Focus on Form : J. J. Tikkanen, Giotto and Art Research in the 19th Century

My doctoral dissertation is on Johan Jakob Tikkanen (1857 1930), the first professor of art history in Finland, and his significance and methods in the context of late 19th and early 20th-century European art history. Tikkanen was one of the pioneering scholars in the field of medieval art research, and, along with Anton Springer, Heinrich Wölfflin, Aloïs Riegl, Adolfo Venturi, Franz Wickhoff, Julius von Schlosser, Aby Warburg, Emile Mâle and others, one of the scholars who defined art history as an independent academic discipline. Tikkanen s scholarly interests and his methods resemble those of many formalistically oriented German and Austrian art historians of his time. He became well known throughout Europe, mainly for his studies on illustrated medieval manuscripts. Tikkanen s dissertation, Der Malerische Styl Giotto s Versuch zu einer Characteristik Desselben, from 1884 was regarded in its day as the best form-analytical study on the painter. It has a central position in the present thesis, as it already included nearly all the methods that Tikkanen used and elaborated upon throughout his career. Giotto also gives a good perspective for comparing Tikkanen s ideas with a long art-historical tradition. Tikkanen was profoundly interested in artistic creativity. In his own words, he wanted to study das künstlerische Können , artistic ability, instead of das künstlerische Wollen or artistic will, which was an important theoretical issue in art history in the late 19th century. This starting point led him to the history of style and iconographical research. Along with the Danish art historian, Julius Lange, he was one of the first scholars who began to study the meaning of gestures and postures in art. In my dissertation I have emphasized the importance of Tikkanen s personal art education. I regard it as having influenced both his scholarly argumentation and his working methods. I have also written a short overview of the situation of art history in Finland and in Northern Countries before Tikkanen s time in order to give an idea of his scientific background. My thesis is a critical and historiographical study on J. J. Tikkanen s role in the development of art history and its methodology.

Campylobacter Infections of Domestic Origin in Finland

Campylobacter jejuni and C. coli are the leading causes of human bacterial gastroenteritis in developed countries. Most human Campylobacter infections are sporadic and a seasonal peak in the distribution of infections can be seen in the summer months in several countries, including Finland. A variety of risk factors for Campylobacter infections have been identified; handling and eating poultry, drinking unpasteurized milk, contact with domestic animals, and travelling abroad. However, the relative importance of the different risk factors in sporadic cases of Campylobacter infection remains unknown. In most cases, the infection is self-limiting and no specific treatment is required. Campylobacter enteritis can cause a wide range of complications, including reactive arthritis (ReA) that is reported in 1-5% of the cases. Seven clinical microbiology laboratories serving different geographical areas of Finland, participated in this multi-centre study, conducted during a seasonal peak in 2002. In a matched case-control study, domestically-acquired sporadic Campylobacter infections from three geographical areas were collected. The final study comprised 100 cases and 137 controls. Risk factors for sporadic domestically-acquired Campylobacter infections were identified on the basis of a questionnaire; swimming in natural waters was found to be a novel risk factor for Campylobacter infection. Other independent risk factors were tasting or eating raw or undercooked meat and drinking untreated water from a dug well. The role of bacterial strain and host characteristics are not fully understood in Campylobacter infections. Exposure factors, demographical characteristics, and the serotype of the Campylobacter isolate may affect the severity of the enteritis. This cross-sectional study comprised 114 patients with C. jejuni enteritis, diagnosed in three clinical microbiology laboratories; most of the patients had participated in the previous case-control study. Swimming was associated with age ≤ 5 years and serotype Pen 6,7 was found significantly more often among patients reporting swimming. The geographical distribution among serotypes varied; serotype Pen 4-complex appeared more often in patients from urban areas and serotype Pen 21 among patients from more rural areas. Thus, risk factors and sources of infection for C. jejuni infection may vary among individuals depending on age and geographical location. The in vitro susceptibilities of C. jejuni and C. coli strains isolated from patients infected abroad (85 strains) or domestically (393 strains) revealed that susceptibility to erythromycin is still high, even among isolates of foreign origin. However, the novel antimicrobial agent telithromycin did not offer any advantage over erythromycin; isolates with high minimal inhibitory concentrations (MICs) for erythromycin also showed reduced susceptibility to telithromycin. Reduced susceptibility to fluoroquinolones was detected almost exclusively among isolates of foreign origin and half of these isolates with high MICs for fluoroquinolones also showed elevated MICs for doxycycline. Questionnaires concerning complications associated with C. jejuni enteritis were sent to patients two months after becoming ill; 201 patients from seven different geographical areas were included in the study. Musculoskeletal complications after C. jejuni infection were commonly reported by patients (39%). The incidence of classical ReA was 4% and that of Achilles enthesopathy and/or heel pain 9%. Other C. jejuni-associated reactive joint symptoms were commonly reported, however, due to their milder nature seldom seen and diagnosed by a physician. The severity of the enteritis may predict further complications; stomach ache during enteritis was connected to the development of later joint pain. Early antimicrobial treatment, within two days from the start of symptoms, shortened the duration of diarrhoea by two days but did not prevent later musculoskeletal complications. Campylobacter is an important human enteropathogen and causes a significant burden of illness. As the incidence of Campylobacter infections is high, the importance of the infection and the occurrence of complications will increase. This stresses the importance of understanding the risk factors for acquiring Campylobacter infection and how bacterial strain and host characteristics may affect the risk for infection. The role of antimicrobial treatment for acute Campylobacter enteritis seems to be marginal and should be used restrictively.

Novel insights on functions of myotilin/palladin family members

Poikkijuovaisen luuranko- ja sydänlihaksen supistumisyksikkö, sarkomeeri, koostuu tarkoin järjestyneistä aktiini- ja myosiinisäikeistä. Rakenne eroaa muista solutyypeistä, joissa aktiinisäikeistö muovautuu jatkuvasti ja sen järjestyminen säätelee solun muotoa, solujakautumista, soluliikettä ja solunsisäisten organellien kuljetusta. Myotilin, palladin ja myopalladin kuuluvat proteiiniperheeseen, jonka yhteispiirteenä ovat immunoglobuliinin kaltaiset (Igl) domeenit. Proteiinit liittyvät aktiinitukirankaan ja niiden arvellaan toimivan solutukirangan rakenne-elementteinä ja säätelijöinä. Myotilinia ja myopalladinia ilmennetään poikkijuovaisessa lihaksessa. Sen sijaan palladinin eri silmukointimuotoja tavataan monissa kudostyypeissä kuten hermostossa, ja eri muodoilla saattaa olla solutyypistä riippuvia tehtäviä. Poikkijuovaisessa lihaksessa kaikki perheen jäsenet sijaitsevat aktiinisäikeitä yhdistävässä Z-levyssä ja ne sitovat Z-levyn rakenneproteiinia, -aktiniinia. Myotilingeenin pistemutaatiot johtavat periytyviin lihastauteihin, kun taas palladinin mutaatioiden on kuvattu liittyvän periytyvään haimasyöpään ja lisääntyneeseen sydäninfarktin riskiin. Tässä tutkimuksessa selvitettin myotilinin ja pallainin toimintaa. Kokeissa löydettiin uusia palladinin 90-92kDa alatyyppiin sitoutuvia proteiineja. Yksi niistä on aktiinidynamiikkaa säätelevä profilin. Profilinilla on kahdenlaisia tehtäviä; se edesauttaa aktiinisäikeiden muodostumista, mutta se voi myös eristää yksittäisiä aktiinimolekyylejä ja edistää säikeiden hajoamista. Solutasolla palladinin ja profilinin sijainti on yhtenevä runsaasti aktiinia sisältävillä solujen reuna-alueilla. Palladinin ja profilinin sidos on heikko ja hyvin dynaaminen, joka sopii palladinin tehtävään aktiinisäideiden muodostumisen koordinoijana. Toinen palladinin sitoutumiskumppani on aktiinisäikeitä yhteensitova -aktiniini. -Aktiniini liittää solutukirangan solukalvon proteiineihin ja ankkuroi solunsisäisiä viestintämolekyylejä. Sitoutumista välittävä alue on hyvin samankaltainen palladinissa ja myotilinissa. Luurankolihaksen liiallinen toistuva venytys muuttaa Z-levyjen rakennetta ja muotoa. Prosessin aikana syntyy uusia aktiinifilamenttejä sisältäviä tiivistymiä ja lopulta uusia sarkomeereja. Löydöstemme perusteella myotilinin uudelleenjärjestyminen noudattaa aktiinin muutoksia. Tämä viittaa siihen, että myotilin liittää yhteen uudismuodostuvia aktiinisäikeitä ja vakauttaa niitä. Myotilin saattaa myös ankkuroida viesti- tai rakennemolekyylejä, joiden tehtävänä on edesauttaa Z-levyjen uudismuodostusta. Tulostemme perusteella arvelemme, että myotilin toimii Z-levyjen rakenteen vakaajana ja aktiinisäikeiden säätelijänä. Palladinin puute johtaa sikiöaikaiseen kuolemaan hiirillä, mutta myotilinin puutoksella ei ole samanlaisia vaikutuksia. Tuotettujen myotilin poistogeenisten hiirten todetiin syntyvän ja kehittyvän normaalisti eikä niillä esiintynyt rakenteellisia tai toiminnallisia häiriöitä. Toisaalta aiemmissa kokeissa, joissa hiirille on siirretty ihmisen lihastautia aikaansaava myotilingeeni, nähdään samankaltaisia kuin sairailla ihmisillä. Näin ollen muuntunut myotilin näyttä olevan lihaksen toiminnalle haitallisempi kuin myotilinin puute. Myotilinin ja palladinin yhteisvaikutusta selvittääksemme risteytimme myotilin poistegeenisen hiiren ja hiirilinjan, joka ilmentää puutteellisesti palladinin 200 kDa muotoa. Puutteellisesti 200 kDa palladinia ilmentävien hiirten sydänlihaksessa todettiin vähäisiä hienorakenteen muutoksia, mutta risteytetyillä hiirillä tavattiin rakenteellisia ja toiminnallisia muutoksia myös luurankolihaksessa. Tulosten perusteella voidaan todeta, että palladinin 200 kDa muoto säätelee sydänlihassolujen rakennetta. Luurankolihaksessa sen sijaan myotilinilla ja palladinilla näyttäisi olevan päällekkäisiä tehtäviä.

Agronomic challenges for organic crop husbandry

With respect to resource management and environmental impact, organic farming offers rationales for agricultural sustainability. However, agronomic productivity is usually higher with conventional farming. This work aimed at investigating two factors of major importance for the agronomic productivity of organic crop husbandry, nitrogen (N) supply through symbiotic N fixation (SNF) and weed occurrence. Perennial red clover-grass leys and spring cereal crops subjected to regular agricultural practices were studied on 34 organic farms located in the southern and the north-western coastal regions of Finland. Herbage growth, clover content as a proportion of the ley and extent of SNF in perennial leys, and the occurrence of weed species and weed-crop competition in spring cereal stands were related to climate conditions, soil properties, and management measures. The herbage accumulated from the first and the second cut of one- and two-year-old leys averaged 7.5 t DM ha-1 (SD ± 1.7 t DM ha-1); the clover content averaged 43.9% (SD ± 18.8%). Along with the clover content, herbage production decreased with ley age. Radiation use efficiency (RUE) correlated positively with clover proportion but despite low clover contents, three-year-old leys were still productive with regard to RUE. SNF in the accumulated annual growth of one- and two-year-old leys averaged 247.5 kg N ha-1 yr-1 (SD ± 114.4 kg N ha-1 yr-1). It was supposed that if red clover-grass leys constituted 40% of the rotation, then the mean N supply by SNF would be able to sustain two or three succeeding cereal crops (green manure and forage ley, respectively), yielding 3.0 to 4.0 t grain ha-1. Being a function of clover biomass, the SNF increased from the first to the second cut and thereafter declined with ley age. Coefficients of variation of clover contents (and SNF) between and within fields were around 50%, which was about twice as high as those of herbage production. The lower were the clover contents, the higher were the within-field variations of clover as a proportion of the ley. Low clover contents in one-year-old leys and increasing variability with ley age suggested that red clover growth was limited by poor establishment and poor overwintering. The proportions of clover in leys were lower and their variability was higher in the northwest than in the south. Soil properties, primarily texture and structure, had a major impact on clover proportion and herbage production, which largely explained regional differences in ley growth. Within-field variability of soil properties can be amended through site-specific measures, including drainage, liming, and applications of organic manures and mineral fertilizers. Overwintering and the persistence of leys can be improved by the choice of winter-hardy varieties, careful establishment and the appropriate harvest regime. Mean grain yields of spring cereal crops amounted to 3.2 t ha-1 in the south and 3.6 t ha-1 in the northwest. At 570 and 565 m-2 for the south and northwest respectively, mean weed densities did not differ between the regions, whereas the respective mean weed biomass of 697 and 1594 kg dry weight ha-1, respectively did differ. Weed abundance varied remarkably between single fields. The number of weed species was higher in the south than in the northwest. For example, Fumaria officinalis and Lamium spp. were found only in the south. Frequencies and abundances of Lapsana communis, Myosotis arvensis, Polygonum aviculare, Tripleurospermum inodorum, and Vicia spp. were higher in the south, whereas those of Elymus repens, Persicaria spp. and Spergula arvensis were higher in the northwest. The number of years since conversion to organic farming, i.e. long-term management, was one of the variables that explained the abundance of single weed species. E. repens was the weed species whose biomass increased most with the duration of organic farming. Another significant variable was crop biomass, which was affected by short-term management. The presence of different weed species was related to the duration of organic farming and to low crop yield. This finding demonstrated that it was not the organic farming regime per se, which resulted in high weed infestation and low yielding crops, but failures in the understanding and the management of organic farming systems. Successful weed control relies on farm- and field-specific long- and short-term management approaches. The agronomic productivity of ley and spring cereal crops managed by full-time farmers with an interest in organic farming was on the same level as of the mean for conventional farming. Given the many options for further improvements of the agronomic performance of organic arable systems, organic farming offers foundations for the development of sustainable agriculture. The main threat to the sustainability of farming in Finland, both conventional and organic, is the spatial separation of crop production and animal husbandry by region, along with the simplification of associated crop rotations.

Sianlihan tuotantoon vaikuttavat tekijät vuosina 1995-2006

Ennen Suomen EU-jäsenyyttä kansallisen maatalouspolitiikan yksi päätavoitteista oli elintarvikeomavaraisuus. Tavoitteen saavuttamiseksi Suomessa oli maatalouspolitiikan osalta käytössä hintatukijärjestelmä, jossa yksi pääasiallisista tuotannon ohjauskeinoista oli tavoitehinnat, joilla valtiovalta pyrki vaikuttamaan tuottajahintoihin. Tavoitehintojen avulla tuottajat pystyivät ennakoimaan tulevan hintatason ja näin siirtämään tuotantoaan taloudellisesti kannattavimpaan suuntaan. Tästä oli kuitenkin seurauksena kotimaisen elintarvikeomavaraisuuden ylittyminen varsinkin eläinkunnan tuotteiden osalta. Vuonna 1994 lihatuotteiden yhteenlaskettu omavaisuus oli 110 prosenttia. Sianlihan osalta omavaisuus oli hieman tätä suurempi, 114 prosenttia. Suomen liityttyä EU:n jäsenmaaksi vuonna 1995 tavoitehinnoista luovuttiin ja samalla tuottajahinnat putosivat. Korvaukseksi tuottajahintojen pudotuksesta tuottajille alettiin maksaa suoria tulotukia. Tutkimuksen tarkoituksena oli selvittää mitkä tekijät vaikuttivat sianlihan tuotantopäätöksiin maatalouden muuttuneessa toimintaympäristössä ja miten yhteisen maatalouspolitiikan uudistukset vaikuttivat sianlihan tarjontaan. Tutkimuksen tarkasteluaikavälinä olivat vuodet 1995 2006. Tutkimuksen tavoitteena oli myös tuotantoon vaikuttavien tekijöiden pohjalta ennustaa sianlihan tuotantoa vuoteen 2013. Tuotantopäätöksiin vaikuttavia tekijöitä tarkasteltiin regressio-analyysin avulla, jotta saataisiin selville sianlihan tuotantoa parhaiten selittävät tekijät. Tutkimuksen aikasarja-aineisto poimittiin maa- ja metsätalousministeriön tietopalvelukeskuksen (Tike:n) ja tilastokeskuksen julkaisemista ja ylläpitämistä tilastoista. Sianlihan tuotantoon vaikuttavien tekijöiden ennusteisiin tutkimuksessa käytettiin sekä kansainvälisten että kotimaisten taloustutkimuslaitosten ja organisaatioiden ennusteita. Tutkimuksen teoreettinen viitekehys muodostui yrityksen teoriasta, tarjontateoriasta ja aikavälin merkityksestä tarjontaan. Tuotantomallin estimoinnin tuloksena sianlihan tuotantoon vaikuttivat vuosien 1996 2006 aikana sianlihan tuotannon tuottavuuden kasvua kuvaava teknologiamuuttuja, neljällä neljänneksellä viivästetty sianlihan tuottajahinta ja tuotantotuet yhteenlaskettuna, kolmella neljänneksellä viivästetty vehnän tuottajahinta, kahdeksalla neljänneksellä viivästetty sianlihan tuotanto, kahdella neljänneksellä viivästetty porsaan välityshinta ja kuudella neljänneksellä viivästetty investointituet. Sianlihan tuotantomallin selitysasteeksi saatiin 0,91. Estimoidulla tuotantomallilla ennustettiin sianlihan tuotannon kehitystä vuosina 2007 2013. Perusskenaariossa tuotannon ennustettiin muuttuvan vuodesta 2007 eteenpäin samalla tavalla kuin vuosina 1995 2006 keskimäärin. Perusskenaarion lisäksi tuotantomallilla simuloitiin tuotantotukien ja investointitukien dekoplauksen vaikutusta sianlihan tuotantoon. Tuotantotukien dekoplauksen myötä sianlihan tuotanto laskisi 177 milj. kiloon vuonna 2009, mutta nousisi 193 milj. kiloon vuonna 2013. Investointitukien dekoplauksen myötä tuotanto laskisi 176 milj. kiloon vuonna 2009 ja nousisi vuoteen 2013 mennessä 191 milj. kiloon. Suurimman pudotuksen aiheutti kuitenkin vehnän tuottajahinnan nousu vuosien 2006 ja 2007 aikana, jonka seurauksena sianlihan tuotanto laskisi jo vuonna 2008 180 milj. kiloon.

Kehottomat sielut ja reinkarnaatio Filonin ajattelussa

Egyptin Aleksandriassa ajanlaskun taitteen molemmin puolin elänyt hellenistijuutalainen raamattufilosofi Filon korostaa laajassa tuotannossaan, että ihmisen on suuntauduttava pois kehon, aistinautintojen ja paheiden orjuudesta kohti hyveitä, oikeaa filosofiaa ja pelastusta: sielun transsendenttia päämäärää, Jumalaa. Filon selittää heprealaista Raamattua - lähinnä Tooraa - vertauskuvallisen menetelmän ja kreikkalaisen, etenkin Platonin, filosofian avulla. Filon samaistaa toisiinsa ihmisyksilön henkisen olemuspuolen eli sielun (????) tai mielen (????) ja alkuperäisen, Jumalan kuvan mukaan luodun ihmisen. Ihmisen sielu on Filoninin raamatunselityksessä olemassa ennen kuin se laskeutuu ihmiskehoon, ja sen on aktiivisesti pyrittävä vapautumaan tuosta "vankilastaan" tai "haudastaan" noustakseen jälleen taivaalliseen alkutilaansa. Tämä vastaa läheisesti Platonin etenkin dialogeissaan Faidros ja Timaios esittämää skeemaa, ja myös sanastolliset yhteydet Platoniin ovat merkittäviä. Filon on kuitenkin myös muokannut tämän suuresti arvostamansa filosofin ajatuksia esimerkiksi korostamalla Jumalan armon merkitystä ihmisen pelastumiselle. Ihmisen keho-vankeuden juuret juontavat Filon ajattelussa ensimmäisen maallisen ihmisen lankeemuksesta, jota - kuten paheellista elämää yleisemminkin - hän luonnehtii sielun kuolemaksi. Nautinto vietteli mielen aistien välityksellä, ja ihminen vaihtoi kuolemattomuutensa kuolevaiselämään kehossa. Vaihtokauppa on kuitenkin mahdollista purkaa ja kehosta vähittäin vapautua. Platonilla sielut reinkarnoituvat maan päälle, kunnes ne kykenevät lopullisesti jättämään kehon taakseen. Reinkarnoituminen johtuu yhtäältä sielujen maallista kohtaan tuntemasta vetovoimasta. Toisaalta on kyse paheellisen elämän pitkittämästä rangaistuksesta, jonka alkuperäinen syy Faidroksessa esitetyssä vertauksessa on taitamattomuus taivaallisessa, Zeuksen johtamassa valjakkoajelussa. Lopulta sielut kykenevät kasvattamaan siivet ja nousemaan takaisin taivaaseen. Ne voivat nopeuttaa prosessia suuntautumalla pois ruumiillisista asioista oikeanlaiseen filosofiaan. Filon mainitsee reinkarnaation suoraan vain muutaman kerran koko tuotannossaan. Unien selittämistä koskevan teoksensa De somniis kohdassa 1.138-1.139 hän tuo sen esiin kaikkein selvimmin: kehoista fyysisessä kuolemassa vapautuneista sieluista "yhdet kuolevaiselämän tavanomaisuuksia kaivaten palaavat takaisin". Exodusta selittävän Quaestiones in Exodum -teoksensa kohdassa 2.40 hän puolestaan kuvaa sieluja, joiden ei onnistu nousta taivaan tuolle puolen, Jumalaan: "siipien vähän matkaa niitä kannettua [ne] palaavat heti"; toisille se Jumalan armosta onnistuu: "Onnellisia ovat ne, jotka eivät palaa." Lisäksi teoksen De cherubim kohtaan 114 sisältyy mahdollinen viittaus reinkarnaatioon, maininta kuoleman jälkeen aineettomaan tilaan päätyneiden sielujen rientämisestä "uuteen syntymään". Tutkimuskirjallisuudessa ei reinkarnaatioteema ole saanut osakseen kovin suurta huomiota. Useat tutkijat sivuuttavat aiheen. Jotkut suhtautuvat Filonin reinkarnaatiouskoon epäillen ja jotkut jopa kiistävät sen, mutta näiden tutkijoiden perustelut joko puuttuvat kokonaan tai eivät kestä lähempää tarkastelua. Löytämistäni kannanotoista suuri enemmistö on sillä kannalla, että usko ihmissielun paluuseen maan päälle uuteen kehoon todellakin kuului Filonin ajatteluun. Sen lisäksi, että Filon mainitsee asian suoraan joitain kertoja, reinkarnaatio on myös loogisesti ottaen välttämätön osa hänen ajatteluaan: ihmisen tulee vapautua kehostaan, mutta Filon tekee selväksi, ettei kyse ole fyysisen kuoleman tavoittelusta.

Health-Related Quality of Life, Costs and Treatment of Inflammatory Rheumatic Diseases in Routine Practice : With special emphasis on biological drugs

Rheumatoid arthritis (RA) and other chronic inflammatory joint diseases already begin to affect patients health-related quality of life (HRQoL) in the earliest phases of these diseases. In treatment of inflammatory joint diseases, the last two decades have seen new strategies and treatment options introduced. Treatment is started at an earlier phase; combinations of disease-modifying anti-rheumatic drugs (DMARDs) and corticosteroids are used; and in refractory cases new drugs such as tumour necrosis factor (TNF) inhibitors or other biologicals can be started. In patients with new referrals to the Department of Rheumatology of the Helsinki University Central Hospital, we evaluated the 15D and the Stanford Health Assessment Questionnaire (HAQ) results at baseline and approximately 8 months after their first visit. Altogether the analysis included 295 patients with various rheumatic diseases. The mean baseline 15D score (0.822, SD 0.114) was significantly lower than for the age-matched general population (0.903, SD 0.098). Patients with osteoarthritis (OA) and spondyloarthropathies (SPA) reported the poorest HRQoL. In patients with RA and reactive arthritis (ReA) the HRQoL improved in a statistically significant manner during the 8-month follow-up. In addition, a clinically important change appeared in patients with systemic rheumatic diseases. HAQ score improved significantly in patients with RA, arthralgia and fibromyalgia, and ReA. In a study of 97 RA patients treated either with etanercept or adalimumab, we assessed their HRQoL with the RAND 36-Item Health Survey 1.0 (RAND-36) questionnaire. We also analysed changes in clinical parameters and the HAQ. With etanercept and adalimumab, the values of all domains in the RAND-36 questionnaire increased during the first 3 months. The efficacy of each in improving HRQoL was statistically significant, and the drug effects were comparable. Compared to Finnish age- and sex-matched general population values, the HRQoL of the RA patients was significantly lower at baseline and, despite the improvement, remained lower also at follow-up. Our RA patients had long-standing and severe disease that can explain the low HRQoL also at follow-up. In a pharmacoeconomic study of patients treated with infliximab we evaluated medical and work disability costs for patients with chronic inflammatory joint disease during one year before and one year after institution of infliximab treatment. Clinical and economic data for 96 patients with different arthritis diagnoses showed, in all patients, significantly improved clinical and laboratory variables. However, the medical costs increased significantly during the second period by 12 015 (95% confidence interval, 6 496 to 18 076). Only a minimal decrease in work disability costs occurred mean decrease 130 (-1 268 to 1 072). In a study involving a switch from infliximab to etanercept, we investigated the clinical outcome in 49 patients with RA. Reasons for switching were in 42% failure to respond by American College of Rheumatology (ACR) 50% criteria; in 12% adverse event; and in 46% non-medical reasons although the patients had responded to infliximab. The Disease Activity Score with 28 joints examined (DAS28) allowed us to measure patients disease activity and compare outcome between groups based on the reason for switching. In the patients in whom infliximab was switched to etanercept for nonmedical reasons, etanercept continued to suppress disease activity effectively, and 1-year drug survival for etanercept was 77% (95% CI, 62 to 97). In patients in the infliximab failure and adverse event groups, DAS28 values improved significantly during etanercept therapy. However, the 1-year drug survival of etanercept was only 43% (95% CI, 26 to 70) and 50% (95% CI, 33 to 100), respectively. Although the HRQoL of patients with inflammatory joint diseases is significantly lower than that of the general population, use of early and aggressive treatment strategies including TNF-inhibitors can improve patients HRQoL effectively. Further research is needed in finding new treatment strategies for those patients who fail to respond or lose their response to TNF-inhibitors.

Tuntemattomista vertaistuttaviksi : Esikoisäitien ja -isien perhevalmennusprosessi Espoon uudentyyppisessä perhevalmennuskokeilussa

From Strangers to Peer Acquaintances Mothers and Fathers with a First Born and their Experiences of the New Family Training Process in Espoo This research is composed of two interrelated case studies. The first case was a family training experiment conducted in the City of Espoo during 2003 2005. In the experiment, the content, duration and procedures were modified from the previous family training policy. The new family training system stressed peer group activities and the peer support formed between the participating mothers and fathers. The second case comprised the stories of 14 parents about the family training process. The aim of the research was to find out whether peer group activities and support was demonstrated between the participating parents during the family training process. The second case and its narrative material constituted the main research material. The narrative material was collected by interviews. Eight mothers and six fathers were interviewed twice within a year between their sessions. The parents also filled in questionnaires about their daily life and participated in a drawing exercise, in which they visualized how they experienced the family training during the antenatal period, labour and the postnatal period. A narrative approach was applied to the analysis of the narrative material. The analysis consisted of several stages. In the final stage, the fathers main story was combined with all the participating fathers personal stories. The mothers main story was also constructed from their personal stories. The study implicated that in some parts the mothers and fathers main stories were similar. During the family training, previously unacquainted parents became peer acquaintances. In particular, the first born as a focus created interaction and cooperation among the parents. Parents in similar circumstances became significant to each other. Different figurations formed during the family training. However, the main stories did not always entwine. The mothers were in contact with the other mothers almost daily using mobile phones, email and mother-child activities. The fathers employed outside home met each other only during the family training meetings, but felt being supported by the other fathers. Some families visited one another outside of the family training. This new type of family training had characteristics typical of the project society. The parents peer activities were based on trust, negotiation and contracts between partners. The parents evaluated the benefits of participation in the family training. If they appreciated the activities with peers and peer compassion, they were willing to participate in the family training during the postnatal period. Keywords: family training, parenthood, motherhood, fatherhood, peer, peer group, peer support, social support, social relationships, figurations, the project society, pastoral power, epistolary power

Measurements of the top-quark mass using charged particle tracking

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