Childhood otitis media - risk factors and surgical management

Background: Otitis media (OM) is one of the most common childhood diseases. Approximately every third child suffers from recurrent acute otitis media (RAOM), and 5% of all children have persistent middle ear effusion for months during their childhood. Despite numerous studies on the prevention and treatment of OM during the past decades, its management remains challenging and controversial. In this study, the effect of adenoidectomy on the risk for OM, the potential risk factors influencing the development of OM and the frequency of asthma among otitis-prone children were investigated. Subjects and methods: One prospective randomized trial and two retrospective studies were conducted. In the prospective trial, 217 children with RAOM or chronic otitis media with effusion (COME) were randomized to have tympanostomy with or without adenoidectomy. The age of the children at recruitment was between 1 and 4 years. RAOM was defined as having at least 3 episodes of AOM during the last 6 months or at least 5 episodes of AOM during the last 12 months. COME was defined as having persistent middle ear effusion for 2-3 months. The children were followed up for one year. In the first retrospective study, the frequency of childhood infections and allergy was evaluated by a questionnaire among 819 individuals. In the second retrospective study, data of asthma diagnosis were analysed from hospital discharge records of 1616 children who underwent adenoidectomy or had probing of the nasolacrimal duct. Results: In the prospective randomized study, adenoidectomy had no beneficial effect on the prevention of subsequent episodes of AOM. Parental smoking was found to be a significant risk factor for OM even after the insertion of tympanostomy tubes. The frequencies of exposure to tobacco smoke and day-care attendance at the time of randomization were similar among children with RAOM and COME. However, the frequencies of allergy to animal dust and pollen and parental asthma were lower among children with COME than those with RAOM. The questionnaire survey and the hospital discharge data revealed that children who had frequent episodes of OM had an increased risk for asthma. Conclusions: The first surgical intervention to treat an otitis-prone child younger than 4 years should not include adenoidectomy. Interventions to stop parental smoking could significantly reduce the risk for childhood RAOM. Whether an otitis-prone child develops COME or RAOM, seems to be influenced by genetic predisposition more strongly than by environmental risk factors. Children who suffer from repeated upper respiratory tract infections, like OM, may be at increased risk for developing asthma.

The Media and the Academic Globalization Debate : Theoretical Analysis and Critique

This study offers a reconstruction and critical evaluation of globalization theory, a perspective that has been central for sociology and cultural studies in recent decades, from the viewpoint of media and communications. As the study shows, sociological and cultural globalization theorists rely heavily on arguments concerning media and communications, especially the so-called new information and communication technologies, in the construction of their frameworks. Together with deepening the understanding of globalization theory, the study gives new critical knowledge of the problematic consequences that follow from such strong investment in media and communications in contemporary theory. The book is divided into four parts. The first part presents the research problem, the approach and the theoretical contexts of the study. Followed by the introduction in Chapter 1, I identify the core elements of globalization theory in Chapter 2. At the heart of globalization theory is the claim that recent decades have witnessed massive changes in the spatio-temporal constitution of society, caused by new media and communications in particular, and that these changes necessitate the rethinking of the foundations of social theory as a whole. Chapter 3 introduces three paradigms of media research the political economy of media, cultural studies and medium theory the discussion of which will make it easier to understand the key issues and controversies that emerge in academic globalization theorists treatment of media and communications. The next two parts offer a close reading of four theorists whose works I use as entry points into academic debates on globalization. I argue that we can make sense of mainstream positions on globalization by dividing them into two paradigms: on the one hand, media-technological explanations of globalization and, on the other, cultural globalization theory. As examples of the former, I discuss the works of Manuel Castells (Chapter 4) and Scott Lash (Chapter 5). I maintain that their analyses of globalization processes are overtly media-centric and result in an unhistorical and uncritical understanding of social power in an era of capitalist globalization. A related evaluation of the second paradigm (cultural globalization theory), as exemplified by Arjun Appadurai and John Tomlinson, is presented in Chapter 6. I argue that due to their rejection of the importance of nation states and the notion of cultural imperialism for cultural analysis, and their replacement with a framework of media-generated deterritorializations and flows, these theorists underplay the importance of the neoliberalization of cultures throughout the world. The fourth part (Chapter 7) presents a central research finding of this study, namely that the media-centrism of globalization theory can be understood in the context of the emergence of neoliberalism. I find it problematic that at the same time when capitalist dynamics have been strengthened in social and cultural life, advocates of globalization theory have directed attention to media-technological changes and their sweeping socio-cultural consequences, instead of analyzing the powerful material forces that shape the society and the culture. I further argue that this shift serves not only analytical but also utopian functions, that is, the longing for a better world in times when such longing is otherwise considered impracticable.

Ruumis ja rauta : esseitä esineiden sosiaalisuudesta

"Body and Iron: Essays on the Socialness of Objects" focuses on the bodily-material interaction of human subjects and technical objects. It poses a question, how is it possible that objects have an impact on their human users and examines the preconditions of active efficacy of objects. In this theoretical task the work relies on various discussions drawing from realistic ontology, phenomenology of body, neurophysiology of Antonio Damasio and psychoanalysis to establish both objects and bodies as material entities related in a causal interaction with each other. Out of material interaction emerge a symbolic field, psyche and culture that produce representations of interactions with material world they remain dependent on and conditioned by. Interaction with objects informs the human body via its somatosensory systems: interoseptive and proprioseptive (or kinesthetic) systems provide information to central nervous system of the internal state of the body and muscle tensions and motor activity of the limbs. Capability to control the movements of one's body by the internal "feel" of being a body turns out to be a precondition to the ability to control artificial extensions of the body. Motor activity of the body is involved in every perception of environment as the feel of one's own body is constitutive of any perception of external objects. Perception of an object cause changes in the internal milieu of the body and these changes in the organism form a bodily representation of an external object. Via these "muscle images" the subject can develop a feel for an instrument. Bodily feel for an object is pre-conceptual, practical knowledge that resists articulation but allows sensing the world through the object. This is what I would call sensual knowledge. Technical objects intervene between body and environment, transforming the relation of perception and motor activity. Once connected to a vehicle, human subject has to calibrate visual information of his or her position and movement in space to the bodily actions controlling the machine. It is the machine that mediates the relation of human actions to the relation of her body to its environment. Learning to use the machine necessarily means adjusting his or her bodily actions to the responses of the machine in relation to environmental changes it causes. Responsiveness of the machine to human touch "teaches" its subject by providing feedback of the "correctitude" of his or her bodily actions. Correct actions form a body technique of handling the object. This is the way of socialness of objects. While responding to human actions they generate their subjects. Learning to handle a machine means accepting the position of the user in the program of action materialized in the construction of the object. Objects mediate, channel and transform the relation of the body to its environment and via environment to the body itself according to their material and technical construction. Objects are sensory media: they channel signals and information from the environment thus constituting a representation of environment, a virtual or artificial reality. They also feed the body directly with their powers equipping their user with means of regulating somatic and psychic states of her self. For these reasons humans look for the company of objects. Keywords: material objects, material culture, sociology of technology, sociology of body, mobility, driving

A Success Story or a Failure? : Representing the European Integration in the Curricula and Textbooks of Five Countries

The economic, political and social face of Europe has been changing rapidly in the past decades. These changes are unique in the history of Europe, but not without challenges for the nation states. The support for the European integration varies among the countries. In order to understand why certain developments or changes are perceived as threatening or as desired by different member countries, we must consider the social representations of the European integration on the national level: how the EU is represented to its citizens in media and in educational systems, particularly in the curricula and textbooks. The current study is concerned with the social representations of the European integration in the curricula and school textbooks in five European countries: France, Britain, Germany, Finland and Sweden. Besides that, the first volume of the common Franco-German history textbook was analyzed, since it has been seen as a model for a common European history textbook. As the collective representations, values and identities are dominantly mediated and imposed through media and educational systems, the national curricula and textbooks make an interesting starting point for the study of the European integration and of national and European identities. The social representations theory provides a comprehensive framework for the study of the European integration. By analyzing the curricula and history and civics textbooks of major educational publishers, the study aimed to demonstrate what is written on the European integration and how it is portrayed how the European integration is understood, made familiar and concretized in the educational context in the five European countries. To grasp the phenomenon of the European integration in the textbooks in its entirety, it was investigated from various perspectives. The two analysis methods of content analysis, the automatic analysis with ALCESTE and a more qualitative theory-driven content analysis, were carried out to give a more vivid and multifaceted picture of the object of the research. The analysis of the text was complemented with the analysis of visual material. Drawing on quantitative and qualitative methods, the contents, processes, visual images, transformations and structures of the social representations of European integration, as well as the communicative styles of the textbooks were examined. This study showed the divergent social representations of the European integration, anchored in the nation states, in the five member countries of the European Union. The social representations were constructed around different central core elements: French Europe in the French textbooks, Ambivalent Europe in the British textbooks, Influential and Unifying EU in the German textbooks, Enabling and Threatening EU in the Finnish textbooks, Sceptical EU in the Swedish textbooks and EU as a World Model in the Franco-German textbook. Some elements of the representations were shared by all countries such as peace and economic aspects of the European cooperation, whereas other elements of representations were found more frequently in some countries than in others, such as ideological, threatening or social components of the phenomenon European integration. The study also demonstrated the linkage between social representations of the EU and national and European identities. The findings of this study are applicable to the study of the European integration, to the study of education, as well as to the social representation theory.

Lapset, media ja symbolinen vuorovaikutus : Suomalaisten, englantilaisten ja saksalaisten lasten mediasuhteen tarkastelua

Tämän hetken mediaympäristölle on ominaista intensiivisyys ja jatkuva läsnäolo. Medialla on merkittävä rooli myös pienten lasten jokapäiväisessä elämässä, sillä he aloittavat median säännöllisen seuraamisen keskimäärin kolmen vuoden iässä. Mediasisällöt, mediavälineet ja mediaan liittyvät sosiaaliset suhteet muodostavatkin lapsille mediaympäristön, jossa lapset rakentavat identiteettejään, oppivat sosiaalista kanssakäymistä ja kehittävät näkemyksiään yhteiskunnasta ja kulttuurista. Tutkimuksessa on selvitetty 4-6-vuotiaitten suomalaisten, englantilaisten ja saksalaisten lasten audiovisuaalisen median tulkintaa ja median roolia heidän elämässään. Tutkimuksen tavoitteena on ollut syventää tutkimuksellista tietoa median sosiaalisesta ja kulttuurisesta merkityksestä pienten lasten elämässä ja sitä, miten he tulkitsevat mediasisältöä. Tutkimuksessa lasten mediasuhdetta on tarkasteltu välineellisenä, sosiaalisena, symbolisena ja kulttuurisena tulkintaympäristönä. Edellisten lisäksi tutkimuksessa on arvioitu harvemmin viestinnän tutkimuksessa käytetyn symbolisen interaktionismin teorian tarjoamia mahdollisuuksia lasten mediasuhteen tarkasteluun. Suomessa, Englannissa ja Saksassa kootun kansainvälisen aineiston pohjalta on tarkasteltu myös vertailuryhmien välillä olevia mediaan liittyviä kulttuurisia eroja. Eri vertailumaiden melko samankaltaisesta mediaympäristöstä huolimatta tutkimus antaa viitteitä mediatulkinnoissa olevista kulttuurisista eroista. Media mahdollistaa lapsen erilaistan taitojensa kehittymistä ja voi siten muodostaa heille sosiaalisia, symbolisia ja kulttuurisia resursseja, joilla on merkitystä lapsen kehittymisen kannalta. Lapsen ja median suhde on kaksisuuntainen vuorovaikutussuhde ja mediainformaation tulkinnassa ovat mukana lapsen aiemmat tiedolliset ja sosiaaliset kokemukset. Aktiivisessa mediatulkintasuhteessaan lapsi kehittää sanavarastoaan, havainnointiaan, ajatteluaan ja tunne-elämäänsä. Median käyttö sosiaalisena tapahtumana kehittää osaltaan lapsen sosiaalisia valmiuksia. Siten esimerkiksi perheen median käyttöön liittyvät säännöt ja ohjeet ohjaavat perheen sisäistä toimintaa ja määrittävät lapsen asemaa perheessä. Median sisällöt ja niihin liittyvät erilaiset oheistuotteet toimivat osaltaan lapsen kulttuuristen koodistojen ja luokittelujen muodostajana. Tutkimus osoittaa myös symbolisen interaktionismin teorian tarjoavan varsin poikkitieteellisen tutkimuksellisen viitekehyksen lapsia ja mediaa koskevalle tutkimukselle ja mahdollistaa lasten mediasuhteen tutkimisen ja ymmärtämisen useiden, erilaisten tekijöiden suhteena.

Immigrant Associations in the Metropolitan Area of Finland : Forms of Mobilisation, Participation and Representation

This study examines the role of immigrant associations in the societal and political integration of immigrants into Finnish society. The societal focus is on the ability of immigrant associations to mobilise their ethnic group members to participate in the socio-economic, cultural and political domains of Finnish society and in certain cases even beyond. The political integrative aims are the opportunities of immigrant associations to participate and represent the interests of their ethnic group in local and national policy making. This study focuses on associations in the Metropolitan Area of Finland, (Espoo, Helsinki and Vantaa).The qualitative research consisted of 71 interviews conducted with members of immigrant associations and civil servants. These interviews were mainly semi-structured, including some additional open-ended questions. Additional data consisted of documents, planning reports and of follow-up enquiries. -- In the analysis of the data I categorised thirty-two immigrant associations according to the activity forms and the description of the goals by the members. The four categories consisted of integrative, societal, ethno-cultural and transnational immigrant associations. Most of the immigrant associations belonged to the integrative category (15 of 32 associations). On the one hand the aims of these associations are to provide access for their ethnic group members into Finnish society, while on the other to strengthen the ethnic identity of their members by organising ethno-cultural activities. The societal associations only focused on activities with the objective of including immigrants into the Finnish labour market and educational system. The goal of ethno-cultural associations was to strengthen the ethnic identity of their ethnic group members. The transnational associations aimed at improving the living conditions of women and children in the members' country of origin. The possibilities for immigrant associations to mobilise their members depends partly on external financing. Subsidies have been allocated for societal activities in particular. There remains a risk of the crowding out of ethno-cultural activities: something which has already taken place in several European countries. Immigrant associations aim to strengthen the identity of immigrants mainly by organising social and ethno-cultural activities. Another important target was to provide peer support and therapy courses. Additionally, immigrant women's associations offer assistance to women who have encountered violence by providing counselling and in some cases access to shelter. The data showed that there is an ever growing need to pay heed to the well-being of women, children and elderly immigrants. The participation of immigrant associations in the municipalities' integrative issues takes place mainly through cooperative projects. Until the end of the 1990s there had not been much cooperation. The problem with the projects was that they had mainly been managed by civil servants, whereas members from immigrant associations had remained in a more passive position. Representation of immigrant associations in councils has been fairly weak. Immigrant associations are included in the multicultural councils of Espoo and Vantaa, but only in the planning stages. The municipality of Helsinki does not include immigrant associations due to the large number of organisations which causes problems in finding fair, democratic representation. At the national level, the ‘Advisory Board for Ethnic Relations’ – ETNO didn’t chose its members based on membership of ethnic associations, but based on belongingness to one of the larger language groups spoken by the foreign population in Finland. Since ETNO’s third period (2005-2007), the representatives of immigrant associations and ethnic minority groups have been chosen from proposed candidates. Key words: immigrant associations, integration, mobilisation, participation, representation, the Metropolitan area of Finland, immigrant (women), civil servants

Rethinking Media Pluralism : A Critique of Theories and Policy Discourses

This study examines different ways in which the concept of media pluralism has been theorized and used in contemporary media policy debates. Access to a broad range of different political views and cultural expressions is often regarded as a self-evident value in both theoretical and political debates on media and democracy. Opinions on the meaning and nature of media pluralism as a theoretical, political or empirical concept, however, are many, and it can easily be adjusted to different political purposes. The study aims to analyse the ambiguities surrounding the concept of media pluralism in two ways: by deconstructing its normative roots from the perspective of democratic theory, and by examining its different uses, definitions and underlying rationalities in current European media policy debates. The first part of the study examines the values and assumptions behind the notion of media pluralism in the context of different theories of democracy and the public sphere. The second part then analyses and assesses the deployment of the concept in contemporary European policy debates on media ownership and public service media. Finally, the study critically evaluates various attempts to create empirical indicators for measuring media pluralism and discusses their normative implications and underlying rationalities. The analysis of contemporary policy debates indicates that the notion of media pluralism has been too readily reduced to an empty catchphrase or conflated with consumer choice and market competition. In this narrow technocratic logic, pluralism is often unreflectively associated with quantitative data in a way that leaves unexamined key questions about social and political values, democracy, and citizenship. The basic argument advanced in the study is that media pluralism needs to be rescued from its depoliticized uses and re-imagined more broadly as a normative value that refers to the distribution of communicative power in the public sphere. Instead of something that could simply be measured through the number of media outlets available, the study argues that media pluralism should be understood in terms of its ability to challenge inequalities in communicative power and create a more democratic public sphere.

Construing and Defining the Out of Control : Addiction in the Media 1968-2008.

The four scientific articles comprising this doctoral dissertation offer new information on the presentation and construction of addiction in the mass media during the period 1968 - 2008. Diachronic surveys as well as quantitative and qualitative content analyses were undertaken to discern trends during the period in question and to investigate underlying conceptions of the problems in contemporary media presentations. The research material for the first three articles consists of a sample of 200 texts from Finland s biggest daily newspaper, Helsingin Sanomat, from the period 1968 - 2006. The fourth study examines English-language tabloid material published on the Internet in 2005 - 2008. A number of principal trends are identified. In addition to a significant increase in addiction reporting over time, the study shows that an internalisation of addiction problems took place in the media presentations under study. The phenomenon is portrayed and tackled from within the problems themselves, often from the viewpoint of the individuals concerned. The tone becomes more personal, and technical and detailed accounts are more and more frequent. Secondly, the concept of addiction is broadened. This can be dated to the 1990s. The concept undergoes a conventionalisation: it is used more frequently in a manner that is not thought to require explanation. The word riippuvuus (the closest equivalent to addiction in Finnish) was adopted more commonly in the reporting at the same time, in the 1990s. Thirdly, the results highlight individual self-governance as a superordinate principle in contemporary descriptions of addiction. If the principal demarcation in earlier texts was between us and them , it is now focused primarily on the individual s competence and ability to govern the self, to restrain and master one's behaviour. Finally, in the fourth study investigating textual constructions of female celebrities (Amy Winehouse, Britney Spears and Kate Moss) in Internet tabloids, various relations and functions of addiction problems, intoxication, body and gender were observed to function as cultural symbols. Addiction becomes a sign, or a style, that represents different significations in relation to the main characters in the tabloid stories. Tabloids, as a genre, play an important role by introducing other images of the problems than those featured in mainstream media. The study is positioned within the framework of modernity theory and its views on the need for self-reflexivity and biographies as tools for the creation and definition of the self. Traditional institutions such as the church, occupation, family etc. no longer play an important role in self-definition. This circumstance creates a need for a culture conveying stories of success and failure in relation to which the individual can position their own behaviour and life content. I propose that addiction , as a theme in media reporting, resolves the conflict that emanates from the ambivalence between the accessibility and the individualisation of consumer society, on the one hand, and the problematic behavioural patterns (addictions) that they may induce, on the other.

Why Do Russians Support Censorship of the Media?

This article analyses support for censorship in Russia as part of the democratization process. Censorship has been an important part of Russian history and it was strengthened during the Soviet era. After the collapse of the Soviet system formal censorship was banned even though the reality has been different. Therefore it is not strange that many Russians would like to limit the freedom of the media and to censor certain topics. The views of Russians on censorship have been studied on the basis of a survey carried out in 2007. According to the results, three different dimensions of censorship were found. These dimensions include moral censorship, political censorship, and censorship of religious materials. Support for these dimensions varies on the basis of socio-demographic characteristics and media use. The article concludes that many Russians reject new phenomena, while support for the censorship of political criticism is not as high, but political censorship seems to enjoy more support among elites than among the common people.

Social Media as a Form of Organizational Knowledge Sharing

This study investigates the role of social media as a form of organizational knowledge sharing. Social media is investigated in terms of the Web 2.0 technologies that organizations provide their employees as tools of internal communication. This study is anchored in the theoretical understanding of social media as technologies which enable both knowledge collection and knowledge donation. This study investigates the factors influencing employees’ use of social media in their working environment. The study presents the multidisciplinary research tradition concerning knowledge sharing. Social media is analyzed especially in relation to internal communication and knowledge sharing. Based on previous studies, it is assumed that personal, organizational, and technological factors influence employees’ use of social media in their working environment. The research represents a case study focusing on the employees of the Finnish company Wärtsilä. Wärtsilä represents an eligible case organization for this study given that it puts in use several Web 2.0 tools in its intranet. The research is based on quantitative methods. In total 343 answers were obtained with the aid of an online survey which was available in Wärtsilä’s intranet. The associations between the variables are analyzed with the aid of correlations. Finally, with the aid of multiple linear regression analysis the causality between the assumed factors and the use of social media is tested. The analysis demonstrates that personal, organizational and technological factors influence the respondents’ use of social media. As strong predictive variables emerge the benefits that respondents expect to receive from using social media and respondents’ experience in using Web 2.0 in their private lives. Also organizational factors such as managers’ and colleagues’ activeness and organizational guidelines for using social media form a causal relationship with the use of social media. In addition, respondents’ understanding of their responsibilities affects their use of social media. The more social media is considered as a part of individual responsibilities, the more frequently social media is used. Finally, technological factors must be recognized. The more user-friendly social media tools are considered and the better technical skills respondents have, the more frequently social media is used in the working environment. The central references in relation to knowledge sharing include Chun Wei Choo’s (2006) work Knowing Organization, Ikujiro Nonaka and Hirotaka Takeuchi’s (1995) work The Knowledge Creating Company and Linda Argote’s (1999) work Organizational Learning.