Primary Fallopian tube carcinoma:occurrence, risk and prognostic factors

The aim of the study was to clarify the occurrence, and etiological and prognostic factors of primary fallopian tube carcinoma (PFTC). We studied the sociodemographic determinants of the incidence of PFTC in Finland and the role of chlamydial infections and human papillomavirus infections as risk factors for PFTC. Serum tumor markers were studied as prognostic factors for PFTC. We also evaluated selected reproductive factors (parity, sterilization and hysterectomy) as risk or protective factors of PFTC. The risks of second primary cancers after PFTC were also studied. The age-adjusted incidence of PFTC in Finland increased to 5.4 / 1,000,000 in 1993 97. The incidence rate was higher in the cities, but the relative rise was higher in rural areas. Women in the two highest social classes showed a 1.8 fold incidence compared with those in the lowest. Women in agriculture and those not working outside the home showed only half the PFTC incidence of those in higher socioeconomic occupations. Pretreatment serum concentrations of hCGβ, CA125 and TATI were evaluated as prognostic markers for PFTC. Elevated hCGβ values (above the 75th percentile, 3.5 pmol/L; OR 2.49, 95% CI 1.22 5.09), stage and histology were strong independent prognostic factors for PFTC. The effects of parity, sterilization and hysterectomy on the risk of PFTC were studied in a case control-study with 573 PFTC cases from the Finnish Cancer Registry. In multivariate analysis parity was the only significant protective factor as regards PFTC, with increasing protection associated with increasing number of deliveries. In univariate analysis sterilization gave borderline protection against PFTC and the protective effect increased with time since the operation. In multivariate analysis the protection did not reach statistical significance. Chlamydial and human papillomavirus (HPV) infections were studied in two separate seroepidemiological case-control studies with 78 PFTC patients. The incidence of women with positive HPV or chlamydial serology was the same in PFTC patients and in the control group and was not found to be a risk factor for PFTC. Finally, the possible risk of a second primary cancer after diagnosis and treatment of PFTC in a cohort of 2084 cases from 13 cancer registries followed for second primary cancers within the period 1943 2000 was studied. In PFTC patients, second primary cancers were 36% more common than expected (SIR 1.36, 95% CI 1.13 1.63). In conclusion, the incidence of PFTC has increased in Finland, especially in higher social classes and among those in certain occupations. Elevated serum hCGβ reflect a worsened prognosis. Parity is a clear protective factor, as is previous sterilization. After PFTC there is a risk of second primary cancers, especially colorectal, breast, lung and bladder cancers and non-lymphoid leukemia. The excess of colorectal and breast cancers after PFTC may indicate common effects of earlier treatments, or they could reflect common effects of lifestyle or genetic, immunological or environmental background.

Topeliaaninen usko : Kirjailija Sakari Topelius uskontokasvattajana

ABSTRACT The author Zacharias Topelius as a religious educator The present study concerns the author Zacharias Topelius (1818-98) as a religious educator. The study´s main questions are as follows: What is the theological and pedagogical content of Topelius books and how is his religious instruction linked with the history of his time. The primary sources are his educational books Naturens bok (The Book of the Nature, 1856), Boken om vårt land (The Book of our Land, 1875) and Evangelium för Barnen (Gospel for Children, 1893), as well as his storybooks Läsning för barn I-VIII (Reading for Children I-VIII, 1865-96). The dissertation concerns the his-tory of religious education. Its primary method is background-based systematic analy-sis. In Topelius children s books the view of God is characterised both as an omnipresent spirit and as Providence, who guides world history according to his plan. In addition to Lutheranism this view is also influenced by Nationalism and Romanticism. The theological content of the books emphasises instruction in Christian life that is natural to normative children s books. Topelius strongly expresses the importance of a personal relationship to God, an idealistic Christian view of one s fellow man and of one s own nation as well as the value of nature conservation. The books of Topelius were some of the first educational works on nature preservation in Finland. The didactic quality of Topelius children s books was high for 19th century Finland. Their main emphasis in terms of educational goals is on civilisation (Bildung), self-awareness, national solidarity and living idealism. The pedagogical argumentation is mostly based on theological, historical, social and rational reasoning. The primary principles in Topelius teaching are Christian nationalism, idealistic harmony and the agrarian bourgeois. Christian nationalism is the main element of Topelius religious education. He considers the fatherland as a God-given project and the taking care of it as a part of holy service. Idealistic harmony is seen as the comprehensive development of one s character in the sense of romantic idealism. The agrarian bourgeois principle combines the Finnish peasant tradition with the values of 19th century modern bourgeois culture. I have named Topelius vision of religious education the Christian national project of civilisation (Bildung). Its main theses are home, religion and fatherland. The author himself strongly believed in this vision and never questioned it despite its national chauvinism and theological inconsistency. The religious ideology represented in Topelius educational works and storybooks was popular among pedagogues during the whole era of the Finnish folk school. It fit per-fectly with the Christian national discourse stemming from 19th century ideological ten-dencies. Due to their appropriate content combined with their practical language and pedagogical methods, the books were popular both at school and in the home for a long period of time. Therefore the books of Topelius aptly symbolise the religious education of their time and manifest their author s pedagogical talent as a national religious educator and as a populariser of Christian nationalism. Topelius books have had a lasting influence on Finnish religiosity. Key words: Topelius, theology, religion, education, nationalism and national project

Variation i kvinnors namnfraser i officiella dokument i Helsingfors 1780-1930 : Socioonomastiska synvinklar på makt och identitet

This dissertation is an onomastic study of variation in women s name phrases in official documents in Finland during the period 1780−1930. The aim is to discuss from a socio-onomastic perspective both the changeover from patronymics to inherited family names and the use of surnames after marriage (i.e. whether women adopted their husbands family names or retained their maiden names), before new laws in this area entered into force in Finland in the early 20th century. In 1920, a law on family names that required fixed names put an end to the use of the patronymic as a person s only surname. After 1929, it was no longer possible for a married woman to retain her maiden name. Methodologically, to explain this development from a socio-onomastic perspective, I have based my study on a syntactic-semantic analysis of the actual name phrases. To be able to demonstrate the extensive material, I have elaborated a scheme to divide the 115 different types of name phrases into 13 main categories. The analysis of the material for Helsinki is based on frequency calculations of the different types of name phrases every thirtieth year, as well as on describing variation in the structure and semantic content of the name phrases, e.g. social variation in the use of titles and epithets. In addition to this, by applying a biographic-genealogical method, I have conducted two case studies of the usage of women s name phrases in the two chosen families. The study is based on parish registers from the period 1780−1929, estate inventory documents from the period 1780−1928, registration forms for liberty of trade from the period 1880−1908, family announcements on newspapers from the period 1829−1888, gravestones from the period 1796−1929 and diaries from the periods 1799−1801 and 1818−1820 providing a corpus of 5 950 name phrases. The syntactic-semantic analysis has revealed the overall picture of various ways of denoting women in official documents. In Helsinki, towards the end of the 19th century, the use of inherited family names seems to be almost fully developed in official contexts. At the late 19th century, a patronymic still appears as the only surname of some working-class women whereas in the early 20th century patronymics were only entered in the parish register as a kind of middle name. In the beginning of the 19th century, most married women were still registered under their maiden names, with a few exceptions among the bourgeoisie and upper class. The comparative analysis of name phrases in diaries, however, indicates that the use of the husband s family name by married women was a much earlier phenomenon in private contexts than in official documents. Keywords: socio-onomastics, syntactic-semantic analysis, name phrase, patronymic, maiden name, husband s family name