PERFECT Stroke : PERFormance, Effectiveness, and Costs of treatment episodes in Stroke

Stroke is a major cause of death and disability, incurs significant costs to healthcare systems, and inflicts severe burden to the whole society. Stroke care in Finland has been described in several population-based studies between 1967 and 1998, but not since. In the PERFECT Stroke study presented here, a system for monitoring the Performance, Effectiveness, and Costs of Treatment episodes in Stroke was developed in Finland. Existing nationwide administrative registries were linked at individual patient level with personal identification numbers to depict whole episodes of care, from acute stroke, through rehabilitation, until the patients went home, were admitted to permanent institutional care, or died. For comparisons in time and between providers, patient case-mix was adjusted for. The PERFECT Stroke database includes 104 899 first-ever stroke patients over the years 1999 to 2008, of whom 79% had ischemic stroke (IS), 14% intracerebral hemorrhage (ICH), and 7% subarachnoid hemorrhage (SAH). A 18% decrease in the age and sex adjusted incidence of stroke was observed over the study period, 1.8% improvement annually. All-cause 1-year case-fatality rate improved from 28.6% to 24.6%, or 0.5% annually. The expected median lifetime after stroke increased by 2 years for IS patients, to 7 years and 7 months, and by 1 year for ICH patients, to 4 years 5 months. No change could be seen in median SAH patient survival, >10 years. Stroke prevalence was 82 000, 1.5% of total population of Finland, in 2008. Modern stroke center care was shown to be associated with a decrease in both death and risk of institutional care of stroke patients. Number needed to treat to prevent these poor outcomes at one year from stroke was 32 (95% confidence intervals 26 to 42). Despite improvements over the study period, more than a third of Finnish stroke patients did not have access to stroke center care. The mean first-year healthcare cost of a stroke patient was ~20 000 , and among survivors ~10 000 annually thereafter. Only part of this cost was incurred by stroke, as the same patients cost ~5000 over the year prior to stroke. Total lifetime costs after first-ever stroke were ~85 000 . A total of 1.1 Billion , 7% of all healthcare expenditure, is used in the treatment of stroke patients annually. Despite a rapidly aging population, the number of new stroke patients is decreasing, and the patients are more likely to survive. This is explained in part by stroke center care, which is effective, and should be made available for all stroke patients. It is possible, in a suitable setting with high-quality administrative registries and a common identifier, to avoid the huge workload and associated costs of setting up a conventional stroke registry, and still acquire a fairly comprehensive dataset on stroke care and outcome.

Uhrihaastatteluista poliitikkojen kovisteluun : Tutkimus Jokelan ja Kauhajoen koulusurmien tv-uutisoinnin kerrontatavoista

Medialla on valta päättää, miten väkivallasta kerrotaan, ja miten kriisit esitetään. Median kerrontatavoilla on suuri vaikutus siihen, miten katastrofi näyttäytyy tavalliselle kansalaiselle. Keskityn tutkielmassani siihen, millaisia kerrontatapoja Jokelan ja Kauhajoen koulusurmien tv-uutisointiin on rakennettu. Selvitän, mitä eroja ja yhtäläisyyksiä uutiskerronnassa oli kahden koulusurmatapauksen välillä sekä eri tv-kanavien välillä. Tarkastelen myös, mitkä toimijat korostuvat uutisten eri kerrontatavoissa. Laadullisen tutkimusotteen piirissä metodologinen tutkimustapani on representaatioanalyysi. Tutkielman lähtökohtana on malli katastrofiuutisoinnin kerrontatavoista. Gert Z. Nordström (1996) on kehittänyt mallin alun perin kuva-analyysiä varten. Myöhemmin sitä on sovellettu mediatekstien analyysiin (Huhtala jaa Hakala 2007). Tässä tutkielmassa sovellan mallia audiovisuaalisen kerronnan analyysiin. Tutkimusaineistoni koostuu television uutislähetyksistä seitsemän päivän ajalta sekä Jokelan että Kauhajoen tapahtumien jälkeen neljällä valtakunnallisella tv-kanavalla. Analyysimallin mukaisesti koulusurmat esitetään televisiossa käyttäen eeppistä, dramaattista, lyyristä ja didaktista kerrontatapaa. Lisäksi kyseessä olleesta tv-aineistosta nousi viides kerronnan luokka, kriittinen kerronta. Eeppisellä kerronnalla tarkoitetaan tyypillistä raportoivaa ja referoivaa uutiskerrontaa. Dramaattista kerrontaa käytetään raportoitaessa suoraan tapahtumapaikalta. Lyyrinen kerronta kuvaa tunteita. Didaktisessa kerronnassa pohditaan, mitä tapahtuneesta voi oppia. Kriittisen kerronnan keinoin vaaditaan vastuunottoa tapahtuneesta. Tv-uutisten kerrontatavoissa näyttäisi korostuvan eeppisen kerronnan määrä. Kauhajoen ja Jokelan uutiskerronnat kuitenkin erosivat toisistaan niin, että eeppinen kerronta lisääntyi entisestään Kauhajoen uutisoinnissa. Myös kriittinen kerronta korostui Kauhajoen uutisoinnissa. Jokelan uutisoinnissa esiintyi puolestaan enemmän dramaattista, lyyristä ja didaktista kerrontaa. MTV3-kanavalla käytettiin muita kanavia vähemmän eeppistä kerrontaa. Didaktista kerrontaa esiintyi MTV3:lla muita kanavia reilusti enemmän molempien koulusurmatapausten yhteydessä. Lisäksi MTV3-kanavalla esiintyi eniten kriittistä kerrontaa Kauhajoen uutisoinnissa. YLEn ja Nelosen kerrontatapojen esiintyminen oli lähes samankaltaista sekä Jokelan että Kauhajoen uutisoinnissa. Jokelan uutisoinnissa Nelonen käytti kuitenkin merkittävästi enemmän dramaattista kerrontaa YLEen verrattuna. Jokelan uutisoinnissa toimijoina korostuivat ampuja, ja uhrit, kun taas Kauhajoella päätoimijoita olivat poliisi ja poliitikot. Jokelan tv-uutisoinnissa sekä uhrit että ampuja olivat kolmen keskeisimmän toimijan joukossa useassa kerrontatavan luokassa. Kauhajoen uutisoinnissa puolestaan uhrit eivät olleet missään kerrontatavan luokassa kolmen keskeisimmän toimijan joukossa, ja ampujakin vain yhdessä luokassa. Eeppisen ja kriittisen kerrontatavan korostuminen sekä poliitikkojen keskeisyys toimijoina Kauhajoen tv-uutisoinnissa kertoo siitä, että Jokelaan nähden Kauhajoen koulusurmien uutisointi oli selvästi yhteiskuntakeskeisempää. Jokelan uutisointi painottui enemmän yksittäisen tapahtuman traagisuuteen sekä henkilökohtaloihin.

Internet- karttapalveluiden arviointi ja kehitys strategisessa maankäytön suunnittelussa, tapaustutkimuksena Esikaupunkien renessanssi -hanke

Participation is located in a living and complex environment. Traditional means of participation are only partially able to meet the new environmental requirements. In need are forms of participation which take into account the new opportunities of the environment and residents expertise. Internet map applications are an important channel of participation which potential is in many respects as unexplored and unutilized. They are commonly in inventory the perspectives, bringing out the concerns of the area, and only little for discussing about solutions. Interpretation is usually made by designer. This study focuses on evaluation and development of Internet map applications in strategic land use planning. Subject matter is dealt from designer and the inhabitants point of view. City Planning Department of Helsinki s Esikau-punkien Renessanssi -project and the associated SoftGIS survey acts as the case study. In the beginning of the study I tried to recognize the new environment in which the Internet map applications are placed. The research question is, what kind of challenges and opportunities the e-participation confronts in information society, and what kind of requirements the environmental creates for development of an application. In chapter three I evaluate how successfully these requirements are met in Esikau-punkien Renessanssi -project. I m trying to examine how the application would look like if the environment and the characteristics of the project are met better. The approach is experimental and I try to find new ways to take advantage of Internet maps. I try not to be too limited to current projects and studies. For example, I try to examine how social media and Web 2.0 opportunities can be utilized, and how the learning and shaping nature of planning may be reached in Internet map environment. In chapter four I have developed a new concept for the Esikaupunkien Renessanssi map application, and made images to visualize its operation in practice. I collect all the data in the research and gather it into a new service. The aim is to create a better application for Esikaupunkien Renessanssi -project, which takes into account the living and complex environment of participation and responds to threats and opportunities arising from it. The presented outcome is in many respects different from the current query. In the new service the role of residents is to interact and learn. The traditional standing of the Internet maps and the position of resident as one-sided information donor are questioned. In the concept, the residents innovate and make interpretations too. Influences are taken from a number of modern applications and for example services that make use of social media. The user experience is intended to be interactive, fast and easy. The idea is that the service keeps you up to date with planning matters, not the other way around. Service guides inhabitants, striving to achieve a deeper knowledge of the project's objectives as well as the dynamics and realities that different individuals experience.

Differences in the climatic adaptation of silver birch (Betula pendula) and downy birch (B. pubescens) in Finland based on male flowering phenology.

Male flowering was studied at the canopy level in 10 silver birch (Betula pendula Roth) stands from 8 localities and in 14 downy birch (B. pubescens Ehrh.) stands from 10 localities in Finland from 1963 to 1973. Distributions of cumulative pollen catches were compared to the normal Gaussian distribution. The basis for the timing of flowering was the 50 per cent point of the anthesis-fitted normal distribution. To eliminate effects of background pollen, only the central, normally distributed part of the cumulative distribution was used. Development up to the median point of the distribution was measured and tested in calendar days, in degree days (> 5 °C) and in period units. The count of each parameter began on and included March 19. Male flowering in silver birch occurred from late April to late June depending on latitude, and flowering in downy birch took place from early May to early July. The heat sums needed for male flowering varied in downy birch stands latitudinally but there was practically no latitudinal variation in heat sums needed for silver birch flowering. The amount of male flowering in stands of both birch species were found to have a large annual variation but without any clear periodicity. The between years pollen catch variation in stands of either birch species did not show any significant latitudinal correlation in contrast to Norway spruce stands. The period unit heat sum gave the most accurate forecast of the timing of flowering for 60 per cent of the silver birch stands and for 78.6 per cent of the for downy birch stands. Calendar days, however, gave the best forecast for silver birch in 25 per cent of the cases, while degree days gave the best forecast for downy birch in 21.4 per cent of the cases. Silver birch seems to have a local inclination for a more fixed flowering date compared to downy birch, which could mean a considerable photoperiodic influence on flowering time of silver birch. Silver birch and downy birch had different geographical correlations. Frequent hybridization of birch species occurs more often in northern Finland in than in more southern latitudes. The different timing in flowering caused increasing scatter in flowering times in the north, especially in the case of downy birch. The chance of simultaneous flowering of silver birch and downy birch so increased northwards due to a more variable climate and also higher altitudinal variations. Compared with conifers, the reproduction cycles of both birch species were found to be well protected from damage by frost.

Accurate mass-based analysis in human sport doping control : Application of liquid chromatography - time-of-flight mass spectrometry

Human sport doping control analysis is a complex and challenging task for anti-doping laboratories. The List of Prohibited Substances and Methods, updated annually by World Anti-Doping Agency (WADA), consists of hundreds of chemically and pharmacologically different low and high molecular weight compounds. This poses a considerable challenge for laboratories to analyze for them all in a limited amount of time from a limited sample aliquot. The continuous expansion of the Prohibited List obliges laboratories to keep their analytical methods updated and to research new available methodologies. In this thesis, an accurate mass-based analysis employing liquid chromatography - time-of-flight mass spectrometry (LC-TOFMS) was developed and validated to improve the power of doping control analysis. New analytical methods were developed utilizing the high mass accuracy and high information content obtained by TOFMS to generate comprehensive and generic screening procedures. The suitability of LC-TOFMS for comprehensive screening was demonstrated for the first time in the field with mass accuracies better than 1 mDa. Further attention was given to generic sample preparation, an essential part of screening analysis, to rationalize the whole work flow and minimize the need for several separate sample preparation methods. Utilizing both positive and negative ionization allowed the detection of almost 200 prohibited substances. Automatic data processing produced a Microsoft Excel based report highlighting the entries fulfilling the criteria of the reverse data base search (retention time (RT), mass accuracy, isotope match). The quantitative performance of LC-TOFMS was demonstrated with morphine, codeine and their intact glucuronide conjugates. After a straightforward sample preparation the compounds were analyzed directly without the need for hydrolysis, solvent transfer, evaporation or reconstitution. The hydrophilic interaction technique (HILIC) provided good chromatographic separation, which was critical for the morphine glucuronide isomers. A wide linear range (50-5000 ng/ml) with good precision (RSD<10%) and accuracy (±10%) was obtained, showing comparable or better performance to other methods used. In-source collision-induced dissociation (ISCID) allowed confirmation analysis with three diagnostic ions with a median mass accuracy of 1.08 mDa and repeatable ion ratios fulfilling WADA s identification criteria. The suitability of LC-TOFMS for screening of high molecular weight doping agents was demonstrated with plasma volume expanders (PVE), namely dextran and hydroxyethylstarch (HES). Specificity of the assay was improved, since interfering matrix compounds were removed by size exclusion chromatography (SEC). ISCID produced three characteristic ions with an excellent mean mass accuracy of 0.82 mDa at physiological concentration levels. In summary, by combining TOFMS with a proper sample preparation and chromatographic separation, the technique can be utilized extensively in doping control laboratories for comprehensive screening of chemically different low and high molecular weight compounds, for quantification of threshold substances and even for confirmation. LC-TOFMS rationalized the work flow in doping control laboratories by simplifying the screening scheme, expediting reporting and minimizing the analysis costs. Therefore LC-TOFMS can be exploited widely in doping control, and the need for several separate analysis techniques is reduced.

Methods and applications for improving parameter prediction models for stand structures in Finland

This thesis report attempts to improve the models for predicting forest stand structure for practical use, e.g. forest management planning (FMP) purposes in Finland. Comparisons were made between Weibull and Johnson s SB distribution and alternative regression estimation methods. Data used for preliminary studies was local but the final models were based on representative data. Models were validated mainly in terms of bias and RMSE in the main stand characteristics (e.g. volume) using independent data. The bivariate SBB distribution model was used to mimic realistic variations in tree dimensions by including within-diameter-class height variation. Using the traditional method, diameter distribution with the expected height resulted in reduced height variation, whereas the alternative bivariate method utilized the error-term of the height model. The lack of models for FMP was covered to some extent by the models for peatland and juvenile stands. The validation of these models showed that the more sophisticated regression estimation methods provided slightly improved accuracy. A flexible prediction and application for stand structure consisted of seemingly unrelated regression models for eight stand characteristics, the parameters of three optional distributions and Näslund s height curve. The cross-model covariance structure was used for linear prediction application, in which the expected values of the models were calibrated with the known stand characteristics. This provided a framework to validate the optional distributions and the optional set of stand characteristics. Height distribution is recommended for the earliest state of stands because of its continuous feature. From the mean height of about 4 m, Weibull dbh-frequency distribution is recommended in young stands if the input variables consist of arithmetic stand characteristics. In advanced stands, basal area-dbh distribution models are recommended. Näslund s height curve proved useful. Some efficient transformations of stand characteristics are introduced, e.g. the shape index, which combined the basal area, the stem number and the median diameter. Shape index enabled SB model for peatland stands to detect large variation in stand densities. This model also demonstrated reasonable behaviour for stands in mineral soils.

Substance misuse problems during pregnancy with special emphasis on buprenorphine

Maternal drug abuse during pregnancy endangers the future health and wellbeing of the infant and growing child. On the other hand, via maternal abstinence, these problems would never occur; so the problems would be totally preventable. Buprenorphine is widely used in opioid maintenance treatment as a substitute medication. In Finland, during 2000 s buprenorphine misuse has steadily increased. In 2009 almost one third of clientele of substance treatment units were in treatment because of buprenorphine dependence. At Helsinki Women s Clinic the first child with prenatal buprenorphine exposure was born in 2001. During 1992-2001 in the three capital area maternity hospitals (Women s clinic, Maternity hospital, Jorvi hospital) 524 women were followed at special antenatal clinics due to substance abuse problems. Three control women were drawn from birth register to each case woman and matched for parity and same place and date of the index birth. According to register data mortality rate was 38-fold higher among cases than controls within 6-15 years after index birth. Especially, the risk for violent or accidental death was increased. The women with substance misuse problems had also elevated risk for viral hepatitis and psychiatric morbidity. They were more often reimbursed for psychopharmaceuticals. Disability pensions and rehabilitation allowances were more often granted to cases than controls. In total 626 children were born from these pregnancies. According to register data 38% of these children were placed in out-of-home care as part of child protection services by the age of two years, and half of them by the age of 12 years, the median follow-up time was 5.8 years. The risk for out-of-home care was associated with factors identifiable during the pre- and perinatal period. In 2002-2005 67 pregnant women with buprenorphine dependence were followed up at the Helsinki University Hospital, Department of Obstetrics and Gynecology. Their pregnancies were uneventful. The prematurity rate was similar and there were no more major anomalies compared to the national statistics. The neonates were lighter compared to the national statistics. They were also born in good condition, with no perinatal hypoxia as defined by standard clinical parameters or certain biochemical markers in the cord blood: erythropoietin, S100 and cardiac troponin-t. Almost 80% of newborns developed neonatal abstinence syndrome (NAS) and two third of them needed morphine medication for it. Maternal smoking over ten cigarettes per day aggravated and benzodiazepine use attenuated NAS. An infant s highest urinary norbuprenorphine concentration during their first 3 days of life correlated with the duration of morphine treatment. The average length of infant s hospital stay was 25 days.

Treatment of illicit opioid and γ-hydroxybutyrate overdose by Helsinki emergency medical services

Aims: To examine the characteristics, incidence, treatment and outcome of presumed opioid, γ-hydroxybutyrate (GHB) and γ-butyrolactone (GBL) overdoses involving users of illicit drugs in Helsinki. GHB/GBL were included in this study, despite not being opioids, due to the relative ease with which they can cause potentially fatal respiratory depression. The incidence and time interval of recurrent opioid toxicity after prehospital administration of naloxone, an opioid antagonist, was studied in presumed heroin overdose patients. Naloxone has been reported to have many adverse effects and the effects of naloxone administered during an opioid overdose on the cardiovascular system and catecholamine levels in piglets were studied. Materials and methods: Patients included in these published retrospective studies were from the following time periods: Study I: 1995-2002, II: 1997-2000, III: 1995-2000, V: 2006-2007. Presumed opioid overdose patients were examined in studies I, II and III. GHB/GBL overdoses among injecting drug users was examined in study V. Recurrent opioid toxicity after prehospital naloxone administration in heroin overdose patients was examined in study III. The effects of naloxone (80 μg/kg i.v.) on the cardiovascular system and catecholamine levels administered during morphine overdose (8mg/kg i.v.) and under propofol anesthesia with spontaneous breathing were studied in eight piglets (IV). In this thesis, previously unpublished data on the incidence of opioid overdose between 2001-2007 and comparison of the characteristics of buprenorphine and heroin overdose patients encountered in 1995-2005 are also included. Results: Helsinki Emergency Medical Service (EMS) ambulances were dispatched annually to 34,153- 45,118 calls from 1995 to 2007. Of them, 7-8% were coded as intoxications or overdoses. During this time, 436 patients were treated by the EMS for presumed opioid overdose. The peak incidence of opioid overdoses was in the year 2000 (113 cases), after which they declined to 6-26 cases annually. The annual incidence of buprenorphine related overdoses increased from 4 (4% of opioid overdoses) in the year 2000 to 8 (30% of opioid overdoses) in 2007. The annual number of GHB related overdose patients treated by Helsinki EMS increased from 21 to 73 between 2004-2007. There appeared to be a peak in the incidence of both GHB/GBL and opioid related overdoses on Saturdays. Characteristics of opioid overdose patients The median age of opioid overdose patients was 28 years (22;33, 25- and 75-percentiles), and 84% were male. Buprenorphine overdose patients had more polydrug, such as alcohol and/or benzodiazepines, use in comparison with heroin overdose patients, 70% versus 33%, respectively. Severe respiratory depression was reported less often with buprenorphine overdoses compared to heroin overdoses, in 67.0% versus 85.4%, respectively. Outcome of heroin overdose patients with cardiac arrest Ninety four patients suffered cardiac arrest due to acute drug poisoning/overdose and were thus considered for resuscitation. Resuscitation was attempted in 72 cases. Cardiac arrest was caused by heroin overdose for 19 patients of which three (16%) were discharged alive. Other agents also induced cardiac arrest in 53 patients, of which six (11%) were discharged alive. The arrest was either EMS witnessed or occurring after the emergency call for all survivors of heroin induced cardiac arrest. Characteristics of GHB/GBL overdose patients The records of 100 GHB/GBL related overdose patients from 2006-2007 were retrieved. The median age of GHB/GBL overdose patients encountered on weekend nights was 24 years (22;27, 25- and 75-percentiles) and 49% were male. Polydrug use was reported in 62-80% of the cases. Thirty nine patients were encountered on Friday-Saturday or Saturday-Sunday night between 11 pm-6 am. The remaining sixty one patients were outside this time frame. There was a statistically significant difference between these two groups in history of chronic injecting drug use (33% vs. 59%, respectively, p=0.012). Recurrent heroin toxicity after prehospital naloxone administration Study III included 145 presumed heroin overdose patients. After prehospital care, 84 patients refused further care and were not transported to an Emergency Department (ED). Seventy one (85%) of them were administered naloxone by the EMS. During a 12-h follow up period, none of these patients developed severe recurrent opioid toxicity. The remaining 61 patients were transported to an ED. Prior to transportation, 52 (85%) patients were administered naloxone by the EMS. Fifteen of them were administered naloxone also in the ED and recurrent opioid toxicity was evident either on arrival at the ED or shortly thereafter. Prehospital naloxone was administered either intravenously, intramuscularly (i.m.) or subcutaneously (s.c.). There was a tendency for more frequent recurrent heroin toxicity among the patients with only intravenous administration of prehospital naloxone (13/36) compared with the patients with intramuscular or subcutaneous prehospital naloxone (2/16), p=0.106. The effects of naloxone on the cardiovascular system and catecholamine levels in piglets The administration of morphine to piglets resulted in an obvious respiratory depression, which was reversed by naloxone. Two severely hypoxemic piglets developed cardiac arrest after naloxone administration. In the other six animals, the administration of naloxone did not provoke arrhythmias, cardiac ischemia or visible evidence of pulmonary edema. There was a statistically significant (p=0.012) increase in norepinephrine levels after morphine administration and before naloxone administration: from 1.9 (1.3-2.3) ng/ml at baseline, to 31.7 (8.3-83.0) ng/ml (median, 25 and 75 percentiles parentheses) after morphine administration. After the administration of naloxone, the catecholamine levels continued to increase in only one of the animals. Conclusions: The incidence of buprenorphine related overdoses increased during the study period, but was still lower in comparison to those involving heroin. Injecting drug users have also started to use GHB/GBL. While recreational drug users use GHB/GBL during weekend nights, a GHB/GBL overdose patient encounter during weekdays has a more probable history of injecting drug use. Patients with cardiac arrest after heroin overdose have a poor prognosis. It appears to be safe to leave heroin overdose patients on scene after prehospital treatment with naloxone. Although no statistically significant difference was observed, it seems prudent to administer part of the total naloxone dose s.c. or i.m. to reduce the risk of recurrent respiratory depression. If transported to an ED, an observation period of one to two hours after the last naloxone dose seems adequate. The treating physician must be vigilant, however, due to the high prevalence of polydrug use and high morbidity after non fatal heroin overdose. Furthermore, care should be taken regarding possible chronic disorders and drug rehabilitation should be addressed. In the experimental animal study, two animals developed cardiac arrest after receiving naloxone while in hypoxemia and bradycardia. Further studies are required to assess the effect of naloxone during opioid-induced hypercapnia and hypoxemia in animals addicted to opioids.

Wegener's granulomatosis in Finland in 1981-2000

Objectives: Wegener s granulomatosis (WG) is a vasculitis with a predilection for the airways and kidneys. An increasing incidence and improved prognosis of WG has been shown. The aim of this study was to evaluate the incidence, clinical presentation, diagnostic delay, risk of dialysis-dependent renal insufficiency and mortality of WG in 1981-2000. Patients and methods: Data was retrieved from the Finnish hospital discharge register and hospital case reports. Patients diagnosed with WG in 1981-2000 were included, and their demographic and clinical data recorded. The patients were crossed with the national kidney dialysis register and the national mortality statistics. Results: A total of 492 patients (243 ♂ , 249 ♀) were diagnosed at a mean age of 54 years (SD 18). The incidence increased from 1.9 to 9.3/ million/ year. The median diagnostic delay decreased from 17 to 4 months. Patients presented most often with symptoms of the ear, nose and throat (ENT) (45%), lung (36%), musculoskeletal system (22%) and kidney (11%). Initial lung involvement, constitutional symptoms, high erythrocyte sedimentation rate (ESR) and high ELK scores [(number of simultaneously involved organ groups (ENT, Lung, Kidney)] were associated with a shorter diagnostic delay. Medical treatment of WG patients remained similar in the 1980s and 1990s. Almost 90% of patients received cyclophosphamide (CYC) and more than 90% glucocorticoid medication at some point during the course of the disease. Eighty-four patients (17%) needed dialysis. Initial renal involvement and elevated serum creatinine values were related to an increased risk of dialysis-dependent kidney disease. In two-thirds of the patients, renal impairment was reversible. Dialysis became chronic (>3 months) in 32 patients (6.5%). Nineteen patients (3.9%) received a kidney transplant. Altogether 203 patients (99 men, 104 women) died before 30 June 2005. WG was the underlying cause of death in 37%. The crude one-year and five-year survival rates were 83.3% and 74.2%, respectively. The standardized mortality ratio was 3.43 (95% CI = 2.98 to 3.94). Older age and elevated creatinine level at diagnosis predicted shorter survival. ENT symptoms at presentation and treatment with CYC were associated with better outcome. There was no additional risk associated with male gender or with either of the decades (1981-1990 and 1991-2000) Conclusions: In 1981-2000, the incidence of WG increased ca. 4.5-fold and diagnostic delay decreased to ca. one-fourth, reflecting increased recognition of the disease and improved diagnostic means. WG patients are at great risk of developing dialysis-dependent renal insufficiency and an increased risk of dying. During the study period the treatment of WG did not change markedly, nor did the prognosis improve.

”Ihanan överi ja juhlallinen jakku olisi kyllä kiva lisä vaatekaappiin” – tutkimus kuluttamisesta ja professionalisoitumisesta elämäntyyliblogeissa

Tarkastelen tutkimuksessani muotibloggaajien kulutuspuhetta. Tutkimuksen tarkoituksena on selvittää, millaista kuluttajuutta muotiblogeissa ilmaistaan ja millainen kehityskaari muotiblogeissa on tapahtunut vuodesta 2007 tämän tutkimuksen tekemiseen asti tutkimusaineiston sekä tekemieni havaintojen perusteella. Tutkimus on toteutettu laadullisia tutkimusmenetelmiä käyttämällä. Olen kerännyt aineistoni kymmenestä naisten kirjoittamasta muotiblogista kahtena eri ajanjaksona vuonna 2009. Lisäksi tutkimuksessa on sekä etnografisen että netnografisen havainnoinnin piirteitä. Aineiston analysoinnin apuna olen käyttänyt teemoittelua sekä tyypittelyä. Tutkimuksesta selvisi, että muotibloggaajien näkeminen identiteettiään etsivänä liittyy oman tyylin etsimiseen ja erottautumisen haluun. Perinteinen näkemys kuluttajasta valitsijana ja passiivisena markkinoilla toimijana on väistymässä, sillä muotibloggaajat näyttäytyvät tutkimuksessa aktiivisina toimijoina ja tuottajina. Muotibloggaajat hakevat myös jatkuvasti uusia kulutuselämyksiä ja kommunikoivat toistensa kanssa välittämällä merkityksiä kuluttamisensa kautta. Muotibloggaajien kulutuspuheet näyttäytyvät tutkimuksessa ekonomistisen kulutuseetoksen ja perinteisen suomalaisen kulutuspuheen mukaisesti järkevinä. Säästäväisyyttä pidetään hyveellisenä ja tuotteiden hinnat vaikuttavat ostopäätösten tekemiseen. Muotibloggaajat osaavat kuitenkin kontrolloidusti nauttia kuluttamisesta. Kulutuspuheet noudattavat myös ekologis-eettisen kulutuseetoksen perinnettä, mikä ilmenee fanaattisuuden välttämisenä sekä perinteisten että sosiaalisen median kirpputorien suosimisena. Lisäksi muotibloggaajien kulutuspuheet käyvät ilmi sosiaalisena pakkona, sillä muotiblogin pitäminen mielenkiintoisena vaatii jatkuvaa himoa uusia kulutustuotteita kohtaan. Tutkimuksen perusteella muotiblogeissa korostuu yhteisöllisyys ja kuluttaminen on hyvin naisellista. Tutkimusaineistosta sekä havainnoista tekemieni päätelmien mukaan muotiblogit ovat muuttumassa elämäntyyliblogeiksi, sillä niissä kerrotaan yhä enemmän myös muista kuin kuluttamiseen liittyvistä aiheista. Samalla muotibloggaajat ovat kehittymässä tavallisesta kuluttajasta kohti asiantuntijuutta eli professionalisoitumassa. Professionalisoitumisen myötä muotibloggaajat toimivat uuden ajan kuluttajavalistajina ja muotiblogeissa syntyy uusia sanoja ja merkityksiä. Lisäksi muotibloggaajille on kehittynyt sellaisia tietoja ja taitoja, joita voi myydä. Muotibloggaajista onkin tulossa muodin ammattilaisia, joille maksetaan tulevaisuudessa bloggaamisesta myös palkkaa.

Jean Sibelius -viulukilpailun näkyvyys, argumentointi ja viihteellisyys valtakunnallisessa lehdistössä 1965 ja 2005

Kansainvälinen Jean Sibelius -viulukilpailu on järjestetty Suomessa kymmenen kertaa vuodesta 1965 lähtien, ja se on vakiinnuttanut asemansa musiikki-instituutiona niin Suomen kulttuurielämässä kuin valtakunnallisessa mediassa. Tässä tutkimuksessa selvitetään kilpailun reseptiota, eli millaista näkyvyyttä Sibelius-viulukilpailu on saanut valtakunnallisissa viestintävälineissä vuosina 1965 ja 2005. Journalistisesta aineistosta poimitaan esiin niitä teemoja ja ilmaisun tapoja, jotka ovat korostuneet kilpailuun liittyvissä teksteissä. Tutkimuksessa pohditaan, onko toimittajien kirjoittamien tekstien argumentointi muuttunut neljänkymmenen vuoden aikana, ja kuinka internet sekä median viihteellistyminen ovat muuttaneet journalistista kilpailua eri viestinten kesken. Tutkimusongelmia lähestytään kvalitatiivisesti viestinnän oppiaineen tutkimusmenetelmiä hyödyntäen. Ensin sisällönanalyysin avulla hahmotetaan kokonaiskäsitys aineistosta, minkä jälkeen yksittäisiin teksteihin pureudutaan argumenttianalyysin keinoin. Tutkimusaineisto on rajattu valtakunnallisiin viestintävälineisiin, joita ovat suurimmat sanoma- ja aikakauslehdet, Yleisradion kilpailuaiheiset televisio- ja radio-ohjelmat sekä viulukilpailun internet-sivut. Sanomalehdissä julkaistu aineisto on laajuutensa ja monipuolisuutensa vuoksi tarkimpana analyysikohteena; muu tutkimusaineisto täydentää lehtitekstien perusteella tehtyjä havaintoja. Tutkimustulokset osoittavat, että Sibelius-viulukilpailu on ollut näkyvästi esillä valtakunnallisessa lehdistössä niin vuonna 1965 kuin 2005. Molempina vuosina kilpailun näkyvyys pohjautui hyvin vahvasti painettuun sanomalehteen. Lehdistöaineistosta erottuivat selvästi kansallisuuden, rodun ja sukupuolen käsittelyn näkökulmat, vaikka kielellinen ilmaisu onkin ajan mittaan neutraloitunut. Sisällönanalyyttinen tarkastelu ja argumenttianalyysit osoittavat, että toimittajien käyttämä argumentointi on muuttunut neljän vuosikymmenen aikana. Toimittajien työnkuva on monipuolistunut, ja viihteellisyys on vähitellen soluttautunut iltapäivälehdistä niin sanottuihin laatumedioihin . Internet on tehnyt kilpailun reaaliaikaisesta seuraamisesta entistä nopeampaa ja helpompaa.

Kansalaistoimintaa internet-ajalla : tapaustutkimus Porkkanamafian alkuvaiheista Suomessa

Tutkimus käsittelee Porkkanamafiaksi nimetyn kansalaisliikehdinnän alkuvaiheita ja organisoitumista Suomessa. Toimintaryhmä sai alkunsa Suomessa loppukesällä vuonna 2008, jolloin idea uudenlaisesta toimintamallista levisi sosiaalisen median kautta Yhdysvalloista. Uudenlaista kuluttaja-aktiivisuutta korostanut toiminta-ajatus konkretisoitui varsin nopeasti tempaukseksi, johon osallistui satoja ihmisiä. Organisoimisessa on hyödynnetty internetin sovelluksia tehokkaasti, mikä on vaikuttanut Porkkanamafian toiminnan luonteeseen ja nopeaan leviämiseen. Tapaustutkimus Porkkanamafiasta keskittyy tarkastelemaan kansalaistoiminnan syntyprosesseja ja sijoittuu yhteiskunnallisten liikkeiden tutkimuksen kenttään. Lähtökohtana tutkimuksessa on prosessin empiirinen kuvaus. Toiminnan alkuvaiheen organisoitumista, idean kehittymistä konkreettiseksi toiminnaksi ja ihmisten rekrytoitumista mukaan toimintaan kuvataan Doug McAdamin liikehdinnän syntyä käsittelevän mallin pohjalta. Mallia on tarpeen myös täydentää ottamalla huomioon internetin ja sosiaalisen median vaikutukset. Porkkanamafian toiminnan piirteiden ja syntyprosessien tarkastelu avaa näkökulman siihen, miten kansalaistoiminta toteutuu Suomessa internet-ajalla. Tutkimusta varten olen haastatellut seitsemää Helsingin Porkkanamafian toimijaa sekä kerännyt aineistoa osallistuvan havainnoinnin avulla. Haastattelumateriaalin ja kenttähavaintojen lisäksi olen hyödyntänyt aineistona toimintaa käsitteleviä verkkosivustoja ja-julkaisuja. Tutkimuksen mukaan Porkkanamafian toiminta sijoittuu niin kutsutun perinteisen kansalaistoiminnan ja uudenlaisen verkkoaktivismin välimaastoon. Internet ja erityisesti sosiaalinen media ovat keskeisiä areenoita toiminnan organisoimiseen ja kannattajien mobilisoimiseen. Toiminnan onnistumisen kannalta olennaista on kuitenkin saada ihmiset mukaan tempauksiin, jotka edellyttävät fyysistä läsnäoloa. Porkkanamafian toiminta on internet-vahvisteista eli pääasiallinen toiminta-areena ei ole verkossa, vaikka organisoinnissa hyödynnetään monipuolisesti uutta tieto- ja viestintäteknologiaa. Tutkimus osoittaa, että internetillä ja sen erilaisilla sovelluksilla oli merkittävä asema Porkkanamafian toiminnan syntyvaiheessa. Niiden vaikutus oli keskeinen niin toimintaidean saapumisessa Suomeen, sen omaksumisessa toteutettavaksi kuin itse toiminnan leviämisessä ja organisoimisessa. Rekrytoitumis- ja mobilisaatioprosesseissa internet ja sosiaalisen median valmiit verkostot mahdollistavat ihmisten tavoittamisen nopeasti ilman kustannuksia. Nämä kanavat muokkaavat myös osallistumisen kulttuuria, sillä toimintaa koskevan tiedon levitessä verkossa innostus lähteä mukaan liikehdintään alkaa usein ennestään tuntemattomien henkilöiden kautta. Tukea oman toiminnan oikeellisuudesta saadaan läheisten ihmisten sijaan verkkoyhteisöjen massoilta. Porkkanamafian kaitaisessa epämuodollisessa kansalaistoiminnassa osallistuminen on mahdollista tapahtumakohtaisesti omien resurssien mukaan ja ilman pitkäaikaista sitoutumista. Osallistuminen ei myöskään vaadi yhteisen laaja-alaisen ideologian jakamista. Nämä nykyliikehdinnän piirteet mahdollistavat helpon osallistumisen ja madaltavat näin kynnystä lähteä mukaan toimintaan. Keskeistä yhteiskunnallisen liikehdinnän syntyprosessissa on uusi ja innovatiivinen toimintaidea, joka Porkkanamafialla on ollut niin kutsuttu käänteinen tai positiivinen boikotti eli yrittäjien kannustaminen ympäristön tilaa parantaviin toimenpiteisiin kuluttajien ostovoiman avulla.

Biomarkers in acute respiratory failure

Acute respiratory failure (ARF) is the most common type of organ failure leading to the need for intensive care. It is often secondary to acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS). ARF, and especially ALI and ARDS, cause increased morbidity, and mortality rates remain high (up to 40%). These disorders are characterised by inflammatory reaction and tissue damage. In some cases, inflammation continues and leads to an overwhelming repair process with ongoing fibrosis, accompanied by organ dysfunction and eventually a loss of function. Measuring the magnitude of the inflammation, and the repair process, would theoretically offer information concerning outcome. Early identification of patients whose disease process is likely to proceed unfavourably, would help clinicians to optimise their treatment. The aim of this study was to evaluate the epidemiology of ARF, its treatment, and outcome in Finland, with special interest in biomarkers, and their value in the prediction of mortality. Altogether, 958 adult patients treated with ventilatory support were prospectively included in this study during an eight week period in 2007 in 25 intensive care units. Plasma aminoterminal pro-brain natriuretic peptide (NT-pro-BNP) was assessed in 602 patients, and plasma cell-free DNA in 580 patients, to evaluate their prognostic value in ARF. Markers of collagen metabolism were studied in longitudinal serum samples in 68 patients in order to evaluate their evolution in ARF and the association to multiple organ dysfunction (MOD). Ventilatory support was used in 39% of all ICU patients. The estimated incidence of ARF was 149.5/100 000 per year. Median tidal volumes used were higher than recommended. Overall mortality at 90 days was 31%. Plasma NT-pro-BNP and cell-free DNA were highly increased in the majority of patients. Both markers were independent predictors of 90-day mortality, but their discriminative power was at most moderate when used separately. The mortality was highest in those patients, in whom both biomarkers were over their separate cut-off values. Thus, combined use of these biomarkers may increase their clinical value in the mortality prediction. The markers of collagen metabolism changed significantly over time in surviving patients. None of these markers did associate with MOD in these patients.

Young Actors in Transnational Agoras : Multi-sited Ethnography of Cosmopolitan Micropolitical Orientations

This study examines young people s political participation in transnational meetings. Methodologically the study aims to shed light on multi-sited global ethnography. Young people are viewed here as a social age group sensitive to critical, alternative and even radical political participation. The diversity of the young actors and their actions is captured by using several different methods. What is more, the study spurs us coming from the Global North to develop social science research towards methodological cosmopolitanism and to consider our research practices from a moral cosmopolitan perspective. The research sites are the EU Presidency Youth Event (2006 Hyvinkää, Finland), the Global Young Greens Founding Conference (2007 Nairobi, Kenya), the European Social Forum (2008 Malmö, Sweden) and three World Social Forums (2006 Bamako, Mali; 2007 Nairobi Kenya and 2009 Belém, Brazil). The data consists of participant observation, documents and media articles of the meetings, interviews, photos, video, and internet data. This multidisciplinary study combines youth research, development studies, performative social science and political sociology. In this research the diverse field of youth political participation in transnational agoras is studied by using a cross-table of cosmopolitan resources (or the lack of them) and everydaymakers expert citizen dichotomy. First, the young participants of the EU Presidency youth event are studied as an example of expert citizens with cosmopolitan resources (these resources include, for example, language skills, higher education and international social network). Second, the study analyses those everyday-makers who use performative politics to demonstrate their political missions here and now. But in order to make the social movement global they need cosmopolitan resources to be able to use the social media tools and work globally. Third, the study reflects upon the difficulties of reaching those actors who lack cosmopolitan resources, either everyday-makers or expert citizens. The go-along method and the use of the interpreters are shown as ways to reach these young people s political missions. Fourth, the research underlines the importance of contact zones (i.e. spaces or situations where the aforementioned orientations and their differences temporarily disappear or weaken) for deeper democracy and for boosted dialogue between different kinds of participants. Keywords: political participation, young people, multi-sited ethnography, youth research, political sociology, development studies, performative social science

Molecular diagnosis of developmental disorders

ABSTRACT Idiopathic developmental disorders (DDs) affect ~1% of the population worldwide. This being a considerable amount, efforts are being made to elucidate the disease mechanisms. One or several genetic factors cause 30-40% of DDs, and only 10% are caused by environmental factors. The remaining 50% of DD patients go undiagnosed, mostly due to a lack of diagnostic techniques. The cause in most undiagnosed cases is though to be a genetic factor or a combination of genetic and environmental factors. Despite the surge of new technologies entering the market, their implementation into diagnostic laboratories is hampered by costs, lack of information about the expected diagnostic yield, and the wide range of selection. This study evaluates new microarray methods in diagnosing idiopathic DDs, providing information about their added diagnostic value. Study I analysed 150 patients by array comparative genomic hybridization (array CGH, 44K and 244K), with a subsequent 18% diagnostic yield. These results are supported by other studies, indicating an enourmous added diagnostic value of array CGH, compared with conventional cytogenetic analysis. Nevertheless, 80% of the patients remained undiagnosed in Study I. In an effort to diagnose more patients, in Study IV the resolution was increased from 8.9 Kb of the 244K CGH array to 0.7 Kb, by using a single-nucleotide polymorphism (SNP) array. However, no additional pathogenic changes were detected in the 35 patients assessed, and thus, for diagnostic purposes, an array platform with ca 9 Kb resolution appears adequate. The recent vast increase in reports of detected aberrations and associated phenotypes has enabled characterization of several new syndromes first based on a common aberration and thereafter by delineation of common clinical characteristics. In Study II, a familial deletion at 9q22.2q22.32 with variable penetrance was described. Despite several reports of aberrations in the adjacent area at 9q associated with Gorlin syndrome, the patients in this family had a unique phenotype and did not present with the syndrome. In Study III, a familial duplication of chromosome 6p22.2 was described. The duplication caused increased expression of an important enzyme of the γ-aminobutyric acid (GABA) degradation pathway, causing oxidative stress of the brain, and thus, very likely, the mild mental retardation of these patients. These two case studies attempted to pinpoint candidate genes and to resolve the pathogenic mechanism causing the clinical characteristics of the patients. Presenting rare genetic and clinical findings to the international science and medical community enables interpretation of similar findings in other patients. The added value of molecular karyotyping in patients with idiopathic DD is evident. As a first line of testing, arrays with a median resolution of at least 9 Kb should be considered and further characterization of detected aberrations undertaken when possible. Diagnostic whole-exome sequencing may be the best option for patients who remain undiagnosed after high-resolution array analysis.