Kelan mielenterveyskuntoutuksessa olleiden lasten ja nuorten psyykenlääkkeiden käyttö ja kuntoutuminen. Rekisteriselvitys vuosilta 2000-2006

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Kaukainen rakkaus : Saavuttamattomuuden semantiikka Kaija Saariahon oopperassa

L Amour de loin: The semantics of the unattainable in Kaija Saariaho s opera Kaija Saariaho (born 1952) is one of the most internationally successful Finnish composers there has ever been. Her first opera L Amour de loin (Love from afar, 1999-2000) has been staged all over the world and has won a number of important prizes. The libretto written for L Amour de loin by Amin Malouf (born 1949) sets the work firmly in the culture of courtly love and the troubadours, which flourished in Occitania in the South of France during the Middle Ages. The male lead in the opera is the troubadour Jaufré Rudel, who lived in the twelfth century and is known to have taken part in the Second Crusade in 1147-1148. This doctoral thesis L Amour de loin: The semantics of the unattainable in Kaija Saariaho s opera, which comes within the field of musicology and opera research, examines the dimensions of meaning contained in Kaija Saariaho s opera L Amour de loin. This hermeneutic-semiotic study is the first doctoral thesis dealing with Saariaho to be completed at the University of Helsinki. It is also the first thesis-level study of Saariaho s opera to be completed anywhere in the world. The study focuses on the libretto and music of the opera, that is to say the dramatic text (L Amour de loin 1980), and examines on the one hand the dimensions of meaning produced by the dramatic text and on the other, the way in which they fix the dramatic text in a historical and cultural context. Thus the study helps to answer questions about the dimensions of meaning contained in the dramatic text of the opera and how they can be interpreted. The most important procedural viewpoint is Lawrence Kramer s hermeneutic window (1990), supplemented by Raymond Monelle s semiotic theory of musical topics (2000, 2006) and the philosophical concept of Emmanuel Levinas (1996, 2002) in which the latter acts as an instrument for semantic interpretation to build up an analysis. The analytical section of the study is built around the three characters in the opera, Jaufré Rudel, Clémence the Countess of Tripoli, and the Pilgrim. The study shows that the music of Saariaho, who belongs to the third generation of Finnish modernists, has become distanced from the post-serial aesthetic towards a more diatonic form of expression. There is diatonicity, for instance, in the sonorous individuality of the male lead, which is based on the actual melodies of the historical Jaufré Rudel. The use of outside material in this context is exceptional in the work of Saariaho. At the same time, Saariaho s opera contains a wealth of expressive devices she has used in her earlier work. It became apparent during the study that, as a piece of music, L Amour de loin is a many layered and multi-dimensional work that does not unambiguously represent any single stylistic trend or aesthetic. Despite the composer s post-serial background and its abrasive relationship with opera, L Amour de loin is firmly attached to the tradition of western opera. The analysis based on the theory of musical topics that was carried out in the study, shows that topics referring to death and resurrection, used in opera since the seventeenth century, appear in L Amour de loin. The troubadour topic, mainly identified with the harp, also emerges in the work. The study also shows that the work is firmly attached to the tradition of western opera in other aspects, too, such as the travesti or trouser role played by the Pilgrim, and the idea of deus ex machina derived from Ancient Greek theatre. The study shows that the concept of love based on the medieval practices of courtly love, and the associated longing for another defined by almost 1,000 years of western culture, are both manifested in the semantics of Kaija Saariaho s opera which takes its place in the contemporary music genre.

Individualized immunosuppression after renal transplantation in childhood

Pediatric renal transplantation (TX) has evolved greatly during the past few decades, and today TX is considered the standard care for children with end-stage renal disease. In Finland, 191 children had received renal transplants by October 2007, and 42% of them have already reached adulthood. Improvements in treatment of end-stage renal disease, surgical techniques, intensive care medicine, and in immunosuppressive therapy have paved the way to the current highly successful outcomes of pediatric transplantation. In children, the transplanted graft should last for decades, and normal growth and development should be guaranteed. These objectives set considerable requirements in optimizing and fine-tuning the post-operative therapy. Careful optimization of immunosuppressive therapy is crucial in protecting the graft against rejection, but also in protecting the patient against adverse effects of the medication. In the present study, the results of a retrospective investigation into individualized dosing of immunosuppresive medication, based on pharmacokinetic profiles, therapeutic drug monitoring, graft function and histology studies, and glucocorticoid biological activity determinations, are reported. Subgroups of a total of 178 patients, who received renal transplants in 1988 2006 were included in the study. The mean age at TX was 6.5 years, and approximately 26% of the patients were <2 years of age. The most common diagnosis leading to renal TX was congenital nephrosis of the Finnish type (NPHS1). Pediatric patients in Finland receive standard triple immunosuppression consisting of cyclosporine A (CsA), methylprednisolone (MP) and azathioprine (AZA) after renal TX. Optimal dosing of these agents is important to prevent rejections and preserve graft function in one hand, and to avoid the potentially serious adverse effects on the other hand. CsA has a narrow therapeutic window and individually variable pharmacokinetics. Therapeutic monitoring of CsA is, therefore, mandatory. Traditionally, CsA monitoring has been based on pre-dose trough levels (C0), but recent pharmacokinetic and clinical studies have revealed that the immunosuppressive effect may be related to diurnal CsA exposure and blood CsA concentration 0-4 hours after dosing. The two-hour post-dose concentration (C2) has proved a reliable surrogate marker of CsA exposure. Individual starting doses of CsA were analyzed in 65 patients. A recommended dose based on a pre-TX pharmacokinetic study was calculated for each patient by the pre-TX protocol. The predicted dose was clearly higher in the youngest children than in the older ones (22.9±10.4 and 10.5±5.1 mg/kg/d in patients <2 and >8 years of age, respectively). The actually administered oral doses of CsA were collected for three weeks after TX and compared to the pharmacokinetically predicted dose. After the TX, dosing of CsA was adjusted according to clinical parameters and blood CsA trough concentration. The pharmacokinetically predicted dose and patient age were the two significant parameters explaining post-TX doses of CsA. Accordingly, young children received significantly higher oral doses of CsA than the older ones. The correlation to the actually administered doses after TX was best in those patients, who had a predicted dose clearly higher or lower (> ±25%) than the average in their age-group. Due to the great individual variation in pharmacokinetics standardized dosing of CsA (based on body mass or surface area) may not be adequate. Pre-Tx profiles are helpful in determining suitable initial CsA doses. CsA monitoring based on trough and C2 concentrations was analyzed in 47 patients, who received renal transplants in 2001 2006. C0, C2 and experienced acute rejections were collected during the post-TX hospitalization, and also three months after TX when the first protocol core biopsy was obtained. The patients who remained rejection free had slightly higher C2 concentrations, especially very early after TX. However, after the first two weeks also the trough level was higher in the rejection-free patients than in those with acute rejections. Three months after TX the trough level was higher in patients with normal histology than in those with rejection changes in the routine biopsy. Monitoring of both the trough level and C2 may thus be warranted to guarantee sufficient peak concentration and baseline immunosuppression on one hand and to avoid over-exposure on the other hand. Controlling of rejection in the early months after transplantation is crucial as it may contribute to the development of long-term allograft nephropathy. Recently, it has become evident that immunoactivation fulfilling the histological criteria of acute rejection is possible in a well functioning graft with no clinical sings or laboratory perturbations. The influence of treatment of subclinical rejection, diagnosed in 3-month protocol biopsy, to graft function and histology 18 months after TX was analyzed in 22 patients and compared to 35 historical control patients. The incidence of subclinical rejection at three months was 43%, and the patients received a standard rejection treatment (a course of increased MP) and/or increased baseline immunosuppression, depending on the severity of rejection and graft function. Glomerular filtration rate (GFR) at 18 months was significantly better in the patients who were screened and treated for subclinical rejection in comparison to the historical patients (86.7±22.5 vs. 67.9±31.9 ml/min/1.73m2, respectively). The improvement was most remarkable in the youngest (<2 years) age group (94.1±11.0 vs. 67.9±26.8 ml/min/1.73m2). Histological findings of chronic allograft nephropathy were also more common in the historical patients in the 18-month protocol biopsy. All pediatric renal TX patients receive MP as a part of the baseline immunosuppression. Although the maintenance dose of MP is very low in the majority of the patients, the well-known steroid-related adverse affects are not uncommon. It has been shown in a previous study in Finnish pediatric TX patients that steroid exposure, measured as area under concentration-time curve (AUC), rather than the dose correlates with the adverse effects. In the present study, MP AUC was measured in sixteen stable maintenance patients, and a correlation with excess weight gain during 12 months after TX as well as with height deficit was found. A novel bioassay measuring the activation of glucocorticoid receptor dependent transcription cascade was also employed to assess the biological effect of MP. Glucocorticoid bioactivity was found to be related to the adverse effects, although the relationship was not as apparent as that with serum MP concentration. The findings in this study support individualized monitoring and adjustment of immunosuppression based on pharmacokinetics, graft function and histology. Pharmacokinetic profiles are helpful in estimating drug exposure and thus identifying the patients who might be at risk for excessive or insufficient immunosuppression. Individualized doses and monitoring of blood concentrations should definitely be employed with CsA, but possibly also with steroids. As an alternative to complete steroid withdrawal, individualized dosing based on drug exposure monitoring might help in avoiding the adverse effects. Early screening and treatment of subclinical immunoactivation is beneficial as it improves the prospects of good long-term graft function.

The impact of stock option incentives on investment and firm value

This paper analyzes the relations among firm-level stock option portfolio incentives, investment, and firm value based on a sample of Finnish firms during the time period 1987 – 2000. Utilizing exact and complete information regarding stock option portfolio characteristics, we find some evidence that firm investment is increasing in the incentives to increase stock price (delta) and risk (vega). Furthermore, we find strong evidence of a positive relation between both incentive effects and firm value (Tobin’s Q). In contrast, when we allow for stock option incentives, investment, and firm value to be simultaneously determined, we find no evidence that investment is increasing in incentives. However, even after controlling for endogeneity, we find that both incentive effects arising from stock option compensation display a positive and significant effect on firm value. Finally, in contradiction to earlier findings, we observe that neither Tobin’s Q nor investment drives incentives.

Does Uncertainty Affect Investment and Labor Demand?

This paper analyzes the effect of uncertainty on investment and labor demand for Finnish firms during the time period 1987 – 2000. Utilizing a stock return based measure of uncertainty decomposed into systematic and idiosyncratic components, the results reveal that idiosyncratic uncertainty significantly reduces both investment and labor demand. Idiosyncratic uncertainty seems to influence investment in the current period, whereas the depressing effect on labor demand appears with a one-year lag. The results provide support that the depressing effect of idiosyncratic uncertainty on investment is stronger for small firms in comparison to large firms. Some evidence is reported regarding differential effects of uncertainty on labor demand conditional on firm characteristics. Most importantly, the depressing effect of lagged idiosyncratic uncertainty on labor demand tends to be stronger for diversified firms compared with focused firms.

Kouluvalinta vai koulun valinta? : Oppilaiden valikoituminen yläkouluihin Espoossa keväällä 2006

Changes in governance in the public sector made it possible to give the power to the level of service production. In Finland schools were diversified. They wanted to be as attractive as possible. In her dissertation (2006) Piia Seppänen studied parental choice and schools choice policies in Espoo, in Kuopio, in Lahti, inTurku and in some levels in Helsinki too. After her study was done there has been some changes in school choise policy in Espoo. The catchments areas changed radically; earlier every school did have its own catchment area. But now three or even five school has the same catchment area. On the base of the Seppänen’s dissertation I wondered who’s choice it really were? Is the choice maker customer or producer of the service? In my study I tried to understand those processes where pupils were selected for the 7th grade in lower secondary schools in the spring in 2006. To make the picture clear, I have to study the history of pupil selection and the changes of it in the 21st century. I also have to study the geography of the town which is quite special in comparison with the normal cities with one central area. This has its own effects on the pupil selection system as well as in the whole study. In my study I try to present what kind of process the pupil selection is in Espoo and how it was done actually in the spring of 2006. The empirical data of my study were statistical data, documents of different kind, conversations with principals, local authorities and politicians. I also interviewed one politician and observed a few information meetings about the pupil selection process. Based on this large variety of data I tried to draw a picture of the way of speaking (writing) about the ability of the choice. Furthermore, how this pupil selection is done in reality. The ability to apply to special instruction in f. e. music, graphic arts or maths and sciences or to language based instruction (bilingual and immersion teaching) depends on the district you live. Because there is one catchment area which has no special or language based instruction available. Also the poor public transport system might have some effects on the parental choice. According to my study, 20 % of the 7th grade pupils were selected with criteria of different kind to special classes. Because the ability to get special or language based instruction depends on your district, there is a big risk for a selection based on the pupils' socio-economic background.

Maissin tuotantoon ja markkinoihin vaikuttavat tekijät Yhdysvalloissa 2000-luvulla

Tutkimus käsittelee maissin tuotantoon ja markkinoihin vaikuttavia tekijöitä Yhdysvalloissa 2000-luvulla. Yhdysvallat on maailman merkittävin maissin tuottaja. Aikaisemmin maissia on tuotettu suoraan tai välillisesti eläinten rehuna ihmisten ruuantuotannon tarpeisiin. 2000-luvulla maissin käyttö liikenteen polttoaineena käytettävän etanolin raaka-aineena on merkittävästi lisääntynyt. Samaan aikaan maissin hinta on noussut ennätyskorkeaksi. Tässä tutkimuksessa maissimarkkinoihin vaikuttavia tekijöitä tutkittiin ajankohtaisen viranomaistiedon, aiheeseen liittyvän aikaisemman tutkimuksen ja empiirisen ekonometrisen estimoinnin perusteella. Tutkimuksen teoreettinen viitekehys perustuu kysyntä- ja tarjontateoriaan. Lisäksi tässä tutkimuksessa on kerrottu Yhdysvaltojen maatalouspolitiikan lähihistoriasta ja tarkemmin tällä hetkellä rehuviljan tuotantoon vaikuttavasta maatalouspolitiikasta. Tutkimuksessa estimoitiin maissin tuottajien viljelypäätöksiin vaikuttavia tekijöitä käyttäen pienimmän neliösumman menetelmää. Viljelypäätöstä kuvaavaksi selitettäväksi muuttujaksi valittiin maissin viljelypinta-ala. Aineiston saatavuus rajasi tutkimuksen vuosiin 1987 – 2010. Viljelypinta-alaa selittäviä muuttujia valittiin 12. Muuttujien valinta perustui maissin tuotantoon liittyviin tekijöihin, joita on käytetty muissa alan tutkimuksissa ja joiden käyttöä voidaan perustella talousteorialla. Vähitellen kokeilemalla mallista karsittiin turhat muuttujat pois ja viljelypinta-alaa selittämään jäi maissin ja soijan viivästetty hintasuhde, viivästetty typpilannoitteen hinta, maissifutuurien ostomäärät sekä viivästetty etanolin tuotanto ja maissin muu teollinen käyttö. Paras ja luotettavin lineaarisella mallilla saatu tulos sai selitysasteeksi 0,85. Tässä mallissa molemmat kysyntää kuvaavat muuttujat olivat alle 1 % virhetasolla tilastollisesti merkitseviä. Alle 10 % virhetasolla tilastollisesti merkitseviä olivat myös maissin ja soijan hintasuhde samoin kuin futuuriostot. Samoilla muuttujilla testattu log-lineaarinen malli antoi tutkimuksen korkeimman selitysasteen 0,87. Selittävistä muuttujista etanolin tuotanto oli edelleen alle 1 % virhetasolla tilastollisesti merkitsevä. Sen sijaan maissin muun teollisen käytön merkitsevyys heikkeni, ollen kuitenkin alle 10 % virhetasolla tilastollisesti merkitsevä. Lannoitteen hinnan p-arvo laski, joten lannoitteen hinta oli nyt alle 5 % virhetasolla tilastollisesti merkitsevä samoin kuin futuuriostot. Log-lineaarinen malli paransi myös maissin ja soijan hintasuhteen merkitsevyyttä. Tutkimustulokset ovat loogisia ja vastaavat teoriaa ja muita tutkimuksia siltä osin, että maissin korkeampi hinta, maissin lisääntynyt kysyntä ja futuuriostot lisäävät maissin viljelypinta-alaa. Tulosten perusteella voi todeta maissin tuotantokustannusten nousun ja soijan hinnan nousun laskevan maissin viljelypinta-alaa. Tutkimuksen tuloksena saadut joustokertoimet ovat pieniä, mikä kertoo maissin viljelypinta-alan vaihtelujen olevan melko joustamattomia markkinoilla tapahtuviin muutoksiin nähden. Tästä voisi päätellä viljelijöiden tuotantopäätösten olevan melko riippumattomia markkinoiden muutoksista. Tämä voi selittyä maatalouspolitiikan luomalla vahvalla turvaverkolla, rajoitteilla ja kannustimilla.

Social and material deprivation among youth in Finland : causes, consequences, and coping.

Background: Social and material deprivation is associated with poor health, decreased subjective well-being, and limited opportunities for personal development. To date, little is known about the lived experiences of Finnish low-income youths and the general purpose of this study is to fill this gap. Despite the extensive research on socioeconomic income disparities, only a few scholars have addressed the question of how low socioeconomic position is experienced by disadvantaged people themselves. Little is known about the everyday social processes that lead to decreased well-being of economically and socially disadvantaged citizens. Data: The study is based on the data of 65 autobiographical essays written by Finnish low-income youths aged 14-29 (M=23.51, SD=3.95). The research data were originally collected in a Finnish nationwide writing contest “Arkipäivän kokemuksia köyhyydestä” [Everyday Experiences of Poverty] between June and September of 2006. The contest was partaken by 850 Finnish writers. Methods and key concepts: Autobiographical narratives (N=65) of low-income youths were analyzed based on grounded theory methodology (GTM). The analysis was not built on specific pre-conceived categorizations; it was guided by the paradigm model and so-called “sensitizing concepts”. The concepts this study utilized were based on the research literature on socioeconomic inequalities, resilience, and coping. Socioeconomic inequalities refer to unequal distribution of resources, such as income, social status, and health, between social groups. The concept of resilience refers to an individual’s capacity to cope despite existing risk factors and conditions that are harmful to health and well-being. Coping strategies can be understood as ways by which a person tries to cope with psychological stress in a situation where internal or externals demands exceed one’s resources. The ways to cope are cognitive or behavioral efforts by which individual tries to relieve the stress and gain new resources. Lack of material and social resources is associated with increased exposure to health-related stressors during the life-course. Aims: The first aim of this study is to illustrate how youths with low socioeconomic status perceive the causes and consequences of their social and material deprivation. The second aim is to describe what kind of coping strategies youths employ to cope in their everyday life. The third aim is to build an integrative conceptual framework based on the relationships between causes, consequences, and individual coping strategies associated with deprivation. The analysis was carried out through systematic coding and orderly treatment of the data based on the grounded theory methodology. Results: Finnish low-income youths attributed the primary causes of deprivation to their family background, current socioeconomic status, sudden life changes, and contextual factors. Material and social deprivation was associated with various kinds of negative psychological, social, and material consequences. Youths used a variety of coping strategies that were identified as psychological, social, material, and functional-behavioral. Finally, a conceptual framework was formulated to link the findings together. In the discussion, the results were compared and contrasted to the existing research literature. The main references of the study were: Coping: Aldwin (2007); Lazarus & Folkman (1984); Hobfoll (1989, 2001, 2002). Deprivation: Larivaara, Isola, & Mikkonen (2007); Lister (2004); Townsend (1987); Raphael (2007). Health inequalities: Dahlgren & Whitehead (2007); Lynch. et al. (2000); Marmot & Wilkinson (2006); WHO (2008). Methods: Charmaz (2006); Flick (2009); Strauss & Corbin (1990). Resilience: Cutuli & Masten (2009); Luthar (2006).