Monimuotoisuus ja esteettömyys : Näkövammaisten asiantuntijoiden työelämäkokemuksia

The purpose of this study is to analyse education, employment, and work-life experiences of visually impaired persons in expert jobs. The empirical data consists of 30 thematic interviews (24 visually impaired persons, 1 family-member of a visually impaired person, 5 persons working with diversity issues), of supplementary articles, and of statistics on the socio-economic status of the visually impaired. The interviewees experiences of education and employment have been analysed by a qualitative method. The analysis has been deepened by reflecting it against the recent discussion on the concept of diversity. The author s methodological choice as a disability researcher has been to treat the interviewees as co-researchers rather than objects of research. Accessibility in its different forms is a prerequisite of diversity in the workplace, and this study examines what kind of accessibility is required by visually impaired professionals. Access to working life depends on the attitudes prejudices and expectations that society has towards a minority group. Social accessibility is connected with internal relationships in the workplace, and achieving social accessibility is a bilateral process. Information technology has revolutionised the visually impaired people s possibilities of accessing information and performing expert tasks. Accessible environment, good mobility skills, and transportation services enable visually impaired employees to get to their workplaces and to navigate there with ease. Integration has raised the level of education and widened the selection of career options for the visually impaired. However, even visually impaired people with academic degrees often need employment support services. Visually impaired professionals are mainly employed in the public and third sector. Achieving diversity in the labour market is a multiactor process. Social support services are needed, as well as courage and readiness from employers to hire people with disabilities. The organisations of the visually impaired play an important role in affecting the attitudes and providing peer support. Visually impaired employees need good professional skills, blindness skills, and social courage, and they need to be comfortable with their disability. In the workplace, diversity may actualise as diverse ways of working: the work is done by using technical aids or other means of compensating for the lack of eyesight. When an employee must find compensatory solutions for disability-related limitations at work, this will also develop his/her problem-solving abilities. Key words: visually impaired, diversity, accessibility, working life

The effects of the 2004 reduction in the price of alcohol on alcohol-related harm in Finland : A natural experiment based on register data

Changes in alcohol pricing have been documented as inversely associated with changes in consumption and alcohol-related problems. Evidence of the association between price changes and health problems is nevertheless patchy and is based to a large extent on cross-sectional state-level data, or time series of such cross-sectional analyses. Natural experimental studies have been called for. There was a substantial reduction in the price of alcohol in Finland in 2004 due to a reduction in alcohol taxes of one third, on average, and the abolition of duty-free allowances for travellers from the EU. These changes in the Finnish alcohol policy could be considered a natural experiment, which offered a good opportunity to study what happens with regard to alcohol-related problems when prices go down. The present study investigated the effects of this reduction in alcohol prices on (1) alcohol-related and all-cause mortality, and mortality due to cardiovascular diseases, (2) alcohol-related morbidity in terms of hospitalisation, (3) socioeconomic differentials in alcohol-related mortality, and (4) small-area differences in interpersonal violence in the Helsinki Metropolitan area. Differential trends in alcohol-related mortality prior to the price reduction were also analysed. A variety of population-based register data was used in the study. Time-series intervention analysis modelling was applied to monthly aggregations of deaths and hospitalisation for the period 1996-2006. These and other mortality analyses were carried out for men and women aged 15 years and over. Socioeconomic differentials in alcohol-related mortality were assessed on a before/after basis, mortality being followed up in 2001-2003 (before the price reduction) and 2004-2005 (after). Alcohol-related mortality was defined in all the studies on mortality on the basis of information on both underlying and contributory causes of death. Hospitalisation related to alcohol meant that there was a reference to alcohol in the primary diagnosis. Data on interpersonal violence was gathered from 86 administrative small-areas in the Helsinki Metropolitan area and was also assessed on a before/after basis followed up in 2002-2003 and 2004-2005. The statistical methods employed to analyse these data sets included time-series analysis, and Poisson and linear regression. The results of the study indicate that alcohol-related deaths increased substantially among men aged 40-69 years and among women aged 50-69 after the price reduction when trends and seasonal variation were taken into account. The increase was mainly attributable to chronic causes, particularly liver diseases. Mortality due to cardiovascular diseases and all-cause mortality, on the other hand, decreased considerably among the-over-69-year-olds. The increase in alcohol-related mortality in absolute terms among the 30-59-year-olds was largest among the unemployed and early-age pensioners, and those with a low level of education, social class or income. The relative differences in change between the education and social class subgroups were small. The employed and those under the age of 35 did not suffer from increased alcohol-related mortality in the two years following the price reduction. The gap between the age and education groups, which was substantial in the 1980s, thus further broadened. With regard to alcohol-related hospitalisation, there was an increase in both chronic and acute causes among men under the age of 70, and among women in the 50-69-year age group when trends and seasonal variation were taken into account. Alcohol dependence and other alcohol-related mental and behavioural disorders were the largest category in both the total number of chronic hospitalisation and in the increase. There was no increase in the rate of interpersonal violence in the Helsinki Metropolitan area, and even a decrease in domestic violence. There was a significant relationship between the measures of social disadvantage on the area level and interpersonal violence, although the differences in the effects of the price reduction between the different areas were small. The findings of the present study suggest that that a reduction in alcohol prices may lead to a substantial increase in alcohol-related mortality and morbidity. However, large population group differences were observed regarding responsiveness to the price changes. In particular, the less privileged, such as the unemployed, were most sensitive. In contrast, at least in the Finnish context, the younger generations and the employed do not appear to be adversely affected, and those in the older age groups may even benefit from cheaper alcohol in terms of decreased rates of CVD mortality. The results also suggest that reductions in alcohol prices do not necessarily affect interpersonal violence. The population group differences in the effects of the price changes on alcohol-related harm should be acknowledged, and therefore the policy actions should focus on the population subgroups that are primarily responsive to the price reduction.

Humanitaarisuuden varjossa : Poliittiset tekijät lastensiirroissa Ruotsiin sotiemme aikana ja niiden jälkeen

The evacuation of Finnish children to Sweden during WW II has often been called a small migration . Historical research on this subject is scarce, considering the great number of children involved. The present research has applied, apart from the traditional archive research, the framework of history-culture developed by Rüsen in order to have an all-inclusive approach to the impact of this historical event. The framework has three dimensions: political, aesthetic and cognitive. The collective memory of war children has also been discussed. The research looks for political factors involved in the evacuations during the Winter War and the Continuation War and the post-war period. The approach is wider than a purely humanitarian one. Political factors have had an impact in both Finland and Sweden, beginning from the decision-making process and ending with the discussion of the unexpected consequences of the evacuations in the Finnish Parliament in 1950. The Winter War (30.11.1939 13.3.1940) witnessed the first child transports. These were also the model for future decision making. The transports were begun on the initiative of Swedes Maja Sandler, the wife of the resigned minister of foreign affairs Rickard Sandler, and Hanna Rydh-Munck af Rosenschöld , but this activity was soon accepted by the Swedish government because the humanitarian help in the form of child transports lightened the political burden of Prime Minister Hansson, who was not willing to help Finland militarily. It was help that Finland never asked for and it was rejected at the beginning. The negative response of Minister Juho Koivisto was not taken very seriously. The political forces in Finland supporting child transports were stronger than those rejecting them. The major politicians in support belonged to Finland´s Swedish minority. In addition, close to 1 000 Finnish children remained in Sweden after the Winter War. No analysis was made of the reasons why these children did not return home. A committee set up to help Finland and Norway was established in Sweden in 1941. Its chairman was Torsten Nothin, an influential Swedish politician. In December 1941 he appealed to the Swedish government to provide help to Finnish children under the authority of The International Red Cross. This plea had no results. The delivery of great amounts of food to Finland, which was now at war with Great Britain, had automatically caused reactions among the allies against the Swedish imports through Gothenburg. This included the import of oil, which was essential for the Swedish navy and air force. Oil was later used successfully to force a reduction in commerce between Sweden and Finland. The contradiction between Sweden´s essential political interests and humanitarian help was solved in a way that did not harm the country´s vital political interests. Instead of delivering help to Finland, Finnish children were transported to Sweden through the organisations that had already been created. At the beginning of the Continuation War (25.6.1941 27.4.1945) negative opinion regarding child transports re-emerged in Finland. Karl-August Fagerholm implemented the transports in September 1941. In 1942, members of the conservative parties in the Finnish Parliament expressed their fear of losing the children to the Swedes. They suggested that Finland should withdraw from the inter-Nordic agreement, according to which the adoptions were approved by the court of the country where the child resided. This initiative failed. Paavo Virkkunen, an influential member of the conservative party Kokoomus in Finland, favoured the so-called good-father system, where help was delivered to Finland in the form of money and goods. Virkkunen was concerned about the consequences of a long stay in a Swedish family. The risk of losing the children was clear. The extreme conservative party (IKL, the Patriotic Movement of the Finnish People) wanted to alienate Finland from Sweden and bring Finland closer to Germany. Von Blücher, the German ambassador to Finland, had in his report to Berlin, mentioned the political consequences of the child transports. Among other things, they would bring Finland and Sweden closer to each other. He had also paid attention to the Nordic political orientation in Finland. He did not question or criticize the child transports. His main interest was to increase German political influence in Finland, and the Nordic political orientation was an obstacle. Fagerholm was politically ill-favoured by the Germans, because he had a strong Nordic political disposition and had criticised Germany´s activities in Norway. The criticism of child transports was at the same time criticism of Fagerholm. The official censorship organ of the Finnish government (VTL) denied the criticism of child transports in January 1942. The reasons were political. Statements made by members of the Finnish Parliament were also censored, because it was thought that they would offend the Swedes. In addition, the censorship organ used child transports as a means of active propaganda aimed at improving the relations between the two countries. The Finnish Parliament was informed in 1948 that about 15 000 Finnish children still remained in Sweden. These children would stay there permanently. In 1950 the members of the Agrarian Party in Finland stated that Finland should actively strive to get the children back. The party on the left (SKDL, the Democratic Movement of Finnish People) also focused on the unexpected consequences of the child transports. The Social Democrats, and largely Fagerholm, had been the main force in Finland behind the child transports. Members of the SKDL, controlled by Finland´s Communist Party, stated that the war time authorities were responsible for this war loss. Many of the Finnish parents could not get their children back despite repeated requests. The discussion of the problem became political, for example von Born, a member of the Swedish minority party RKP, related this problem to foreign policy by stating that the request to repatriate the Finnish children would have negative political consequences for the relations between Finland and Sweden. He emphasized expressing feelings of gratitude to the Swedes. After the war a new foreign policy was established by Prime Minister (1944 1946) and later President (1946 1956) Juho Kusti Paasikivi. The main cornerstone of this policy was to establish good relations with the Soviet Union. The other, often forgotten, cornerstone was to simultaneously establish good relations with other Nordic countries, especially Sweden, as a counterbalance. The unexpected results of the child evacuation, a Swedish initiative, had violated the good relations with Sweden. The motives of the Democratic Movement of Finnish People were much the same as those of the Patriotic Movement of Finnish People. Only the ideology was different. The Nordic political orientation was an obstacle to both parties. The position of the Democratic Movement of Finnish People was much better than that of the Patriotic Movement of Finnish People, because now one could clearly see the unexpected results, which included human tragedy for the many families who could not be re-united with their children despite their repeated requests. The Swedes questioned the figure given to the Finnish Parliament regarding the number of children permanently remaining in Sweden. This research agrees with the Swedes. In a calculation based on Swedish population registers, the number of these children is about 7 100. The reliability of this figure is increased by the fact that the child allowance programme began in Sweden in 1948. The prerequisite to have this allowance was that the child be in the Swedish population register. It was not necessary for the child to have Swedish nationality. The Finnish Parliament had false information about the number of Finnish children who remained in Sweden in 1942 and in 1950. There was no parliamentary control in Finland regarding child transports, because the decision was made by one cabinet member and speeches by MPs in the Finnish Parliament were censored, like all criticism regarding child transports to Sweden. In Great Britain parliamentary control worked better throughout the whole war, because the speeches regarding evacuation were not censored. At the beginning of the war certain members of the British Labour Party and the Welsh Nationalists were particularly outspoken about the scheme. Fagerholm does not discuss to any great extent the child transports in his memoirs. He does not evaluate the process and results as a whole. This research provides some possibilities for an evaluation of this sort. The Swedish medical reports give a clear picture of the physical condition of the Finnish children when arriving in Sweden. The transports actually revealed how bad the situation of the poorest children was. According to Titmuss, similar observations were made in Great Britain during the British evacuations. The child transports saved the lives of approximately 2 900 children. Most of these children were removed to Sweden to receive treatment for illnesses, but many among the healthy children were undernourished and some suffered from the effects of tuberculosis. The medical inspection in Finland was not thorough. If you compare the figure of 2 900 children saved and returned with the figure of about 7 100 children who remained permanently in Sweden, you may draw the conclusion that Finland as a country failed to benefit from the child transports, and that the whole operation was a political mistake with far-reaching consequenses. The basic goal of the operation was to save lives and have all the children return to Finland after the war. The difficulties with the repatriation of the children were mainly psychological. The level of child psychology in Finland at that time was low. One may question the report by Professor Martti Kaila regarding the adaptation of children to their families back in Finland. Anna Freud´s warnings concerning the difficulties that arise when child evacuees return are also valid in Finland. Freud viewed the emotional life of children in a way different from Kaila: the physical survival of a small child forces her to create strong emotional ties to the person who is looking after her. This, a characteristic of all small children, occurred with the Finnish children too, and it was something the political decision makers in Finland could not see during and after the war. It is a characteristic of all little children. Yet, such experiences were already evident during the Winter War. The best possible solution had been to limit the child transports only to children in need of medical treatment. Children from large and poor families had been helped by organising meals and by buying food from Denmark with Swedish money. Assisting Finland by all possible means should have been the basic goal of Fagerholm in September 1941, when the offer of child transports came from Sweden. Fagerholm felt gratitude towards the Swedes. The risks became clear to him only in 1943. The war children are today a rather scattered and diffuse group of people. Emotionally, part of these children remained in Sweden after the war. There is no clear collective memory, only individual memories; the collective memory of the war children has partly been shaped later through the activities of the war child associations. The main difference between the children evacuated in Finland (for example from Karelia to safer areas with their families) and the war children, who were sent abroad, is that the war children lack a shared story and experience with their families. They were outsiders . The whole matter is sensitive to many of such mothers and discussing the subject has often been avoided in families. The war-time censorship has continued in families through silence and avoidance and Finnish politicians and Finnish families had to face each other on this issue after the war. The lack of all-inclusive historical research has also prevented the formation of a collective awareness among war children returned to Finland or those remaining permanently abroad.. Knowledge of historical facts will help war-children by providing an opportunity to create an all-inclusive approach to the past. Personal experiences should be regarded as part of a large historical entity shadowed by war and where many political factors were at work in both Finland and Sweden. This means strengthening of the cognitive dimension discussed in Rüsen´s all-inclusive historical approach.

Part I: Enzyme replacement versus neurotrophic factor viral vector-mediated gene therapy of Parkinson’s disease, Part II: The effects of orally dosed tolcapone and entacapone on dopamine metabolism in the dorsal striatum and nucleus accumbens in rats

Part I: Parkinson’s disease is a slowly progressive neurodegenerative disorder in which particularly the dopaminergic neurons of the substantia nigra pars compacta degenerate and die. Current conventional treatment is based on restraining symptoms but it has no effect on the progression of the disease. Gene therapy research has focused on the possibility of restoring the lost brain function by at least two means: substitution of critical enzymes needed for the synthesis of dopamine and slowing down the progression of the disease by supporting the functions of the remaining nigral dopaminergic neurons by neurotrophic factors. The striatal levels of enzymes such as tyrosine hydroxylase, dopadecarboxylase and GTP-CH1 are decreased as the disease progresses. By replacing one or all of the enzymes, dopamine levels in the striatum may be restored to normal and behavioral impairments caused by the disease may be ameliorated especially in the later stages of the disease. The neurotrophic factors glial cell derived neurotrophic factor (GDNF) and neurturin have shown to protect and restore functions of dopaminergic cell somas and terminals as well as improve behavior in animal lesion models. This therapy may be best suited at the early stages of the disease when there are more dopaminergic neurons for neurotrophic factors to reach. Viral vector-mediated gene transfer provides a tool to deliver proteins with complex structures into specific brain locations and provides long-term protein over-expression. Part II: The aim of our study was to investigate the effects of two orally dosed COMT inhibitors entacapone (10 and 30 mg/kg) and tolcapone (10 and 30 mg/kg) with a subsequent administration of a peripheral dopadecarboxylase inhibitor carbidopa (30 mg/kg) and L- dopa (30 mg/kg) on dopamine and its metabolite levels in the dorsal striatum and nucleus accumbens of freely moving rats using dual-probe in vivo microdialysis. Earlier similarly designed studies have only been conducted in the dorsal striatum. We also confirmed the result of earlier ex vivo studies regarding the effects of intraperitoneally dosed tolcapone (30 mg/kg) and entacapone (30 mg/kg) on striatal and hepatic COMT activity. The results obtained from the dorsal striatum were generally in line with earlier studies, where tolcapone tended to increase dopamine and DOPAC levels and decrease HVA levels. Entacapone tended to keep striatal dopamine and HVA levels elevated longer than in controls and also tended to elevate the levels of DOPAC. Surprisingly in the nucleus accumbens, dopamine levels after either dose of entacapone or tolcapone were not elevated. Accumbal DOPAC levels, especially in the tolcapone 30 mg/kg group, were elevated nearly to the same extent as measured in the dorsal striatum. Entacapone 10 mg/kg elevated accumbal HVA levels more than the dose of 30 mg/kg and the effect was more pronounced in the nucleus accumbens than in the dorsal striatum. This suggests that entacapone 30 mg/kg has minor central effects. Also our ex vivo study results obtained from the dorsal striatum suggest that entacapone 30 mg/kg has minor and transient central effects, even though central HVA levels were not suppressed below those of the control group in either brain area in the microdialysis study. Both entacapone and tolcapone suppressed hepatic COMT activity more than striatal COMT activity. Tolcapone was more effective than entacapone in the dorsal striatum. The differences between dopamine and its metabolite levels in the dorsal striatum and nucleus accumbens may be due to different properties of the two brain areas.

Lippu, uhri, kansakunta : Ryhmäkokemukset ja -rajat Suomessa 1917 1945

This dissertation deals with the notions of sacrifice and violence in connection with the Fin¬nish flag struggles between 1917 and 1945. The study begins with the basic idea that sacrificial thinking is a key element in nationalism and the social cohesion of large groups. The method used in the study combines anthropological notions of totemism with psychoanalytical object relation theory. The aim is to explore the social and psychological elements of the Finnish national flag and the workers flags during the times of crisis and nation building. The phenomena and concepts addressed include self-sacrifice, scapegoating, remembrance of war, inclusion, and exclusion. The research is located at the intersection of nationalism studies and the cultural history of war. The analysis is based primarily on the press debates, public speeches and archival sources of the civic organizations that promoted the Finnish flag. The study is empirically divided into three sections: 1) the years of the Revolution and the Civil War (1917 1918), 2) the interwar period (1919 1938), and 3) the Second World War (1939 1945). The research demonstrates that the modern national flags and workers flags in Finland maintain certain characteristics of primitive totems. When referred to as a totem the flag means an emotionally charged symbol, a reservoir of the collective ideals of a large group. Thus the flag issue offers a path to explore the perceptions and memory of sacrifice and violence in the making of the First Republic . Any given large group, for example a nation, must conceptually pursue a consensus on its past sacrifices. Without productive interpretation sacrifice represents only meaningless violence. By looking at the passions associated with the flag the study also illuminates various group identities, boundaries and crossings of borders within the Finnish society at the same time. The study shows further that the divisive violence of the Civil War was first overcome in the late 1930s when the social democrats adopted a new perception of the Red victims of 1918 they were seen as part of the birth pains of the nation, and not only the martyrs of class struggle. At the same time the radical Right became marginalized. The study also illuminates how this development made the Spirit of the Winter War possible, a genuine albeit brief experience of horizontal brother and sisterhood, and how this spirit was reflected in the popular adoption of the Finnish flag. The experience was not based only on the external and unifying threat posed by the Soviet Union: it was grounded in a sense of unifying sacrifice which reflected a novel way of understanding the nation and its past sacrifices. Paradoxically, the newly forged consensus over the necessity and the rewards of the common sacrifices of the Winter War (1939 1940) made new sacrifices possible during the Continuation War (1941 1944). In spite of political discord and war weariness, the concept of a unified nation under the national flag survived even the absurdity of the stationary war phase. It can be said that the conflict between the idea of a national community and parliamentary party politics dissolved as a result of the collective experience of the Second World War.

Breathing, swallowing and voice in laryngeal disorsers

The aim of this work was to examine how breathing, swallowing and voicing are affected in different laryngeal disorders. For this purpose, we examined four different patient groups: patients who had undergone total laryngectomy, anterior cervical decompression (ACD), or injection laryngoplasty with autologous fascia (ILAF), and patients with dyspnea during exercise. We studied the problems and benefits related to the automatic speech valve used for the rehabilitation of speech in laryngectomized patients. The device was given to 14 total laryngectomized patients who used the traditional valve especially well. The usefulness of voice and intelligibility of speech were assessed by speech pathologists. The results demonstrated better performance with the traditional valve in both dimensions. Most of the patients considered the automatic valve a helpful additional device but because of heavier breathing and the greater work needed for speech production, it was not suitable as a sole device in speech rehabilitation. Dysphonia and dysphagia are known complications of ACD. These symptoms are caused due to the stretching of tissue needed during the surgery, but the extent and the recovery from them was not well known before our study. We studied two patient groups, an early group with 50 patients who were examined immediately before and after the surgery and a late group with 64 patients who were examined 3 9 months postoperatively. Altogether, 60% reported dysphonia and 69% dysphagia immediately after the operation. Even though dysphagia and dysphonia often appeared after surgery, permanent problems seldom occurred. Six (12 %) cases of transient and two (3 %) permanent vocal cord paresis were detected. In our third study, the long-term results of ILAF in 43 patients with unilateral vocal cord paralysis were examined. The mean follow-up was 5.8 years (range 3 10). Perceptual evaluation demonstrated improved results for voice quality, and videostroboscopy revealed complete or partial glottal closure in 83% of the patients. Fascia showed to be a stable injection material with good vocal results. In our final study we developed a new diagnostic method for exertional laryngeal dyspnea by combining a cardiovascular exercise test with simultaneous fiberoptic observation of the larynx. With this method, it is possible to visualize paradoxal closure of the vocal cords during inspiration, which is a diagnostic criterion for vocal cord dysfunction (VCD). We examined 30 patients referred to our hospital because of suspicion of exercise-induced vocal cord dysfunction (EIVCD). Twenty seven out of thirty patients were able to perform the test. Dyspnea was induced in 15 patients, and of them five had EIVCD and four high suspicion of EIVCD. With our test it is possible to set an accurate diagnosis for exertional laryngeal dyspnea. Moreover, the often seen unnecessary use of asthma drugs among these patients can be avoided.

Työ- ja pääomapanokset maidontuotannon kannattavuustekijöinä - asema- ja automaattilypsytilojen vertailu

Maatalousyrittäjä toimii muuttuvassa toimintaympäristössä, jonka muutokset asettavat yrittäjälle ja yritykselle haasteita ja vaatimuksia. Tuotantoteorian mukaisesti maatalousyrittäjän oletetaan maksimoivan voittoa ja/tai minimoimaan kustannuksia. Tavoitteen saavuttamiseksi yrittäjä sopeuttaa tuotosmääriään ja panoskäyttöään vallitsevien olosuhteiden mukaan. Tuotantoteknologialla voidaan puolestaan vaikuttaa siihen, millaisia panoksia tuotoksen aikaansaamiseksi tarvitaan. Maidontuotannossa lypsyjärjestelmä on yksi keskeinen teknologiavalinta. Kannattavuus on Suomessa kriittinen tekijä maataloustuotannon kilpailukykyä ja pitkän ajan toimintaedellytyksiä ajatellen. Yhtenä merkittävänä tuotantokustannuksiin vaikuttavana tekijänä maidontuotannossa voidaan pitää keskimäärin korkeaa työkustannusta tuoteyksikköä kohden. Rakennekehityksellä tavoitellaan suurtuotannon etuja ja yksikkökustannusten alentamista. Yrityskoon kasvattamisen yhteyteen liittyy usein uuden tuotantoteknologian käyttöönotto. Uudella teknologialla ja siihen sijoitetulla pääomalla korvataan yhä kallistuvaa työpanosta. Uutta teknologiaa edustavat mm. automaattinen lypsyjärjestelmä. Keskeisintä kehityksessä on, että viljelijöiden on ollut mahdollista vähentää työn määrää tuotettua yksikköä kohti. Tämä on helpottanut tilakoon kasvua ja samalla on ollut mahdollista kasvattaa työmenekin silti olennaisesti kasvamatta. Ensimmäiset automaattilypsyjärjestelmät otettiin Suomessa käyttöön vuonna 2000 ja vuoden 2009 lopussa niitä oli jo 563 laitetta yhteensä 465 maidontuotantotilalla. Tutkimuksen tarkoituksena oli tutkia asema- ja automaattilypsyä käyttävien tilojen tuottavuus- ja kannattavuuseroja ja miten investoinneilla pystytään korvaamaan työtä. Aineistona käytettiin maatalouden kannattavuuskirjanpitoaineistoa vuosilta 2005- 2008. Tutkimusaineistossa olivat mukana kaikki tilat, joilla tutkimusjakson alussa oli automaattinen lypsyjärjestelmä tai jotka siirtyivät siihen ajanjakson aikana. Automaattilypsytilojen vertailuryhmänä olivat maidontuotantoon keskittyneet samaan kokoluokkaan kuuluvat asemalypsytilat. Lypsyjärjestelmän valinnan maidontuottaja tekee omista lähtökohdistaan. Tässä tutkimuksessa tehty lypsyjärjestelmän taloudellinen valintaperusteiden tarkastelu osoittaa, että uuden teknologian käyttöönotto on haasteellista. Valinnan taustalla olevat odotukset eivät välttämättä toteudu ainakaan heti investoinnin jälkeisinä vuosina. Työn tuottavuus, määriteltynä työtuntia kohden tuotettuina maitokiloina, oli automaattilypsytiloilla parempi kuin asematiloilla. Pääoman tuottavuus, määriteltynä lypsykarjatalouden pääomaa (1000 €) kohti tuotettuina maitokiloina oli puolestaan asemalypsytiloilla parempi kuin automaattilypsytiloilla. Asemalypsytiloilla nettotuottavuus, työn sekä pääoman nettotuottavuudet olivat parempia kuin automaattitiloilla. Automaattitilojen kokonaistuottavuuden muutos oli 7,49 %, kun asematiloilla se oli vain 2,30 % tutkimusajanjakson aikana. Lehmää kohti työkustannukset pienenivät ja maksettujen korkojen määrät kasvoivat kummallakin lypsytavalla. Verrattaessa työkustannusten ja maksettujen korkomenojen muutosta voitiin havaita, että työkustannukset eivät automaattilypsytiloilla kuitenkaan pienentyneet niin paljon, että ne olisivat kattaneet maksettujen korkomenojen lisäyksen. Kannattavuuskertoimen perusteella kumpikaan tilaryhmä ei saavuttanut asettamiaan tavoitteita oman työn palkkavaatimuksen eikä oman pääoman korkovaatimuksen suhteen. Asemalypsytiloilla kannattavuus oli parempi ja yrittäjäntappio oli alhaisempi kuin automaattitiloilla.

Electrocardiographic parameters of ventricular repolarization : modifiers and the prognostic value

Electric activity of the heart consists of repeated cardiomyocyte depolarizations and repolarizations. Abnormalities in repolarization predispose to ventricular arrhythmias. In body surface electrocardiogram, ventricular repolarization generates the T wave. Several electrocardiographic measures have been developed both for clinical and research purposes to detect repolarization abnormalities. The study aim was to investigate modifiers of ventricular repolarization with the focus on the relationship of the left ventricular mass, antihypertensive drugs, and common gene variants, to electrocardiographic repolarization parameters. The prognostic value of repolarization parameters was also assessed. The study subjects originated from a population of more than 200 middle-aged hypertensive men attending the GENRES hypertension study, and from an epidemiological survey, the Health 2000 Study, including more than 6000 participants. Ventricular repolarization was analysed from digital standard 12-lead resting electrocardiograms with two QT-interval based repolarization parameters (QT interval, T-wave peak to T-wave end interval) and with a set of four T-wave morphology parameters. The results showed that in hypertensive men, a linear change in repolarization parameters is present even in the normal range of left ventricular mass, and that even mild left ventricular hypertrophy is associated with potentially adverse electrocardiographic repolarization changes. In addition, treatments with losartan, bisoprolol, amlodipine, and hydrochlorothiazide have divergent short-term effects on repolarization parameters in hypertensive men. Analyses of the general population sample showed that single nucleotide polymorphisms in KCNH2, KCNE1, and NOS1AP genes are associated with changes in QT-interval based repolarization parameters but not consistently with T-wave morphology parameters. T-wave morphology parameters, but not QT interval or T-wave peak to T-wave end interval, provided independent prognostic information on mortality. The prognostic value was specifically related to cardiovascular mortality. The results indicate that, in hypertension, altered ventricular repolarization is already present in mild left ventricular mass increase, and that commonly used antihypertensive drugs may relatively rapidly and treatment-specifically modify electrocardiographic repolarization parameters. Common variants in cardiac ion channel genes and NOS1AP gene may also modify repolarization-related arrhythmia vulnerability. In the general population, T-wave morphology parameters may be useful in the risk assessment of cardiovascular mortality.

Suomen suuriruhtinaskunnan virkamiehistön yksityiskirjastot ja sensuurin kieltämä kirjallisuus niissä 1800-luvun alkuvuosikymmeninä

Tutkimus luotaa 1800-luvun alkuvuosikymmenten Suomen suuriruhtinaskunnan virkamiehistön poliittisia asenteita sensuuri-ja painovapauskysymysten valossa. Sadan virkamiehistöön kuuluneen henkilön yksityiskirjastot ja niiden sisältämät mahdolliset sensuurin kieltämät nimikkeet on seulottu Kansalliskirjaston kokoelmissa olevista 1800- luvun kirjahuutokauppaluetteloista vertailemalla niitä Kansallisarkistossa säilytettäviin sensuuriviranomaisten kiellettyjen teosten listoihin. Tutkimuksen keskeisimmiksi teemoiksi nousevat näin poliittis- sekä kirjahistorialliset, kirjallista kulttuuria koskettelevat ulottuvuudet. Virkamiehistön yksityiskirjastot mahdollisine kiellettyine nimikkeineen on esitelty tilastollisen taulukoinnin avulla kirjastojen koon, virkamiehistön hallintoalan, rankiluokan sekä alueellisen identiteetin mukaan jaoteltuina. Vaikka lähdeaineiston perusteella on tämänkaltaisen poliittisväritteisen kirjallisen kulttuurin tavoittaminen osaksi ongelmallista, ovat huutokauppaluettelot systemaattisesta ja säännöllisestä luonteestaan johtuen merkittävää ja satunnaisten inventaarioluetteloiden ohella lähestulkoon ainoaa käsillä olevaa yksityiskirjastoja koskevaa lähdeaineistoa. Suomen 1800-luvun valtiolliseen asemaan liittyviä historiantulkintoja on tutkimuksen edetessä pyritty kuljettamaan rinnakkain; niitä ovat toisaalta suomalaisten käsitykset maansa perustuslaillisesta asemasta ja toisaalta venäläisten viranomaisten tulkinnat Suomen asemasta yleisvaltakunnallisessa viitekehyksessä. Tämän ohella tutkimusaihetta on lähestytty sen ajalliseeen kontekstiin olennaisesti kytkeytyvien yhteiskunta-ja historianfilosofisten teorioiden avulla. Ne ovat olleet myös tutkimuksen kohteena olleille aikalaisille relevantti henkinen ulottuvuus. Tämä on perusteltua, koska filosofista ja valtiotieteellistä kirjallisuutta on ollut kirjastoissa paljon. Etiikasta ja moraalista lähtevä vapauden ongelma on ollut yksi tämänkaltainen yhteiskuntafilosofinen kysymys. Tutkimuksessa aika ajoin esiin nouseva aatteellinen vertailu muiden Euroopan maiden oloihin laajentaa tutkimuksen historiallisen viitekehyksen osaksi 1800-luvun eurooppalaisen henkisen aatemaailman maisemaa. Tutkimuksen varovaiset johtopäätökset juontuvat erilaisista näkökulmista. Kiellettyjä nimikkeitä löytyi hieman yli 30 % kaikista virkamiehistön yksityiskirjastoista, mutta kiellettyjen nimikkeiden määrät osoittautuivat kirjastokohtaisesti laskettuna pienehköiksi. Ilmiön voi näin väittää olleen toisaalta marginaalista, mutta toisaalta konkreettinen osoitus poliittiseen vakaumukseen viittaavasta asennoitumisesta; sensuuria esimerkiksi saatettiin tulkita perustuslaillisuutta ja Aleksanteri I:n antaman hallitsijanvakuutuksen taustaa vasten. Kielletyn kirjallisuuden hankkiminen sensuurilaeista piittaamatta saattoi myös olla kamppailua hyvänä pidetyn yhteiskuntajärjestyksen puolesta järjestelmän epäkohtia vastaan. Keisaria kohtaan tunnettiin lojaalisuutta, mutta hänen hallitsemaansa järjestelmää edustavia sensuuriviranomaisia kohtaan välttämättä ei. Tässä kohdin Suomen tilanteella oli vastaavuutta Saksan oloihin, j o s s a nuorhegeliläiset halusivat muuttaa yhteiskuntaa ideaalimpaan suuntaan. Venäjän keisarikuntaan kuuluminen toi mukanaan maallista hyvää, mutta henkisen kulttuurin puolella orientoiduttiin pääasiassa länteen, ja pitäydyttiin Ruotsin ajan luomassa perinnössä. Yksi keskeinen tästä kummunnut valistusaatteen traditionaalinen arvo oli itsensä vapaa kehittäminen, joten sensuurikysymyksissä ajauduttiin väistämättä törmäyskurssille valtiopoliittisen ja kulttuurisen identiteetin ristipaineessa. Vaikka valtiopoliittinen identiteetti vaihtui vuoden 1809 jälkeen, ei kulttuurisen identiteetin kohdalla näin käynyt. Tätä kautta vahvistuu kokonaiskuva 1700-luvun historian ja Ruotsin ajan perinnön tärkeydestä 1800-luvun henkiselle kehitykselle etenkin kirjallisen kulttuurin saralla.

Functional limitations and quality of life in schizophrenia and other psychotic disorders

There is substantial evidence of the decreased functional capacity, especially everyday functioning, of people with psychotic disorder in clinical settings, but little research about it in the general population. The aim of the present study was to provide information on the magnitude of functional capacity problems in persons with psychotic disorder compared with the general population. It estimated the prevalence and severity of limitations in vision, mobility, everyday functioning and quality of life of persons with psychotic disorder in the Finnish population and determined the factors affecting them. This study is based on the Health 2000 Survey, which is a nationally representative survey of 8028 Finns aged 30 and older. The psychotic diagnoses of the participants were assessed in the Psychoses of Finland survey, a substudy of Health 2000. The everyday functioning of people with schizophrenia is studied widely, but one important factor, mobility has been neglected. Persons with schizophrenia and other non-affective psychotic disorders, but not affective psychoses had a significantly increased risk of having both self-reported and test-based mobility limitations as well as weak handgrip strength. Schizophrenia was associated independently with mobility limitations even after controlling for lifestyle-related factors and chronic medical conditions. Another significant factor associated with problems in everyday functioning in participants with schizophrenia was reduced visual acuity. Their vision was examined significantly less often during the five years before the visual acuity measurement than the general population. In general, persons with schizophrenia and other non-affective psychotic disorder had significantly more limitations in everyday functioning, deficits in verbal fluency and in memory than the general population. More severe negative symptoms, depression, older age, verbal memory deficits, worse expressive speech and reduced distance vision were associated with limitations in everyday functioning. Of all the psychotic disorders, schizoaffective disorder was associated with the largest losses of quality of life, and bipolar I disorder with equal or smaller losses than schizophrenia. However, the subjective loss of qualify of life associated with psychotic disorders may be smaller than objective disability, which warrants attention. Depressive symptoms were the most important determinant of poor quality of life in all psychotic disorders. In conclusion, subjects with psychotic disorders need regular somatic health monitoring. Also, health care workers should evaluate the overall quality of life and depression of subjects with psychotic disorders in order to provide them with the basic necessities of life.

Methods in general model localization

The aim of this study was to evaluate and test methods which could improve local estimates of a general model fitted to a large area. In the first three studies, the intention was to divide the study area into sub-areas that were as homogeneous as possible according to the residuals of the general model, and in the fourth study, the localization was based on the local neighbourhood. According to spatial autocorrelation (SA), points closer together in space are more likely to be similar than those that are farther apart. Local indicators of SA (LISAs) test the similarity of data clusters. A LISA was calculated for every observation in the dataset, and together with the spatial position and residual of the global model, the data were segmented using two different methods: classification and regression trees (CART) and the multiresolution segmentation algorithm (MS) of the eCognition software. The general model was then re-fitted (localized) to the formed sub-areas. In kriging, the SA is modelled with a variogram, and the spatial correlation is a function of the distance (and direction) between the observation and the point of calculation. A general trend is corrected with the residual information of the neighbourhood, whose size is controlled by the number of the nearest neighbours. Nearness is measured as Euclidian distance. With all methods, the root mean square errors (RMSEs) were lower, but with the methods that segmented the study area, the deviance in single localized RMSEs was wide. Therefore, an element capable of controlling the division or localization should be included in the segmentation-localization process. Kriging, on the other hand, provided stable estimates when the number of neighbours was sufficient (over 30), thus offering the best potential for further studies. Even CART could be combined with kriging or non-parametric methods, such as most similar neighbours (MSN).

Vastasyntyneen varsan sepsis osa II - Infektion diagnosoiminen, aiheuttajamikrobit ja mikrobilääkeresistenssi

Sepsis eli infektion aiheuttama yleistynyt tulehdusreaktio on merkittävä kuolleisuuden aiheuttaja vastasyntyneillä varsoilla. Kirjallisuuskatsauksessa on käsitelty sepsiksen patofysiologiaa ja kliinisiä oireita vastasyntyneillä varsoilla sekä sepsikselle altistavia tekijöitä. Vastasyntyneen varsan sepsiksen diagnosoimisessa kliinisten oireiden arvioinnilla on keskeinen merkitys sairauden varhaisessa tunnistamisessa ja hoidon aloittamisessa. Sairauden nopean etenemisen ja veriviljelytulosten hitaan valmistumisen vuoksi antibioottihoito joudutaan aloittamaan jo ennen viljelytulosten valmistumista. Veriviljelyllä on kuitenkin tärkeä merkitys sepsisdiagnoosin ja valitun antibioottihoidon varmistamisessa. Sairaalakohtaisten veriviljelynäytetulosten seuranta mahdollistaa ensisijaisen mikrobilääkkeen valinnan aiemmin eristettyjen aiheuttajamikrobien esiintyvyyden ja mikrobilääkeherkkyyksien perusteella. Yleisimpiä vastasyntyneen varsan sepsiksen aiheuttajia ovat kirjallisuuden mukaan suolistoperäiset gram-negatiiviset bakteerit. Escherichia colin osuus vastasyntyneiltä varsoilta otetuista veriviljelynäytteistä eristetyistä bakteerikannoista on vaihdellut eri tutkimuksissa 18,7 - 50,0 %. Pohjois-Amerikassa tehdyissä tutkimuksissa varsojen veriviljelynäytteistä eristettyjen E.coli -kantojen herkkyys yleisesti käytetylle trimetopriimi-sulfadiatsiinille on ollut huono (57–71 %). Penisilliinin ja gentamisiinin yhdistelmälle enterobakteerien herkkyyden on raportoitu olevan hyvä. Suomessa tilanteen on arvioitu olevan parempi. Tutkimuksessa kartoitettiin retrospektiivisesti veriviljelyn käyttöä varsojen sepsiksen diagnostiikassa, sepsiksen aiheuttajamikrobien esiintymistä ja mikrobilääkkeiden käyttöä Yliopistollisessa eläinsairaalassa (YES) vuosina 2004–2006. Tutkimusaineisto koostuu yhteensä 90 korkeintaan 10 päivän ikäisenä YES:aan tuodun varsan potilastiedoista. Sairaalaan saapuneista varsoista 30 % oli otettu veriviljelynäyte. Veriviljelynäytteistä positiivisia oli 62,5 %. 60 % positiivisista näytteistä kasvoi vähintään kahta bakteerilajia. Yleisin aiheuttajabakteeri oli Escherichia coli (23,1 %). Yksi eristetyistä E.coli -kannoista oli resistentti ampisilliinille, gentamisiinille ja trimetopriimi-sulfadiatsiinille. Aineiston pienen koon vuoksi tutkimus ei kuitenkaan anna luotettavaa kuvaa eristettyjen aiheuttajamikrobien mikrobilääkeherkkyydestä laajemmin. Sekakasvujen osuus oli suuri ja tyypillisten veriviljelynäytteitä kontaminoivien bakteerilajien (Streptococcus viridans sp., Micrococcus sp., koagulaasinegatiiviset stafylokokit) osuus oli yli 30 % eristetyistä bakteerikannoista. Tämä viittaa ongelmiin veriviljelynäytteenottotekniikassa riittävän aseptiikan saavuttamien osalta. Koagulaasinegatiiviset stafylokokit voivat myös aiheuttaa sepsiksen, mutta niiden merkitys vastasyntyneiden varsojen sepsiksen aiheuttajina on epäselvä.

Excimer laser refractive surgery : corneal wound healing and clinical results

Although the first procedure in a seeing human eye using excimer laser was reported in 1988 (McDonald et al. 1989, O'Connor et al. 2006) just three studies (Kymionis et al. 2007, O'Connor et al. 2006, Rajan et al. 2004) with a follow-up over ten years had been published when this thesis was started. The present thesis aims to investigate 1) the long-term outcomes of excimer laser refractive surgery performed for myopia and/or astigmatism by photorefractive keratectomy (PRK) and laser-in situ- keratomileusis (LASIK), 2) the possible differences in postoperative outcomes and complications when moderate-to-high astigmatism is treated with PRK or LASIK, 3) the presence of irregular astigmatism that depend exclusively on the corneal epithelium, and 4) the role of corneal nerve recovery in corneal wound healing in PRK enhancement. Our results revealed that in long-term the number of eyes that achieved uncorrected visual acuity (UCVA)≤0.0 and ≤0.5 (logMAR) was higher after PRK than after LASIK. Postoperative stability was slightly better after PRK than after LASIK. In LASIK treated eyes the incidence of myopic regression was more pronounced when the intended correction was over >6.0 D and in patients aged <30 years.Yet the intended corrections in our study were higher for LASIK than for PRK eyes. No differences were found in percentages of eyes with best corrected visual acuity (BCVA) or loss of two or more lines of visual acuity between PRK and LASIK in the long-term. The postoperative long-term outcomes of PRK with two different delivery systems broad beam and scanning laser were compared and revealed no differences. Postoperative outcomes of moderate-to-high astigmatism yielded better results in terms of UCVA and less compromise or loss of two more lines of BCVA after LASIK that after PRK.Similar stability for both procedures was revealed. Vector analysis showed that LASIK outcomes tended to be more accurate than PRK outcomes, yet no statistically differences were found. Irregular astigmatism secondary to recurrent corneal erosion due to map-dot-fingerprint was successfully treated with phototherapeutic keratectomy (PTK). Preoperative videokeratographies (VK) showed irregular astigmatism. However, postoperatively, all eyes showed a regular pattern. No correlation was found between pre- and postoperative VK patterns. Postoperative outcomes of late PRK in eyes originally subjected to LASIK showed that all (7/7) eyes achieved UCVA ≤0.5 at last follow-up (range 3 — 11 months), and no eye lost lines of BCVA. Postoperatively all eyes developed and initial mild haze (0.5 — 1) into the first month. Yet, at last follow-up 5/7 eyes showed a haze of 0.5 and this was no longer evident in 2/7 eyes. Based on these results, we demonstrated that the long-term outcomes after PRK and LASIK were safe and efficient, with similar stability for both procedures. The PRK outcomes were similar when treated by broad-beam or scanning slit laser. LASIK was better than PRK to correct moderate-to-high astigmatism, yet both procedures showed a tendency of undercorrection. Irregular astigmatism was proven to be able to depend exclusively from the corneal epithelium. If this kind of astigmatism is present in the cornea and a customized PRK/LASIK correction is done based on wavefront measurements an irregular astigmatism may be produced rather than treated. Corneal sensory nerve recovery should have an important role in the modulation of the corneal wound healing and post-operative anterior stromal scarring. PRK enhancement may be an option in eyes with previous LASIK after a sufficient time interval that in at least 2 years.