Genetic variation in the LDL receptor-related protein 5 (LRP5) gene : Association with bone health and metabolic parameters

Bone mass accrual and maintenance are regulated by a complex interplay between genetic and environmental factors. Recent studies have revealed an important role for the low-density lipoprotein receptor-related protein 5 (LRP5) in this process. The aim of this thesis study was to identify novel variants in the LRP5 gene and to further elucidate the association of LRP5 and its variants with various bone health related clinical characteristics. The results of our studies show that loss-of-function mutations in LRP5 cause severe osteoporosis not only in homozygous subjects but also in the carriers of these mutations, who have significantly reduced bone mineral density (BMD) and increased susceptibility to fractures. In addition, we demonstrated for the first time that a common polymorphic LRP5 variant (p.A1330V) was associated with reduced peak bone mass, an important determinant of BMD and osteoporosis in later life. The results from these two studies are concordant with results seen in other studies on LRP5 mutations and in association studies linking genetic variation in LRP5 with BMD and osteoporosis. Several rare LRP5 variants were identified in children with recurrent fractures. Sequencing and multiplex ligation-dependent probe amplification (MLPA) analyses revealed no disease-causing mutations or whole-exon deletions. Our findings from clinical assessments and family-based genotype-phenotype studies suggested that the rare LRP5 variants identified are not the definite cause of fractures in these children. Clinical assessments of our study subjects with LPR5 mutations revealed an unexpectedly high prevalence of impaired glucose tolerance and dyslipidaemia. Moreover, in subsequent studies we discovered that common polymorphic LRP5 variants are associated with unfavorable metabolic characteristics. Changes in lipid profile were already apparent in pre-pubertal children. These results, together with the findings from other studies, suggest an important role for LRP5 also in glucose and lipid metabolism. Our results underscore the important role of LRP5 not only in bone mass accrual and maintenance of skeletal health but also in glucose and lipid metabolism. The role of LRP5 in bone metabolism has long been studied, but further studies with larger study cohorts are still needed to evaluate the specific role of LRP5 variants as metabolic risk factors.

Kuntien palvelutuotannon kehittäminen kustannushallinnan avulla Etelä-Pohjanmaalla

Tutkimusten mukaan kuntien palvelujen kustannuksissa on huomattavia eroja. Palvelujen kustannukset ja kustannuserot syntyvät prosessissa, jossa kuntalaiset käyttävät palveluja, joita kunnan palvelutuotannosta vastaavat yksiköt tarjoavat. Kunnan palvelutuotannon ylläpitämiseksi ja kehittämiseksi tarvitaan riittävät taloudelliset resurssit. Maamme kunnissa parhaillaan meneillään olevan Paras-hankkeen puitteissa pyritään monin eri tavoin vahvistamaan kuntien kykyä tuottaa tai järjestää palvelut. Osana tähän sisältyy palvelurakenteiden uudistaminen, kunnan talouden perustan vahvistaminen ja talouden tasapainottaminen. Talouden tasapainottamisessa ja palvelujen kehittämisessä tarvitaan aiempaa täsmällisempää tietoa palvelujen kustannusrakenteesta ja konkreettisista tekijöistä, jotka aiheuttavat eroja kustannuksiin. Kuntien kannalta on erittäin tärkeää, että ne kykenevät aiempaa paremmin arvioimaan omien palvelujensa kustannuksia ja kohdentamaan mahdolliset toimenpiteet toiminnan ja talouden sopeuttamiseksi ja palvelurakenteen uudistamiseksi oikeisiin kohteisiin sekä kehittämään siten palvelutuotan-toaan. Tähän haasteeseen esillä olevassa projektissa pyritään vastaamaan. Projektin kohteena olevat palvelut ovat lasten päivähoito, perusopetus ja perusterveydenhuolto. Kohdekuntina ovat Alavus, Jalasjärvi, Kauhajoki, Kuortane ja Lappajärvi. Kun Alavuden ja Kuortaneen perusterveydenhuollon palvelut tuottaa Kuusiokuntien Terveyskuntayhtymä ja Lappajärven perusterveydenhuollon palvelut Kuntayhtymä Kaksineuvoinen, projekti sivuaa myös mainittujen kuntayhtymien palveluja. Projektin aineistona on käytetty pääosin tilastokeskuksen tilastoja, kuntien ja kuntayhtymien talous- ja toimintatilastoja sekä kuntien omia tilinpäätöstietoja vuodelta 2007. Kuntien ja kuntayhtymien henkilöstömäärää koskevat tiedot on saatu suoraan kunnista ja kuntayhtymistä. Rahoituksesta ovat vastanneet Etelä-Pohjanmaan Liitto, Alavuden, Jalasjärven, Kauhajoen, Kuortaneen ja Lappajärven kunnat sekä Ruralia-instituutin Seinäjoen yksikkö.

Down, You Vagabond of a Heart! : Romance and Created Personas in the Journals of L. M. Montgomery

Kanadalainen kirjailija L. M. (Ludy Maud) Montgomery (1874-1942) tunnetaan parhaiten lasten ja nuorten kirjallisuudestaan, erityisesti Anne of Green Gables -romaanistaan (suom. Annan nuoruusvuodet). Graduni tutkii kuitenkin Montgomeryn vähemmän tunnettua omaelämäkerrallista tuotantoa, hänen päiväkirjojaan, jotka on julkaistu viidessä osassa (1985-2004). Keskityn romanssin kuvaukseen Montgomeryn päiväkirjojen ensimmäisessä osassa ja tutkin, millaisia tekstuaalisia persoonia (personas) kertoja luo autobiografisessa prosessissa. Tähän narratiiviseen prosessiin vaikuttavat erityisesti päiväkirjan yleisö tai lukijat (audience), samoin kuin fiktiiviset esikuvat ja fiktiivisesti kirjoittaminen (fictionalisation) sekä kysymys päiväkirjan kertovasta ja kerrotusta minästä (narrated and narrating I). Romanssi on pääosassa Montgomeryn päiväkirjojen ensimmäisessä julkaistussa osassa, joka kuvaa hänen teini- ja varhaisaikuisuusvuosiaan. Väitän, että vaikka päiväkirjateksti saattaa vaikuttaa rehelliseltä ja todenmukaiselta kuvaukselta elämästä, varsinkin Montgomeryn tapauksessa kyseessä on silti läpikotaisin editoitu ja muokattu teksti, jota päiväkirjan tekijä hallitsee rautaisella otteella ja joka käyttää hyväkseen fiktiivisiä keinoja. Aineistonani käytän sekä Montgomeryn julkaistuja että julkaisemattomia päiväkirjoja, joita säilytetään University of Guelphin arkistoissa, Kanadan Ontariossa. Päiväkirjat ovat moneen kertaan sekä Montgomeryn että julkaistujen päiväkirjojen editoijien muokkaamia, joten niiden tutkiminen lähilukemalla (close-reading) ja eri versioita vertaillen on erityisen tärkeää. Teorian osalta keskityn lähinnä Pohjois-Amerikassa kirjoitettuun autobiografia- ja (naisten) päiväkirjatutkimukseen. Väitän gradussani, että Montgomeryn kuvaus heteroseksuaalisesta romanssista välttää tarjoamasta lukijalle romanssijuonen tyypillistä katharsista. Montgomeryn romanttiset persoonat ovat yllättävän epäromanttisia ja ristiriidassa keskenään. Romantiikan traditiolle tyypillistä kieltä ja personifikaatiota käytetään joko korostetun liioitellusti tai humoristisesti ja parodioiden.

Consequences of Vertebral Fractures

Vertebral fractures occur due to forces applied to spinal structures. When the bone tissue is weakened, vertebral fractures can result from a minor trauma. Adult vertebral fractures are commonly considered to be an indication for osteoporosis. In children osteoporosis is a rare condition, and pediatric vertebral fractures are usually clearly trauma-related. The aims of this dissertation are to produce knowledge of the epidemiology of osteoporotic vertebral fractures and to analyse their association with total and cause-specific mortality, to find indicators with which to identify individuals who are at great risk of subsequent fractures, to study the incidence of pediatric vertebral fractures and need for their operative treatment and hospital care. The Mobile-Clinic and Mini-Finland Health surveys of the adult population were used as materials in this research. Record linkages to the Finnish Hospital Discharge Register and the Official Cause of Death register were used to study mortality and hospitalization in the same population group. These registers were also used to evaluate epidemiology, mortality, hospitalization and the need for operative management of pediatric vertebral fracture patients. The main findings and conclusions of the present dissertation are: 1. The presence of a thoracic vertebral fracture in adults is a significant predictor of cancer and respiratory mortality. In women, but not in men, vertebral fractures strongly predict mortality due to injuries. Most of these deaths in the study group were hip fracture related. 2. Severe thoracic vertebral fracture in adults was a strong predictor of a subsequent hip fracture, whereas mild or moderate fractures and the number of compressed vertebrae were much weaker predictors, 3. Pediatric spinal fractures were rare: The incidence was 66 per one million children per year. In younger children cervical spine was most often affected, whereas in older children fractures of the thoracic and lumbar spine were more common. Maturation of spinal structures seems to play a major role in the typical injury patterns in children. Thirty per cent of pediatric spinal fractures required surgical treatment. The current study focuses on consequences of vertebral fractures in general, without evaluating further the causation of the studied phenomena. Further studies are needed to clarify the mechanisms of association between vertebral fractures and specific causes of mortality. A severe vertebral fracture appears to indicate a substantial risk of a subsequent hip fracture. If such a fracture is identified from a chest radiograph, urgent clinical evaluation, treatment of osteoporosis and protective measures against falls are recommended.

Ravinnon kasvinsuojeluainejäämät

Kasvinsuojeluaineita käytetään elintarviketuotannossa kasvitautien ehkäisemiseen sekä kasvintuhoojien vaikutusten ajoittamiseen ja kasvun säätelyyn. Käytettyjen tehoaineiden riskinarviointi yksi kerrallaan on tuottanut tärkeää perustietoa, mutta se ei ole antanut selkeää kokonaiskuvaa kuluttajien altistumisesta. Tämän vuoksi asetelmaa tarkasteltiin kokonaisvaltaisesti, ottaen kaikki elintarvikkeista havaitut tehoainejäämät mukaan arvioon kumulatiivisesti. Aikuisten lisäksi mukana on ensi kertaa myös lapsiryhmiä. Ensimmäistä kertaa Suomessa tarkastellaan sekä pitkäaikaista että akuuttia altistusta. Esitetty kumulatiivinen riskinarviointi perustuu vuosina 2002- 2008 kasvinsuojeluainejäämien valvonnassa yhteensä 10 565 elintarvikenäytteestä saatuihin tutkimustuloksiin. Lisäksi riskinarvioinnissa on käytetty Terveyden ja hyvinvoinnin laitoksen ja DIPP-konsortion tuottamia aikuisten ja lasten ruoankulutustietoja (Finravinto 2007 ja DIPP-ravintotutkimukset). Ravinnon välittämälle tehoainejäämien altistukselle on tunnusomaista matala perustaso, jossa esiintyy lyhytaikaisia altistushuippuja. Kun ravinnon välittämä pitkäaikainen altistus kasvinsuojeluaineille on hyväksyttävällä tasolla, ei lyhytaikaisen altistuksen tilanne kaikilta osin ole yhtä hyvä. Kolmivuotiailla lapsilla todennäköisyys aRfD:n ylittymiselle on organofosfaattien ja karbamaattien osalta ollut suurempi kuin 0,1 % eli enemmän kuin yksi tuhannesta, mikä ei vielä vastaa tavoitteita. Ylitykset aiheutuvat tuontituotteista,koska niiden taustalla olevia karbamaatteja ja organofosfaatteja ei enää käytetä Suomessa. Myönteistä kehitystä on tapahtunut, mutta tilannetta on aiheellista edelleen seurata.

Growing up in Affiliation with a Religious Community : A Case Study of Seventh-day Adventist Youth in Finland

This study investigates how the religious community as a socialization context affects the development of young people's religious identity and values, using Finnish Seventh-day Adventism as a context for the case study. The research problem is investigated through the following questions: (1) What aspects support the intergenerational transmission of values and tradition in religious home education? (2) What is the role of social capital and the social networks of the religious community in the religious socialization process? (3) How does the religious composition of the peer group at school (e.g., a denominational school in comparison to a mainstream school) affect these young people s social relations and choices and their religious identity (as challenged versus as reinforced by values at school)? And (4) How do the young people studied negotiate their religious values and religious membership in the diverse social contexts of the society at large? The mixed method study includes both quantitative and qualitative data sets (3 surveys: n=106 young adults, n=100 teenagers, n=55 parents; 2 sets of interviews: n=10 young adults and n=10 teenagers; and fieldwork data from youth summer camps). The results indicate that, in religious home education, the relationship between parents and children, the parental example of a personally meaningful way of life, and encouraging critical thinking in order for young people to make personalized value choices were important factors in socialization. Overall, positive experiences of the religion and the religious community were crucial in providing direction for later choices of values and affiliations. Education that was experienced as either too severe or too permissive was not regarded as a positive influence for accepting similar values and lifestyle choices to those of the parents. Furthermore, the religious community had an important influence on these young people s religious socialization in terms of the commitment to denominational values and lifestyle and in providing them with religious identity and rooting them in the social network of the denomination. The network of the religious community generated important social resources, or social capital, for both the youth and their families, involving both tangible and intangible benefits, and bridging and bonding effects. However, the study also illustrates the sometimes difficult negotiations the youth face in navigating between differentiation and belonging when there is a tension between the values of a minority group and the larger society, and one wants to and does belong to both. It also demonstrates the variety within both the majority and the minority communities in society, as well as the many different ways one can find a personally meaningful way of being an Adventist. In the light of the previous literature about socialization-in-context in an increasingly pluralistic society, the findings were examined at four levels: individual, family, community and societal. These were seen as both a nested structure and as constructing a funnel in which each broader level directs the influences that reach the narrower ones. The societal setting directs the position and operation of religious communities, families and individuals, and the influences that reach the developing children and young people are in many ways directed by societal, communal and family characteristics. These levels are by nature constantly changing, as well as being constructed of different parts, like the pieces of a jigsaw puzzle, each of which alters in significance: for some negotiations on values and memberships the parental influence may be greater, whereas for others the peer group influences are. Although agency does remain somewhat connected to others, the growing youth are gradually able to take more responsibility for their own choices and their agency plays a crucial role in the process of choosing values and group memberships. Keywords: youth, community, Adventism, socialization, values, identity negotiations

Simplified Treatment of Childhood Acute Bone and Joint Infections

Acute childhood osteomyelitis (OM), septic arthritis (SA), and their combination osteomyelitis with adjacent septic arthritis (OM+SA), are treated with long courses of antimicrobials and immediate surgery. We conducted a prospective multi-center randomized trial among Finnish children at age 3 months to 15 years in 1983-2005. According to the two-by-two factorial study design, children with OM or OM+SA received 20 or 30 days of antimicrobials, whereas those with SA were treated for 10 or 30 days. In addition, the whole series was randomized to be treated with clindamycin or a first-generation cephalosporin. Cases were included only if the causative agent was isolated. The treatment was instituted intravenously, but only for the first 2-4 days. Percutaneous aspiration was done to obtain a representative sample for bacteriology, but all other surgical intervention was kept at a minimum. A total of 265 patients fulfilled our strict inclusion criteria and were analyzed; 106 children had OM, 134 SA, and 25 OM+SA. In the OM group, one child in the long and one child in the short-term treatment group developed sequelae. One child with SA twice developed a late re-infection of the same joint, but the causative agents differed. Regarding surgery, diagnostic arthrocentesis or corticotomy was the only surgical procedure performed in most cases. Routine arthrotomy was not required even in hip arthritis. Serum C-reactive protein (CRP) proved to be a reliable laboratory index in the diagnosis and monitoring of osteoarticular infections. The recovery rate was similar regardless of whether clindamycin or a first-generation cephalosporin was used. We conclude that a course of 20 days of these well-absorbing antimicrobials is sufficient for OM or OM+SA, and 10 days for SA in most cases beyond the neonatal age. A short intravenous phase of only 2-5 days often suffices. CRP gives valuable information in monitoring the course of illness. Besides diagnostic aspiration, surgery should be reserved for selected cases.

Sosiaalityön ammattilaiset refleksiivisinä toimijoina : tutkimus erikoistumiskoulutuksesta Margaret Archerin teorian valossa

In Finland, specialized studies in social work (professional licentiate education) were begun in the year 2000. The education is targeted at experienced social workers and leads to a licentiate degree (a degree between master s and doctorate). In this study, the experiences of members of the first study cohort, specializing in social work with children and young people, are examined. The study s theoretical frame of reference is based on the morphogenetic approach, developed by British sociologist Margaret Archer. In it, the potential powers of both an agent as well as social and cultural structures are considered important and worth taking into account. Archer sees reflexivity, a person s ability to analyze herself/himself, as an essential starting point for agency. Thanks to reflexivity, people are able to engage in internal conversations , discuss the concerns that are important to them and form agential projects . In Archer s theory, the social structures and traits of the cultural system are seen as having potential power in relation to people s agential projects; these powers can enable but also restrain the realization of the projects. On the other hand, individuals can try to review the factors affecting their agential projects and find ways of action that facilitate them. The research task is to study the self-understanding of social work professionals in the 21st century, the issues and goals professionally important for them, as well as the contexts framing the realization of these goals. The research questions are as follows: 1) What kind of internal conversations, concerns and agential projects related to their work did the professionals taking part in licentiate education bring to light? 2) What kind of enabling and restraining factors can be identified in their situations? And 3) What kind of social structures and traits related to the cultural system are connected to these factors? The research material was collected by interviewing the students in different phases of their education. In 2001 and 2004 all members of the study group (n = 25) were interviewed. In 2007, 13 students took part. The themes of the internal conversations brought to light in the interviews were divided into four broad thematic categories: professional development, the position of children in social work, multiprofessional work and structural social work. In relation to these themes the students formed different kinds of agential projects. In addition, the study reveals several cultural and social structures that have enabled but also restrained the realization of the agential projects. These structures are linked, for example, to the relations between employees and employers, students and teachers, children and adults as well as between the representatives of different professions. Working conditions which social workers often consider weak are discussed as a focal issue related to many themes. These working conditions become evident, for example, in the great imbalance which exists between the professional tasks and the amount of time that social workers have for them. Difficult situations arise when social workers feel they cannot reach the goals that are professionally important to them because of the strict external conditions of the work.

Human parvovirus infections during pregnancy : Special reference to the child-care employees

Human parvovirus B19 (B19V) is known to cause anemia, hydrops fetalis, and fetal death especially during the first half of pregnancy. Women who are in occupational contact with young children are at increased risk of B19V infection. The role of the recently discovered human parvovirus, human bocavirus (HBoV), in reproduction is unknown. The aim of this research project was to establish a scientific basis for assessing the work safety of pregnant women and for issuing special maternity leave regulations during B19V epidemics in Finland. The impact of HBoV infection on the pregnant woman and her fetus was also defined. B19V DNA was found in 0.8% of the miscarriages and in 2.4% of the intrauterine fetal death (IUFD; fetal death after completed 22 gestational weeks). All control fetuses (from induced abortions) were B19V-DNA negative. The findings on hydropic B19V DNA-positive IUFDs with evidence of acute or recent maternal B19V infection are in line with those of previous Swedish studies. However, the high prevalence of B19V-related nonhydropic IUFDs noted in the Swedish studies was mostly without evidence of maternal B19V infection and was not found during the third trimester. HBoV was not associated with miscarriages or IUFDs. Almost all of the studied pregnant women were HboV-IgG positive, and thus most probably immune to HBoV. All preterm births, perinatal deaths, smallness for gestational age (SGA) and congenital anomaly were recorded among the infants of child-care employees in a nationwide register-based cohort study over a period of 14 years. Little or no differences in the results were found between the infants of the child-care employees and those of the comparison group. The annual B19V seroconversion rate was over two-fold among the child-care employees, compared to the women in the comparison group. The seropositivity of the child-care employees increased with age, and years from qualification/joining the trade union. In general, the child-care employees are not at increased risk for adverse pregnancy outcome. However, at the population level, the risk of rare events, such as adverse pregnancy outcomes attributed to infections, could not be determined. According to previous studies, seronegative women had a 5 10% excess risk of losing the fetus during the first half of their pregnancy, but thereafter the risk was very low. Therefore, an over two-fold increased risk of B19V infection among child-care employees is considerable, and should be taken into account in the assessment of the occupational safety of pregnant women, especially during the first half of their pregnancy.

Vanhemmuuden piirteet venäläistaustaisten maahanmuutajien perheissä

Tutkimustavoitteena oli tuottaa tietoa venäjäntaustaisten vanhempien kokemuksista lasten kasvatuksessa maahanmuutossa ja monikulttuurisuudessa. Aineisto koostuu 7 haastatteluista venäjätaustaisten vanhempien kanssa, joilla ei ollut lastensuojelun asiakkuutta. Tutkimukseni keskiössä on saada lisää tietoja ja ymmärrystä onnistumisen periaatteista vanhemmuudessa, auttaakseen jatkossa venäläistaustaisia lapsiperheitä lasten kasvatuksen ongelmatilanteiden ennaltaehkäisemiseksi. Haen tutkimuksessani vastauksia seuraaviin kysymyksiin: 1. Miten venäläistaustaiset vanhemmat ymmärtävät oman vanhemmuutensa kahden kulttuurin välissä? 2. Mitkä ovat vanhempien mielestä keskeisiä vanhemmuuden onnistumisen avaintekijöitä? 3. Mitkä erityisongelmat ja pulmat omassa vanhemmuudessa ja lasten kasvatuksessa nousevat esiin venäläistaustaisten vanhempien haastatteluissa? 4. Mistä venäläistaustaiset vanhemmat ovat saanet tukea vanhemmuuteensa pulmatilanteiden ratkaisemiseksi? Maahanmuuttajien tilanne suhteessa vanhemmuuteen ei ole pysyvä ominaisuus, vaan se muuttuu väistämättä koko ajan. Juuri tämän muutoksen takia maahanmuuttajia koskeva tutkimus on aina ajankohtainen. Ymmärrys vanhempien tehtävästä on aikojen kuluessa vaihdellut ja vaihtelee luonnollisesti myös perheiden välillä. Eri kulttuurista ja monikulttuurisuudesta sekä siirtolaisuuden ja maahanmuuttajuuden vaikutuksista perhe-elämään ja vanhemmuuteen tarvitaan yhä enemmän tietoa ja ymmärrystä. Tutkielmani teeman valitsemiseen on vaikuttanut oma henkilökohtainen kiinnostukseni tutkia venäjänkielisten vanhempien kokemuksia lasten kasvatuksesta myös henkilökohtaista kokemuksestani maahanmuuttajana, äitinä ja sosiaalialan ammattilaisena Itse muutin asumaan Suomeen Latviasta seitsemäntoista vuotta sitten. Tässä tutkimuksessa aineiston analyysiin sovellettiin sisällönanalyysin lähestymistapoja. Vanhemmuus voi saada erilaisia kulttuurisia ja yksilöllisiä merkityksiä, jolloin myös vanhemmuuden sisältö määritellään eri tavoin. Omaksumiensa arvojen perusteella vanhempien voidaan olettaa painottavan vanhemman roolissaan tiettyjä asioita. Painotukset ilmenevät siinä mitä he itseltään ja lapsiltaan odottavat, sekä miten he eri tilanteissa kohtelevat lapsia. Luottamus ja kommunikointi lapsen kanssa ovat ensisijaisia. Venäjäntaustaisten maahanmuuttajaperheiden lapsilla ja nuorilla on usein monta kulttuurista identiteettiä, he oppivat elämään kahden tai usein useammankin

Teini-ikäisten tyttöjen ruokaturva Zambézian kaupungeissa ja maaseudulla

Johdanto Riittämätön ravinnonsaanti haittaa lasten fyysistä ja psyykkistä kasvua. Se myös heikentää Saharan eteläpuoleisen Afrikan tuottavuutta ja taloudellista kehitystä. Erityisen heikossa asemassa ovat lapset ja hedelmällisessä iässä olevat naiset johtuen nopean kasvun, raskauden ja imetyksen aiheuttamista vaatimuksista. Yleensä ruokaturvattomuus johtuu fyysisestä tai taloudellisesta ruoan hankintamahdollisuuden puuttumisesta ja on näin ollen läheisesti yhteydessä köyhyyteen sekä kestävien elinkeinojen ja turvaverkostojen puuttumiseen. Kaupungistumisen myötä monien afrikkalaisten elinkeinot, ruokatottumukset ja elämäntyyli ovat muuttuneet. Koska elämä kaupungeissa poikkeaa monin tavoin elämästä maaseudulla, myös ruokaturva ja sen taustalla olevat tekijät voivat olla erilaiset kaupungissa ja maaseudulla. Tällöin myös ruokaturvaohjelmat tulee suunnitella asuinpaikan mukaan ja kohdistaa voimavarat tarpeen mukaan. Harvat tutkimukset kuitenkaan tarkastelevat ruokaturvaa yhtä aikaa kaupungissa ja maaseudulla, mistä johtuen ruokaturvan erilaisuudesta näissä eri asuinympäristöissä on vähän tietoa. Tutkimuksen tavoite Tutkimuksen tarkoituksena on selvittää teini-ikäisten tyttöjen ruokaturvan taso Zambézian maakunnan maaseudulla ja kaupungeissa sekä tarkastella onko ruokaturva erilainen maaseudulla ja kaupungeissa. Lisäksi selvitetään mitkä tekijät ovat yhteydessä hyvään ruokaturvaan ja ovatko siihen yhteydessä olevat tekijät erilaisia näissä asuinympäristöissä. Aineisto ja menetelmät Tämä pro gradu -tutkielma on osa suomalais-mosambikilaista yhteistyöprojektia: Teini-ikäisten tyttöjen ravitsemus ja ruokavalio Zambéziassa (Estudo do Estado Nutricional e da Dieta em Raparigas Adolescentes na Zambézia). Tutkimus selvittää 15–18-vuotiaiden teinityttöjen ravitsemustilaa, ruokavaliota ja ruokaturvaa maaseudulla ja kaupunkiympäristössä Zambézian maakunnassa, ennen sadonkorjuuta ja sadonkorjuun jälkeen. Tämä osatutkimus perustuu ennen sadonkorjuuta tammi-helmikuussa 2010 kerättyyn aineistoon (n=277). Ruokaturvaa mitattiin Household Food Insecurity Access Scale (HFIAS) -kyselylomakkeella. Taustatietohaastattelusta poimittiin ruokaturvan kannalta mielenkiintoiset tekijät ja tarkasteltiin niiden yhteyttä ruokaturvaan. Tulokset Ruokaturvan havaittiin olevan huomattavasti parempi maaseudulla kuin kaupungissa. Maaseudulla kotieläimiä omistavat perheet kuuluivat harvemmin huonoon ruokaturvaluokkaan, kuin perheet jotka eivät omistaneet eläimiä. Kaupungissa ylimmässä varallisuustertiilissä olevat perheet kuuluivat keskimmäisessä varallisuustertiilissä olevia harvemmin huonoon ruokaturvaluokkaan. Maaseudun ja kaupungin välillä havaittavaa eroa ruokaturvassa selitti varallisuus. Johtopäätökset Maaseutua ja kaupunkeja tulisi ruokaturvatutkimuksissa käsitellä erillisinä tutkimuskohteina. Erilaiset ruokatottumukset saattavat vaikuttaa koettuun ruokaturvaan kaupungeissa ja maaseudulla. Ruokaturvan taustatekijät ovat myös erilaiset, jolloin ruokaturvattomuuden poistaminen vaatii eri toimintatapoja asuinpaikasta riippuen. Varallisuudella saattaa olla suurempi merkitys ruokaturvan kannalta kaupungeissa kuin maaseudulla. Varallisuuden ja ruokaturvan välisen yhteyden selvittäminen kaupungissa ja maaseudulla vaatii kuitenkin luotettavan varallisuusmittarin. Vuodenaika tulisi ottaa huomioon aiempaa paremmin kun tutkitaan kroonista ruokaturvattomuutta. Ruokaturvatutkimuksissa tulisi kerätä tietoa myös ruokavalion monipuolisuudesta ja tehdä antropometrisiä mittauksia, jotta ruokaturvasta saataisiin kokonaisvaltainen kuva.

Magnetic resonance imaging and ultrasonography in brachial plexus birth injury

Brachial plexus birth injury (BPBI) is caused by stretching, tearing or avulsion of the C5-C8 or Th1 nerve roots during delivery. Foetal-maternal disproportion is the main reason for BPBI. The goal of this study was to find out the incidence of posterior subluxation of the humeral head during first year of life in BPBI and optimal timing of the ultrasonographic screening of the glenohumeral joint. The glenohumeral congruity and posterior subluxation of the humeral head associated to muscle atrophy were assessed and surgical treatment of the shoulder girdle as well as muscle changes in elbow flexion contracture were evaluated. The prospective, population based part of the study included all neonates born in Helsinki area during years 2003-2006. Patients with BPBI sent to the Hospital for Children and Adolescents because of decreased external rotation, internal rotation contracture or deformation of the glenohumeral joint as well as patients with elbow flexion contracture were also included in this prospective study. The incidence of BPBI was calculated to be 3.1/1000 newborns in Helsinki area. About 80% of the patients with BPBI recover totally during the follow-up within the first year of life. Permanent plexus injury at the age of one year was noted in 20% of the patients (0.64/1000 newborns). Muscle imbalance resulted in sonographically detected posterior subluxation in one third of the patients with permanent BPBI. If muscle imbalance and posterior subluxation are left untreated bony deformities will develop. All patients with internal rotation contracture of the glenohumeral joint presented muscle atrophy of the rotator cuff muscles. Especially subscapular and infraspinous muscles were affected. A correlation was found particularly between greatest thickness of subscapular muscle and subluxation of the humeral head, degree of glenoid retroversion, as well as amount of internal rotation contracture. Supinator muscle atrophy was evident among all the studied patients with elbow flexion contracture. Brachial muscle pathology seemed to be an important factor for elbow flexion contracture in BPBI. Residual dysfunction of the upper extremity may require operative treatment such as tendon lengthening, tendon transfers, relocation of the humeral head or osteotomy of the humerus. Relocation of the humeral head improved the glenohumeral congruency among patients under 5 years of age. Functional improvement without remodeling of the glenohumeral joint was achieved by other reconstructive procedures. In conclusion: Shoulder screening by US should be done to all patients with permanent BPBI at the age of 3 and 6 months. Especially atrophy of the subscapular muscle correlates with glenohumeral deformity and posterior subluxation of the humeral head, which has not been reported in previous studies. Permanent muscle changes are the main reason for diminished range of motion of the elbow and forearm. Relocation of the humeral head, when needed, should be performed under the age of 5 years.

The effects of organic environmental toxicants on hard tissue formation in developing tooth : An in vitro study in mice

Dioxins are organic toxicants that are known to impair tooth development, especially dental hard tissue formation. The most toxic dioxin congener is 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Further, clinical studies suggest that maternal smoking during pregnancy can affect child s tooth development. One of the main components of tobacco smoke is the group of non-halogenated polycyclic aromatic hydrocarbons (PAHs), a representative of which is 7,12-dimethylbenz[a]anthracene (DMBA). Tributyltin (TBT), an organic tin compound, has been shown to impair bone mineralization in experimental animals. In addition to exposure to organic toxicants, a well-established cause for enamel hypomineralization is excess fluoride intake. The principal aim of this thesis project was to examine in vitro if, in addition to dioxins, other organic environmental toxicants, like PAHs and organic tin compounds, have adverse effects on tooth development, specifically on formation and mineralization of the major dental hard tissues, the dentin and the enamel. The second aim was to investigate in vitro if fluoride could intensify the manifestation of the detrimental developmental dental effects elicited by TCDD. The study was conducted by culturing mandibular first and second molar tooth germs of E18 NMRI mouse embryos in a Trowell-type organ culture and exposing them to DMBA, TBT, and sodium fluoride (NaF) and/or TCDD at various concentrations during the secretory and mineralization stages of development. Specific methods used were HE-staining for studying cell and tissue morphology, BrdU-staining for cell proliferation, TUNEL-staining for apoptosis, and QPCR, in situ hybridization and immunohistochemistry for the expressions of selected genes associated with mineralization. This thesis work showed that DMBA, TBT, TCDD and NaF interfere with dentin and enamel formation of embryonic mouse tooth in vitro, and that fluoride can potentiate the harmful effect of TCDD. The results suggested that adverse effects of TBT involve altered expression of genes associated with mineralization, and that DMBA and TBT as well as NaF and TCDD together primarily affect dentin mineralization. Since amelogenesis does not start until mineralization of dentin begins, impaired enamel matrix secretion could be a secondary effect. Dioxins, PAHs and organotins are all liposoluble and can be transferred to the infant by breast-feeding. Since doses are usually very low, developmental toxicity on most of the organs is difficult to indentify clinically. However, tooth may act as an indicator of exposure, since the major dental hard tissues, the dentin and the enamel, are not replaced once they have been formed. Thus, disturbed dental hard tissue formation raises the question of more extensive developmental toxicity.

"Miksi lehmät pitää tappaa?" : Etnografinen tutkimus 2000-luvun alun huumemarkkinoista Helsingissä

The present study focuses on the drug market in Helsinki in the early 2000s, mainly on the dealing in and use of amphetamines, cannabis and the pharmaceutical Subutex. The drug market is usually analysed into upper, middle and lower level markets. These levels are very different in terms of their operating practices, although there may be some mingling. The present study is mainly concerned with drug dealers and users in the lower and middle level markets. Operations also differ depending on whether the dealing involves just one drug or several. Dealing in and using Subutex is a very different business from dealing and using home grown cannabis, for instance: both the customers and the dealers are mostly quite different. The study material was mostly collected through ethnographical field work, including observations and interviews. Interviews with officials and minutes of pre-trial investigations concerning aggravated drug crimes are also included. The study discusses the roles of dealers on the various levels of the drug market in Helsinki and traces activities at various levels. Ethnographical methods are employed to observe day-to-day drug dealing and use and leisure pursuits in private homes and in public premises. The study takes note of the risks inherent in drug dealing and estimates what kind of drug dealers can last the longest on the market without the authorities intervening. At the same time, the study discusses how small groups on the middle and lower levels of the drug market avoid control measures undertaken by the authorities and how the authorities address these groups. Moreover, the study discusses what the drug market is like in prison from the perspective of a drug dealer sent to prison, what their everyday lives are like after release, and how much money dealers on various levels of the drug market make. The study demonstrates that drug dealing in Helsinki, whether we consider the very top or the very bottom of the pyramid, is a far from rational pursuit. The undertakings are not very systematic; they are more a reaction to intoxicant addiction( s) and other problems caused by other dealers, the dealers own actions and the actions of the police. The everyday lives of drug dealers are often chaos only alleviated by drug use in the company of buyers or alone. If a drug dealer uses drugs himself/herself, things become even more complicated and a vicious circle develops. At the same time, everyday life is certainly exciting, and a drug dealer often has a highly eventful if brief life. Drug dealing is a very masculine pursuit, and there is a sort of macho code governing it, although this does not nearly always work as it should. This macho code, typically for illegal activities, involves the threat of violence as a control measure. Hence the untranslatable slang expression Kill the cows : the Finnish word for calf has the slang meaning snitch or police informant . No more cows, no more calves. But informing on others to the authorities is a fact of life in the drug-dealing world. Contributing factors to being reported to the authorities are the dealer s own mistakes and the actions of other dealers and the police. A determined drug dealer will not be deterred from drug dealing by a prison sentence. However, following time in prison only few dealers manage to gain an income from drug dealing commensurate with its risks.

The Politics and Policies of Reproductive Agency

This study examines the politics and policies of reproductive agency through a redescription of three Finnish policy documents dealing with the declining birth rate: the Government report on the future 'Finland for people of all ages' (2004), Business and Policy Forum EVA report 'Condemned to Diminish?' (Tuomitut vähenemään?) (2003), and the Family Federation's 'Population Policy Program' (2004). The redescription is done with the help of the notion of reproductive agency, which draws on Drucilla Cornell's concepts of the imaginary domain and bodily integrity. The imaginary domain is the moral and psychic space people need in order to form their personality, which is created in constant identificatory processes. The aim of the processes is imaginary coherence. As the personality is embodied, forming one s imaginary coherence always includes attempts for bodily integrity, also entailing attempts to arrive at an understanding of one's procreative capacities. Besides Cornell, I draw on Judith Butler's thinking and comprehend gender performatively as doing, and in relation to that agency as part of the performative process of one's personality. Reproductive agency is understood in this study as the possibilities to live differently the hegemonic forms of procreative life. I deal with three redescriptive themes: the family, economics and gender. The family is a central element in that it is considered the main location of reproduction. With regard to reproductive agency, the documents include problematic conceptions of the family. It is defined as a heterosexual, monogamous, conjugal relationship, which affects reproductive agency in that these notions do not allow for different modes of family life. The second prominent aspect, economics, features on two levels: the macroeconomic level of GDP, employment and competitiveness, and the level of family policies and concern about family finances. Macroeconomic-level argumentation is problematic in the context of reproductive agency because it implies that procreation is a duty of citizens, and thus has effects on values attached to reproductive potential. On the other hand, family policies may advance reproductive agency in supporting families financially. However, such policies also define how the family is understood, thereby affecting reproductive agency. The third theme, gender, intersects with many issues in the policy documents. All three texts consider the roles of men and women differently: women are primarily responsible for the family, and both men's and women's reproductive agency is affected in that the roles in the procreative process are predefined. EVA and the Family Federation see women as the main target of population policies, and consider it legitimate to try to change women s reproductive decisions. Implicit in the notion of reproductive agency is the idea that it should be possible to overcome and live differently the sex difference, but the three documents do not open up opportunities for that. The notion of reproductive agency makes it also possible to question the legitimacy of population policies in general and offers new perspectives on the vocabularies used in the three policy texts, providing insights into the values and logics that support the concepts.