Testicular function in adolescent boys with Klinefelter syndrome

Klinefelter syndrome (KS) is the most frequent karyotype disorder of male reproductive function. Since its original clinical description in 1942 and the identification of its chromosomal basis 47,XXY in 1959, the typical KS phenotype has become well recognized, but the mechanisms behind the testicular degeneration process have remained unrevealed. This prospective study was undertaken to increase knowledge about testicular function in adolescent KS boys. It comprised a longitudinal follow-up of growth, pubertal development, and serum reproductive hormone levels in 14 prepubertal and pubertal KS boys. Each boy had a testicular biopsy that was analyzed with histomorphometric and immunohistochemical methods. The KS boys had sufficient testosterone levels to allow normal onset and progression of puberty. Their serum testosterone levels remained within the low-normal range throughout puberty, but from midpuberty onwards, findings like a leveling-off in testosterone and insulin-like factor 3 (INSL3) concentrations, high gonadotropin levels, and exaggerated responses to gonadotropin-releasing hormone stimulation suggest diminished testosterone secretion. We also showed that the Leydig cell differentiation marker INSL3 may serve as a novel marker for onset and normal progression of puberty in boys. In the KS boys the number of germ cells was already markedly lower at the onset of puberty. The pubertal activation of the pituitary-testicular axis accelerated germ cell depletion, and germ cell differentiation was at least partly blocked at the spermatogonium or early primary spermatocyte stages. The presence of germ cells correlated with serum reproductive hormone levels. The immature Sertoli cells were incapable of transforming to the adult type, and during puberty the degeneration of Sertoli cells increased markedly. The older KS boys displayed an evident Leydig cell hyperplasia, as well as fibrosis and hyalinization of the interstitium and peritubular connective tissue. Altered immunoexpression of the androgen receptor (AR) suggested that in KS boys during puberty a relative androgen deficiency develops at testicular level. The impact of genetic features of the supernumerary X chromosome on the KS phenotype was also studied. The present study suggests that parental origin of the supernumerary X chromosome and the length of the CAG repeat of the AR gene influence pubertal development and testicular degeneration. The current study characterized by several means the testicular degeneration process in the testes of adolescent KS boys and confirmed that this process accelerates at the onset of puberty. Although serum reproductive hormone levels indicated no hypogonadism during early puberty, the histological analyses showed an already markedly reduced fertility potential in prepubertal KS boys. Genetic features of the X chromosome affect the KS phenotype.

Leisure activities and obesity in adolescence : a follow-up study among twins

The aims of this dissertation were 1) to investigate associations of weight status of adolescents with leisure activities, and computer and cell phone use, and 2) to investigate environmental and genetic influences on body mass index (BMI) during adolescence. Finnish twins born in 1983–1987 responded to postal questionnaires at the ages of 11-12 (5184 participants), 14 (4643 participants), and 17 years (4168 participants). Information was obtained on weight and height, leisure activities including television viewing, video viewing, computer games, listening to music, board games, musical instrument playing, reading, arts, crafts, socializing, clubs, sports, and outdoor activities, as well as computer and cell phone use. Activity patterns were studied using latent class analysis. The relationship between leisure activities and weight status was investigated using logistic and linear regression. Genetic and environmental effects on BMI were studied using twin modeling. Of individual leisure activities, sports were associated with decreased overweight risk among boys in both cross-sectional and longitudinal analyses, but among girls only cross-sectionally. Many sedentary leisure activities, such as video viewing (boys/girls), arts (boys), listening to music (boys), crafts (girls), and board games (girls), had positive associations with being overweight. Computer use was associated with a higher prevalence of overweight in cross-sectional analyses. However, musical instrument playing, commonly considered as a sedentary activity, was associated with a decreased overweight risk among boys. Four patterns of leisure activities were found: ‘Active and sociable’, ‘Active but less sociable’, ‘Passive but sociable’, and ‘Passive and solitary’. The prevalence of overweight was generally highest among the ‘Passive and solitary’ adolescents. Overall, leisure activity patterns did not predict overweight risk later in adolescence. An exception were 14-year-old ‘Passive and solitary’ girls who had the greatest risk of becoming overweight by 17 years of age. Heritability of BMI was high (0.58-0.83). Common environmental factors shared by family-members affected the BMI at 11-12 and 14 years but their effect had disappeared by 17 years of age. Additive genetic factors explained 90-96% of the BMI stability across adolescence. Genetic correlations across adolescence were high, which suggests similar genetic effects on BMI throughout adolescence, while unique environmental effects on BMI appeared to vary. These findings suggest that family-based interventions hold promise for obesity prevention into early and middle adolescence, but that later in adolescence obesity prevention should focus on individuals. A useful target could be adolescents' leisure time, and our findings highlight the importance of versatility in leisure activities.

Ethics in a Technological World : Framing the Questions and Three Approaches

This study addresses the following question: How to think about ethics in a technological world? The question is treated first thematically by framing central issues in the relationship between ethics and technology. This relationship has three distinct facets: i) technological advance poses new challenges for ethics, ii) traditional ethics may become poorly applicable in a technologically transformed world, and iii) the progress in science and technology has altered the concept of rationality in ways that undermine ethical thinking itself. The thematic treatment is followed by the description and analysis of three approaches to the questions framed. First, Hans Jonas s thinking on the ontology of life and the imperative of responsibility is studied. In Jonas s analysis modern culture is found to be nihilistic because it is unable to understand organic life, to find meaning in reality, and to justify morals. At the root of nihilism Jonas finds dualism, the traditional Western way of seeing consciousness as radically separate from the material world. Jonas attempts to create a metaphysical grounding for an ethic that would take the technologically increased human powers into account and make the responsibility for future generations meaningful and justified. The second approach is Albert Borgmann s philosophy of technology that mainly assesses the ways in which technological development has affected everyday life. Borgmann admits that modern technology has liberated humans from toil, disease, danger, and sickness. Furthermore, liberal democracy, possibilities for self-realization, and many of the freedoms we now enjoy would not be possible on a large scale without technology. Borgmann, however, argues that modern technology in itself does not provide a whole and meaningful life. In fact, technological conditions are often detrimental to the good life. Integrity in life, according to him, is to be sought among things and practices that evade technoscientific objectification and commodification. Larry Hickman s Deweyan philosophy of technology is the third approach under scrutiny. Central in Hickman s thinking is a broad definition of technology that is nearly equal to Deweyan inquiry. Inquiry refers to the reflective and experiential way humans adapt to their environment by modifying their habits and beliefs. In Hickman s work, technology consists of all kinds of activities that through experimentation and/or reflection aim at improving human techniques and habits. Thus, in addition to research and development, many arts and political reforms are technological for Hickman. He argues for recasting such distinctions as fact/value, poiesis/praxis/theoria, and individual/society. Finally, Hickman does not admit a categorical difference between ethics and technology: moral values and norms need to be submitted to experiential inquiry as well as all the other notions. This study mainly argues for an interdisciplinary approach to the ethics of technology. This approach should make use of the potentialities of the research traditions in applied ethics, the philosophy of technology, and the social studies on science and technology and attempt to overcome their limitations. This study also advocates an endorsement of mid-level ethics that concentrate on the practices, institutions, and policies of temporal human life. Mid-level describes the realm between the instantaneous and individualistic micro-level and the universal and global macro level.

Sostdc1 Plays an Essential Role in Mammalian Tooth Patterning : Insight into the Rodent Dental Evolution

This thesis work focuses on the role of TGF-beta family antagonists during the development of mouse dentition. Tooth develops through an interaction between the dental epithelium and underlying neural crest derived mesenchyme. The reciprocal signaling between these tissues is mediated by soluble signaling molecules and the balance between activatory and inhibitory signals appears to be essential for the pattern formation. We showed the importance of Sostdc1 in the regulation of tooth shape and number. The absence of Sostdc1 altered the molar cusp patterning and led to supernumerary tooth formation both in the molar and incisor region. We showed that initially, Sostdc1 expression is in the mesenchyme, suggesting that dental mesenchyme may limit supernumerary tooth induction. We tested this in wild-type incisors by minimizing the amount of mesenchymal tissue surrounding the incisor tooth germs prior to culture in vitro. The cultured teeth phenocopied the extra incisor phenotype of the Sostdc1-deficient mice. Furthermore, we showed that minimizing the amount of dental mesenchyme in cultured Sostdc1-deficient incisors caused the formation of additional de novo incisors that resembled the successional incisor development resulting from activated Wnt signaling. Sostdc1 seemed to be able to inhibit both mesenchymal BMP4 and epithelial canonical Wnt signaling, which thus allows Sostdc1 to restrict the enamel knot size and regulate the tooth shape and number. Our work emphasizes the dual role for the tooth mesenchyme as a suppressor as well as an activator during tooth development. We found that the placode, forming the thick mouse incisor, is prone to disintegration during initiation of tooth development. The balance between two mesenchymal TGF-beta family signals, BMP4 and Activin is essential in this regulation. The inhibition of BMP4 or increase in Activin signaling led to the splitting of the large incisor placode into two smaller placodes resulting in thin incisors. These two signals appeared to have different effects on tooth epithelium and the analysis of the double null mutant mice lacking Sostdc1 and Follistatin indicated that these TGF-beta inhibitors regulate the mutual balance of BMP and Activin in vivo. In addition, this work provides an alternative explanation for the issue of incisor identity published in Science by Tucker et al. in 1998 and proposes that the molar like morphology that can be obtained by inhibiting BMP signaling is due to partial splitting of the incisor placodes and not due to change in tooth identity from the incisor to the molar. This thesis work presents possible molecular mechanisms that may have modified the mouse dental pattern during evolution leading to the typical rodent dentition of modern mouse. The rodent dentition is specialized for gnawing and consists of two large continuously growing incisors and toothless diastema region separating the molars and incisors. The ancestors of rodents had higher number of more slender incisors together with canines and premolars. Additionally, murine rodents, which include the mouse, have lost their ability for tooth replacement. This work has revealed that the inhibitory molecules appear to play a role in the tooth number suppression by delineating the spatial and temporal action of the inductive signals. The results suggest that Sostdc1 plays an essential role in several stages of tooth development through the regulation of both the BMP and Wnt pathway. The work shows a dormant sequential tooth forming potential present in wild type mouse incisor region and gives a new perspective on tooth suppression by dental mesenchyme. It reveals as well a novel mechanism to create a large mouse incisor through the regulation of mesenchymal balance between inductive and inhibitory signals.

Nature of chemistry in the national frame curricula for upper secondary education in Finland, Norway and Sweden

The aim of this study was to discover how current chemistry syllabi in the frame curricula for up- per secondary education in three Nordic countries (Finland, Norway, and Sweden) take into account topics related to the nature of chemistry. By qualitative content analysis, the statements related to the nature of chemistry were divided into categories. Conclusions and implications for improving the frame curricula under study were made by comparing results with research into the nature of science. Chemistry syllabi from the Nordic frame curricula analyzed take into account the aims related to the nature of chemistry in a very similar manner. The ideas that should be made more explicit in all of the analyzed curricula are: i) the limits of the chemical models and theories, ii) the relationship between chemistry and other natural sciences, iii) the importance of creativity in chemical research, iv) the concepts of evidence in science texts, v) the social nature of chemical research, and vi) chemistry as a technological practice.

Tiedettä Pohjantähden alla : Pohjoisen tutkimus ja Ruotsin tiedeseurojen suhteet Ranskaan 1700-luvulla

In the eighteenth century, the birth of scientific societies in Europe created a new framework for scientific cooperation. Through a new contextualist study of the contacts between the first scientific societies in Sweden and the most important science academy in Europe at the time, l Académie des Sciences in Paris, this dissertation aims to shed light on the role taken by the Swedish learned men in the new networks. It seeks to show that the academy model was related to a new idea of specialisation in science. In the course of the eighteenth century, it is argued, the study of the northern phenomena and regions offered the Swedes an important field of speciality with regard to their foreign colleagues. Although historical studies have often underlined the economic, practical undertone of eighteenth-century Swedish science, participation in fashionable scientific pursuits had also become an important scene for representation. However, the views prevailing in Europe tied civilisation and learning closely to the sunnier, southern climates, which had lead to the difficulty of portraying Sweden as a learned country. The image of the scientific North, as well as the Swedish strategies to polish the image of the North as a place for science, are analysed as seen from France. While sixteenth-century historians had preferred to put down the effects of the cold and claim a similarity of northern conditions to the others, the scientific exchange between Swedish and French researchers shows a new tendency to underline the difference of the North and its harsh climate. An explanation is sought by analysing how information about northern phenomena was used in France. In the European academies, new empirical methods had lead to a need for direct observations on different phenomena and circumstances. Rather than curiosities or objects for exoticism, the eighteenth-century depictions of the northern periphery tell about an emerging interest in the most extreme, and often most telling, examples of the workings of the invariable laws of nature. Whereas the idea of accumulating knowledge through cooperation was most manifest in joint astronomical projects, the idea of gathering and comparing data from differing places of observation appears also in other fields, from experimental philosophy to natural studies or medicine. The effects of these developments are studied and explained in connection to the Montesquieuan climate theories and the emerging pre-romantic ideas of man and society.

Lukemisen vaikeuden kuntoutus ensiluokkalaisilla : Kolme pedagogista interventiota

Remediation of Reading Difficulties in Grade 1. Three Pedagogical Interventions Keywords: initial teaching, learning to read, reading difficulties, intervention, dyslexia, remediation of dyslexia, home reading, computerized training In this study three different reading interventions were tested for first-graders at risk of reading difficulties at school commencement. The intervention groups were compared together and with a control group receiving special education provided by the school. First intervention was a new approach called syllable rhythmics in which syllabic rhythm, phonological knowledge and letter-phoneme correspondence are emphasized. Syllable rhythmics is based on multi-sensory training elements aimed at finding the most functional modality for every child. The second intervention was computerized training of letter-sound correspondence with the Ekapeli learning game. The third intervention was home-based shared book reading, where every family was given a story book, and dialogic reading style reading and writing exercises were prepared for each chapter of the book. The participants were 80 first-graders in 19 classes in nine schools. The children were matched in four groups according to pre-test results: three intervention and one control. The interventions took ten weeks starting from September in grade 1. The first post-test including several measures of reading abilities was administered in December. The first delayed post-test was administered in March, the second in September in grade 2, and the third, “ALLU” test (reading test for primary school) was administered in March in grade 2. The intervention and control groups differed only slightly from each other in grade 1. However, girls progressed significantly more than boys in both word reading and reading comprehension in December and this difference remained in March. The children who had been cited as inattentive by their teachers also lagged behind the others in the post-tests in December and March. When participants were divided into two groups according to their initial letter knowledge at school entry, the weaker group (maximum 17 correctly named letters in pre-test) progressed more slowly in both word reading and reading comprehension in grade 1. Intervention group and gender had no interaction effect in grade 1. Instead, intervention group and attentiveness had an interaction effect on most test measures the inattentive students in the syllable rhythmic group doing worst and attentive students in the control group doing best in grade 1. The smallest difference between results of attentive and inattentive students was in the Ekapeli group. In grade 2 still only minor differences were found between the intervention groups and control group. The only significant difference was in non-word reading, with the syllable rhythmics group outperforming the other groups in the fall. The difference between girls’ and boys’ performances in both technical reading and text comprehension disappeared in grade 2. The difference between the inattentive and attentive students cold no longer be found in technical reading, and the difference became smaller in text comprehension as well. The difference between two groups divided according to their initial letter knowledge disappeared in technical reading but remained significant in text comprehension measures in the ALLU test in the spring of grade 2. In all, the children in the study did better in the ALLU test than expected according to ALLU test norms. Being the weakest readers in their classes in the pre-test, 52.3 % reached the normal reading ability level. In the norm group 72.3 % of all students attained normal reading ability. The results of this study indicate that different types of remediation programs can be effective, and that special education has been apparently useful. The results suggest careful consideration of first-graders’ initial reading abilities (especially letter knowledge) and possible failure of attention; remediation should be individually targeted while flexibly using different methods.

"Haluan tuonne heti!" : Tulevaisuuskuvia ghanalaisten, isobritannialaisten,suomalaisten ja tansanialaisten lasten piirustuksissa

"I want there now!" Images of the future in the drawings of Ghanaian, British, Finnish and Tanzanian children The aim of the Thesis is to examine what kind of images children aged between 8 and 12 years in Ghana, Great Britain, Finland and Tanzania hold of their future. The study is a qualitative analysis based on data that consists of 214 drawings, digitally photographed and analysed using AtlasTI computer program. The data was coded and divided into " families " whose frequencies were compared in order to maintain results. The assignment was given to the children in the language used in the school and it was similar in each country. The children were introduced to the idea with a set of stimulating questions and after that they were asked to draw and colour with a pen a picture of 1) him/herself as an adult, 2) his/her future home and 3) the people and the animals they think they will be living with. The children were also asked to write down the country and the place they believe to live in their future. They were also encouraged to write down e.g. their dream profession, what they would like to have as hobbies in their adulthood and other important things in their lives. The analysis focuses on the content of the drawings instead of artistic or psychological interpretations. The differences between the drawings from different countries as well as the differences in a single country were significant. The current trends and the experiences children had lived through were present in the drawings. There were no differences in the colour of the skin and the most popular professions were doctor, police and football player. The football was very strongly present in all of the data; almost fourth of the children had either drawn or mentioned football as their future profession or hobby. Different flora was present in 84% of Tanzanian and 70% of Ghanaian drawings compared to the 23% of British and 17% of Finnish drawings. Of all the family forms a dream of the traditional nuclear family could be found among 29% of the drawings. Compared to that a total of 30% wanted either a child of their own without a spouse (15%) or a spouse without a child (15%). Also grandparents, childhood friends, other adults, animals or even space aliens were present and sharing a home with the children in the drawings. Of all children 15% wanted to live totally alone in the future. This was most typical (38%) among the Finnish boys. The cat and the dog were the most popular animals to appear in the drawings. Moving abroad proved to be purely a western phenomenon, dreamed by 57% of the British and 18% of the Finnish children. As results, a negative self-image, violence, lack of expressions of positive feelings and solitude among the Finnish boys in the data were very concerning. Keywords: Images of the future, future studies, future-education, picture analysis

Mikä on ihme ja mitä ihmeistä voidaan tietää? : Keskustelu ihmeistä uusimmassa englanninkielisessä uskonnonfilosofiassa

What is a miracle and what can we know about miracles? A discussion of miracles in anglophone philosophy of religion literature since the late 1960s. The aim of this study is to systematically describe and philosophically examine the anglophone discussion on the subject of miracles since the latter half of the 1960s. The study focuses on two salient questions: firstly, what I will term the conceptual-ontological question of the extent to which we can understand miracles and, secondly, the epistemological question of what we can know about miracles. My main purpose in this study is to examine the various viewpoints that have been submitted in relation to these questions, how they have been argued and on what presuppositions these arguments have been based. In conducting the study, the most salient dimension of the various discussions was found to relate to epistemological questions. In this regard, there was a notable confrontation between those scholars who accept miracles and those who are sceptical of them. On the conceptual-ontological side I recognised several different ways of expressing the concept of miracle . I systematised the discussion by demonstrating the philosophical boundaries between these various opinions. The first and main boundary was related to ontological knowledge. On one side of this boundary I placed the views which were based on realism and objectivism. The proponents of this view assumed that miraculousness is a real property of a miraculous event regardless of how we can perceive it. On the other side I put the views which tried to define miraculousness in terms of subjectivity, contextuality and epistemicity. Another essential boundary which shed light on the conceptual-ontological discussion was drawn in relation to two main views of nature. The realistic-particularistic view regards nature as a certain part of reality. The adherents of this presupposition postulate a supernatural sphere alongside nature. Alternatively, the nominalist-universalist view understands nature without this kind of division. Nature is understood as the entire and infinite universe; the whole of reality. Other, less important boundaries which shed light on the conceptual-ontological discussion were noted in relation to views regarding the laws of nature, for example. I recognised that the most important differences between the epistemological approaches were in the different views of justification, rationality, truth and science. The epistemological discussion was divided into two sides, distinguished by their differing assumptions in relation to the need for evidence. Adherents of the first (and noticeably smaller) group did not see any epistemological need to reach a universal and common opinion about miracles. I discovered that these kinds of views, which I called non-objectivist, had subjectivist and so-called collectivist views of justification and a contextualist view of rationality. The second (and larger) group was mainly interested in discerning the grounds upon which to establish an objective and conclusive common view in relation to the epistemology of miracles. I called this kind of discussion an objectivist discussion and this kind of approach an evidentialist approach. Most of the evidentialists tried to defend miracles and the others attempted to offer evidence against miracles. Amongst both sides, there were many different variations according to emphasis and assumption over how they saw the possibilities to prove their own view. The common characteristic in all forms of evidentialism was a commitment to an objectivist notion of rationality and a universalistic notion of justification. Most evidentialists put their confidence in science in one way or another. Only a couple of philosophers represented the most moderate version of evidentialism; they tried to remove themselves from the apparent controversy and contextualised the different opinions in order to make some critical comments on them. I called this kind of approach a contextualising form of evidentialism. In the final part of the epistemological chapter, I examined the discussion about the evidential value of miracles, but nothing substantially new was discovered concerning the epistemological views of the authors.

Tutkimusetiikka ja tutkimusympäristön normit

According to some scientists it is not useful to integrate ethics into research practices. Their claim is that only unethical persons have ethical problems and because of this we must accept ethical misbehaviour as a phenomenon typical of human society. In the present study the argument that the moral personality of scientists explains ethical problems in science is questioned; in addition, the focus is shifted from individuals to the level of the research environment. The question asked is whether the research environment somehow contributes to research ethics violations. To answer this question the focus was turned towards the research environment norms. The aim of the study was to investigate whether or not these norms are consistent with the norms of research ethics, so that it would be possible to evaluate if the research environment supports scientists in their task of meeting the ethical standards of scientific research. In the study the research environment was examined in three parts. The first deals with society especially Finnish society as a research environment. The second deals with the autonomous science institution as a research environment, while the third deals with scientific society (working according to scientific criteria) as a research environment. The conceptual analysis method was used. This means that various normative arguments were analysed, the primary assumptions behind them were recognized, and the acceptability of normative claims was evaluated according to their consistency. The results of the study do not support the claim that ethical violations in science could be satisfactorily explained by referring only to the personal qualities of scientists. The research environment can limit the freedom to follow the ethical principles of science, it can prevent scientists from handling ethical problems openly and from integrating ethical norms effectively into research practices. The norms of research environment are often implicit but nevertheless influence scientific practices. Further, the results indicate that handling ethical questions should be a part of scientific training.

Primary Dislocation of the Patella : A Clinical Study

A total of 177 patients with primary dislocation of the patella (PDP) were admitted to two trauma centers in Helsinki, Finland during 1991 to 1992. The inclusion criteria were: 1. Acute (≤14 days old) first-time lateral dislocation of the patella. 2. No previous knee operations or major knee injuries. 3. No ligament injuries to be repaired. 4. No osteochondral fractures requiring fixation. 50 patients were excluded. 30 of these excluded patients would have met the inclusion criteria, 19 patients received treatment by consultants not involved in the study, 7 refused to participate and 4 had an erroneous randomization. 127 patients including, 82 females, were then randomized to have either tailor-made operative procedure (group O) or conservative treatment (group C). The aftercare was similar for both groups. The mean age of the patients was 20 (9-47) years. All patients were subjected to analysis of trauma history (starting position and knee movement during the dislocation), examination under anesthesia (EUA) and arthroscopy. 70 patients (52 females) were randomized by their odd year of birth to operative group O and 57 patients (30 females) by their even year of birth to conservative group C. The diagnosis of PDP was based on locked dislocation in 68 patients, on dislocatability in EUA in 47 patients, and on subluxation in EUA combined with typical intra-articular lesions in 12 patients. In group O, 63 patients had exploration of the injuries on the medial side of the knee and tailor made reconstruction added with lateral release in 54 cases. The medial injury was operated by suturing in 39 patients, by duplication in 18 patients and by additional augmentation of the medial patellofemoral ligament (MPFL) with adductor magnus tenodesis in 6 patients. 7 patients, without locking in trauma history and only subluxation in EUA had only lateral release for realignment. In adductor magnus tenodesis the proximal end of the distal tendinous part was rerouted to the upper medial border of the patella. In the conservative group C, the treatment was adjusted to the extent of patellar displacement in EUA. Patients with dislocation in EUA had 3 weeks’ immobilization with the knee in slight flexion. Mobilization was started with a soft patellar stabilizing orthosis (PSO) used for additional three weeks. The patients with subluxation in EUA wore an orthosis for six weeks. The aftercare was similar in group O. The outcome was similar in both groups. After an average of 25 (20-45) months´ follow-up, the subjective result was better in group C in respect of the mean Hughston VAS knee score (87 for group O and 90 for group C, p=0.04, visual analog scale), but similar in terms of the patient’s own overall opinion and the mean Lysholm II knee score. Recurrent instability episodes occurred in 18 patients in group O and in 20 patients in group C. After an average of 7 (6-9) years´ follow-up, the groups did not show statistical difference either in respect of the patient’s own overall opinion, or the mean Hughston VAS and Kujala knee scores. The proportions of stable patellae was 25/70 (36%) in group O and 17/57 (30%) in group O (p=0.5). In a multivariate risk analysis, there was a correlation between low Kujala score (<90) as dependent parameter and female gender (OR: 3.5; 95% CI: 1.4-9.0), and loose body on primary radiographs (OR: 4.1; 95% CI: 1.2-15). Recurrent instability correlated with young age at the time of PDP (OR: 0.9; 95% CI: 0.8-1.0/year). Girls with open tibial apophysis had the worst prognosis for instability (88%; 95% CI: 77-98). The most common mechanisms in trauma history of the patients were movement to flexion from a straight start (78%) and movement to extension from a well-bent start (8%). Spontaneous relocation of the patella had taken place in 13/39 of girls, in 11/21 of boys, in 26/42 of women and in 17/24 of men with skeletal maturity of the tibia. The dislocation in EUA was non-rotating in 96/126 patients followed by outward rotating dislocation in 14/126 patients. Operative treatment policy in PDP is not recommended. Locking tendency of the patella in PDP depended on the skeletal maturation. Recurrence rate after PDP was higher than expected.

Elämän tiede : Tutkimus lääketieteellisestä teknologiasta, vanhemmuudesta ja perimän hallinnasta

Doctoral dissertation work in sociology examines how human heredity became a scientific, political and a personal issue in the 20th century Finland. The study focuses on the institutionalisation of rationales and technologies concerning heredity, in the context of Finnish medicine and health care. The analysis concentrates specifically on the introduction and development of prenatal screening within maternity care. The data comprises of medical articles, policy documents and committee reports, as well as popular guidebooks and health magazines. The study commences with an analysis on the early 20th century discussions on racial hygiene. It ends with an analysis on the choices given to pregnant mothers and families at present. Freedom to choose, considered by geneticists and many others as a guarantee of the ethicality of medical applications, is presented in this study as a historically, politically and scientifically constructed issue. New medical testing methods have generated new possibilities of governing life itself. However, they have also created new ethical problems. Leaning on recent historical data, the study illustrates how medical risk rationales on heredity have been asserted by the medical profession into Finnish health care. It also depicts medical professions ambivalence between maintaining the patients autonomy and utilizing for example prenatal testing according to health policy interests. Personalized risk is discussed as a result of the empirical analysis. It is indicated that increasing risk awareness amongst the public, as well as offering choices, have had unintended consequences. According to doctors, present day parents often want to control risks more than what is considered justified or acceptable. People s hopes to anticipate the health and normality of their future children have exceeded the limits offered by medicine. Individualization of the government of heredity is closely linked to a process that is termed as depolitization. The concept refers to disembedding of medical genetics from its social contexts. Prenatal screening is regarded to be based on individual choice facilitated by neutral medical knowledge. However, prenatal screening within maternity care also has its basis in health policy aims and economical calculations. Methodological basis of the study lies in Michel Foucault s writings on the history of thought, as well as in science and technology studies.

Ryhmärajoja ja hierarkioita : etnografinen tutkimus peruskoulun yläasteen liikunnanopetuksesta

This study examines gender as a dimension of group divisions and differences in physical education (PE) lessons at school. The aim is to look at those structures and practices which direct the ways the girls and the boys move their bodies at secondary school in 2000’s while growing up to become women and men. Theoretically, the goal is to clarify how the social is inscribed to the bodies in the context of physical education lessons at school. This ethnographic study was conducted in the physical education lessons of 7th graders (13-14-year-olds) by observing the everyday life in five PE groups and by interviewing pupils (N=27) and their teachers (N=2). This method has given the researcher “a sense of the game”; an embodied experience of the feel for the game of the studied phenomenon. The access to the contextual “positions of expertise” does not seem to be socially and materially equally distributed in physical education. In PE the criteria of inclusion and exclusion were intertwined with physical skills and friendships, these hierarchies becoming visible in the situations of team choice in PE lessons. Not all families have possibilities to enable their children to participate in expensive leisure sports activities. Therefore the family’s societal position is in relation to the construction of leisure time activities. The access to certain possibilities demands time and money. In Finland the physical education is mainly carried out in differentiated groups for girls and boys. In physical education, the gender-differentiated groups, and partially the different practices of these groups activate, and on the other hand suppress, situations of gender related borderwork. In this research, both pupils and PE teachers repeatedly mentioned the naturality of the differences while speaking about gender. The differences were also restored to gender. I apply Erving Goffman’s dramaturgical view to the social situations, ethnographic fieldwork and interviews. My central statement is that in ethnography the audience has access to the backstage of the researcher since reporting does not follow the traditional division to the public and the private.

Nainen, mies, rakkaus, seksi : Heterosuhteen kulku, kulttuurinen malli ja sitä selittävät diskurssit kahden omaelämäkerta-aineiston valossa

The subject matter of this study is the cultural knowledge concerning romantic male-female relationships in autobiographies written by so called ordinary Finnish men and women born between 1901 and 1965. The research data (98 autobiographies) is selected from two collections by the Finnish Literature Society s folklore archives in the early 1990 s. Autobiographies are cultural representations where negotiation of shared cultural models and personal meanings given to hetero-relationship is evident in an interesting manner. In this research I analyze autobiographies as a written folklore genre. Information concerning male-female relationships is being analyzed using theoretically informed close readings thematic analysis, intertextual reading and reflexive reading. Theoretical implications stem from cognitive anthropology (the idea of cultural models) and an adaptation of discourse theory inspired by Michel Foucault. The structure of the analysis follows the structure of the shared knowledge concerning romantic male-female relationship: the first phase of analysis presents the script of a hetero-relationship and then moves into the actual structure, the cultural model of a relationship. The components of the model of relationship are, as mentioned in the title of the research, woman, man, love and sex. The research shows that all the writers share this basic knowledge concerning a heterosexual relationship despite their age, background or gender. Also the conflicts described and experienced in the relationships of the writers were similar throughout the timespan of the early 1900 s to 1990 s: lack of love, inability to reconcile sexual desires, housework, sharing the responsibility of childcare and financial problems. The research claims that the conflicts in relationships are a major cause for the binary view on gender. When relationships are harmonious, there seems to be no need to see men and women as opposites. The research names five important discourses present in the meaning giving processes of autobiographers. In doing so, the stabile cultural model of male-female relationship widens to show the complexity and variation in data. In this way it is possible to detect some age and gender specific shifts and emphasis. The discourses give meaning to the components of the cultural model and determine the contents of womanhood, manhood, sexuality and love. The way these discourses are spread and their authority are different: the romantic discourse evident in the autobiographies appeal to the authority of love supreme love is the purpose of male-female relationship and it justifies sexuality. In this discourse sex can be the place for confluence of genders. The ideas of romantic love are widely spread in popular culture. Popular scientific discourse defines a relationship as a site to become a man and a woman either from a psychological or a biological point of view. Genders are seen as opposites. These ideas are often presented in media and their authority in science which is seen as infallible. The Christian discourse defines men and women: both should work for the benefit of the nuclear family under the undisputed authority of God. Marital love is based on Christian virtues and within marriage sexuality is acceptable. The discourse I ve named folk tradition defines women and men as guardians of home and offspring. The authority of folk tradition comes from universal truth based in experience and truths known to the mediators of this discourse grandparents, parents and other elders or peers. Societal discourse defines the hetero relationship as the mainstay of society. The authority in societal discourse stems from the laws and regulations that control relationship practices.