Visual Impairment in Finnish Children : Prevalence, causes and morbidity of full-term and preterm children with visual impairment born from 1972 through 1989

The prevalence and the causes of childhood visual impairment in Finland during the 1970s and the 1980s were investigated, with special attention to risk factors and further prevention of visual impairment in children. The primary data on children with visual impairment were obtained from the Finnish Register of Visual Impairment, one of the patient registers kept up by the National Research and Development Centre for Welfare and Health (Stakes). The data were supplemented from other registers in Stakes and from patient records of the children in Finnish central hospitals. Visual impairment had been registered in 556 children from a population of 1,138,326 children between ages 0-17, born from 1972 through 1989. The age-specific prevalence of registered visual impairment was 49/100,000 in total. Of them, 23/100,000 were blind children and 11/100,000 were children born prematurely. Boys were impaired more often and more severely than girls. Congenital malformations (52%), systemic diseases (48%), and multiple impairments (50%) were common. The main ophthalmic groups of visual impairment were retinal diseases (35%), ocular malformations (29%), and neuro-ophthalmological disorders (29%). Optic nerve atrophy was the most common diagnosis of visual impairment (22%), followed by congenital cataract (11%), retinopathy of prematurity (10%), and cerebral visual impairment (8%). Genetic factors (42%) were the most common etiologies of visual impairment, followed by prenatal (30%) and perinatal (21%) factors. The highest rates of blindness were seen in cerebral visual impairment (83%) and retinopathy of prematurity (82%). Retinopathy of prematurity had developed in the children born at a gestational age of 32 weeks or earlier. Significant risks for visual impairment were found in the association with preterm births, prenatal infections, birth asphyxia, neonatal respiratory difficulties, mechanical ventilation lasting over two weeks, and hyperbilirubinemia. A rise in blind and multi-impaired children was seen during the study period, associating with increases in the survival of preterm infants with extremely low birth weight. The incidence of visual impairment in children born prematurely was seven times higher than in children born at full term. A reliable profile of childhood visual impairment was obtained. The importance of highly qualified antenatal, neonatal, and ophthalmological care was clearly proved. The risks associated with pre- and perinatal disorders during pregnancy must be emphasized, e.g. the risks associated with maternal infections and the use of tobacco, alcohol, and drugs during pregnancy. Obvious needs for gene therapies and other new treatments for hereditary diseases were also proved.

Intrahepatic cholestasis of pregnancy : genetic background, epidemiology and hepatobiliary consequences

Intrahepatic cholestasis of pregnancy (ICP) is the most common cholestatic liver disease during pregnancy. The reported incidence varies from 0.4 to 15% of full-term pregnancies. The etiology is heterogeneous but familial clustering is known to occur. Here we have studied the genetic background, epidemiology, and long-term hepatobiliary consequences of ICP. In a register-based nation-wide study (n=1 080 310) the incidence of ICP was 0.94% during 1987-2004. A slightly higher incidence, 1.3%, was found in a hospital-based series (n=5304) among women attending the University Hospital of Helsinki in 1992-1993. Of these 16% (11/69) were familial and showed a higher (92%) recurrence rate than the sporadic (40%) cases. In the register-based epidemiological study, advanced maternal age and, to a lesser degree, parity were identified as new risk factors for ICP. The risk was 3-fold higher in women >39 years of age compared to women <30 years. Multiple pregnancy also associated with an elevated risk. In a genetic study we found no association of ICP with the genes regulating bile salt transport (ABCB4, ABCB11 and ATP8B1). The livers of postmenopausal women with a history of ICP tolerated well the short-term exposure to oral and transdermal estradiol, although the doses used were higher than those in routine clinical use. The response of serum levels of sex hormone-binding globulin (SHBG) to oral estradiol was slightly reduced in the ICP group. Transdermal estradiol had no effect on C-reactive protein (CRP) or SHBG. A number of liver and biliary diseases were found to be associated with ICP. Women with a history of ICP showed elevated risks for non-alcoholic liver cirrhosis (8.2 CI 1.9-36), cholelithiasis and cholecystitis (3.7 CI 3.2-4.2), hepatitis C (3.5 CI 1.6-7.6) and non-alcoholic pancreatitis (3.2 CI 1.7-5.7). In conclusion, ICP complicates around 1% of all full-term pregnancies in Finland and its incidence has remained unchanged since 1987. It is familial in 16% of cases with a higher recurrence rate. Although the cause remains unknown, several risk factors, namely advanced maternal age, parity and multiple pregnancies, can be identified. Both oral and transdermal regimens of postmenopausal hormone therapy (HT) are safe for women with a history of ICP when liver function is considered. Some ICP patients are at risk of other liver and biliary diseases and, contrary to what has been thought, a follow-up is warranted.

Water in Action : Encounters among 2- to 3-Year-Old Children, Adults, and Water in Day Care

In line with cultural psychology and developmental theory, a single case approach is applied to construct knowledge on how children s interaction emerge interlinked to historical, social, cultural, and material context. The study focuses on the negotiation of constraints and meaning construction among 2-to 3-year-old children, a preschool teacher, and the researcher in settings with water. Water as an element offers a special case of cultural canalization: adults selectively monitor and guide children s access to it. The work follows the socio-cultural tradition in psychology, particularly the co-constructivist theory of human development and the Network of Meanings perspective developed at the University of São Paulo. Valsiner s concepts of Zone of Free Movement and Zone of Promoted Action are applied together with studies where interactions are seen as spaces of construction where negotiation of constraints for actions, emotions, and conceptions occur. The corpus was derived at a Finnish municipal day care centre. During a seven months period, children s actions were video recorded in small groups twice a month. The teacher and the researcher were present. Four sessions with two children were chosen for qualitative microanalysis; the analysis also addressed the transformations during the months covered by the study. Moreover, the data derivation was analyzed reflectively. The narrowed down arenas for actions were continuously negotiated among the participants both nonverbally and verbally. The adults expectations and intentions were materialized in the arrangements of the setting canalizing the possibilities for actions. Children s co-regulated actions emerged in relation to the adults presence, re-structuring attempts, and the constraints of the setting. Children co-constructed novel movements and meanings in relation to the initiatives and objects offered. Gestures, postures, and verbalizations emerged from the initially random movements and became constructed to have specific meanings and functions; meaning construction became abbreviated. The participants attempted to make sense of the ambiguous (explicit and implicit) intentions and fuzzy boundaries of promoted and possible actions: individualized yet overlapping features were continuously negotiated by all the participants. Throughout the months, children s actions increasingly corresponded adults (re-defined) conceptions of water researchers as an emerging group culture. Water became an instrument and a context for co-regulations. The study contributes to discussions on children as participants in cultural canalization and emphasizes the need for analysis in early childhood education practices on the implicit and explicit constraint structures for actions.

What should I think; How should I feel? : The balancing of personal experiences and social norms in the outgroup attitude formation of youth

The present study focused on the associations between the personal experiences of intergroup contact, perceived social norms and the outgroup attitudes of Finnish majority and Russian-speaking minority youth living in Finland. The theoretical background of the study was derived from Allport s (1954) theory of intergroup contact (i.e., the contact hypothesis), social psychological research on normative influences on outgroup attitudes (e.g., Rutland, 2004; Stangor and Leary, 2006) and developmental psychological research on the formation of explicit (deliberate) and implicit (automatically activated) outgroup attitudes in adolescence (e.g., Barrett, 2007; Killen, McGlothlin and Henning, 2008). The main objective of the study was to shed light on the role of perceived social norms in the formation of outgroup attitudes among adolescents. First, the study showed that perceived normative pressure to hold positive attitudes towards immigrants regulated the relationship between the explicit and implicit expression of outgroup attitudes among majority youth. Second, perceived social norms concerning outgroup attitudes (i.e., the perceived outgroup attitudes of parents and peers) affected the relationship between intergroup contact and explicit outgroup attitudes depending on gender and group status. Positive social norms seem to be especially important for majority boys, who need both pleasant contact experiences and normative support to develop outgroup attitudes that are as positive as girls attitudes. The role of social norms is accentuated also among minority youth, who, contrary to majority youth with their more powerful and independent status position, need to reflect upon their attitudes and experiences of negative intergroup encounters in relation to the experiences and attitudes of their ingroup members. Third, the results are indicative of the independent effects of social norms and intergroup anxiety on outgroup attitudes: the effect of perceived social norms on the outgroup attitudes of youth seems to be at least as strong as the effect of intergroup anxiety. Finally, it was shown that youth evaluate intergroup contact from the viewpoint of their ingroup and society as a whole, not just based on their own experiences. In conclusion, the outgroup attitudes of youth are formed in a close relationship with their social environment. On the basis of this study, the importance of perceived social norms for research on intergroup contact effects among youth cannot be overlooked. Positive normative influences have the potential to break the strong link between rare and/or negative personal contact experiences and negative outgroup attitudes, and norms also influence the relationship between implicit and explicit attitude expression.

Plexin B2 in mouse and zebrafish development

Plexins (plxn) are receptors of semaphorins (sema), which were originally characterized as axon guidance cues. Semaphorin-plexin signalling has now been implicated in many other developmental and pathological processes. In this thesis, my first aim was to study the expression of plexins during mouse development. My second aim was to study the function of Plexin B2 in the development of the kidney. Thirdly, my objective was to elucidate the evolutionary conservation of Plexin B2 by investigating its sequence, expression and function in developing zebrafish. I show by in situ hybridisation that plexins are widely expressed also in the non-neuronal tissues during mouse development. Plxnb1 and Plxnb2, for example, are expressed also in the ureteric epithelium, developing glomeruli and undifferentiated metanephric mesenchyme of the developing kidney. Plexin B2-deficient (Plxnb2-/-) mice die before birth and have severe defects in the nervous system. I demonstrate that they develop morphologically normal but hypoplastic kidneys. The ureteric epithelium of Plxnb2-/- kidneys has fewer branches and a lower rate of proliferating cells. 10% of the embryos show unilateral double ureters and kidneys. The defect in the branching is intrinsic to the epithelium as the isolated ureteric epithelium grown in vitro fails to respond to Glial-cell-line-derived neurotrophic factor (Gdnf). We prove by co-immunoprecipitation that Plexin B2 interacts with the Gdnf-receptor Ret. Sema4C, the Plexin B2 ligand, increases branching of the ureteric epithelium in controls but not in Plxnb2-/- kidney explants. These results suggest that Sema4C-Plexin B2 signalling modulates ureteric branching in a positive manner, possibly through directly regulating the activation of Ret. I cloned the zebrafish orthologs of Plexin B2, Plexin B2a and B2b. The corresponding proteins contain the conserved domains the B-subfamily plexins. Especially the expression pattern of plxnb2b recapitulates many aspects of the expression pattern of Plxnb2 in mouse. Plxnb2a and plxnb2b are expressed, for example, in the pectoral fins and at the midbrain-hindbrain region during zebrafish development. The nearly complete knockdown of Plexin B2a alone or together with the 45% knockdown of Plexin B2b did not interfere with the normal development of the zebrafish. In conclusion, my thesis reveals that plexins are broadly expressed during mouse embryogenesis. It also shows that Sema4C-Plexin B2 signalling modulates the branching of the ureteric epithelium during kidney development, perhaps through a direct interaction with Ret. Finally, I show that the sequence and expression of Plexin B2a and B2b are conserved in zebrafish. Their knockdown does not, however, result in the exencephaly phenotype of Plxnb2-/- mice.

Kehittävän kuntoutuksen mahdollisuudet. : Tutkimus Aslak -kuntoutuksen työkytkennän ja asiakkuuden rakentumisesta.

The possibilities of developmental rehabilitation. A study on the construction of work relatedness and the customer in Aslak rehabilitation The challenge of work-related rehabilitation is to anticipate the factors threatening work ability and to affect them. The purpose of this study was to analyze how work-related rehabilitation is constructed in practice and what are the challenges and, at the same time, the possibilities of an innovative transformation of rehabilitation when trying to achive this goal. The theoretical basis is cultural-historical activity theory and developmental work research. Based on a historical analysis, I studied rehabilitation activity empirically using the data gathered from one Aslak programme (Aslak = occupationally oriented medical rehabilitation) over two years. I described and analysed the construction of Aslak using ethnographic data and interviews. The data includes audio- and video-recordings of the Aslak course, fieldnotes, documents and other materials used in the course. The study aimed to reveal rehabilitation practices from different perspectives carried out by different stakeholders and participants in the Aslak course. It focused on the Aslak trajectory produced by a multiorganizational subject. I analyzed the rehabilitation activity using the method of ethnographic analysis of infrastructure. The method of analyzing the construction of the object of rehabilititation the customer was a membership categorization analysis (MCD) based on the ethnomethodological research tradition. I analyzed the meanings denoting customers given by different parties during one Aslak process and the relations between the meanings. Based on this analysis, I studied the disturbances, ruptures, and innovations in the rehabilitation activity. The results of the study show that the infrastructure of Aslak has different basic ideas. Aslak is constructed most explicitly on the infrastructure of medical rehabilitation. The second layer has been provided with some tools of identifying and preventing well-defined occupation-specific load factors. However, it has failed to perform a new structure, as Aslak has encountered, at the same time, rapid changes in working life. The study identified some promising markers representing new kinds of work-related rehabilitation ideas, but they proved to be incomplete and fragile. As a consequence of the multilayered infrastructure, the contents of the Aslak course were split into fragmented phases and disconnected themes, which were blocked in by the master idea of medical orientation. Its relationship to work remained weak and obscure. The categorizations of customers in Aslak were manifold and contradictory. According to the results, the possibilities for transforming work-related rehabilitation lie both in changing the orientation to the customer to be more relevant to changing working life and forging the infrastructural innovations related to this change. The results showed that a new work-relatedeness would be difficult but possible to construct. What is needed is the construction of an infrastructure that will support a coherent master idea of work-related rehabilitation over the entire trajectory of a process. A shared idea of a rehabilitation object must be constructed in close collaboration between different stakeholders, such as Kela (the Social Insurance Institution of Finland), occupational health services, work organizations, and rehabilitation institutes. Key words: Aslak rehabilitation, work-related rehabilitation, development of rehabilitation, customer of rehabilitation, developmental work research, analysis of infrastructure, membership category analysis

On the environmental genetics of depressive symptoms : Focus on two serotonergic genes

Depression is a complex psychiatric disorder influenced by several genes, environmental factors, and their interplay. Serotonin receptor 2A (HTR2A) and tryptophan hydroxylase 1 (TPH1) genes have been implicated in vulnerability to depression and other psychiatric disorders, but the results have been inconsistent. The present study examined whether these two genes moderated the influence of different depressogenic environmental factors on subthreshold depressive symptoms (assessed on a modified version of Beck s Depression Inventory, BDI) and depression-related temperament, i.e., harm avoidance (assessed on the Temperament and Character Inventory, TCI). The environmental factors included measures of childhood and adolescence exposure, i.e., maternal nurturance and parental socioeconomic status, and adulthood social circumstances, i.e., perceived social support and urban/rural residence. The participants were two randomly selected subsamples (n = 1246, n = 341) from the longitudinal population-based Cardiovascular Risk in Young Finns study (n = 3596). Childhood environmental factors were assessed when the participants were 3 to 18 years of age, and three years after the baseline. Adulthood environmental factors and outcome measures were assessed 17 and 21 years later when the participants were 21 to 39 years of age. The T102C polymorphism of the HTR2A gene moderated the association between childhood maternal nurturance and adulthood depressive symptoms, such that exposure to high maternal nurturance predicted low depressive symptoms among individuals carrying the T/T or T/C genotypes, but not among those carrying the C/C genotype. Likewise, high parental SES predicted low adulthood harm avoidance in individuals carrying the T/T or T/C genotype, but not in C/C-genotype carriers. Individuals carrying the T/T or T/C genotype were also sensitive to urban/rural residence, such that they had lower depressive symptoms in urban than in rural areas, whereas those carrying the C/C genotype were not sensitive to urban/rural residence difference. HTR2A did not moderate the influence of social support. TheA779C/A218C haplotype of the TPH1 gene was not involved in the association between childhood environment and adulthood outcomes. However, individuals carrying A alleles of the TPH1 haplotype were more vulnerable to the lack of adulthood social support in terms of high depressive symptoms than their counterparts carrying no A alleles. Furthermore, individuals living in remote rural areas and carrying the A/A haplotype had higher depressive symptoms than those carrying other genotypes of the TPH1. The findings suggest that the HTR2A and TPH1 genes may be involved in the development of depression by influencing individual s sensitivity to depressogenic environmental influences.

Post-industrial Intervention : An Activity-Theoretical Expedition Tracing the Proximal Development of Forms of Conducting Interventions

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Learning challenges of NGOs in development : Co-operation of Finnish NGOs in Morogoro, Tanzania

Non-governmental organisations (NGOs) have gained an important role in development co-operation during the last two decades. The development funding channelled through NGOs has increased and the number of NGOs engaged in development activities, both North and South, has been growing. Supporting NGOs has been seen as one way to strengthen civil society in the South and to provide potential for enhancing more effective development than the state, and to exercise participatory development and partnership in their North-South relationships. This study focuses on learning in the co-operation practices of small Finnish NGOs in Morogoro, Tanzania. Drawing on the cultural-historical activity theory and the theory of expansive learning, in this study I understand learning as a qualitative change in the actual co-operation practices. The qualitative change, for its part, emerges out of attempts to deal with the contradictions in the present activity. I use the concept of developmental contradiction in exploring the co-operation of the small Finnish NGOs with their Tanzanian counterparts. Developmental contradiction connects learning to actual practice and its historical development. By history, in this study I refer to multiple developmental trajectories, such as trajectories of individual participants, organisations, co-operation practices and the institutional system in which the NGO-development co-operation is embedded. In the empirical chapters I explore the co-operation both in the development co-operation projects and in micro-level interaction between partners taking place within the projects. I analyse the perceptions of the Finnish participants about the different developmental trajectories, the tensions, inclusions and exclusions in the evolving object of co-operation in one project, the construction of power relations in project meetings in three projects, and the collision of explicated partnership with the emerging practice of trusteeship in one project. On the basis of the empirical analyses I elaborate four developmental contradictions and learning challenges for the co-operation. The developmental contradictions include: 1) implementing a ready-made Finnish project idea vs. taking the current activities of Tanzanian NGO as a starting point; 2) gaining experiences and cultural interaction vs. access to outside funding; 3) promoting the official tools of development co-operation in training vs. use of tools and procedures taken from the prior activities of both partners in actual practice; and 4) asymmetric relations between the partners vs. rhetoric of equal partnership. Consequently, on the basis of developmental contradictions four learning challenges are suggested: a shift from legitimation of Finnish ideas to negotiation, transcending the separate objects and finding a partly joint object, developing locally shared tools for the co-operation, and identification and reflection of the power relations in the practice of co-operation. Keywords: activity theory; expansive learning; NGO development co-operation; partnership; power

Kaveriporukasta liiketoiminnaksi : Tuotannon häiriöt ja organisaation oppiminen nopeasti muuttuvassa yrityksessä

In the 1990 s the companies utilizing and producing new information technology, especially so-called new media, were also expected to be forerunners in new forms of work and organization. Researchers anticipated that new, more creative forms of work and the changing content of working life were about to replace old industrial and standardized ways of working. However, research on actual companies in the IT sector revealed a situation where only minor changes to existing organizational forms were seen .Many of the independent companies faced great difficulties trying to survive the rapid changes in the products and production forms in the emerging field. Most of the research on the new media field has been conducted as surveys, and an understanding of the actual everyday work process has remained thin. My research is a longitudinal study of the early phases of one new media company in Finland. The study is an analysis of the challenges the company faced in a rapidly changing business field and the attempts to overcome these challenges. The two main analyses in the study focus on the developmental phases of the company and the disturbances in the production process. Based on these analyses, I study changes and learning at work using the methodological framework of developmental work research. Developmental work research is a Finnish variant of the cultural-historical activity theory applied to the study of learning and transformations at work. The data was gathered over a three-year period of ethnographic fieldwork. I documented the production processes and everyday life in the company as a participant observer. I interviewed key persons, video and audio-taped meetings, followed e-mail correspondence and collected various documents, such as agreements and memos. I developed a systematic method for analyzing the disturbances in the production process by combining the various data sources. The systematic analysis of the disturbances depicted a very complex and only partly managed production process. The production process had a long duration, and no single actor had an understanding of it as a whole. Most of the disturbances had to do with the customer relationships. The nature of the disturbances was latent; they were recognized but not addressed. In the particular production processes that I analyzed, the ending life span of a particular product, a CD-ROM, became obvious. This finding can be interpreted in relation to the developmental phase of the production and the transformation of the field as a whole. Based on the analysis of the developmental phases and the disturbances, I formulate a hypothesis of the contradictions and developmental potentials of the activity studied. The conclusions of the study challenge the existing understanding of how to conceptualize and study organizational learning in production work. Most theories of organizational learning do not address qualitative changes in production nor historical challenges of organizational learning itself. My study opens up a new horizon in understanding organizational learning in a rapidly changing field where a learning culture based on craft or mass production work is insufficient. There is a need for anticipatory and proactive organizational learning. Proactive learning is needed to anticipate the changes in production type, and the life cycles of products.

Tieteellinen ajattelu yliopisto-opinnoissa : haastattelututkimus psykologian, teologian ja farmasian opiskelijoista

The aim of this dissertation is to explore the academic thinking and personal epistemology of university students. More specifically, the aim is to understand and promote students’ research and academic skills as a central goal of academic studies in the research-intensive university of Helsinki. Two of the four studies examine the personal epistemology of psychology students in different study phases, and the variation in personal epistemology among final-year psychology, theology and pharmacy students. Furthermore, personal epistemology was explored as a phenomenon among the student groups. In the fourth study the individual answers of the students interviewed are investigated in more detail. The main focus is on examining students’ beliefs about the nature of knowledge and knowledge acquisition as a representation of their personal epistemology. Study I presents a model which describes the main elements and aspects of teaching and learning in pharmacy education. Firstly, the meaning of quality of teaching and learning is explored. On the basis of this information, the study concentrates on the pedagogical implications of changing pharmacy teaching to improve the quality of learning. Study II describes the results of a cross-sectional study of psychology students participating in undergraduate and master’s level psychology programmes. The students (N = 53) were interviewed concerning their beliefs about knowledge and knowing, the aim being to explore students’ responses about thinking and reasoning. The results are analysed using content analysis to create categories of personal epistemology and comparisons among the students according to the phase of their studies. Study III examines interdisciplinary differences in final-year psychology, pharmacy and theology students’ (N = 52) academic thinking and personal epistemology. The aims of study IV are to examine and compare the consistency of personal epistemology profiles among university students (N = 87) representing three academic disciplines. The individual answers are examined and rated on a scale from absolutist to evaluativist thinking. On the basis of this data, three personal epistemology profiles are identified: a) absolutist profiles; b) relativistic profiles; and c) evaluativist profiles consisting of the subgroups entitled “limited” and “sophisticated”. The results of the studies clearly demonstrate that personal epistemology varies between students in different age groups, study phases, and disciplines. Three categories, including several subcategories, emerge to describe the personal epistemology of students. Furthermore, three personal epistemology profiles can be identified from the data. The comparison between students reveals interesting differences and similarities among student groups, and developmental trends of personal epistemology.

Transcending “the Impossible” : From Dead End to Expansive Learning

This dissertation investigates changes in bank work and the experience of impossibility attached to these by workers at the local level from the viewpoint of work-related well-being and collective learning. A special challenge in my work is to conceptualize the experience of impossibility as related to change, and as a starting point and tool for development work. The subject of the dissertation, solving the impossible as a collective learning process, came up as a central theme in an earlier project: Work Units between the Old and the New (1997 – 1999). Its aim was to investigate how change is constructed as a long-term process, starting from the planning of the change until its final realization in everyday banking work. I studied changes taking place in the former Postipankki (Postal Bank), later called Leonia. The three-year study involved the Branch Office of Martinlaakso, and was conducted from the perspective of well-being in a change process. The sense of impossibility involved in changes turned out to be one of the most crucial factors impairing the sense of well-being. The work community that was the target of my study did not have the available tools to construct the change locally, or to deal with the change-related impossibility by solving it through a mutual process among themselves. During the last year of the project, I carried out an intervention for development in the Branch Office, as collaboration between the researchers and the workers. The purpose of the intervention was to resolve such perceived change-related impossibility as experienced repeatedly and considered by the work community as relevant to work-related well-being. The documentation of the intervention – audio records from development sessions, written assignments by workers and assessment or evaluation interviews – constitute the essential data for my dissertation. The earlier data, collected and analysed during the first two years, provides a historical perspective on the process, all the way from construction of the impossibility towards resolving and transcending it. The aim of my dissertation is to understand the progress of developmental intervention as a shared, possibly expansive learning process within a work community and thus to provide tools for perceiving and constructing local change. I chose the change-related impossibility as a starting point for development work in the work community and as a target of conceptualization. This, I feel, is the most important contribution of my dissertation. While the intervention was in progress, the concept of impossibility started emerging as a stimulating tool for development work. An understanding of such a process can be applied to development work outside banking work as well. According to my results, it is pivotal that a concept stimulating development is strongly connected with everyday experiences of and speech about changes in work activity, as well as with the theoretical framework of work development. During this process, development work on a local level became of utmost interest as a case study for managing change. Theoretically, this was conceptualized as so-called second-order work and this concept accompanies us all the way through the research process. Learning second-order work and constructing tools based on this work have proved crucial for promoting well-being in the change circumstances in a local work unit. The lack of second-order work has led to non-well-being and inability to transcend the change-related sense of impossibility in the work community. Solving the impossible, either individually or situationally, did not orient the workers towards solving problems of impossibility together as a work community. Because the experience of the impossibility and coming to terms with transcending it are the starting point and the target of conceptualization in this dissertation, the research provides a fresh viewpoint on the theoretical framework of change and developmental work. My dissertation can facilitate construction of local changes necessitated by the recent financial crisis, and thus promote fluency and well-being in work units. It can also support change-related well-being in other areas of working life.

Työlähtöiset menetelmät työterveyshuollossa : Oppimisen johtaminen uuden toimintakonseptin käyttöönotto- ja vakiinnuttamisvaiheessa

Working life is changing. The core of the change is change in the production and service concepts of organizations. Changes at work are connected to problems in the well-being of employees. To respond to this challenge, occupational health care must develop a course of action. A group of occupational health care units has developed new activity theory-based methods, the object of which is to change the service concept of occupational health care. The focus is on the changes and disturbances in work activity. My aim was to study this development from the perspective of knowledge management; to clarify directors'/ managers' conceptions of the content and object of their managerial work and the tensions included in these conceptions; to examine the learning process involved in these methods and to bring to light the problems, developmental needs and challenges during the implementation and consolidation phases of the process. This was a case study which included 10 occupational health care units using or being trained to use activity theory-based methods. My data consisted of interviews with directors/managers and recordings of the meetings; 20 directors/ managers are represented; I interviewed seven directors/ managers who represented four units. Directors'/ managers' conceptions of the content and object of managerial work were divided into eight categories of description, which I connected to the historical forms of organizations and types of management. Intuitive and rational management are historically older forms of management. The categories of description representing intuitive and rational management contained many internal tensions, i.e. they do not satisfy the demands of the environment. On the other hand, the categories of description which represented management by results and the control of the development process contained very few or no tensions at all; they are effective in the present environment of occupational health care. The learning process of activity theory-based methods has been expansive in nature. The occupational health care units studied are in different phases of the learning process, and these processes have been different. In three units the focus was on work development; in one unit the focus was on development of the service concept. The most central problems, challenges and developmental needs during the implementation phase were related to learning and spreading of methods inside one's own unit, and during the consolidation phase to working with partners.

Supervisors' emerging role in second-generation knowledge management

This study examines supervisors' emerging new role in a technical customer service and home customers division of a large Finnish telecommunications corporation. Data of the study comes from a second-generation knowledge management project, an intervention research, which was conducted for supervisors of the division. The study exemplifies how supervision work is transforming in high technology organization characterized with high speed of change in technologies, products, and in grass root work practices. The intervention research was conducted in the division during spring 2000. Primary analyzed data consists of six two-hour videorecorded intervention sessions. Unit of analysis has been collective learningactions. Researcher has first written conversation transcripts out of the video-recorded meetings and then analyzed this qualitative data using analytical schema based on collective learning actions. Supervisors' role is conceptualized as an actor of a collective and dynamic activity system, based on the ideas from cultural historical activity theory. On knowledge management researcher has takena second-generation knowledge management viewpoint, following ideas fromcultural historical activity theory and developmental work research. Second-generation knowledge management considers knowledge embedded and constructed in collective practices, such as innovation networks or communities of practice (supervisors' work community), which have the capacity to create new knowledge. Analysis and illustration of supervisors' emerging new role is conceptualized in this framework using methodological ideas derived from activity theory and developmental work research. Major findings of the study show that supervisors' emerging new role in a high technology telecommunication organization characterized with high speed of discontinuous change in technologies, products, and in grass-root practices cannot be defined or characterized using a normative management role/model. Their role is expanding two-dimensionally, (1) socially and (2) in new knowledge, and work practices. The expansion in organization and inter-organizational network (social expansion) causes pressures to manage a network of co-operation partners and subordinates. On the other hand, the faster speed of change in technological solutions, new products, and novel customer wants (expansion in knowledge) causes pressures for supervisors to innovate quickly new work practices to manage this change. Keywords: Activity theory, knowledge management, developmental work research, supervisors, high technology organizations, telecommunication organizations, second-generation knowledge management, competence laboratory, intervention research, learning actions.

Middleware for Mobile Sensing Applications in Urban Environments

Sensor networks represent an attractive tool to observe the physical world. Networks of tiny sensors can be used to detect a fire in a forest, to monitor the level of pollution in a river, or to check on the structural integrity of a bridge. Application-specific deployments of static-sensor networks have been widely investigated. Commonly, these networks involve a centralized data-collection point and no sharing of data outside the organization that owns it. Although this approach can accommodate many application scenarios, it significantly deviates from the pervasive computing vision of ubiquitous sensing where user applications seamlessly access anytime, anywhere data produced by sensors embedded in the surroundings. With the ubiquity and ever-increasing capabilities of mobile devices, urban environments can help give substance to the ubiquitous sensing vision through Urbanets, spontaneously created urban networks. Urbanets consist of mobile multi-sensor devices, such as smart phones and vehicular systems, public sensor networks deployed by municipalities, and individual sensors incorporated in buildings, roads, or daily artifacts. My thesis is that "multi-sensor mobile devices can be successfully programmed to become the underpinning elements of an open, infrastructure-less, distributed sensing platform that can bring sensor data out of their traditional close-loop networks into everyday urban applications". Urbanets can support a variety of services ranging from emergency and surveillance to tourist guidance and entertainment. For instance, cars can be used to provide traffic information services to alert drivers to upcoming traffic jams, and phones to provide shopping recommender services to inform users of special offers at the mall. Urbanets cannot be programmed using traditional distributed computing models, which assume underlying networks with functionally homogeneous nodes, stable configurations, and known delays. Conversely, Urbanets have functionally heterogeneous nodes, volatile configurations, and unknown delays. Instead, solutions developed for sensor networks and mobile ad hoc networks can be leveraged to provide novel architectures that address Urbanet-specific requirements, while providing useful abstractions that hide the network complexity from the programmer. This dissertation presents two middleware architectures that can support mobile sensing applications in Urbanets. Contory offers a declarative programming model that views Urbanets as a distributed sensor database and exposes an SQL-like interface to developers. Context-aware Migratory Services provides a client-server paradigm, where services are capable of migrating to different nodes in the network in order to maintain a continuous and semantically correct interaction with clients. Compared to previous approaches to supporting mobile sensing urban applications, our architectures are entirely distributed and do not assume constant availability of Internet connectivity. In addition, they allow on-demand collection of sensor data with the accuracy and at the frequency required by every application. These architectures have been implemented in Java and tested on smart phones. They have proved successful in supporting several prototype applications and experimental results obtained in ad hoc networks of phones have demonstrated their feasibility with reasonable performance in terms of latency, memory, and energy consumption.