Conducting Gestures : Institutional and Educational Construction of Conductorship in Finland, 1973-1993

Anu Konttinen: Conducting Gestures Institutional and Educational Construction of Conductorship in Finland, 1973-1993. This doctoral thesis concentrates on those Finnish conductors who have participated in Professor Jorma Panula s conducting class at the Sibelius Academy during the years 1973 1993. The starting point was conducting as a myth, and the goal has been to find its practical opposite the practical core of the profession. What has been studied is whether one can theorise and analyse this core, and how. The theoretical goal has been to find out what kind of social construction conductorship is as a historical, sociological and practical phenomenon. In practical terms, this means taking the historical and social concept of a great conductor apart to look for the practical core gestural communication. The most important theoretical tool is the concept of gesture. The idea has been to sketch a theoretical model based on gestural communication between a conductor and an orchestra, and to give one example of the many possible ways of studying the gestures of a conductor.

Lapsuusiän kantasolusiirrot HUS:ssa vuosina 1993-2006

Tutkielma kuvaa lapsuusiän kantasolusiirtojen merkittävimmät tulokset ja komplikaatiot keskeisissä tautiryhmissä modernin hoidon aikakaudella HUS:ssä. Aineistona on HUS:n Lasten ja nuorten sairaalan veri- ja syöpätautien sekä kantasolusiirtoyksikön potilaista kerätty, vuonna 1993 perustetun ProLapsi-rekisterin sisältämä kliininen kantasolusiirtoaineisto vuosilta 1993-2006. Aineisto sisältää runsaat 90% Suomessa tehdyistä lasten allogeenisista kantasolusiirroista (n=233) sekä kaikki HUS:in autologiset siirrot (n=117) ko. aikajaksolla. Tutkielma on toteutettu kvantitatiivisia tutkimusmenetelmiä käyttäen. Suurin allogeenisen kantasolusiirron saaneiden potilaiden diagnoosiryhmä oli akuutti lymfoblastileukemia, ja suurin autologisen kantasolusiirron saaneiden ryhmä neuroblastoomapotilaat. Allogeenisista kantasolusiirroista 38% tehtiin HLA-identtiseltä sukulaisluovuttajalta ja 53% rekisteriluovuttajan soluilla. Kumulatiivinen kokonaisselviytyminen oli merkitsevästi parempaa sukulaisluovuttajan soluilla tehdyissä siirroissa kuin rekisteriluovuttajan (p=0,003). Allogeenisen kantasolusiirron saaneista potilaista 71% sai jonkin asteisen akuutin ja 42% kroonisen käänteishyljinnän (GVHD). Sekä akuutin että kroonisen GVHD:n vaikeus puolestaan korreloi kuolleisuuteen. Allogeenisen kantasolusiirron pitkäaikaisvaikutusta arvioitiin seurantatietojen perusteella. 58%:lla elämänlaatu arvioitiin normaaliksi, 35%:lla hieman rajoittuneeksi ja 7%:lla heikoksi.

Tuloverotuksen reaalinen muuttuminen Suomessa : Kuusikymmentä vuotta verojen vuoristorataa

The study seeks to find out whether the real burden of the personal taxation has increased or decreased. In order to determine this, we investigate how the same real income has been taxed in different years. Whenever the taxes for the same real income for a given year are higher than for the base year, the real tax burden has increased. If they are lower, the real tax burden has decreased. The study thus seeks to estimate how changes in the tax regulations affect the real tax burden. It should be kept in mind that the progression in the central government income tax schedule ensures that a real change in income will bring about a change in the tax ration. In case of inflation when the tax schedules are kept nominally the same will also increase the real tax burden. In calculations of the study it is assumed that the real income remains constant, so that we can get an unbiased measure of the effects of governmental actions in real terms. The main factors influencing the amount of income taxes an individual must pay are as follows: - Gross income (income subject to central and local government taxes). - Deductions from gross income and taxes calculated according to tax schedules. - The central government income tax schedule (progressive income taxation). - The rates for the local taxes and for social security payments (proportional taxation). In the study we investigate how much a certain group of taxpayers would have paid in taxes according to the actual tax regulations prevailing indifferent years if the income were kept constant in real terms. Other factors affecting tax liability are kept strictly unchanged (as constants). The resulting taxes, expressed in fixed prices, are then compared to the taxes levied in the base year (hypothetical taxation). The question we are addressing is thus how much taxes a certain group of taxpayers with the same socioeconomic characteristics would have paid on the same real income according to the actual tax regulations prevailing in different years. This has been suggested as the main way to measure real changes in taxation, although there are several alternative measures with essentially the same aim. Next an aggregate indicator of changes in income tax rates is constructed. It is designed to show how much the taxation of income has increased or reduced from one year to next year on average. The main question remains: How aggregation over all income levels should be performed? In order to determine the average real changes in the tax scales the difference functions (difference between actual and hypothetical taxation functions) were aggregated using taxable income as weights. Besides the difference functions, the relative changes in real taxes can be used as indicators of change. In this case the ratio between the taxes computed according to the new and the old situation indicates whether the taxation has become heavier or easier. The relative changes in tax scales can be described in a way similar to that used in describing the cost of living, or by means of price indices. For example, we can use Laspeyres´ price index formula for computing the ratio between taxes determined by the new tax scales and the old tax scales. The formula answers the question: How much more or less will be paid in taxes according to the new tax scales than according to the old ones when the real income situation corresponds to the old situation. In real terms the central government tax burden experienced a steady decline from its high post-war level up until the mid-1950s. The real tax burden then drifted upwards until the mid-1970s. The real level of taxation in 1975 was twice that of 1961. In the 1980s there was a steady phase due to the inflation corrections of tax schedules. In 1989 the tax schedule fell drastically and from the mid-1990s tax schedules have decreased the real tax burden significantly. Local tax rates have risen continuously from 10 percent in 1948 to nearly 19 percent in 2008. Deductions have lowered the real tax burden especially in recent years. Aggregate figures indicate how the tax ratio for the same real income has changed over the years according to the prevailing tax regulations. We call the tax ratio calculated in this manner the real income tax ratio. A change in the real income tax ratio depicts an increase or decrease in the real tax burden. The real income tax ratio declined after the war for some years. In the beginning of the 1960s it nearly doubled to mid-1970. From mid-1990s the real income tax ratio has fallen about 35 %.

Eläke- ja vammaisetuuksien, maahanmuuttajan erityistuen ja eläkkeensaajan asumistuen muutokset 1.1.2011

Kansaneläkeindeksi 1 508, elinkustannusindeksi 1 749 (pistelukujen keskiarvo heinäsyyskuulta 2010) Vuoden 2011 alusta kansaneläkkeisiin, perhe-eläkkeisiin, lapsikorotuksiin, rintamalisiin, vammaisetuuksiin (pl. ruokavaliokorvaukset) ja maahanmuuttajan erityistukiin tehtiin 0,4 prosentin indeksitarkistus. Eläke-etuusmenot kasvoivat 9,7 milj. euroa (0,4 %), vammaisetuusmenot 1,9 milj. euroa (0,4 %) ja maahanmuuttajan erityistukimenot 0,1 milj. euroa (0,3 %). Laskelmat perustuvat joulukuun 2010 etuuskantaan.

The Impact of Cultural Factors on Post-Acquisition Integration: Domestic and Foreign Acquisitions of Finnish Companies in 1993-2004

Acquisitions are a central component of corporate strategy. They contribute to competitive advantage by offering possibilities for both cost reductions and for revenue enhancements. However, many acquisition benefits cannot be realized without a successful integration of the acquiring and the acquired firms. Previous research shows that national and organizational culture can play a major role in determining the integration outcomes. Therefore, the overall aim of the thesis is to map out and illustrate the impact mechanisms of cultural factors in post-acquisition integration in order to explain the cultural aspects of acquisitions. This study has three main contributions. First, the study shows that international and domestic acquisitions differ concerning both strategic and cultural fit. Second, the findings highlight the importance of acculturation and cultural integration in determining post-acquisition outcomes. Finally, the study uncovers several impact mechanisms that shed light to the contradictory results related to cultural differences in previous research.

Keskileveysasteiden syklonitoiminnan muutokset kasvihuoneilmiön voimistuessa

Keskileveysasteilla sään päivittäiset vaihtelut ovat pitkälti sidoksissa syklonien liikkeisiin. Siksi on tärkeä selvittää, miten syklonitoiminta mahdollisesti muuttuu kasvihuoneilmiön voimistuessa. Tähänastisessa tutkimuksessa on tarkasteltu sekä olemassa olevia uusanalysoituja säähavaintoaikasarjoja että simuloitu syklonitoiminnan muutoksia ilmastomallien avulla. Uusanalyysien ongelmana on niiden epähomogeenisuus ja lyhyys. Ilmastomallien avulla voidaan sen sijaan luoda pitempiä, tulevaisuuteen ulottuvia aikasarjoja, joissa ilmastopakotteen vaikutus on mahdollista saada selvemmin esiin. Tutkielmassa pyritään selvittämään 30:n vuosina 1993-2009 julkaistun, ilmastomalleihin pohjautuvan tutkimuksen perusteella, millaisia tuloksia syklonitoiminnan muutoksia simuloitaessa on tähän asti saatu. Tulokset ovat osin ristiriitaisia, mikä johtuu eroista mm. mallien ominaisuuksissa, käytetyissä ilmastopakotteissa sekä tavoissa, joilla aikasarjoja on analysoitu. Erityisesti tapa, jolla sykloniklimatologiat on eristetty aikasarjoista, luo eroja tutkimusten välille. Yleisimmät menetelmät ovat kaistanpäästösuodatus (BP-suodatus) ja erilaiset hahmontunnistukseen perustuvat syklonien paikannus- ja jäljitysmenetelmät. Vaikka tutkimuksessa on pääasiassa siirrytty käyttämään paikannus- ja jäljitysmenetelmiä, ongelmana ovat niiden erilaiset toimintatavat, minkä vuoksi niitä on vaikea vertailla keskenään. Menetelmien kirjavuudesta huolimatta joistain syklonitoiminnan kvalitatiivisiin muutoksiin liittyvistä seikoista vallitsee kohtalainen yksimielisyys: keskileveysasteilla syklonien lukumäärä tulee vähenemään, keskimääräinen intensiteetti voimistumaan ja syklonien radat siirtyvät molemmilla pallonpuoliskoilla kohti napaa. Uusanalyysien perusteella saadut tulokset tukevat intensiteetin voimistumista ja ratojen siirrosta mutta eriävät lukumäärän suhteen. On mahdollista, että uusanalyyseissä 1900-luvun loppupuoliskolla havaittu lukumäärän kasvutrendi selittyy tarkentuneilla havaintomenetelmillä tai syklonitoiminnan pitkäaikaisella, luonnollisella vaihtelulla.

Uusi työ, vanhat erot? Tutkielma moraalisen työnjaon tuottamisesta

Vuosituhannen vaihteessa on länsimaissa esitetty vahvoja väitteitä työn järjestämisessä tapahtuneista muutoksista. Väitteiden mukaan perinteiset erojen kategoriat, kuten jako miesten ja naisten tehtäviin tai ruumiilliseen ja henkiseen työhön ovat menettäneet perustaansa tilanteessa, jossa kaikesta työstä on tullut enemmän tai vähemmän samaa: palvelusten tuottamista, sosiaalisten suhteiden järjestelyä, vuorovaikutusta ja organisointia, ilman konkreettisia ja materiaalisia tekijän persoonasta erotettavissa olevia työn lopputuotteita. Tutkielmassa työn järjestämistä tarkastellaan diskursiivisesta näkökulmasta. Diskurssit ymmärretään vakiintuneina kielenkäytön tapoina, jotka konstruoivat todellisuutta ja tarjoavat yksilöille vaihtoehtoisia subjektipositioita (Davies & Harré 1990; Burr 1995). Tutkielmassa esitetään, että ”vanhat” työn järjestämisen diskurssit tuottivat henkisen ja ruumiillisen työn välille järjestelmällisen erottelun. ”Uudemmat” diskurssit tarjoavat vaihtoehdon tälle kahtiajaolle yhtäältä määrittelemällä itseohjautuvuuden ja älyllisyyden kaiken työn yhtäläiseksi vaatimukseksi sekä toisaalta edellyttämällä työntekijöiltä ominaisuuksia, jotka eivät ole yksiselitteisen henkisiä eivätkä ruumiillisia. Kielenkäytön tavat ovat kuitenkin riippuvaisia niitä ylläpitävästä toiminnasta. Tutkielmassa empiirisen näytteen työtä järjestävästä toiminnasta tarjoavat Pyhtään kunnan asukkailta vuosina 1982, 1993 ja 2007 kerätyt lomakehaastattelut. Symbolisen interaktionismin (Hughes 1984a–1984e) ja sosiaalisen konstruktionismin (Berger & Luckmann 1994) näkökulmasta tutkielmassa kysytään, miten työtä ja työnjaon erilaisia paikkoja on eri vuosien haastatteluissa määritelty, rajattu ja tehty ymmärrettäväksi. Ovatko vanhat erottelut menettämässä merkitystään työtä ja työnjakoa koskevassa puheessa? Näkökulma poikkeaa tähänastisista työn muutosta tarkastelleista surveytutkimuksista siten, että se ottaa lähtökohdakseen työntekijöiden omat selonteot työnsä vaatimuksista, työtään määrittävistä hyveistä sekä selonteoissa tuotettavan ”moraalisen työnjaon”. 1900-luvun historiassa henkisen ja ruumiillisen työn erottelua on institutionalisoitu esimies–alainen-erottelun lisäksi toimihenkilö–työntekijä-erotteluksi. Työn muutosta koskevasta keskustelusta huolimatta nämä erottelut uusinnettiin myös vuoden 2007 haastatteluissa – jopa johdonmukaisemmin kuin vuosina 1982 ja 1993. Lisäksi henkisen ja ruumiillisen työn kategoriat olivat haastatteluissa säilyneet vahvasti toisensa poissulkevina ja kategorioiden erottelu tavanomaisena työnjaon tuottamisen tapana. Näiden erottelujen ohella työnjakoa tuotettiin haastatteluissa luovan ja suorittavan työn vastakohtaisuutena, joskin nämä jäsennykset olivat vähemmän säännönmukaisia eivätkä uusintaneet edellä mainittuja esimies–alainen- tai työntekijä–toimihenkilö-erotteluja. Vahvan pysyvyyden lisäksi aineisto tarjosi näytteen muutoksesta: Vuosina 1982 ja 1993 henkisen työn paikat olivat haastatteluissa olleet erityisesti miesten paikkoja. Vuonna 2007 myös naiset tekivät haastatteluissa näkyviksi työnsä henkisiä sisältöjä. Työn muutosta koskevan keskustelun lisäksi tutkielma osallistuu metodologiseen keskusteluun lähestyessään lomakehaastattelua toiminnallisena selontekojen tuottamisen kontekstina. Näin tehdessään tutkielma ehdottaa totutulle faktanäkökulmalle (Alasuutari 1999) vaihtoehtoista tapaa tarkastella lomakehaastattelussa tuotettua tietoa.

Ruoholahden sekatalomallin arviointia 2011

Helsingin yliopiston sosiaalipolitiikan opiskelijat kuvasivat ja arvioivat Ruoholahteen sijoittuvia niin kutsuttuja sekataloja. Mukana kaupunkitutkimuksellisessa tarkastelussa oli historiaa sekä nykypäivää, tehtiin myös lyhyt kurkistus vuokra- ja omistusasumista sekoittavien taloyhtiöiden mahdolliseen tulevaisuuteen. Kolmen erillisen tutkimusryhmän työt on koottu yhdeksi raportiksi. Aineistot kerättiin syksyllä 2010 ja alkuvuodesta 2011. Ensimmäisenä esillä on tutkimusosio, jota varten on haastateltu kolmea sekataloja hallinnoivaa isännöitsijää. Toiseksi käydään läpi asukaskyselyn tuloksia. Kysely jätettiin parille sadalle asukkaalle, joista hieman päälle kolmekymmentä palautti lomakkeen. Havainnot ovat näin suuntaa-antavia. Lopuksi pohdittiin Ruoholahden sekatalojen mahdollista kehitystä taloyhtiöiden hallitusten jäseniltä pyydettyjen kirjoitelmien pohjalta. Kussakin ryhmätyössä käytiin läpi aiempaa Ruoholahtea koskevaa tutkimusta, jota on julkaistu 1990-luvun alusta lähtien noin viiden vuoden välein. Näin nyt yliopistollisena harjoitustyönä tehdyt selvitykset asettuvat osaksi pitkää, parin kymmenen vuoden seurantatutkimusta. Tekstit ovat muutamaa kirjoitusvirheen korjausta lukuun ottamatta opiskelijaryhmien kirjaamassa muodossa. Tutkimusryhmien työskentelyä avittivat Helsingin kaupunkisuunnitteluviraston toimistopäällikkö Rikhard Manninen ja Tietokeskuksen tutkija Ari Niska sekä kaupunkitutkija Pekka Vehviläinen.

Population projection for Namibia 2011-2020 - With an estimation of the impact of HIV/AIDS

This study presents a population projection for Namibia for years 2011–2020. In many countries of sub-Saharan Africa, including Namibia, the population growth is still continuing even though the fertility rates have declined. However, many of these countries suffer from a large HIV epidemic that is slowing down the population growth. In Namibia, the epidemic has been severe. Therefore, it is important to assess the effect of HIV/AIDS on the population of Namibia in the future. Demographic research on Namibia has not been very extensive, and data on population is not widely available. According to the studies made, fertility has been shown to be generally declining and mortality has been significantly increasing due to AIDS. Previous population projections predict population growth for Namibia in the near future, yet HIV/AIDS is affecting the future population developments. For the projection constructed in this study, data on population is taken from the two most recent censuses, from 1991 and 2001. Data on HIV is available from HIV Sentinel Surveys 1992–2008, which test pregnant women for HIV in antenatal clinics. Additional data are collected from different sources and recent studies. The projection is made with software (EPP and Spectrum) specially designed for developing countries with scarce data. The projection includes two main scenarios which have different assumptions concerning the development of the HIV epidemic. In addition, two hypothetical scenarios are made: the first considering the case where HIV epidemic would never have existed and the second considering the case where HIV treatment would never have existed. The results indicate population growth for Namibia. Population in the 2001 census was 1.83 million and is projected to result in 2.38/2.39 million in 2020 in the first two scenarios. Without HIV, population would be 2.61 million and without treatment 2.30 million in 2020. Urban population is growing faster than rural. Even though AIDS is increasing mortality, the past high fertility rates still keep young adult age groups quite large. The HIV epidemic shows to be slowing down, but it is still increasing the mortality of the working-aged population. The initiation of HIV treatment in 2004 in the public sector seems to have had an effect on many projected indicators, diminishing the impact of HIV on the population. For example, the rise of mortality is slowing down.

Antioxidants, weight change and risk of type 2 diabetes

The incidence of type 2 diabetes has increased rapidly worldwide. Obesity is one of the most important modifiable risk factors of type 2 diabetes: weight gain increases and weight loss decreases the risk. However, the effects of weight fluctuation are unclear. Reactive oxygen species are presumably part of the complicated mechanism for the development of insulin resistance and beta-cell destruction in the pancreas. The association of antioxidants with the risk of incident type 2 diabetes has been studied in longitudinal prospective human studies, but so far there is no clear conclusion about protective effect of dietary or of supplementary antioxidants on diabetes risk. The present study examined 1) weight change and fluctuation as risk factors for incident type 2 diabetes; 2) the association of baseline serum alpha-tocopherol or beta-carotene concentration and dietary intake of antioxidants with the risk of type 2 diabetes; 3) the effect of supplementation with alpha-tocopherol or beta-carotene on the risk of incident type 2 diabetes; and on macrovascular complications and mortality among type 2 diabetics. This investigation was part of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study, a randomized, double-blind, placebo-controlled prevention trial, which has undertaken to examine the effect of alpha-tocopherol and beta-carotene supplementation on the development of lung cancer, other cancers, and cardiovascular diseases in male smokers aged 50-69 years at baseline. Participants were assigned to receive either 50 mg alpha-tocopherol, 20mg beta-carotene, both, or placebo daily in a 2 x 2 factorial design experiment during 1985-1993. Cases of incident diabetes were identified through a nationwide register of drug reimbursements of the Social Insurance Institution. At baseline 1700 men had a history of diabetes. Among those (n = 27 379) with no diabetes at baseline 305 new cases of type 2 diabetes were recognized during the intervention period and 705 during the whole follow-up to 12.5 years. Weight gain and weight fluctuation measured over a three year period were independent risk factors for subsequent incident type 2 diabetes. Relative risk (RR) was 1.77 (95% confidence interval [CI] 1.44-2.17) for weight gain of at least 4 kg compared to those with a weight change of less than 4 kg. The RR in the highest weight fluctuation quintile compared to the lowest was 1.64 (95% CI 1.24-2.17). Dietary tocopherols and tocotrienols as well as dietary carotenoids, flavonols, flavones and vitamin C were not associated with the risk of type 2 diabetes. Baseline serum alpha-tocopherol and beta-carotene concentrations were not associated with the risk of incident diabetes. Neither alpha-tocopherol nor beta-carotene supplementation affected the risk of diabetes. The relative risks for participants who received alpha-tocopherol compared with nonrecipients and for participants who received beta-carotene compared with nonrecipients were 0.92 (95% CI 0.79-1.07) and 0.99 (95% CI 0.85-1.15), respectively. Furthermore, alpha-tocopherol or beta-carotene supplementation did not affect the risk of macrovascular complications or mortality of diabetic subjects during the 19 years follow-up time. In conclusion, in this study of older middle-aged male smokers, weight gain and weight fluctuation were independent risk factors for type 2 diabetes. Intake of antioxidants or serum alpha-tocopherol or beta-carotene concentrations were not associated with the risk of type 2 diabetes. Supplementation with of alpha-tocopherol or beta-carotene did not prevent type 2 diabetes. Neither did they prevent macrovascular complications, or mortality among diabetic subjects.

Perinatal mortality and maternal health in rural China

Background and context Since the economic reforms of 1978, China has been acclaimed as a remarkable economy, achieving 9% annual growth per head for more than 25 years. However, China's health sector has not fared well. The population health gains slowed down and health disparities increased. In the field of health and health care, significant progress in maternal care has been achieved. However, there still remain important disparities between the urban and rural areas and among the rural areas in terms of economic development. The excess female infant deaths and the rapidly increasing sex ratio at birth in the last decade aroused serious concerns among policy makers and scholars. Decentralization of the government administration and health sector reform impacts maternal care. Many studies using census data have been conducted to explore the determinants of a high sex ratio at birth, but no agreement has been so far reached on the possible contributing factors. No study using family planning system data has been conducted to explore perinatal mortality and sex ratio at birth and only few studies have examined the impact of the decentralization of government and health sector reforms on the provision and organization of maternal care in rural China. Objectives The general objective of this study was to investigate the state of perinatal health and maternal care and their determinants in rural China under the historic context of major socioeconomic reforms and the one child family planning policy. The specific objectives of the study included: 1) to study pregnancy outcomes and perinatal health and their correlates in a rural Chinese county; 2) to examine the issue of sex ratio at birth and its determinants in a rural Chinese county; 3) to explore the patterns of provision, utilization, and content of maternal care in a rural Chinese county; 4) to investigate the changes in the use of maternal care in China from 1991 to 2003. Materials and Methods This study is based on a project for evaluating the prenatal care programme in Dingyuan county in 1999-2003, Anhui province, China and a nationwide household health survey to describe the changes in maternal care utilization. The approaches used included a retrospective cohort study, cross sectional interview surveys, informant interviews, observations and the use of statistical data. The data sources included the following: 1) A cohort of pregnant women followed from pregnancy up to 7 days after birth in 20 townships in the study county, collecting information on pregnancy outcomes using family planning records; 2) A questionnaire interview survey given to women who gave birth between 2001 and 2003; 3) Various statistical and informant surveys data collected from the study county; 4) Three national household health interview survey data sets (1993-2003) were utilized, and reanalyzed to described the changes in maternity care utilization. Relative risks (RR) and their confidence intervals (CI) were calculated for comparison between parity, approval status, infant sex and township groups. The chi-square test was used to analyse the disparity of use of maternal care between and within urban and rural areas and its trend across the years in China. Logistic regression was used to analyse the factors associated with hospital delivery in rural areas. Results There were 3697 pregnancies in the study cohort, resulting in 3092 live births in a total population of 299463 in the 20 study townships during 1999-2000. The average age at pregnancy in the cohort was 25.9 years. Of the women, 61% were childless, 38% already had one child and 0.3% had two children before the current pregnancy. About 90% of approved pregnancies ended in a live birth while 73% of the unapproved ones were aborted. The perinatal mortality rate was 69 per thousand births. If the 30 induced abortions in which the gestational age was more than 28 weeks had been counted as perinatal deaths, the perinatal mortality rate would have been as high as 78 per thousand. The perinatal mortality rate was negatively associated with the wealth of the township. Approximately two thirds of the perinatal deaths occurred in the early neonatal period. Both the still birth rate and the early neonatal death rate increased with parity. The risk of a stillbirth in a second pregnancy was almost four times that for a first pregnancy, while the risk of early neonatal deaths doubled. The early neonatal mortality rate was twice as high for female as for male infants. The sex difference in the early neonatal mortality rate was mainly attributable to mortality in second births. The male early neonatal mortality rate was not affected by parity, while the female early neonatal mortality rate increased dramatically with parity: it was about six times higher for second births than for first births. About 82% early neonatal deaths happened within 24 hours after birth, and during that time, girls were almost three times more likely to die than boys. The death rate of females on the day of birth increased much more sharply with parity than that of males. The total sex ratio at birth of 3697 registered pregnancies was 152 males to 100 females, with 118 and 287 in first and second pregnancies, respectively. Among unapproved pregnancies, there were almost 5 live-born boys for each girl. Most prenatal and delivery care was to be taken care of in township hospitals. At the village level, there were small private clinics. There was no limitation period for the provision of prenatal and postnatal care by private practitioners. They were not permitted to provide delivery care by the county health bureau, but as some 12% of all births occurred either at home or at private clinics; some village health workers might have been involved. The county level hospitals served as the referral centers for the township hospitals in the county. However, there was no formal regulation or guideline on how the referral system should work. Whether or not a woman was referred to a higher level hospital depended on the individual midwife's professional judgment and on the clients' compliance. The county health bureau had little power over township hospitals, because township hospitals had in the decentralization process become directly accountable to the township government. In the township and county hospitals only 10-20% of the recurrent costs were funded by local government (the township hospital was funded by the township government and the county hospital was funded by the county government) and the hospitals collected user fees to balance their budgets. Also the staff salaries depended on fee incomes by the hospital. The hospitals could define the user charges themselves. Prenatal care consultations were however free in most township hospitals. None of the midwives made postnatal home visits, because of low profit of these services. The three national household health survey data showed that the proportion of women receiving their first prenatal visit within 12 weeks increased greatly from the early to middle 1990s in all areas except for large cities. The increase was much larger in the rural areas, reducing the urban-rural difference from more than 4 times to about 1.4 times. The proportion of women that received antenatal care visits meeting the Ministry of Health s standard (at least 5 times) in the rural areas increased sharply from 12% in 1991-1993 to 36% in 2001-2003. In rural areas, the proportion increase was much faster in less developed areas than in developed areas. The hospital delivery rate increased slightly from 90% to 94% in urban areas while the proportion increased from 27% to 69% in rural areas. The fastest change was found to be in type 4 rural areas, where the utilization even quadrupled. The overall difference between rural and urban areas was substantially narrowed over the period. Multiple logistic regression analysis shows that time periods, residency in rural or urban areas, income levels, age group, education levels, delivery history, occupation, health insurance and distance from the nearest health care facilities were significantly associated with hospital delivery rates. Conclusions 1. Perinatal mortality in this study was much higher than that for urban areas as well as any reported rate from specific studies in rural areas of China. Previous studies in which calculations of infant mortality were not based on epidemiological surveys have been shown to underestimate the rates by more than 50%. 2. Routine statistics collected by the Chinese family planning system proved to be a reliable data source for studying perinatal health, including still births, neonatal deaths, sex ratio at birth and among newborns. National Household Health Survey data proved to be a useful and reliable data source for studying population health and health services. Prior to this research there were few studies in these areas available to international audiences. 3.Though perinatal mortality rate was negatively associated with the level of township economic development, the excess female early neonatal mortality rate contributed much more to high perinatal mortality rate than economic factors. This was likely a result of the role of the family planning policy and the traditional preferences for sons, which leads to lethal neglect of female newborns and high perinatal mortality. 4. The selective abortions of female foetuses were likely to contribute most to the high sex ratio at birth. The underreporting of female births seemed to have played a secondary role. The higher early neonatal mortality rate in second-born as compared to first-born children, particularly in females, may indicate that neglect or poorer care of female newborn infants also contributes to the high sex ratio at birth or among newborns. Existing family planning policy proved not to effectively control the steadily increased birth sex ratio. 5. The rural-urban gap in service utilization was on average significantly narrowed in terms of maternal healthcare in China from 1991 to 2003. This demonstrates that significant achievements in reducing inequities can be made through a combination of socio-economic development and targeted investments in improving health services, including infrastructure, staff capacities, and subsidies to reduce the costs of service utilization for the poorest. However, the huge gap which persisted among cities of different size and within different types of rural areas indicated the need for further efforts to support the poorest areas. 6. Hospital delivery care in the study county was better accepted by women because most of women think delivery care was very important while prenatal and postnatal care were not. Hospital delivery care was more systematically provided and promoted than prenatal and postnatal care by township hospital in the study area. The reliance of hospital staff income on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care, since delivery care generated much profits than prenatal and postnatal care . Recommendations 1. It is essential for the central government to re-assess and modify existing family planning policies. In order to keep national sex balance, the existing practice of one couple one child in urban areas and at-least-one-son a couple in rural areas should be gradually changed to a two-children-a-couple policy throughout the country. The government should establish a favourable social security policy for couples, especially for rural couples who have only daughters, with particular emphasis on their pension and medical care insurance, combined with an educational campaign for equal rights for boys and girls in society. 2. There is currently no routine vital-statistics registration system in rural China. Using the findings of this study, the central government could set up a routine vital-statistics registration system using family planning routine work records, which could be used by policy makers and researchers. 3. It is possible for the central and provincial government to invest more in the less developed and poor rural areas to increase the access of pregnant women in these areas to maternal care services. Central government together with local government should gradually provide free maternal care including prenatal and postnatal as well as delivery care to the women in poor and less developed rural areas. 4. Future research could be done to explore if county and the township level health care sector and the family planning system could be merged to increase the effectiveness and efficiency of maternal and child care. 5. Future research could be done to explore the relative contribution of maternal care, economic development and family planning policy on perinatal and child health using prospective cohort studies and community based randomized trials. Key words: perinatal health, perinatal mortality, stillbirth, neonatal death, sex selective abortion, sex ratio at birth, family planning, son preference, maternal care, prenatal care, postnatal care, equity, China

Aktuaariraportti 2011: Kelan hoitama sosiaaliturva 2010–2060

Sivumäärä 69

Kelan Taskutilasto 2011

Taskutilasto on taskukokoon tiivistetty tietopaketti Kelan hoitamasta sosiaaliturvasta. Julkaisu tarjoaa taulukoiden ja graafisten kuvioiden muodossa keskeiset tiedot kustakin Kelan maksamasta etuudesta ja sen saajista. Mukana on vertailutietoa myös muiden organisaatioiden järjestämästä sosiaaliturvasta. Taskutilaston tiedot koskevat vuotta 20010 (pääosin) ja vuotta 2011.