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  • Lyytikäinen, Laura (Helsingin yliopisto, 2014)
    This book examines Russian civil society and democratization from the perspective of the oppositional youth activists in Moscow and St. Petersburg. It takes the Russian youth movement Oborona (Defense) as its case study. Before its dissolution in 2011, the movement was an active participant in the political opposition movement and, thus, it is an interesting case study of the actually existing activist traditions in Russia. The research shows how in Russian political activism, the Soviet continuities and liberal ideas are entangled to create new post-socialist political identities and practices. The study s findings reflect the opportunities and restrictions for activism in Russia in general, and demonstrate the specificities of Russian liberal activism as well as the reasons for the lack of wider oppositional mobilization in the country. The research draws on sociological theories on identities, social performance, and politicization as well as class, gender and generation studies. The data is derived from thematic interviews, informal discussions, participant observations, and selected readings of central Internet and social media sites. The interview data consists of 38 interviews with the activists of youth movements and it was collected in Moscow and in St Petersburg during the period of 2009 2012. In the Oborona movement, the activist identity is constructed in the intersections of the Soviet intelligentsia and dissident traditions, and international influences. On the group level, the activists sense of solidarity relies on friendship and obshchenie (communication and being together) instead of a political connectedness. Also the movement practices tend to emphasize the sense of unity by silencing individual voices and political affiliations. The movement Oborona tries to find its own way between the western imported understanding of democracy and civil society and the dominant symbolic order of sovereign democracy . The book argues that both the state s official view on democracy and Oborona s liberal-democratically oriented interpretation are tied to the political symbols of nationalism and the strong state and its unifying leader, which can be seen as a continuation of the centralized power relationships of the Soviet state. Furthermore, Oborona s repertoire of action brings together the ideals and norms of the activist identity and discursive frameworks of the movement. The book argues that the protest and its actors remain distant from the audiences and this reflects the wider problems of the political opposition and especially the liberals in Russia. The research suggests that the same weakness of collective political identity, lack of common ideological goals, leader-centeredness, and personified power that the case study illustrates are found in the Russian liberal opposition in general. Key words: Russia, political opposition, protest, youth, activism
  • Wu, Zhuochun (Helsingin yliopisto, 2011)
    Background and context Since the economic reforms of 1978, China has been acclaimed as a remarkable economy, achieving 9% annual growth per head for more than 25 years. However, China's health sector has not fared well. The population health gains slowed down and health disparities increased. In the field of health and health care, significant progress in maternal care has been achieved. However, there still remain important disparities between the urban and rural areas and among the rural areas in terms of economic development. The excess female infant deaths and the rapidly increasing sex ratio at birth in the last decade aroused serious concerns among policy makers and scholars. Decentralization of the government administration and health sector reform impacts maternal care. Many studies using census data have been conducted to explore the determinants of a high sex ratio at birth, but no agreement has been so far reached on the possible contributing factors. No study using family planning system data has been conducted to explore perinatal mortality and sex ratio at birth and only few studies have examined the impact of the decentralization of government and health sector reforms on the provision and organization of maternal care in rural China. Objectives The general objective of this study was to investigate the state of perinatal health and maternal care and their determinants in rural China under the historic context of major socioeconomic reforms and the one child family planning policy. The specific objectives of the study included: 1) to study pregnancy outcomes and perinatal health and their correlates in a rural Chinese county; 2) to examine the issue of sex ratio at birth and its determinants in a rural Chinese county; 3) to explore the patterns of provision, utilization, and content of maternal care in a rural Chinese county; 4) to investigate the changes in the use of maternal care in China from 1991 to 2003. Materials and Methods This study is based on a project for evaluating the prenatal care programme in Dingyuan county in 1999-2003, Anhui province, China and a nationwide household health survey to describe the changes in maternal care utilization. The approaches used included a retrospective cohort study, cross sectional interview surveys, informant interviews, observations and the use of statistical data. The data sources included the following: 1) A cohort of pregnant women followed from pregnancy up to 7 days after birth in 20 townships in the study county, collecting information on pregnancy outcomes using family planning records; 2) A questionnaire interview survey given to women who gave birth between 2001 and 2003; 3) Various statistical and informant surveys data collected from the study county; 4) Three national household health interview survey data sets (1993-2003) were utilized, and reanalyzed to described the changes in maternity care utilization. Relative risks (RR) and their confidence intervals (CI) were calculated for comparison between parity, approval status, infant sex and township groups. The chi-square test was used to analyse the disparity of use of maternal care between and within urban and rural areas and its trend across the years in China. Logistic regression was used to analyse the factors associated with hospital delivery in rural areas. Results There were 3697 pregnancies in the study cohort, resulting in 3092 live births in a total population of 299463 in the 20 study townships during 1999-2000. The average age at pregnancy in the cohort was 25.9 years. Of the women, 61% were childless, 38% already had one child and 0.3% had two children before the current pregnancy. About 90% of approved pregnancies ended in a live birth while 73% of the unapproved ones were aborted. The perinatal mortality rate was 69 per thousand births. If the 30 induced abortions in which the gestational age was more than 28 weeks had been counted as perinatal deaths, the perinatal mortality rate would have been as high as 78 per thousand. The perinatal mortality rate was negatively associated with the wealth of the township. Approximately two thirds of the perinatal deaths occurred in the early neonatal period. Both the still birth rate and the early neonatal death rate increased with parity. The risk of a stillbirth in a second pregnancy was almost four times that for a first pregnancy, while the risk of early neonatal deaths doubled. The early neonatal mortality rate was twice as high for female as for male infants. The sex difference in the early neonatal mortality rate was mainly attributable to mortality in second births. The male early neonatal mortality rate was not affected by parity, while the female early neonatal mortality rate increased dramatically with parity: it was about six times higher for second births than for first births. About 82% early neonatal deaths happened within 24 hours after birth, and during that time, girls were almost three times more likely to die than boys. The death rate of females on the day of birth increased much more sharply with parity than that of males. The total sex ratio at birth of 3697 registered pregnancies was 152 males to 100 females, with 118 and 287 in first and second pregnancies, respectively. Among unapproved pregnancies, there were almost 5 live-born boys for each girl. Most prenatal and delivery care was to be taken care of in township hospitals. At the village level, there were small private clinics. There was no limitation period for the provision of prenatal and postnatal care by private practitioners. They were not permitted to provide delivery care by the county health bureau, but as some 12% of all births occurred either at home or at private clinics; some village health workers might have been involved. The county level hospitals served as the referral centers for the township hospitals in the county. However, there was no formal regulation or guideline on how the referral system should work. Whether or not a woman was referred to a higher level hospital depended on the individual midwife's professional judgment and on the clients' compliance. The county health bureau had little power over township hospitals, because township hospitals had in the decentralization process become directly accountable to the township government. In the township and county hospitals only 10-20% of the recurrent costs were funded by local government (the township hospital was funded by the township government and the county hospital was funded by the county government) and the hospitals collected user fees to balance their budgets. Also the staff salaries depended on fee incomes by the hospital. The hospitals could define the user charges themselves. Prenatal care consultations were however free in most township hospitals. None of the midwives made postnatal home visits, because of low profit of these services. The three national household health survey data showed that the proportion of women receiving their first prenatal visit within 12 weeks increased greatly from the early to middle 1990s in all areas except for large cities. The increase was much larger in the rural areas, reducing the urban-rural difference from more than 4 times to about 1.4 times. The proportion of women that received antenatal care visits meeting the Ministry of Health s standard (at least 5 times) in the rural areas increased sharply from 12% in 1991-1993 to 36% in 2001-2003. In rural areas, the proportion increase was much faster in less developed areas than in developed areas. The hospital delivery rate increased slightly from 90% to 94% in urban areas while the proportion increased from 27% to 69% in rural areas. The fastest change was found to be in type 4 rural areas, where the utilization even quadrupled. The overall difference between rural and urban areas was substantially narrowed over the period. Multiple logistic regression analysis shows that time periods, residency in rural or urban areas, income levels, age group, education levels, delivery history, occupation, health insurance and distance from the nearest health care facilities were significantly associated with hospital delivery rates. Conclusions 1. Perinatal mortality in this study was much higher than that for urban areas as well as any reported rate from specific studies in rural areas of China. Previous studies in which calculations of infant mortality were not based on epidemiological surveys have been shown to underestimate the rates by more than 50%. 2. Routine statistics collected by the Chinese family planning system proved to be a reliable data source for studying perinatal health, including still births, neonatal deaths, sex ratio at birth and among newborns. National Household Health Survey data proved to be a useful and reliable data source for studying population health and health services. Prior to this research there were few studies in these areas available to international audiences. 3.Though perinatal mortality rate was negatively associated with the level of township economic development, the excess female early neonatal mortality rate contributed much more to high perinatal mortality rate than economic factors. This was likely a result of the role of the family planning policy and the traditional preferences for sons, which leads to lethal neglect of female newborns and high perinatal mortality. 4. The selective abortions of female foetuses were likely to contribute most to the high sex ratio at birth. The underreporting of female births seemed to have played a secondary role. The higher early neonatal mortality rate in second-born as compared to first-born children, particularly in females, may indicate that neglect or poorer care of female newborn infants also contributes to the high sex ratio at birth or among newborns. Existing family planning policy proved not to effectively control the steadily increased birth sex ratio. 5. The rural-urban gap in service utilization was on average significantly narrowed in terms of maternal healthcare in China from 1991 to 2003. This demonstrates that significant achievements in reducing inequities can be made through a combination of socio-economic development and targeted investments in improving health services, including infrastructure, staff capacities, and subsidies to reduce the costs of service utilization for the poorest. However, the huge gap which persisted among cities of different size and within different types of rural areas indicated the need for further efforts to support the poorest areas. 6. Hospital delivery care in the study county was better accepted by women because most of women think delivery care was very important while prenatal and postnatal care were not. Hospital delivery care was more systematically provided and promoted than prenatal and postnatal care by township hospital in the study area. The reliance of hospital staff income on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care, since delivery care generated much profits than prenatal and postnatal care . Recommendations 1. It is essential for the central government to re-assess and modify existing family planning policies. In order to keep national sex balance, the existing practice of one couple one child in urban areas and at-least-one-son a couple in rural areas should be gradually changed to a two-children-a-couple policy throughout the country. The government should establish a favourable social security policy for couples, especially for rural couples who have only daughters, with particular emphasis on their pension and medical care insurance, combined with an educational campaign for equal rights for boys and girls in society. 2. There is currently no routine vital-statistics registration system in rural China. Using the findings of this study, the central government could set up a routine vital-statistics registration system using family planning routine work records, which could be used by policy makers and researchers. 3. It is possible for the central and provincial government to invest more in the less developed and poor rural areas to increase the access of pregnant women in these areas to maternal care services. Central government together with local government should gradually provide free maternal care including prenatal and postnatal as well as delivery care to the women in poor and less developed rural areas. 4. Future research could be done to explore if county and the township level health care sector and the family planning system could be merged to increase the effectiveness and efficiency of maternal and child care. 5. Future research could be done to explore the relative contribution of maternal care, economic development and family planning policy on perinatal and child health using prospective cohort studies and community based randomized trials. Key words: perinatal health, perinatal mortality, stillbirth, neonatal death, sex selective abortion, sex ratio at birth, family planning, son preference, maternal care, prenatal care, postnatal care, equity, China
  • Bakhshandeh, Soheila (Helsingin yliopisto, 2011)
    ABSTRACT Bakhshandeh, Soheila. Periodontal and dental health and oral self-care among adults with diabetes mellitus. Department of Oral Public Health, Institute of Dentistry, Faculty of Medicine, University of Helsinki, Helsinki, Finland. 2011. 49 pp. ISBN 978-952-10-7193-5(paperback). The aim of the present study was to assess oral health and treatment needs among Iranian adults with diabetes according to socio-demographic status, oral hygiene, diabetes related factors, and to investigate the relation between these determinants and oral health. Moreover, the effect of an educational oral health promotion intervention on their oral health and periodontal treatment needs was studied. The target population comprised adults with diabetes in Tehran, Iran. 299 dentate patients with diabetes, who were regular attendants to a diabetic clinic, were selected as the study subjects. Data collection was performed through a clinical dental examination and self-administered structured questionnaire. The questionnaire covered information of the subject s social background, medical history, oral health behaviour and smoking. The clinical dental examinations covered the registration of caries experience (DMFT), community periodontal index (CPI) and plaque index (PI). The intervention provided the adults with diabetes dental health education through a booklet. Reduction in periodontal treatment needs one year after the baseline examination was used as the main outcome. A high prevalence of periodontal pockets among the study population was found; 52% of the participants had periodontal pockets with a pocket depth of 4 to 5 mm and 35% had periodontal pockets with pocket depth of 6 mm or more. The mean of the DMFT index was 12.9 (SD=6.1), being dominated by filled teeth (mean 6.5) and missing teeth (mean 5.0). Oral self-care among adults with diabetes was inadequate and poor oral hygiene was observed in more than 80% of the subjects. The educational oral health promotion decreased periodontal treatment needs more in the study groups than in the control group. The poor periodontal health, poor oral hygiene and insufficient oral self-care observed in this study call for oral health promotion among adult with diabetes. An educational intervention showed that it is possible to promote oral health behaviour and to reduce periodontal treatment needs among adults with diabetes. The simplicity of the model used in this study allows it to be integrated to diabetes programmes in particular in countries with a developing health care system.
  • Safkan-Seppälä, Bedia (Helsingin yliopisto, 2001)
  • Kuula, Heidi (Helsingin yliopisto, 2009)
    Tissue destruction associated with the periodontal disease progression is caused by a cascade of host and microbial factors and proteolytic enzymes. Aberrant laminin-332 (Ln-332), human beta defensin (hBD), and matrix metalloproteinase (MMP) functions have been found in oral inflammatory diseases. The null-allele mouse model appears as the next step in oral disease research. The MMP-8 knock-out mouse model allowed us to clarify the involvement of MMP-8 in vivo in oral and related inflammatory diseases where MMP-8 is suggested to play a key role in tissue destruction. The cleaved Ln-332 γ2-chain species has been implicated in the apical migration of sulcular epithelial cells during the formation of periodontal pockets. We demonstrated that increased Ln-332 fragment levels in gingival crevicular fluid (GCF) are strongly associated with the severity of inflammation in periodontitis. Porphyromonas gingivalis trypsin-like proteinase can cleave an intact Ln-332 γ2-chain into smaller fragments and eventually promote the formation of periodontal pockets. hBDs are components of an innate mucosal defense against pathogenic microbes. Our results suggest that P. gingivalis trypsin-like proteinase can degrade hBD and thus reduce the innate immune response. Elevated levels and the increased activity of MMPs have been detected in several pathological tissue-destructive conditions where MMPs are shown to cleave extracellular matrix (ECM) and basement membrane (BM) molecules and to facilitate tissue destruction. Elevated levels of MMP-8 have been reported in many inflammatory diseases. In periodontitis, MMP-8 levels in gingival crevicular fluid (GCF) and in peri-implant sulcular fluid (PISF) are elevated at sites of active inflammation, and the increased levels of MMP-8 are mainly responsible for collagenase activity, which leads to tissue destruction. MMP-25, expressed by neutrophils, is involved in inflammatory diseases and in ECM turnover. MMP-26 can degrade ECM components and serve as an activator of other MMP enzymes. We further confirmed that increased levels and activation of MMP-8, -25, and -26 in GCF, PISF, and inflamed gingival tissue are associated with the severity of periodontal/peri-implant inflammation. We evaluated the role of MMP-8 in P. gingivalis-induced periodontitis by comparing MMP-8 knock-out (MMP8-/-) and wild-type mice. Surprisingly, MMP-8 significantly attenuated P. gingivalis-induced site-specific alveolar bone loss. We also evaluated systemic changes in serum immunoglobulin and lipoprotein profiles among these mouse groups. P. gingivalis infection increased HDL/VLDL particle size in the MMP-8-/- mice, which is an indicator of lipoprotein responses during systemic inflammation. Serum total LPS and IgG antibody levels were enhanced in both mice groups. P. gingivalis-induced periodontitis, especially in MMP-8-/- mice, is associated with severe alveolar bone loss and with systemic inflammatory and lipoprotein changes that are likely to be involved in early atherosclerosis.
  • Lindroos, Ann-Christine (Helsingin yliopisto, 2013)
    The major aims with fluid therapy for neurosurgical procedures are to minimize the risk for inadequate cerebral perfusion pressure and to maintain good neurosurgical conditions. Excessive fluid restriction to minimize cerebral oedema may lead to haemodynamic instability. Patient positioning, especially sitting and prone positions, may also promote haemodynamic changes due to diminished venous return to the heart. The effect of fluid therapy on coagulation must be considered, because normal coagulation capacity is of particular importance in neurosurgery to prevent bleeding complications. The haemodynamic profile and complications of the sitting position were analysed retrospectively in 72 neurosurgical patients. Stroke volume (SV)-directed administration of fluids (hydroxyethyl starch 130/0.4 (HES) or Ringer's acetate (RAC)) during neurosurgery in the sitting and the prone position were studied in 60 adult patients; the effects of a totally balanced fluid concept, and mannitol on blood coagulation in vitro was examined in 22 healthy volunteers. The sitting position is associated with hypotension and a risk for venous air embolism (VAE). The crystalloid vs. colloid volume ratio intraoperatively was 1.5. The formation and maximum strength of the fibrin clot were decreased after an aver-age dose of 440 mL of HES in one study, but in the other study an average dose of 460 mL of HES did not impair the coagu-lation profile. No difference appeared in blood loss between the groups. The combination of balanced colloid and crystalloid had similar coagulation effects in vitro as did their respective combinations of unbalanced solutions. Mannitol alone and in combination with HES delayed the initiation of coagulation and fibrin formation and reduced the maximum clot fimness in vitro. The sitting position induces hypotension and carries a risk for VAE. SV-directed administration of either crystalloid or colloid in the sitting and prone position stabilizes the haemodynamic parameters. Most of the patients undergoing neurosurgery in either position can be managed with an acceptable volume of RAC. The haemodynamic response of goal-directed HES administration was more favourable with regard to cardiac index, and a bolus of HES (< 500mL) may be administered when instant restoration of the intravascular volume with minimal fluid loading is indicated. The effect of fluid therapy with HES on coagulation measured in the studies with thromboelastometry varied, but he intraoperative blood loss in these patients was very low. No advantage with the totally balanced fluid therapy for coagulation emerged. Mannitol alone or in combination with HES in vitro impairs clot propagation and clot strength.
  • Väisänen, Misse (Helsingin yliopisto, 2006)
    The series of investigations presented in this thesis examined different aspects of the manifestation of perioperative stress in client-owned dogs and compared the influences of two preanaesthetic medications. Data were obtained from 43 overtly healthy dogs that underwent ovariohysterectomy following preanaesthetic administration of medetomidine and butorphanol (MED) or acepromazine and butorphanol (ACE) (Study 1) and from 96 dogs that were recovering from day-case soft-tissue operations at home (Study 2; data obtained using owner-completed questionnaires). The results indicated better abilities to attenuate perioperative neurohumoral arousal with MED preanaesthetic administration, but no significant differences were detected for the two treatment groups in the incidence of VPCs or in the inflammatory responses. The different physiological states were especially apparent during the early postoperative recovey, but were not reflected in the simultaneous behavioural observations. Overall, the correlations among the different hormonal measures and among plasma catecholamines and heart rates were weak, but the time-related associations increased in their strength during the early postoperative phase. The indices of efferent cardiac vagal activity showed consistent correlations with the heart rate data and the nonlinear measures of HRV seemed to complement the evaluation of beat-to-beat interval behaviour. Among hospitalised dogs, signs indicative of preoperative emotional arousal were frequently encountered, but marked differences existed between individual animals with respect to the level of overall activity. Animal s preoperative physiological or behavioural states provided only minor indications of its characteristics at later time points of observation. As reported by animal owners, various aspects of behaviour were altered during the period of postsurgical recovery and the behavioural symptoms were influenced by the type of operation and owner-rated animal pain. Altogether, the results underline the multi-faceted nature of perioperative stress responses in dogs and the value of using multiple observations for more complete evaluations. The clinical significance of the different effects on perioperative neurohumoral arousal with medetomidine and acepromazine preanaesthetic administration still needs to be determined and better indices to evaluate the characteristics of preoperative arousal are required. Owner-completed observations seem valuable in the assessment of the characteristics of later postsurgical recovery and could be used in future investigations when defining clinically-relevant milestones for postoperative recovery in client-owned dogs.
  • Kanerva, Mervi (Helsingin yliopisto, 2008)
    The objective of this study was to assess the utility of two subjective facial grading systems, to evaluate the etiologic role of human herpesviruses in peripheral facial palsy (FP), and to explore characteristics of Melkersson-Rosenthal syndrome (MRS). Intrarater repeatability and interrater agreement were assessed for Sunnybrook (SFGS) and House-Brackmann facial grading systems (H-B FGS). Eight video-recorded FP patients were graded in two sittings by 26 doctors. Repeatability for SFGS was from good to excellent and agreement between doctors from moderate to excellent by intraclass correlation coefficient and coefficient of repeatability. For H-B FGS, repeatability was from fair to good and agreement from poor to fair by agreement percentage and kappa coefficients. Because SFGS was at least as good in repeatability as H-B FGS and showed more reliable results in agreement between doctors, we encourage the use of SFGS over H-B FGS. Etiologic role of human herpesviruses in peripheral FP was studied by searching DNA of herpes simplex virus (HSV) -1 and -2, varicella-zoster virus (VZV), human herpesvirus (HHV) -6A, -6B, and -7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) by PCR/microarray methods in cerebrospinal fluid (CSF) of 33 peripheral FP patients and 36 controls. Three patients and five controls had HHV-6 or -7 DNA in CSF. No DNA of HSV-1 or -2, VZV, EBV, or CMV was found. Detecting HHV-7 and dual HHV-6A and -6B DNA in CSF of FP patients is intriguing, but does not allow etiologic conclusions as such. These DNA findings in association with FP and the other diseases that they accompanied require further exploration. MRS is classically defined as a triad of recurrent labial or oro-facial edema, recurrent peripheral FP, and plicated tongue. All three signs are present in the minority of patients. Edema-dominated forms are more common in the literature, while MRS with FP has received little attention. The etiology and true incidence of MRS are unknown. Characteristics of MRS were evaluated at the Departments of Otorhinolaryngology and Dermatology focusing on patients with FP. There were 35 MRS patients, 20 with FP and they were mailed a questionnaire (17 answered) and were clinically examined (14 patients). At the Department of Otorhinolaryngology, every MRS patient had FP and half had the triad form of MRS. Two patients, whose tissue biopsies were taken during an acute edema episode, revealed nonnecrotizing granulomatous findings typical for MRS, the other without persisting edema and with symptoms for less than a year. A peripheral blood DNA was searched for gene mutations leading to UNC-93B protein deficiency predisposing to HSV-1 infections; no gene mutations were found. Edema in most MRS FP patients did not dominate the clinical picture, and no progression of the disease was observed, contrary to existing knowledge. At the Department of Dermatology, two patients had triad MRS and 15 had monosymptomatic granulomatous cheilitis with frequent or persistent edema and typical MRS tissue histology. The clinical picture of MRS varied according to the department where the patient was treated. More studies from otorhinolaryngology departments and on patients with FP would clarify the actual incidence and clinical picture of the syndrome.
  • Laakkonen, Hanne (Helsingin yliopisto, 2011)
    Although improved outcomes for children on peritoneal dialysis (PD) have been seen in recent years, the youngest patients continue to demonstrate inferior growth, more frequent infections, more neurological sequelae, and higher mortality compared to older children. Also, maintain-ing normal intravascular volume status, especially in anuric patients, has proven difficult. This study was designed to treat and monitor these youngest PD patients, which are relatively many due to the high prevalence of congenital nephrotic syndrome of the Finnish type (CNF, NPHS1) in Finland, with a strict protocol, to evaluate the results and to improve metabolic balance, growth, and development. A retrospective analysis of 23 children under two years of age at onset of PD, treated between 1995 and 2000, was performed to obtain a control population for our prospective PD study. Respectively, 21 patients less than two years of age at the beginning of PD were enrolled in prospective studies between 2001 and 2005. Medication for uremia and nutrition were care-fully adjusted during PD. Laboratory parameters and intravascular volume status were regu-larly analyzed. Growth was analyzed and compared with midparental height. In a prospective neurological study, the risk factors for development and the neurological development was determined. Brain images were surveyed. Hearing was tested. In a retrospective neurological study, the data of six NPHS1 patients with a congruent neurological syndrome was analyzed. All these patients had a serious dyskinetic cerebral palsy-like syndrome with muscular dysto-nia and athetosis (MDA). They also had a hearing defect. Metabolic control was mainly good in both PD patient groups. Hospitalization time shortened clearly. The peritonitis rate diminished. Hypertension was a common problem. Left ventricular hypertrophy decreased during the prospective study period. None of the patients in either PD group had pulmonary edema or dialysis-related seizures. Growth was good and catch-up growth was documented in most patients in both patient groups during PD. Mortality was low (5% in prospective and 9% in retrospective PD patients). In the prospective PD patient group 11 patients (52%) had some risk factor for their neuro-development originating from the predialysis period. The neurological problems, detected be-fore PD, did not worsen during PD and none of the patients developed new neurological com-plications during PD. Brain infarcts were detected in four (19%) and other ischemic lesions in three patients (14%). At the end of this study, 29% of the prospectively followed patients had a major impairment of their neurodevelopment and 43% only minor impairment. In the NPHS1+MDA patients, no clear explanation for the neurological syndrome was found. The brain MRI showed increased signal intensity in the globus pallidus area. Kernic-terus was contemplated to be causative in the hypoproteinemic newborns but it could not be proven. Mortality was as high as 67%. Our results for young PD patients were promising. Metabolic control was acceptable and growth was good. However, the children were significantly smaller when compared to their midparental height. Although many patients were found to have neurological impairment at the end of our follow-up period, PD was a safe treatment whereby the neurodevelopment did not worsen during PD.
  • Marjamaa, Kaisa (Helsingin yliopisto, 2007)
    Lignin is a complex plant polymer synthesized through co-operation of multiple intracellular and extracellular enzymes. It is deposited to plant cell walls in cells where additional strength or stiffness are needed, such as in tracheary elements (TEs) in xylem, supporting sclerenchymal tissues and at the sites of wounding. Class III peroxidases (POXs) are secreted plant oxidoreductases with implications in many physiological processes such as the polymerization of lignin and suberin and auxin catabolism. POXs are able to oxidize various substrates in the presence of hydrogen peroxide, including lignin monomers, monolignols, thus enabling the monolignol polymerization to lignin by radical coupling. Trees produce large amounts of lignin in secondary xylem of stems, branches and roots. In this study, POXs of gymnosperm and angiosperm trees were studied in order to find POXs which are able to participate in lignin polymerization in developing secondary xylem i.e. are located at the site of lignin synthesis in tree stems and have the ability to oxidize monolignol substrates. Both in the gymnosperm species, Norway spruce and Scots pine, and in the angiosperm species silver birch the monolignol oxidizing POX activities originating from multiple POX isoforms were present in lignifying secondary xylem in stems during the period of annual growth. Most of the partially purified POXs from Norway spruce and silver birch xylem had highest oxidation rate with coniferyl alcohol, the main monomer in guaiacyl-lignin in conifers. The only exception was the most anionic POX fraction from silver birch, which clearly preferred sinapyl alcohol, the lignin monomer needed in the synthesis of syringyl-guaiacyl lignin in angiosperm trees. Three full-length pox cDNAs px1, px2 and px3 were cloned from the developing xylem of Norway spruce. It was shown that px1 and px2 are expressed in developing tracheids in spruce seedlings, whereas px3 transcripts were not detected suggesting low transcription level in young trees. The amino acid sequences of PX1, PX2 and PX3 were less than 60% identical to each other but showed up to 84% identity to other known POXs. They all begin with predicted N-terminal secretion signal (SS) peptides. PX2 and PX3 contained additional putative vacuolar localization determinants (VSDs) at C-terminus. Transient expression of EGFP-fusions of the SS- and VSD-peptides in tobacco protoplasts showed SS-peptides directed EGFP to secretion in tobacco cells, whereas only the PX2 C-terminal peptide seems to be a functional VSD. According to heterologous expression of px1 in Catharanthus roseus hairy roots, PX1 is a guaicol-oxidizing POX with isoelectric point (pI) approximately 10, similar to monolignol oxidizing POXs in protein extracts from Norway spruce lignifying xylem. Hence, PX1 has characteristics for participation to monolignol dehydrogenation in lignin synthesis, whereas the other two spruce POXs seem to have some other functions. Interesting topics in future include functional characterization of syringyl compound oxidizing POXs and components of POX activity regulation in trees.
  • Lundén, Janne (Helsingin yliopisto, 2004)
  • Törnroos, Maria (Helsingin yliopisto, 2015)
    The role of individual differences in perceptions of stress has long been recognized. Despite this, the models that are used to measure stress at the workplace the job strain model and the effort-reward imbalance model were developed to assess strenuous work characteristics and their health effects, regardless of the individual. Because work characteristics are usually measured using self-reports the measures cannot be completely objective. The present study examined the susceptibility of the job strain model and the effort-reward imbalance model to Five-Factor personality traits and cynicism. In addition, this study tested the longitudinal measurement invariance of the effort-reward imbalance scales. This study was part of the ongoing prospective, population-based Young Finns study. The measurements for the present study were carried out in 2001, 2007, and 2012. Five-Factor personality traits were assessed with a questionnaire on the Five-Factor model, and cynicism was assessed with a scale derived from the Minnesota Multiphasic Personality Inventory. Work characteristics were measured with questionnaires on the job strain model and the effort-reward imbalance model. The results showed that high neuroticism was associated with higher job strain and higher effort-reward imbalance and that high agreeableness was associated with lower job strain and lower effort-reward imbalance. High extraversion, high openness, and high conscientiousness were associated with lower job strain. Furthermore, high conscientiousness was related to lower effort-reward imbalance only in men. High job strain prospectively predicted higher cynicism six years later. The effort-reward imbalance scales achieved strict longitudinal measurement invariance and showed adequate criterion validity. Although developed to measure the structural work environment, the job strain model and the effort-reward imbalance model seem to be susceptible to Five-Factor personality traits especially to neuroticism and agreeableness. In addition, high job strain seems to have far reaching consequences on cynical attitudes. Furthermore, the results show that scores on effort-reward imbalance from different time points can reliably be compared with each other. This study shows that organizations and occupational health services should apply a more person-oriented approach to increasing wellbeing at work.
  • Lindfors, Olavi (Terveyden ja hyvinvoinnin laitos, 2014)
    Personality functioning and psychotherapy outcome Personality dysfunction is manifested in interpersonal interactions and self-concept. It generates vulnerability to psychopathology and increases the risk of recurring symptoms and impaired work ability. Change in personality functioning is considered a major goal of psychotherapy, but published studies comparing different psychotherapeutic treatments on the subject are scarce. Likewise, the suitability of short-term and long-term therapy has been suggested to be partly determined by the patient s personality functioning but only limited research evidence on the issue is available. Accordingly, assessment of these personality factors with reliable and valid instruments and knowledge on their prediction on outcome are needed for selecting the most optimal treatment for patients. The aims of this study were to study the effectiveness of short-term and long-term psychotherapy on personality functioning for patients with anxiety or mood disorder, and to study the respective prediction of personality functioning on outcomes, during a 3-year follow-up. The subjects consisted of 326 outpatients with anxiety or mood disorder, randomized to short-term or long-term psychotherapy in the Helsinki Psychotherapy Study (HPS). Altogether 97 patients were randomly assigned to solution-focused therapy (SFT), 101 patients to short-term psychodynamic psychotherapy (SPP) and 128 patients to long-term psychodynamic psychotherapy (LPP). The patients psychological status was monitored by questionnaires and interviews before randomization and at 3, 7, 9, 12, 18, 24 and 36 months after the baseline during the 3-year follow-up. Key personality factors in the study were the quality of object relations and self-concept, measured by the Quality of Object Relations Scale (QORS), assessed at baseline with interview, and the Structural Analysis of Social Behavior self-concept questionnaire (SASB). The QORS was used as a predictor variable and as an effect modifying factor. The SASB was used both as a predictor and an outcome variable, the main dimensions measured being affiliation (AF) and autonomy (AU), as well as the secondary sub-scores: self-free, self-affirm, self-love, self-protect, self-control, self-blame, self-attack, and self-neglect. Outcomes in psychiatric symptoms were assessed by the Global Severity Index and the Anxiety Scale of the self-report Symptom Check List 90 (SCL-90-GSI, SCL-90-ANX), and by the Beck Depression Inventory (BDI). Outcomes in work ability were assessed by three self-report questionnaires, the Work Ability Index (WAI), the work subscale of the Social Adjustment Scale (SAS-work), and with the Perceived Psychological Functioning (PPF) scale. In study I, a methodological cross-sectional study, the concurrent validity of the QORS was examined in a subgroup of 263 patients, and found to be adequate, showing discontinuity and devaluation in relationship to be its main determinants, in line with the theoretical scale constituents. Study II was a randomized clinical trial which compared the effectiveness of the two short-term psychotherapies (SFT and SPP) and LPP on self-concept during the 3-year follow-up. Self-concept improved faster during the first year of follow-up in the short-term therapies than in LPP in most of the self-concept scores, whereas at the 3-year follow-up LPP was more effective than SFT in AF, self-affirm, self-blame and self-neglect. No difference between the short-term and long-term psychodynamic therapies was noted at any measurement point. Long duration and psychodynamic orientation of therapy may thus benefit self-concept improvement in comparison to a short-term, supportive therapy like SFT. Support for the relevance of personality functioning also in the selection of treatment was received from Study III, which was based on the previous study and evaluated the effect modification of the quality of object relations on changes in self-concept, in the two short-term therapies and in LPP. The effectiveness of SFT, but not SPP, was significantly poorer in AF, AU, self-attack, self-love and self-free, for patients with less mature relational patterns (low QORS) than for patients with high QORS, mostly in several follow-up points. Contrary, low QORS predicted better outcome in LPP, albeit to a lesser degree, during the first follow-up year in AF, self-attack and self-love. Finally, in Study IV, the prediction of the QORS and the SASB self-concept scores (AF, AU) on psychiatric symptoms and work ability in short-term and long-term therapy was studied in a cohort study design. As no differences were found between the short-term therapies, a short-term therapy group was formed by combining SFT and SPP, to increase statistical power in the analyses. Negative self-concept (low AF) strongly and overly controlling self-concept (low AU) modestly predicted greater early gains in psychiatric symptoms and work ability in short-term therapy than in LPP. However, at the 3-year follow-up low AF predicted better outcomes in LPP, by a greater reduction in psychiatric symptoms. More limited long-term benefits in LPP vs. short-term therapy were found in symptoms and work ability among the patients with low AU and low QORS. Patients with relatively good personality functioning (high AF, high AU, high QORS) experienced consistently more extensive benefits in work ability and mostly also in psychiatric symptoms, after LPP than after short-term therapy. In conclusion, patients with anxiety or mood disorders, with mild to moderate personality pathology, benefited more in terms of psychiatric symptoms from LPP than from short-term psychotherapy in the long run. This was most evident in the reduction of depressive symptoms among the LPP patients with negative self-concept. Further, the findings showed that favorable aspects of self-concept improved and unfavorable aspects decreased to a greater extent after LPP than after SFT during the 3-year follow-up. The fact that higher QORS was associated with more extensive benefits in self-concept in SFT, suggests that SFT is applicable especially for patients with relatively good personality functioning. Instead, patients with low QORS experienced additional benefits in some areas of self-concept, during the first year in LPP. This indicates that LPP gave them a beneficial start for continuing to work out their problems in self-concept. Thus negative self-concept and low QORS may indicate the need for a more intensive or lengthier psychotherapeutic treatment. Another important issue concerns the finding that short-term therapy generally gave faster benefits in symptoms, work ability and self-concept than LPP, but was more frequently insufficient in providing sustained benefits. Accordingly, careful pre-treatment evaluation is needed to screen those patients for whom short-term therapy or LPP should be considered. The finding that patients with relatively good personality functioning also experienced more extensive benefits after LPP in symptoms and work ability, suggests that patients capacities and motivation for LPP, along with their dysfunction, need to be acknowledged when considering treatment options. More research is needed to confirm the findings and to help in the development of more effective psychotherapies and therapist training. Further research on the relative importance of different personality functioning dimensions on the outcome of short-term and long-term psychotherapies, in comparison with other patient-related factors, will deepen understanding on the most essential predictors of outcome. Further effectiveness research during a longer follow-up is also needed to explore differences in sustained benefits of the therapies, by a more extensive battery of personality functioning factors and in comparison to other outcome dimensions. Keywords: anxiety disorder, mood disorder, object relations, outcome, prediction, psychodynamic, psychotherapy, self-concept, solution-focused
  • Kluen, Edward (Helsingin yliopisto, 2012)
    In order to adapt their behaviour optimally and to be able to increase fitness, individuals are assumed to respond flexibly to environmental variation they encounter. Contrasting with this classical behavioural ecological point of view is the concept of animal personality. The latter focuses on understanding the mechanisms underlying and evolutionary processes maintaining variation in the expression of a behavioural trait over time and across situations or contexts. Originating in human psychology, personality studies have recently been integrated into the fields of ecology and evolution. Studies on consistent variation in behaviour within and between individuals (personality) have resulted in numerous insights and these are still expanding. In the first chapter of this thesis I research underlying factors and possible consequences of the response (delayed hatching) of blue tits (Cyanistes caeruleus) to encountered climatic variation. I find that hatching delay (i.e. number of days hatching was delayed) is associated with early laying dates and low mean temperatures during the egg-laying phase. In addition hatching delay is negatively associated with clutch hatchability and female body condition. Using a reciprocal cross-fostering protocol on a large number of broods, I find that hatching delay may also negatively affect developmental parameters in offspring, in particular body mass of nestlings at fledging. Results from this study demonstrate that environmental conditions during egg laying can have effects lasting throughout the breeding and nestling period. In chapters II to V I investigate variation in behaviour among individuals. The focus in these four chapters is on personality traits in blue tits. I first design an experimental setup, using a bird cage, in which several behavioural traits can be measured in a quick and non-invasive manner and which can be applied in both winter and breeding season. In addition several behavioural traits are measured during handling of both adult and nestling birds. All these behavioural measures are then used to test several aspects of behaviour in a personality context in the blue tit. The behavioural traits derived from the bird cage are repeatable over time and qualify as personality traits in this species. In addition I find an association between one of the measured personality traits in the cage and a single nucleotide polymorphism in the 3rd exon of the dopamine receptor (D4) gene (DRD4), similar to what has been found in recent research on great tits (Parus major). This suggests that there is a genetic basis underlying this personality trait and that this genomic region might be involved in animal personality. I apply a reaction norm framework to assess context specificity of the traits measured in the bird cage, using measures from (partly) the same birds measured in two distinct contexts (winter and breeding season). I show that one needs to carefully consider the context under which individuals are assayed and that a recorded behaviour may or may not be repeatable in another context. Furthermore I use data from a cross-foster protocol on nestling blue tits in combination with quantitative genetics. I assess the heritability of three behavioural traits and show that these traits form a behavioural syndrome at both the phenotypic and genetic level. In addition, from the applied animal model analysis I can conclude that environmental factors, encountered by nestlings during the rearing period, may have a considerable impact on a nestling s personality. Thus, taken into account findings from the first chapter in this thesis, the development of both physical and behavioural traits in an individual seems to find its origin already in the earliest phases of life. Finally I test whether three personality traits and two immunological traits in the blue tit covary and form a syndrome which includes behavioural and immunological traits. I find that there are intrinsic correlations between behavioural and immunological traits; however there is no strong evidence for the existence of a syndrome of these traits in the blue tit.
  • Lindqvist, Ann-Marie (Helsingin yliopisto, 2014)
    The thesis describes how adults with learning disabilities are experiencing, creating and exercising their social citizenship. It concerns lived citizenship, understood as the meaning citizenship actually has in the persons lives and the ways in which the social and cultural background and material circumstances affect their lives as citizens. It is based on Ruth Lister's understanding of citizenship. The study approaches the following questions: How do people with learning disabilities experience their participation and how are obstacles and possibilities for their participation manifested in everyday life? What factors are important when people with learning disabilities are creating and exercising their citizenship in a housing context? The thesis posits itself within an ethnographic tradition and represents disability research where the users' and the professionals perspectives are highlighted. The thesis follows a tradition of research in social work that studies the living conditions for people in vulnerable positions and draws attention to their agency. Critical realism based on Roy Bhaskar and Berth Danermark gives the methodological guidelines for the thesis. To understand disability, critical realism and the International Classification of Functioning, Disability and Health (ICF) provide the theoretical understanding with a focus on interaction between the individual and the environment. Knowledge production has been made in collaboration with a group of people with learning disabilities. The two empirical studies in the thesis are based on interviews with people with learning disabilities and professionals, participant observation and documents. The persons in the study exercise and create their citizenship in areas where they are dependent on how professionals view their work and their role. The study gives some evidence of the fact that both the professionals and the service users are trying to find new roles and new positions. The forums to exercise control over their everyday life are individual plans, formal face to face discussions and everyday informal discussions with staff. However, as service users the persons are unsure of their rights and obligations. Furthermore the persons are not always included in the discussions relating to them. Formulation of wishes and a positive self-relation can be seen as prerequisites when people create their citizenship. The size of the service units is relevant to the amount of control the service users can have over their lives, but what matters most is the professionals approach to work and spatial practice that takes into account opportunities for social interaction and privacy. In collective service units the professionals find it problematic to take into account all the service users´ individual needs while balancing between the rights and individual differences. Citizenship as status gives the rights and opportunities to get one s voice heard as an actor. But rights themselves are not sufficient. While the persons in the study have a will to control their lives they are on different levels, dependent on various degrees of support from the environment, in order to take an active role in the process of creating and exercising their citizenship. Negotiations on belonging and participation take place in interaction with the environment. The persons in the study benefit from supported decision making. It means being provided with information in a way that they understand and having professionals, who are familiar with alternative methods of communicating so as to reach a common understanding. The professionals reflective approach and the persons opportunity to receive support from professionals they have confidence in, make it possible to build up a joint reflection regarding processes where they actively create their citizenship. Key words: lived citizenship, people with learning disability, critical realism, everyday life experiences, ICF, participatory research.
  • Siivonen, Jonita (Helsingin yliopisto, 2007)
    The thesis The portrait interview as a newspaper genre. A qualitative close reading focussing on topical motifs, conventions of narration, and gender defines the portrait interview as a newspaper genre and analyses how the personalities in the portraits are constructed textually. The main body of material consists of 107 portrait interviews in two morning newspapers, Dagens Nyheter (published in Stockholm, Sweden) and Hufvudstadsbladet (published in Swedish in Helsinki, Finland), during two one-week periods (week 46/1999 and week 38/2002). There is also complementary material of 59 portraits from four magazines. The study is carried out within the research traditions of journalistic genre studies, gender and journalism, and critical text analysis. It is comprised of a qualitative close reading focussing on content (topical motifs or themes), conventions of narration, and gender. The methods used to carry out the study are qualitative close reading and quantitative content analysis. The analysis identifies the stylistic elements that differentiate the portrait genre from other journalistic genres, as well as from the autobiographical genre, and explores what opportunities and limitations these elements present for the inclusion of even more women protagonists in the portrait genre. The portrait interview is an exception from the critical mission of journalism in general, with its position as a genre of politeness. Since a typical characteristic of the portrait interview genre is that it pays tribute to the protagonist, the genre reveals the kind of personalities and lives that are seen as admirable in society. Four levels of portrait interview are defined: the prototype portrait, the pure portrait, the hybrid portrait and the marginal portrait. The prototype is a raw version of a portrait that fulfils the criteria but may be lacking in content and stylistics. The pure portrait does not lack these qualities and resembles an ideal portrait. The hybrid is a borderline case which relates to another genre or is a mixture between the portrait and some other genre, most commonly the news genre. The marginal portrait does not fulfil the criteria, and can therefore be seen as an inadequate portrait. For example, obituaries and caricatures are excluded if the protagonist s voice is never quoted. The analysis resulted in three factors that in part help to explain why the portrait interview genre has somewhat more female protagonists than journalistic news texts do in general. The four main reasons why women are presented somewhat more in the portrait genre than in other journalistic genres are: (i) women are shown as exceptions to the female norm when, for example, taking a typical male job or managing in positions where there are few women; (ii) women are shown as representing female themes ; (iii) use of the double bind as a story-generating factor; and (iv) the intimisation of journalism. The double bind usually builds up the narration on female ambiguity in the contradiction between private and public life, for example family and career, personal desire and work. The intimisation of journalism and the double bind give women protagonists somewhat more publicity also because of the tendency of portrait interviews to create conflicts within the protagonist, as an exception to journalism in general where conflicts are created or seen as existing between, for example, persons, groupings or parties. Women protagonists and their lives create an optimal narration of inner conflicts originating in the double bind as men are usually not seen as suffering from these conflicts. The analysis also resulted in gendered portrait norms: The feminine portrait norm and the masculine portrait norm or more concretely, professional life and family life as expectation and exception. Women are expected to be responsible parents and mediocre professionals, while men are expected to be professionals and in their free time engaging fathers. Key words: journalism, genre, portrait interview, gender, interview, newspaper, women s magazine.
  • Toivonen, Kaisu Maria (Helsingin yliopisto, 2014)
    This doctoral thesis focuses on the interpretation of children s ethical growth and education in the Finnish education system through the lens of a specific philosophical approach. The hermeneutic frame of reference is a systematic-holistic model based on Lauri Rauhala s view of the human being and the situational regulation system. It has been widened in this thesis partly concerning socialization and the education system using Urie Bronfenbrenner´s ecological socialization theory. As the level of pre-understanding, Kohlberg´s cognitive-structural theory of moral development is applied. In this research the concepts of human being, personality, value and education have been applied in accordance with existential and phenomenological philosophy. The concepts of good, value mastering and the ethics of virtue are the guiding principles of value and ethical education.The research problem is as follows: what kind of knowledge will emerge as being applicable to ethical education in a postmodern Finnish education system? It was found that ethical growth begins at birth. This is contrary to the previous belief, according to which ethical awareness would emerge as late as at the age of six. Early interaction is also an important part of ethical growth. Personality development is by nature open, dynamic and holistic. It consists of a physical dimension, consciousness and situational components. The subjective world view is built on holistic experience and meaning. It is influenced by concrete situational and ideological factors. In this way children are immediately brought into relation with situational values, moral ideas, norms and rules. This way children create different meanings when building their own world view. During interaction between growth and education the child´s capacity for empathy, feelings, self-control and thinking will become integral parts of their moral action. As a result, ethical growth and social competence will develop. Cognition and the appreciation of values are but one way of looking at ethical growth and moral action. At the micro level, interaction between growth and education takes place between children, parents, friends, homes and schools. It also means that actions transpire at the meso-, exo- and macro levels as well. In the postmodern age, children´s growth and living experiences are strongly affected by media, which creates universal feelings, knowledge and values. In addition, professional educators are affected by laws and other official documents. The aim of dialogical education is the good life and ideals of becoming oneself. Freedom and responsibility are the cornerstones of modern ethics and morality. The educational tradition is no longer enough. In this rapidly changing world with its flood of information, the capacity to make ethically lasting choices is needed. In supporting holistic personal growth, and with the help of value-competence and virtue ethics, individual ethical growth can be developed. This should be taken into account more directly than previously in the Finnish educational context and specially in its official documents. Keywords: dialogical education, ecological socialization theory, ethical education, ethics, existential and phenomenological concept of human being, hermeneutic analysis, moral development, morality, person, systemic- holistic model, values.