledge is constructed by human beings nor did they believe that all interpretations, theories and beliefs are equally right. They thus avoided slipping into relativism. The results revealed that both deeply superficial and thorough processing thinking entails problems if it is connected to an inability to adjust thinking or actions to the demands of the task. This thesis also identified several methodological challenges in assessing critical thinking. The results show that different performance-based critical thinking tests could give completely opposite pictures of a student s abilities. The results further indicated that the group-level analyses could overrun the rich variations in test performance that occurred among individual students. Additionally, the thesis reminds us that the theoretical framework has a great influence on how data are analysed and interpreted. Finally, the thesis argues that one assessment or analysis method is not enough to evaluate the complex cognitive processes of critical thinking. Instead of a sole focus on empirical or theoretical elements, more communication between the theoretical, empirical and methodological perspectives is required to deepen the understanding of critical thinking among students of higher education. Keywords: critical thinking, performance assessment, epistemology, fallibilism, relativism
  • Mäkeläinen, Katri (Helsingin yliopisto, 2006)
    The present study focuses on the translational strategies of Cocksfoot mottle virus (CfMV, genus Sobemovirus), which infects monocotyledonous plants. CfMV RNA lacks the 5'cap and the 3'poly(A) tail that ensure efficient translation of cellular messenger RNAs (mRNAs). Instead, CfMV RNA is covalently linked to a viral protein VPg (viral protein, genome-linked). This indicates that the viral untranslated regions (UTRs) must functionally compensate for the lack of the cap and poly(A) tail. We examined the efficacy of translation initiation in CfMV by comparing it to well-studied viral translational enhancers. Although insertion of the CfMV 5'UTR (CfMVe) into plant expression vectors improved gene expression in barley more than the other translational enhancers examined, studies at the RNA level showed that CfMVe alone or in combination with the CfMV 3'UTR did not provide the RNAs translational advantage. Mutation analysis revealed that translation initiation from CfMVe involved scanning. Interestingly, CfMVe also promoted translation initiation from an intercistronic position of dicistronic mRNAs in vitro. Furthermore, internal initiation occurred with similar efficacy in translation lysates that had reduced concentrations of eukaryotic initiation factor (eIF) 4E, suggesting that initiation was independent of the eIF4E. In contrast, reduced translation in the eIF4G-depleted lysates indicated that translation from internally positioned CfMVe was eIF4G-dependent. After successful translation initiation, leaky scanning brings the ribosomes to the second open reading frame (ORF). The CfMV polyprotein is produced from this and the following overlapping ORF via programmed -1 ribosomal frameshift (-1 PRF). Two signals in the mRNA at the beginning of the overlap program approximately every fifth ribosome to slip one nucleotide backwards and continue translation in the new -1 frame. This leads to the production of C-terminally extended polyprotein, which encodes the viral RNA-dependent RNA polymerase (RdRp). The -1 PRF event in CfMV was very efficient, even though it was programmed by a simple stem-loop structure instead of a pseudoknot, which is usually required for high -1 PRF frequencies. Interestingly, regions surrounding the -1 PRF signals improved the -1 PRF frequencies. Viral protein P27 inhibited the -1 PRF event in vivo, putatively by binding to the -1 PRF site. This suggested that P27 could regulate the occurrence of -1 PRF. Initiation of viral replication requires that viral proteins are released from the polyprotein. This is catalyzed by viral serine protease, which is also encoded from the polyprotein. N-terminal amino acid sequencing of CfMV VPg revealed that the junction of the protease and VPg was cleaved between glutamate (E) and asparagine (N) residues. This suggested that the processing sites used in CfMV differ from the glutamate and serine (S) or threonine (T) sites utilized in other sobemoviruses. However, further analysis revealed that the E/S and E/T sites may be used to cleave out some of the CfMV proteins.
  • Polvi, Jussi (Helsingin yliopisto, 2013)
    Polymers are found everywhere in daily life. Natural polymers, such as wood, wool, cotton and silk have been used by humans for centuries. During the past hundred years, synthetic polymers have taken over from previous structural materials such as wood, stone, iron or glass, and today most of the tools and containers used at home are made of, at least partly, different plastics. This thesis concentrates on studying irradiation effects in two polymers, polyethylene and cellulose. Polyethylene (PE) is the most commonly used synthetic polymer and plastic bottles, pipes, films, toys and food packages are usually made of different brands of polyethylene. As for cellulose, it is the most abundant natural polymer on Earth. As the main component of plant cell walls, almost all plant life contains large amounts of cellulose. Irradiation has been widely used by the industry to process and modify synthetic polymers such as PE since the 1950s. The earliest applications were cross-linking of plastic materials, sterilizing medical equipment and preserving food products, and since then, many more practical applications for radiation processed materials have been developed. Recently there has been a rise of interest in the usage of irradiation in relation to wood products. Since the most abundant molecule in wood is cellulose, this raises an interest in understanding radiation effects in cellulose. Even though irradiation is nowadays widely used in processing of both synthetic and natural polymers, the atomic level description of the physics of irradiation effects in these materials is still very much incomplete. The focus of this thesis is to examine the atomic level mechanism of irradiation induced defect formation in high-density polyethylene and cellulose using molecular dynamics simulations. The results presented in this thesis provide a unique atomic-level view into the reactions initiated by irradiation in polymers, such as chain scission, radical formation and cross-linking.
  • Krogius-Kurikka, Lotta (Helsingin yliopisto, 2011)
    The human gastrointestinal (GI) microbiota is a complex ecosystem that lives in symbiosis with its host. The growing awareness of the importance of the microbiota to the host as well as the development of culture-free laboratory techniques and computational methods has enormously expanded our knowledge of this microbial community. Irritable bowel syndrome (IBS) is a common functional bowel disorder affecting up to a fifth of the Western population. To date, IBS diagnosis has been based on GI symptoms and the exclusion of organic diseases. The GI microbiota has been found to be altered in this syndrome and probiotics can alleviate the symptoms, although clear links between the symptoms and the microbiota have not been demonstrated. The aim of the present work was to characterise IBS related alterations in the intestinal microbiota, their relation to IBS symptoms and their responsiveness to probiotic theraphy. In this thesis research, the healthy human microbiota was characterised by cloning and sequencing 16S rRNA genes from a faecal microbial community DNA pool that was first profiled and fractionated according to its guanine and cytosine content (%G+C). The most noticeable finding was that the high G+C Gram-positive bacteria (the phylum Actinobacteria) were more abundant compared to a corresponding library constructed from the unfractionated DNA pool sample. Previous molecular analyses of the gut microbiota have also shown comparatively low amounts of high G+C bacteria. Furthermore, the %G+C profiling approach was applied to a sample constructed of faecal DNA from diarrhea-predominant IBS (IBS-D) subjects. The phylogenetic microbial community comparison performed for healthy and IBS-D sequence libraries revealed that the IBS-D sample was rich in representatives of the phyla Firmicutes and Proteobacteria whereas Actinobacteria and Bacteroidetes were abundant in the healthy subjects. The family Lachnospiraceae within the Firmicutes was especially prevalent in the IBS-D sample. Moreover, associations of the GI microbiota with intestinal symptoms and the quality of life (QOL) were investigated, as well as the effect of probiotics on these factors. The microbial targets that were analysed with the quantitative real-time polymerase chain reaction (qPCR) in this study were phylotypes (species definition according to 16S rRNA gene sequence similarity) previously associated with either health or IBS. With a set of samples, the presence or abundance of a phylotype that had 94% 16S rRNA gene sequence similarity to Ruminococcus torques (R. torques 94%) was shown to be associated with the severity of IBS symptoms. The qPCR analyses for selected phylotypes were also applied to samples from a six-month probiotic intervention with a mixture of Lactobacillus rhamnosus GG, L. rhamnosus Lc705, Propionibacterium freudenreichii ssp. shermanii JS and Bifidobacterium breve Bb99. The intervention had been previously reported to alleviate IBS symptoms, but no associations with the analysed microbiota representatives were shown. However, with the phylotype-specific assays applied here, the abundance of the R. torques 94% -phylotype was shown to be lowered in the probiotic-receiving group during the probiotic supplementation, whereas a Clostridium thermosuccinogenes 85% phylotype, previously associated with a healthy microbiota, was found to be increased compared to the placebo group. To conclude, with the combination of methods applied, higher abundance of Actinobacteria was detected in the healthy gut than found in previous studies, and significant phylum-level microbiota alterations could be shown in IBS-D. Thus, the results of this study provide a detailed overview of the human GI microbiota in healthy subjects and in subjects with IBS. Furthermore, the IBS symptoms were linked to a particular clostridial phylotype, and probiotic supplementation was demonstrated to alter the GI microbiota towards a healthier state with regard to this and an additional bacterial phylotype. For the first time, distinct phylotype-level alterations in the microbiota were linked to IBS symptoms and shown to respond to probiotic therapy.
  • Uusitalo-Malmivaara, Lotta (Helsingin yliopisto, 2009)
    Remediation of Reading Difficulties in Grade 1. Three Pedagogical Interventions Keywords: initial teaching, learning to read, reading difficulties, intervention, dyslexia, remediation of dyslexia, home reading, computerized training In this study three different reading interventions were tested for first-graders at risk of reading difficulties at school commencement. The intervention groups were compared together and with a control group receiving special education provided by the school. First intervention was a new approach called syllable rhythmics in which syllabic rhythm, phonological knowledge and letter-phoneme correspondence are emphasized. Syllable rhythmics is based on multi-sensory training elements aimed at finding the most functional modality for every child. The second intervention was computerized training of letter-sound correspondence with the Ekapeli learning game. The third intervention was home-based shared book reading, where every family was given a story book, and dialogic reading style reading and writing exercises were prepared for each chapter of the book. The participants were 80 first-graders in 19 classes in nine schools. The children were matched in four groups according to pre-test results: three intervention and one control. The interventions took ten weeks starting from September in grade 1. The first post-test including several measures of reading abilities was administered in December. The first delayed post-test was administered in March, the second in September in grade 2, and the third, “ALLU” test (reading test for primary school) was administered in March in grade 2. The intervention and control groups differed only slightly from each other in grade 1. However, girls progressed significantly more than boys in both word reading and reading comprehension in December and this difference remained in March. The children who had been cited as inattentive by their teachers also lagged behind the others in the post-tests in December and March. When participants were divided into two groups according to their initial letter knowledge at school entry, the weaker group (maximum 17 correctly named letters in pre-test) progressed more slowly in both word reading and reading comprehension in grade 1. Intervention group and gender had no interaction effect in grade 1. Instead, intervention group and attentiveness had an interaction effect on most test measures the inattentive students in the syllable rhythmic group doing worst and attentive students in the control group doing best in grade 1. The smallest difference between results of attentive and inattentive students was in the Ekapeli group. In grade 2 still only minor differences were found between the intervention groups and control group. The only significant difference was in non-word reading, with the syllable rhythmics group outperforming the other groups in the fall. The difference between girls’ and boys’ performances in both technical reading and text comprehension disappeared in grade 2. The difference between the inattentive and attentive students cold no longer be found in technical reading, and the difference became smaller in text comprehension as well. The difference between two groups divided according to their initial letter knowledge disappeared in technical reading but remained significant in text comprehension measures in the ALLU test in the spring of grade 2. In all, the children in the study did better in the ALLU test than expected according to ALLU test norms. Being the weakest readers in their classes in the pre-test, 52.3 % reached the normal reading ability level. In the norm group 72.3 % of all students attained normal reading ability. The results of this study indicate that different types of remediation programs can be effective, and that special education has been apparently useful. The results suggest careful consideration of first-graders’ initial reading abilities (especially letter knowledge) and possible failure of attention; remediation should be individually targeted while flexibly using different methods.
  • Panula, Anne-Mari (Helsingin yliopisto, 2013)
    The purpose of this follow-up study was to explore the occurrence and persistence of reading difficulties and their relation to school achievement as well as the reception of part time special education. The progress of literacy and the changes in school achievement among the students who had received part time special education were also examined in this study. The target group was one age cohort in a small community in southern Finland. A total of 461 students participated the study (boys 49.9% and girls 50.1%). The analysis of the results was mainly done using the data from 3rd to 9th grades of the entire cohort (N=287; boys 53% and girls 47%). The external loss of data was 18.5%. The research questions were also analysed with follow-up data collected after different lengths of time. The longest period started from preschool and continued to the end of the 9th grade (N=137; the external loss of participants over the nine years was 25.5%). Cross data was created for every measuring point (preschool, 3rd, 6th and 9th grades). Eight different reading paths were created for primary school. The preschool screening of reading abilities was done using the individual phonological test Diagnostic Tests I (Diagnostiset testit I; Poskiparta, Niemi and Lepola 1994). In primary school reading abilities were charted using the Primary School Reading Test (Ala-asteen Lukutesti; Lindeman 1998). Screening reading abilities in the secondary school was done with the Niilo Mäki Institute s Screening Test for Adolescents and Adults (Lukivaikeuksien seulontamenetelmä nuorille ja aikuisille; Holopainen, Kairaluoma, Nevala, Ahonen and Aro 2004). School reports for the 6th and 9th grades were used as indicators of school achievement. Comprehensive, dynamic and developmental aspects of reading skills formed the conceptual framework of the study. The classic Simple view of reading model (SVR-malli; Gough and Tunmer 1986; Hoover and Gough 1990) was used as a starting point for the study. The SVR model was developed into a comprehensive literacy model when it was formed using the Convergent Skills Model of Reading Development (Vellutino, Tunmer, Jaccard and Chen 2007) and Component Model of Reading (Aaron, Joshi, Gooden and Bentum 2008) models. The Finnish point of view, the orthographic characteristics of the Finnish language (high transparency of the language, or the regularity of mapping between orthography and phonology) as well as the relations between reading development, reading difficulties, Finnish culture and the education system were emphasized in the resulting reading model. The results suggest that tests in preschool can predict reading comprehension difficulties in primary school fairly well. The most used reading path among the students in primary school was the strong reading path, and the second was the so called weak reading path. Reading difficulties turned out to be quite stable through out primary education. When analysing gender differences, it was discovered that boys have more reading difficulties and that these difficulties are more stable. The average grades in theoretical subjects were statistically highly significantly weaker for students with reading difficulties compared to other students in all examinations. The reading comprehension test in 3rd grade predicted quite well (72% accuracy) whether a student would be in the group with the lowest grades at the end of the 9th grade (an average of theoretical subjects of 7.00 or less). For the boys, weak reading skills were especially related to poor school achievement. The study also brought out the joint effect of word recognition and reading comprehension with 6th and 9th grade school achievement. A positive relation between the amount of part time special education received during primary school and the changes in school achievement between 6th and 9th grade was shown in the study. In addition to individual variations, the school and individual classrooms affected the general variation in reading ability and school achievement. In the study this was demonstrated using multilevel modeling. The class level proved to be a significant factor for 3rd and 6th grade word recognition skills. Keywords: Literacy, follow-up study, reading difficulties, dyslexia, reading comprehension, school achievement, part time special education
  • Pesonen, Anni (Helsingin yliopisto, 2009)
    I examine the portrayal of Jesus as a friend of toll collectors and sinners in the Third Gospel. I aim at a comprehensive view on the Lukan sinner texts, combining questions of the origin and development of these texts with the questions of Luke s theological message, of how the text functions as literature, and of the social-historical setting(s) behind the texts. Within New Testament scholarship researchers on the historical Jesus mostly still hold that a special mission to toll collectors and sinners was central in Jesus public activity. Within Lukan studies, M. Goulder, J. Kiilunen and D. Neale have claimed that this picture is due to Luke s theological vision and the liberties he took as an author. Their view is disputed by other Lukan scholars. I discuss methods which scholars have used to isolate the typical language of Luke s alleged written sources, or to argue for the source-free creation by Luke himself. I claim that the analysis of Luke s language does not help us to the origin of the Lukan pericopes. I examine the possibility of free creativity on Luke s part in the light of the invention technique used in ancient historiography. Invention was an essential part of all ancient historical writing and therefore quite probably Luke used it, too. Possibly Luke had access to special traditions, but the nature of oral tradition does not allow reconstruction. I analyze Luke 5:1-11; 5:27-32; 7:36-50; 15:1-32; 18:9-14; 19:1-10; 23:39-43. In most of these some underlying special tradition is possible though far from certain. It becomes evident that Luke s reshaping was so thorough that the pericopes as they now stand are decidedly Lukan creations. This is indicated by the characteristic Lukan story-telling style as well as by the strongly unified Lukan theology of the pericopes. Luke s sinners and Pharisees do not fit in the social-historical context of Jesus day. The story-world is one of polarized right and wrong. That Jesus is the Christ, representative of God, is an intrinsic part of the story-world. Luke wrote a theological drama inspired by tradition. He persuaded his audience to identify as (repenting) sinners. Luke's motive was that he saw the sinners in Jesus' company as forerunners of Gentile Christianity.
  • Ahola, Suvi (Helsingin yliopisto, 2013)
    The study stems from newspaper articles I wrote. Initially, I outlined the history, then I gathered information on the reading groups existing in Finland in 2009. What kind of people belong to them? What goes on in the meetings? My third goal was to study the reading. Do people read differently when they know their solitary reading will be followed by a discussion? Do they read different books from the ones they read just for leisure? How do they choose and discuss what they read? And finally: what is the purpose of reading groups? I advertised my study in the cultural pages of the newspaper, Helsingin Sanomat, where I work. Reading groups contacted me, and I sent out questionnaires to both the groups and their individual members. This took place in October 2009. By February 2010 I had the corpus of my study: 149 reading groups and a total of 657 members. The history of Finnish reading groups is long. The first one, The Reading Society of Ostrobothnia , dates back to the 1760s, when books were scarce. The history of reading groups also parallels the development of public libraries. Moreover, the rise of the Finnish language and cultural identity in the 19th century encouraged self-improvement. Reading groups were a medium for this throughout society, from the working class to university students, in towns and in the countryside. Although reading groups have existed in Finland since this time, they only became widely popular in the 21st century, mostly with well-educated middle class individuals and women (who account for over 90 % percent in this study). Women especially share the ideals of the culturally curious, ambitious and self-improving creative class . People read more seriously in groups than on their own. The most popular books in 2009 consisted of critically acclaimed, translated novels, rather than original Finnish-language ones. The books were read analytically, emphasizing the language and construction, but also in an opinionated way, making comparisons with the book and the reader s own life. Modern reading groups represent a new light-weight type of community, based on the idea of sharing a work of art. When the act of reading is followed by a discussion, it is intensified and becomes more significant. With their avid readers reading groups are an integral component of Finnish literary culture.
  • Raulio, Susanna (Helsingin yliopisto, 2011)
    Work has a central role in the lives of big share of adult Finns and meals they eat during the workday comprise an important factor in their nutrition, health, and well-being. On workdays, lunch is mainly eaten at worksite canteens or, especially among women, as a packed meal in the workplace s break room. No national-level data is available on the nutritional quality of the meals served by canteens, although the Finnish Institute of Occupational Health laid out the first nutrition recommendations for worksite canteens in 1971. The aim of this study was to examine the contribution of various socio-demographic, socioeconomic, and work-related factors to the lunch eating patterns of Finnish employees during the working day and how lunch eating patterns influence dietary intake. Four different population-based cross-sectional datasets were used in this thesis. Three of the datasets were collected by the National Institute for Health and Welfare (Health Behaviour and Health among the Finnish Adult Population survey from 1979 to 2001, n=24746, and 2005 to 2007, n=5585, the National Findiet 2002 Study, n=261), and one of them by the Finnish Institute of Occupational Health (Work and Health in Finland survey from 1997, 2000, and 2003, n=6369). The Health Behaviour and Health among the Finnish Adult Population survey and the Work and Health in Finland survey are nationally representative studies that are conducted repeatedly. Survey information was collected by self-administered questionnaires, dietary recalls, and telephone interviews. The frequency of worksite canteen use has been quite stable for over two decades in Finland. A small decreasing trend can be seen in all socioeconomic groups. During the whole period studied, those with more years of education ate at worksite canteens more often than the others. The size of the workplace was the most important work-related determinant associated with the use of a worksite canteen. At small workplaces, other work-related determinants, like occupation, physical strain at work, and job control, were also associated with canteen use, whereas at bigger workplaces the associations were almost nonexistent. The major social determinants of worksite canteen availability were the education and occupational status of employees and the only work-related determinant was the size of the workplace. A worksite canteen was more commonly available to employees at larger workplaces and to those with the higher education and the higher occupational status. Even when the canteen was equally available to all employees, its use was nevertheless determined by occupational class and the place of residence, especially among female employees. Those with higher occupational status and those living in the Helsinki capital area ate in canteens more frequently than the others. Employees who ate at a worksite canteen consumed more vegetables and vegetable and fish dishes at lunch than did those who ate packed lunches. Also, the daily consumption of vegetables and the proportion of the daily users of vegetables were higher among those male employees who ate at a canteen. In conclusion, life possibilities, i.e. the availability of a canteen, education, occupational status, and work-related factors, played an important role in the choice of where to eat lunch among Finnish employees. The most basic prerequisite for eating in a canteen was availability, but there were also a number of underlying social determinants. Occupational status and the place of residence were the major structural factors behind individuals choices in their lunch eating patterns. To ensure the nutrition, health, and well-being of employees, employers should provide them with the option to have good quality meals during working hours. The availability of worksite canteens should be especially supported in lower socioeconomic groups. In addition, employees should be encouraged to have lunch at a worksite canteen when one is available by removing structural barriers to its use.