Suomalaisten yritysten vapaaehtoinen sosiaalinen vastuu : Sidosryhmäviitekehys yritysten ja ulkoisten sidosryhmien edustajien näkemyksissä

Corporate social responsibility (CSR) is no longer only an issue of companies but a concern shared by e.g. the European Union, the International Labour Organization, labour market organizations and many others. This thesis examines what kind of voluntary corporate social responsibility exceeding the minimum level set in the legislation can be expected from the Finnish companies. The research was based on the interviews of some representatives of Finnish companies and of external stakeholders. Earlier Finnish empirical research on the topic has solely analysed the stakeholder thinking and the ethics of the views of the company representatives. The views of the external stakeholders brought ht up a much more versatile perspective on the voluntary corporate social responsibility of the companies. That is the particular surplus value of this research. This research, founded on stakeholder thinking, evaluated what kind of starting points and ideas on responsibility the views of the representatives of the companies and the external stakeholders were based on the voluntary social responsibility. Furthermore, the research also investigated how their views about the corporate social responsibility indicated the benefits achieved on the cooperative actions with different partners - for example companies, communities and public administration. To fulfil the aims of the research, the following questions were used as part tasks in mapping the basic foundations and starting points expressed by the representatives of the companies and the external stakeholders: 1) How do laws, directions concerning social responsibility of companies, and opinions and demands of the stakeholders guide and affect the voluntary corporate social responsibility? 2) How can companies assume voluntary corporate social responsibility in addition to their core functions and without compromising their profitability, and how does, for example, the tightening competition affect the possibility of taking responsibility? 3) What kind of ethic and moral foundations is the corporate social responsibility based on? 4) What kind of roles can companies have in securing and promoting the well-being of citizens in Finland and on the global market as one subsystem of the society? The views on the voluntary corporate social responsibility of nine big companies, one medium-sized company and one small company, all considered responsible pioneer companies, were studied with surveys and half-structured theme interviews between 2003 and 2004. The research proceeded as a theory-bounded study. The empirical material and the previous stakeholder thinking theories (Takala 2000b, Vehkaperä 2003) guided the thesis and worked abductively in interplay with each other during the research process. (Tuomi, Sarajärvi 2002.) The aims and the methods of the research and the themes of the interviews were defined on the basis of that information. The aims of the research were surveyed qualitatively with the strategy of a multiple case study. Representatives from nine big peer companies and nine external stakeholders were interviewed with half-structured themes between 2004 and 2005. The external stakeholders and the peer companies were chosen with the "thinking" of theoretical replication by Yin, according to which the views of the representatives of those groups would differ from those of the pioneer companies and also from those of each others. The multiple case study supports analysing the internal cohesion of the views of different groups and comparing their differences, and it supports theoretical evaluation and theory-building as well. (Yin 2003.) Another reason for choosing the external stakeholders was their known cooperation with companies. The spoken argumentations of the company and stakeholder representatives on the voluntary social responsibility of the companies were analysed and interpreted in the first place with an analytic discourse analysis, and the argumentations were classified allusively into the stakeholder discourses in three of the part tasks. In the discourse analysis, argumentations of the speech is seen to be intervowen with cultural meanings. (Jokinen, Juhila 1999.) The views of the representatives of the pioneer companies and the external stakeholders were more stakeholder-orientated than the views of the representatives of the peer companies. For the most part, the voluntary corporate social responsibility was seemingly targeted on single, small cooperation projects of the companies and external stakeholders. The pioneer companies had more of those projects, and they were participating in the projects more actively than the peer companies were. The significant result in this research was the notion that, in particular, the representatives of the pioneer companies and external stakeholders did not consider employing and paying taxes to be enough of reciprocal corporate social responsibility. However, they still wanted to preserve the Finnish welfare model, and the interviewees did not wish major changes in the present legislation or the social agreements. According to this study, the voluntary corporate social responsibility is motivated by ethical utilitarianism which varied from very narrow to very wide in relation to benefits achieved by companies and stakeholders (Velasquez 2002, Lagerspetz 2004). Compared with the peer companies, more of the representatives of the pioneer companies and of external stakeholders estimated that companies in their decision-making and operations considered not only the advantages and the benefits of the owners and other internal stakeholders, but also those of the external stakeholders and of the whole society. However, all interviewees expressed more or less strongly that the economic responsibility guides the voluntary responsible actions of the companies in the first place. This kind of utilitarian foundation of behaviour appeared from this research was named as business-orientated company moral. This thesis also presents a new voluntary corporate social responsibility model with four variables on the stakeholder discourses and their distinctive characteristics. The utilitarian motivation of a company s behaviour on their operations has been criticized on the grounds that the end justifies the means. It has also been stated that it is impossible to evaluate the benefits of the utilitarian type of actions to the individuals and the society. It is expected however that companies for their part promote the material and immaterial well-being of the individuals on the global, national and local markets. The expectations are so strong that if companies do not take into account the ethical and moral values, they can possibly suffer significant financial losses. All stakeholders, especially consumers, can with their own choices promote the responsible behaviour of the companies. Key words: voluntary corporate social responsibility, external stakeholders, corporate citizenship, ethics and morality, utilitarianism, stakeholder discourses, welfare society, globalisation

The Phraseology and Structure of Latin Building Inscriptions in Roman North Africa

This study analyses the diction of Latin building inscriptions. Despite its importance, this topic has rarely been discussed before: the most substantial contribution on the subject is a short dissertation by Klaus Gast (1965) that focuses on 100 inscriptions dating mostly from the Republican period. Marietta Horster (2001) also touched upon this theme in her thesis on imperial building inscriptions. I have collected my source material in North Africa because more Latin building inscriptions dating from the Imperial period have survived there than in any other area of the Roman Empire. By means of a thorough and independent survey, I have assembled all relevant African Latin building inscriptions datable to the Roman period (between 146 BC and AD 425), 1002 texts, into a corpus. These inscriptions are all fully edited in Appendix 1; Appendix 2 contains references to earlier editions. To facilitate search operations, both are also available in electronic form. They are downloadable from the address http://www.helsinki.fi/hum/kla/htm/jatkoopinnot.htm. Chapter one is an introduction dealing with the nature of building inscriptions as source material. Chapter two offers a statistical overview of the material. The following main section of the work falls into five chapters, each of which analyses one main part of a building inscription. An average building inscription can be divided into five parts: the starting phrase opens the inscription (a dedication to gods, for example), the subject part identifies the builder, the object part describes the constructed or repaired building, the predicate part records the building activity and the supplement part offers additional information on the project (it can specify the funding, for instance). These chapters are systematic and chronological and their purpose is to register and interpret the phrases used, to analyse reasons for their use and for their popularity among the different groups of builders. Chapter eight, which follows the main section of the work, creates a typology of building inscriptions based on their structure. It also presents the most frequently attested types of building inscriptions. The conclusion describes, on a general level, how the diction of building inscriptions developed during the period of study and how this striking development resulted from socio-economic changes that took place in Romano-African society during Antiquity. This study shows that the phraseology of building inscriptions had a clear correlation both with the type of builder and with the date of carving. Private builders tended to accentuate their participation (especially its financial side) in the project; honouring the emperor received more emphasis in the building inscriptions set up by communities; the texts produced by the army were concise. The chronological development is so clear that it enables stylistic dating. At the beginning of the imperial period the phrases were clear, concrete, formal and stereotyped but by Late Antiquity they have become vague, subjective, flexible, varied and even rhetorically or poetically coloured.

Text and Intensification of Its Impact in Chishti Samā`

In my master’s thesis I analyse mystical Islamic poetry in ritualistic performance context, samā` , focusing on the poetry used by the Chishti Sufis. The work is based on both literary sources and ethnographic material collected in India. The central textual source is Surūd-i Rūhānī, a compilation of mystical poetry. Textual sources, however, can be understood properly only in relation to the living performance context and therefore I also utilise interviews of Sufis and performers of mystical music and recordings of samā` assemblies along with texts. First part of the thesis concentrates on thematic overview of the poems and the process of selecting a suitable text for performance. The poems are written in three languages, viz. in Persian, Urdu and Hindi. Among the authors are both Sufis and non-Sufis. The poems, mystical and non-mystical alike, share the same poetic images and they acquire a mystical meaning when they are set to qawwali music and performed in samā` assemblies. My work includes several translations of verses not previously translated. Latter part of the thesis analyses the musical idiom of qawwali and the ways in which the impact of text on listeners is intensified in performance. Typically the intensification is accomplished in the level of a single poem through three different techniques: using introductory verses, inserting verses between the verses of the main poem and repeating individual units of text. The former two techniques are tied to creating a mystical state in the listeners while the latter aims at sustaining it. It is customary that a listener enraptured by mystical experience offers a monetary contribution to the performers. Thus, intensification of the text’s impact aims at enabling the listeners to experience mystical states.

Measuring attitudes in translation: a study of Nokia business reports

Background Contemporary Finnish, spoken and written, reveals loanwords or foreignisms in the form of hybrids: a mixture of Finnish and foreign syllables (alumiinivalua). Sometimes loanwords are inserted into the Finnish sentence in their raw form just as they are found in the source language (pulp, after sales palvelu). Again, sometimes loanwords are calques, which appear Finnish but are spelled and pronounced in an altogether foreign manner (Protomanageri, Promenadi kampuksella). Research Questions What role does Finnish business translation play in the migration of foreignisms into Finnish if we consider translation "as a construct of solutions determined by the ideological constraints and conflicts characterizing the target culture" (Robyns 1992: 212)? What attitudes do the Finns display toward the presence of foreignisms in their language? What socio-economic or ideological conditions (Bassnett 1994: 321) are responsible for these attitudes? Are these conditions dynamic? What tools can be used to measure such attitudes? This dissertation set out to answer these and similar questions. Attitudes are imperialist (where otherness is both denied and transformed), defensive (where otherness is acknowledged, transformed, and vilified), transdiscursive (a neutral attitude to both otherness and transformation), or finally defective (where alien migration is acknowledged and "stimulated") (Robyns 1994: 60). Methodology The research method follows Rose's schema (1984: 8): (a) take an existing theory, (b) develop from it a proposition specific enough to be tested, (c) devise a scheme that tests this proposition, (d) carry through the scheme in practice, (e) draw up results and discuss conclusions in relation to the original theory. In other words, the method attempts an explanation of a Finnish social phenomenon based on systematic analyses of translated evidence (Lewins 1992: 4) whereby what really matters is the logical sequence that connects the empirical data to the initial research questions raised above and, ultimately to its conclusion (Yin 1984: 29). Results This research found that Finnish translators of the Nokia annual reports used a foreignism whenever possible such as komponentin instead of rakenneosa, or investoida instead of sijoittaa, and often without any apparent justification (Pryce 2003: 203-12) more than the translator's personal preference. In the old documents (minutes of meetings of the Board of Directors of Osakeyhtio H. Saastamoinen, Ltd. dated 5 July 1912-1917, a NOPSA booklet (1932), Enzo-Gutzeit-Tornator Oy document (1938), Imatra Steel Oy Annual Report 1964, and Nokia Oy Annual Report 1946), foreignisms under Haugen's (1950: 210-31) Classification #1 occurred an average of 0.6 times, while in the new documents (Nokia 1998 translated Annual Reports) they occurred an average of 6.5 times. That big difference, suggests transdiscursive and defective attitudes in Finnish society toward the other. In the 1850s, Finnish attitudes toward alien persons and cultures were hardened, intolerant and prohibitive because language politics were both nascent and emerging, and Finns adopted a defensive stance (Paloposki 2002: 102 ff) to protect their cultural and national treasures such as language and folklore. Innovation The innovation here is that no prior doctoral level research measured Finnish attitudes toward foreignisms using a business translation approach. This is the first time that Haugen's classification has been modified and applied in target language analysis. It is hoped that this method would be replicated in similar research in the future. Applications For practical applications, researchers with interest in languages, language development, language influences, language ideologies, and power structures that affect national language policies will find this thesis useful, especially the model for collecting, grouping, and analyzing foreignisms that has been demonstrated here. It is intended to document for posterity current attitudes of Finns toward the other as revealed in business translations from 1912-1964, and in 1998. This way, future language researchers would be able to explore a time-line of Finnish language development and attitudes toward the other. Communication firms may also find this research interesting. In future, could the model we adopted be used to analyze literary texts or religious texts for example? Future Trends Though business documents show transdiscursive attitudes, other segments of Finnish society may show defensive or imperialist attitudes. When the ideology of industrialization changes in the future, will Finnish attitudes toward the other change as well? Will it then be possible to use the same kind of analytical tools to measure Finnish attitudes? More broadly, will linguistic change continue in the same direction of transdiscursive attitudes, or will the change slow down or even reverse into xenophobic attitudes? Is this our model culture-specific or can it be used in the context of other cultures? Conclusion There is anger against foreignisms in Finland as newspaper publications and television broadcasts show, but research shows that a majority of Finns consider foreignisms and the languages from which they come as sources of enrichment for Finnish culture (Laitinen 2000, Eurobarometer series 41 of July 1994, 44 of Spring 1996, 50 of Autumn 1998). Ideologies of industrialization and globalization in Finland have facilitated transdiscursive tendencies. When Finland's political ideology was intolerant toward foreign influences in the 1850s because Finland was in the process of consolidating her nascent country and language, attitudes toward the importation of loanwords also became intolerant. Presently, when industrialization and globalization became the dominant ideologies, we see a shift in attitudes toward transdiscursive tendencies. Ideology is usually unseen and too often ignored by translation researchers. However, ideology reveals itself as the most powerful factor affecting language attitudes in a target culture. Key words Finnish, Business Translation, Ideology, Foreignisms, Imperialist Attitudes, Defensive Attitudes, Transdiscursive Attitudes, Defective Attitudes, the Other, Old Documents, New Documents.

The Influence of Constantinople on Middle Byzantine Architecture (843-1204) : A typological and morphological approach at the provincial level.

The influence of the architecture of the Byzantine capital spread to the Mediterranean provinces with travelling masters and architects. In this study the architecture of the Constantinopolitan School has been detected on the basis of the typology of churches, completed by certain morphological aspects when necessary. The impact of the Constantinopolitan workshops appears to have been more important than previously realized. This research revealed that the Constantinopolitan composite domed inscribed-cross type or cross-in-square spread everywhere to the Balkans and it was assumed soon by the local schools of architecture. In addition, two novel variants were invented on the basis of this model: the semi-composite type and the so-called Athonite type. In the latter variant lateral conches, choroi, were added for liturgical reasons. Instead, the origin of the domed ambulatory church was partly provincial. One result of this study is that the origin of the Middle Byzantine domed octagonal types was traced to Constantinople. This is attested on the basis of the archaeological evidence. Also some other architectural elements that have not been preserved in the destroyed capital have survived at the provincial level: the domed hexagonal type, the multi-domed superstructure, the pseudo-octagon and the narthex known as the lite. The Constantinopolitan architecture during the period in question was based on the Early Christian and Late Antique forms, practices and innovations and this also emerges at the provincial level.

Wipert von Blücher und Finnland : Alternativpolitik und Diplomatie im 'Dritten Reich'

This dissertation explores the role of the German minister to Helsinki, Wipert von Blücher (1883-1963), within the German-Finnish relations of the late 1930s and the Second World War. Blücher was a key figure – and certainly one of the constants – within German Finland policy and the complex international diplomacy surrounding Finland. Despite representing Hitler’s Germany, he was not a National Socialist in the narrower sense of the term, but a conservative civil servant in the Wilhelmine tradition of the German foreign service. Along with a significant number of career diplomats, Blücher attempted to restrict National Socialist influence on the exercise of German foreign policy, whilst successfully negotiating a modus vivendi with the new regime. The study of his political biography in the Third Reich hence provides a highly representative example of how the traditional élites of Germany were caught in an cycle of conformity and, albeit tacit, opposition. Above all, however, the biographical study of Blücher and his behaviour offers an hitherto unexplored approach to the history of the German-Finnish relations. His unusually long tenure in Helsinki covered the period leading up to the so-called Winter War, which left Blücher severely distraught by Berlin’s effectively pro-Soviet neutrality and brought him close to resigning his post. It further extended to the German-Finnish rapprochement of 1940/41 and the military cooperation of both countries from mid-1941 to 1944. Throughout, Blücher developed a diverse and ambitious set of policy schemes, largely rooted in the tradition of Wilhelmine foreign policy. In their moderation and commonsensical realism, his designs – indeed his entire conception of foreign policy – clashed with the foreign political and ideological premises of the National Socialist regime. In its theoretical grounding, the analysis of Blücher’s political schemes is built on the concept of alternative policy and indebted to A.J.P. Taylor’s definition of dissent in foreign policy. It furthermore rests upon the assumption, introduced by Wolfgang Michalka, that National Socialist foreign policy was dominated by a plurality of rival conceptions, players, and institutions competing for Hitler’s favour (‘Konzeptionen-Pluralismus’). Although primarily a study in the history of international relations, my research has substantially benefited from more recent developments within cultural history, particularly research on nobility and élites, and the renewed focus on autobiography and conceptions of the self. On an abstract level, the thesis touches upon some of the basic components of German politics, political culture, and foreign policy in the first half of the 20th century: national belonging and conflicting loyalties, self-perception and representation, élites and their management of power, the modern history of German conservatism, the nature and practice of diplomacy, and, finally, the intricate relationship between the ethics of the professional civil service and absolute moral principles. Against this backdrop, the examination of Blücher’s role both within Finnish politics and the foreign policy of the Third Reich highlights the biographical dimension of the German-Finnish relationships, while fathoming the determinants of individual human agency in the process.

Konstruktioiden dynamiikkaa

Dynamic constructions Dynamic constructions is a study of the dynamism of Finnish grammar. Dynamism as a linguistic phenomenon is studied on both the diachronic and synchronic level. The study therefore focuses not only on the temporal changes of grammar but also on the conventionality of grammatical structures and on the interplay between closely related constructions. Dynamism is also treated as a phenomenon occurring between different varieties of Finnish. All in all, dynamism is shown to be a key feature of the nature of grammar. The study is set within the framework of cognitive linguistics and construction grammar. Both theories emphasise the role of constructions pairings of form with semantic or discourse function in the composition and development of grammar. The grammar of a language is understood to be a structured inventory of such constructions. I argue that the constructions are best studied in their original contexts of use. Thus, the study is usage-based in a strict sense. The data is compiled from various corpora consisting of both written and spoken as well as standard and non-standard Finnish. The dissertation consists of an introduction and four empirical studies. The four papers examine various Finnish constructions and thereby shed light on different aspects of the dynamism of a grammar. The first paper focuses on the diachronic development of the Finnish temporal converb essa. The second paper discusses a specific construction which includes the essa converb, that is, the mikäs on ollessa construction. Some closely related constructions and their semantic interplay are also examined. The third paper extensively studies what is generally regarded as an ellipsis of the negation verb in Finnish. By using present day Finnish data, I show that the omission of the negation verb is not an instance of mere ellipsis but rather a construction. The final paper combines the themes of the second and the third paper by focusing on closely related constructions of the negative ellipsis construction.

Visual search and eye movements: Studies of perceptual span

In visual search one tries to find the currently relevant item among other, irrelevant items. In the present study, visual search performance for complex objects (characters, faces, computer icons and words) was investigated, and the contribution of different stimulus properties, such as luminance contrast between characters and background, set size, stimulus size, colour contrast, spatial frequency, and stimulus layout were investigated. Subjects were required to search for a target object among distracter objects in two-dimensional stimulus arrays. The outcome measure was threshold search time, that is, the presentation duration of the stimulus array required by the subject to find the target with a certain probability. It reflects the time used for visual processing separated from the time used for decision making and manual reactions. The duration of stimulus presentation was controlled by an adaptive staircase method. The number and duration of eye fixations, saccade amplitude, and perceptual span, i.e., the number of items that can be processed during a single fixation, were measured. It was found that search performance was correlated with the number of fixations needed to find the target. Search time and the number of fixations increased with increasing stimulus set size. On the other hand, several complex objects could be processed during a single fixation, i.e., within the perceptual span. Search time and the number of fixations depended on object type as well as luminance contrast. The size of the perceptual span was smaller for more complex objects, and decreased with decreasing luminance contrast within object type, especially for very low contrasts. In addition, the size and shape of perceptual span explained the changes in search performance for different stimulus layouts in word search. Perceptual span was scale invariant for a 16-fold range of stimulus sizes, i.e., the number of items processed during a single fixation was independent of retinal stimulus size or viewing distance. It is suggested that saccadic visual search consists of both serial (eye movements) and parallel (processing within perceptual span) components, and that the size of the perceptual span may explain the effectiveness of saccadic search in different stimulus conditions. Further, low-level visual factors, such as the anatomical structure of the retina, peripheral stimulus visibility and resolution requirements for the identification of different object types are proposed to constrain the size of the perceptual span, and thus, limit visual search performance. Similar methods were used in a clinical study to characterise the visual search performance and eye movements of neurological patients with chronic solvent-induced encephalopathy (CSE). In addition, the data about the effects of different stimulus properties on visual search in normal subjects were presented as simple practical guidelines, so that the limits of human visual perception could be taken into account in the design of user interfaces.

Becoming a teacher: emerging teacher identity in mathematics teacher education

This research examines three aspects of becoming a teacher, teacher identity formation in mathematics teacher education: the cognitive and affective aspect, the image of an ideal teacher directing the developmental process, and as an on-going process. The formation of emerging teacher identity was approached in a social psychological framework, in which individual development takes place in social interaction with the context through various experiences. Formation of teacher identity is seen as a dynamic, on-going developmental process, in which an individual intentionally aspires after the ideal image of being a teacher by developing his/her own competence as a teacher. The starting-point was that it is possible to examine formation of teacher identity through conceptualisation of observations that the individual and others have about teacher identity in different situations. The research uses the qualitative case study approach to formation of emerging teacher identity, the individual developmental process and the socially constructed image of an ideal mathematics teacher. Two student cases, John and Mary, and the collective case of teacher educators representing socially shared views of becoming and being a mathematics teacher are presented. The development of each student was examined based on three semi-structured interviews supplemented with written products. The data-gathering took place during the 2005 2006 academic year. The collective case about the ideal image provided during the programme was composed of separate case displays of each teacher educator, which were mainly based on semi-structured interviews in spring term 2006. The intentions and aims set for students were of special interest in the interviews with teacher educators. The interview data was analysed following the modified idea of analytic induction. The formation of teacher identity is elaborated through three themes emerging from theoretical considerations and the cases. First, the profile of one s present state as a teacher may be scrutinised through separate affective and cognitive aspects associated with the teaching profession. The differences between individuals arise through dif-ferent emphasis on these aspects. Similarly, the socially constructed image of an ideal teacher may be profiled through a combination of aspects associated with the teaching profession. Second, the ideal image directing the individual developmental process is the level at which individual and social processes meet. Third, formation of teacher identity is about becoming a teacher both in the eyes of the individual self as well as of others in the context. It is a challenge in academic mathematics teacher education to support the various cognitive and affective aspects associated with being a teacher in a way that being a professional and further development could have a coherent starting-point that an individual can internalise.

Do UNESCO Schools in Finland Prepare Their Students for the Future? : A Study of Their School-based Curriculums

The purpose of the research was to study how Finnish lower-stage schools participating in the international network of UNESCO schools, also called the Associated Schools Project (ASP), prepare their students for the future at the level of their school-based curriculums. In the research, the future trends were discussed, and the importance of their consideration in educational practice was explained from a global viewpoint: Based on the examination of today's problematic world state, and development trends characterized by globalization, the challenges and demands set for schooling and education in the future were discussed. Understanding the significance of an individual's action and responsibility was considered to be the central resource for building a more just and sustainable future. The study was grounded on a theoretical model developed by the researcher, which combined the models of Dalin & Rust (1996) and UNESCO (Delors et al. 1996) about future-oriented learning. The model consists of four basic elements of curriculum; "Nature", "Culture", "Myself", and "Others", and four dimension of learning; "Learning to know", "Learning to do", "Learning to live together" and "Learning to be". The model represents the holistic aspect of educational theory, and its aim is to maintain a balance between its different components. The research material composed of ten lower-stage UNESCO schools' school-based curriculums. They were analyzed using the theoretical model by the methology of content analysis. The research results were notably consistent between the different schools. They showed cultural learning and learning concerned with "myself" to be clearly more emphasized than learning referring to nature and other people. In addition, they reflected the central position of subjects, knowledge and skills, thus leaving the development of the pupils' personalities, and particularly learning concerned with living with other people, in a marginal role. The question about whether the schools prepare for the future interms of their curriculums, was discussed in the light of the results. The research offered a way and a model to approach the relationship between education and the future, and to evaluate schools' future-orientation. Based on the results, the schools are suggested to lay more stress on learning concerned with nature and other people, and focus more on developing the mental capasities of their pupils and competencies they need for living with other people. Above all, what the present societies require of schools is education which produces balanced and broadly aware human beings who have the mental strength to face the challenges of the future and abilities to direct it along the lines they desire. Keywords: future, curriculum, content analysis

The scientific basis and development of a matrix metalloproteinase (MMP) -8 specific chair-side test for monitoring of periodontal health and disease from gingival crevicular fluid

Matrix metalloproteinase (MMP) -8, collagenase-2, is a key mediator of irreversible tissue destruction in chronic periodontitis and detectable in gingival crevicular fluid (GCF). MMP-8 mostly originates from neutrophil leukocytes, the first line of defence cells which exist abundantly in GCF, especially in inflammation. MMP-8 is capable of degrading almost all extra-cellular matrix and basement membrane components and is especially efficient against type I collagen. Thus the expression of MMP-8 in GCF could be valuable in monitoring the activity of periodontitis and possibly offers a diagnostic means to predict progression of periodontitis. In this study the value of MMP-8 detection from GCF in monitoring of periodontal health and disease was evaluated with special reference to its ability to differentiate periodontal health and different disease states of the periodontium and to recognise the progression of periodontitis, i.e. active sites. For chair-side detection of MMP-8 from the GCF or peri-implant sulcus fluid (PISF) samples, a dip-stick test based on immunochromatography involving two monoclonal antibodies was developed. The immunoassay for the detection of MMP-8 from GCF was found to be more suitable for monitoring of periodontitis than detection of GCF elastase concentration or activity. Periodontally healthy subjects and individuals suffering of gingivitis or of periodontitis could be differentiated by means of GCF MMP-8 levels and dipstick testing when the positive threshold value of the MMP-8 chair-side test was set at 1000 µg/l. MMP-8 dipstick test results from periodontally healthy and from subjects with gingivitis were mainly negative while periodontitis patients sites with deep pockets ( 5 mm) and which were bleeding on probing were most often test positive. Periodontitis patients GCF MMP-8 levels decreased with hygiene phase periodontal treatment (scaling and root planing, SRP) and even reduced during the three month maintenance phase. A decrease in GCF MMP-8 levels could be monitored with the MMP-8 test. Agreement between the test stick and the quantitative assay was very good (κ = 0.81) and the test provided a baseline sensitivity of 0.83 and specificity of 0.96. During the 12-month longitudinal maintenance phase, periodontitis patients progressing sites (sites with an increase in attachment loss ≥ 2 mm during the maintenance phase) had elevated GCF MMP-8 levels compared with stable sites. General mean MMP-8 concentrations in smokers (S) sites were lower than in non-smokers (NS) sites but in progressing S and NS sites concentrations were at an equal level. Sites with exceptionally and repeatedly elevated MMP-8 concentrations during the maintenance phase were clustered in smoking patients with poor response to SRP (refractory patients). These sites especially were identified by the MMP-8 test. Subgingival plaque samples from periodontitis patients deep periodontal pockets were examined by polymerase chain reaction (PCR) to find out if periodontal lesions may serve as a niche for Chlamydia pneumoniae. Findings were compared with the clinical periodontal parameters and GCF MMP-8 levels to determine the correlation with periodontal status. Traces of C. pneumoniae were identified from one periodontitis patient s pooled subgingival plaque sample by means of PCR. After periodontal treatment (SRP) the sample was negative for C. pneumoniae. Clinical parameters or biomarkers (MMP-8) of the patient with the positive C. pneumoniae finding did not differ from other study patients. In this study it was concluded that MMP-8 concentrations in GCF of sites from periodontally healthy individuals, subjects with gingivitis or with periodontitis are at different levels. The cut-off value of the developed MMP-8 test is at an optimal level to differentiate between these conditions and can possibly be utilised in identification of individuals at the risk of the transition of gingivitis to periodontitis. In periodontitis patients, repeatedly elevated GCF MMP-8 concentrations may indicate sites at risk of progression of periodontitis as well as patients with poor response to conventional periodontal treatment (SRP). This can be monitored by MMP-8 testing. Despite the lower mean GCF MMP-8 concentrations in smokers, a fraction of smokers sites expressed very high MMP-8 concentrations together with enhanced periodontal activity and could be identified with MMP-8 specific chair-side test. Deep periodontal lesions may be niches for non-periodontopathogenic micro-organisms with systemic effects like C. pneumoniae and possibly play a role in the transmission from one subject to another.

Sopimusohjaus ohjausmenettelynä sairaanhoitopiirin ja terveyskeskusten yksiköissä ja niiden lääkärien työssä

This study concerns the implementation of steering by contracting in health care units and in the work of the doctors employed by them. The study analyses how contracting as a process is being implemented in hospital district units, health centres and in the work of their doctors, as well as how these units carry out their operations and patient care within the restrictions set by the contracts. Based on interviews with doctors, the study analyses the realisation of operations within the units from the doctors perspective and through their work. The key result of the study is that the steering impact of contracting was not felt at the level of practical work. The contracting was implemented by assigning the related tasks to management only. The management implemented the contract by managing their resources rather than by intervening in doctors activities or the content of their tasks. The steering did not extend to improving practical care processes. This allowed the unchanged continuation of core operations in an autonomous manner and in part, protected from the impacts of contracting. In health centres, the contract concluded was viewed as merely steering the operations of the hospital district and its implementation did not receive the support of the centres. The fact that primary health care and specialised health care constitute separate contracting parties had adverse effects on the contract s implementation and the integration of care. A theoretical review unveiled several reasons for the failure of steering by contracting to alter operations within units. These included the perception steering by contracting as a weak change incentive. The doctors shunned the introduction of an economic logic and ideology into health care and viewed steering by contracting as a hindrance to delivering care to patients and a disturbance to their work and patient relationships. Contracting caused tensions between representatives of the financial administration and health care professionals. It also caused internal tensions, while it had varying impacts on different specialities, including the introduction of varying potential to influence contracts. Most factors preventing the realisation of the steering objective could have been ameliorated through positive leadership. There is a need to bridge the gap between financial steering and patient work. Key measures include encouraging the commitment of middle management, supporting leadership expertise and identifying the right methods of contributing to a mutual understanding between the cultures of financing, administration and health care. Criticism of the purchasers expertise and the view that undersized orders are due to the purchaser s financial difficulties underlines the importance of the purchaser s size. Overly detailed, product-based contracts seemed to place the focus on the quantities and costs of services rather than health impacts and efficiency of operations. Bundling contracts into larger service packages would encourage the enhancement of operations. Steering by contracting represents unexploited potential: it could function as a forum for integrated regional planning of services, and the prioritisation and integration of care, and offer an opportunity and an incentive for developing core operations.

Modern diagnosis of Epstein-Barr virus infections and post-transplant lymphoproliferative disease

Infection by Epstein-Barr virus (EBV) occurs in approximately 95% of the world s population. EBV was the first human virus implicated in oncogenesis. Characteristic for EBV primary infection are detectable IgM and IgG antibodies against viral capsid antigen (VCA). During convalescence the VCA IgM disappears while the VCA IgG persists for life. Reactivations of EBV occur both among immunocompromised and immunocompetent individuals. In serological diagnosis, measurement of avidity of VCA IgG separates primary from secondary infections. However, in serodiagnosis of mononucleosis it is quite common to encounter, paradoxically, VCA IgM together with high-avidity VCA IgG, indicating past immunity. We determined the etiology of this phenomenon and found that, among patients with cytomegalovirus (CMV) primary infection a large proportion (23%) showed antibody profiles of EBV reactivation. In contrast, EBV primary infection did not appear to induce immunoreactivation of CMV. EBV-associated post-transplant lymphoproliferative disease (PTLD) is a life threatening complication of allogeneic stem cell or solid organ transplantation. PTLD may present with a diverse spectrum of clinical symptoms and signs. Due to rapidity of PTLD progression especially after stem cell transplantation, the diagnosis must be obtained quickly. Pending timely detection, the evolution of the fatal disease may be halted by reduction of immunosuppression. A promising new PTLD treatment (also in Finland) is based on anti-CD-20 monoclonal antibodies. Diagnosis of PTLD has been demanding because of immunosuppression, blood transfusions and the latent nature of the virus. We set up in 1999 to our knowledge first in Finland for any microbial pathogen a real-time quantitative PCR (qPCR) for detection of EBV DNA in blood serum/plasma. In addition, we set up an in situ hybridisation assay for EBV RNA in tissue sections. In collaboration with a group of haematologists at Helsinki University Central Hospital we retrospectively determined the incidence of PTLD among 257 allogenic stem cell transplantations (SCT) performed during 1994-1999. Post-mortem analysis revealed 18 cases of PTLD. From a subset of PTLD cases (12/18) and a series of corresponding controls (36), consecutive samples of serum were studied by the new EBV-qPCR. All the PTLD patients were positive for EBV-DNA with progressively rising copy numbers. In most PTLD patients EBV DNA became detectable within 70 days of SCT. Of note, the appearance of EBV DNA preceded the PTLD symptoms (fever, lymphadenopathy, atypical lymphocytes). Among the SCT controls, EBV DNA occurred only sporadically, and the EBV-DNA levels remained relatively low. We concluded that EBV qPCR is a highly sensitive (100%) and specific (96%) new diagnostic approach. We also looked for and found risk factors for the development of PTLD. Together with a liver transplantation group at the Transplantation and Liver Surgery Clinic we wanted to clarify how often and how severely do EBV infections occur after liver transplantation. We studied by the EBV qPCR 1284 plasma samples obtained from 105 adult liver transplant recipients. EBV DNA was detected in 14 patients (13%) during the first 12 months. The peak viral loads of 13 asymptomatic patients were relatively low (<6600/ml), and EBV DNA subsided quickly from circulation. Fatal PTLD was diagnosed in one patient. Finally, we wanted to determine the number and clinical significance of EBV infections of various types occurring among a large, retrospective, nonselected cohort of allogenic SCT recipients. We analysed by EBV qPCR 5479 serum samples of 406 SCT recipients obtained during 1988-1999. EBV DNA was seen in 57 (14%) patients, of whom 22 (5%) showed progressively rising and ultimately high levels of EBV DNA (median 54 million /ml). Among the SCT survivors, EBV DNA was transiently detectable in 19 (5%) asymptomatic patients. Thereby, low-level EBV-DNA positivity in serum occurs relatively often after SCT and may subside without specific treatment. However, high molecular copy numbers (>50 000) are diagnostic for life-threatening EBV infection. We furthermore developed a mathematical algorithm for the prediction of development of life-threatening EBV infection.

Podocyte molecules in the pancreas and lymphoid tissues and their association to autoimmunity of diabetes

Type 1 diabetes is a disease where the insulin-producing beta cells of the pancreas are destroyed by an autoimmune mechanism. The incidence of type 1 diabetes, as well as the incidence of the diabetic kidney complication, diabetic nephropathy, are increasing worldwide. Nephrin is a crucial molecule for the filtration function of the kidney. It localises in the podocyte foot processes partially forming the interpodocyte final sieve of the filtration barrier, the slit diaphragm. The expression of nephrin is altered in diabetic nephropathy. Recently, nephrin was found from the beta cells of the pancreas as well, which makes this molecule interesting in the context of type 1 diabetes and especially in diabetic nephropathy. In this thesis work, the expression of other podocyte molecules in the beta cells of the pancreas, in addition to nephrin, were deciphered. It was also hypothesised that patients with type 1 diabetes may develop autoantibodies against novel beta cell molecules comparably to the formation of autoantibodies to GAD, IA-2 and insulin. The possible association of such novel autoantibodies with the pathogenesis of diabetic nephropathy was also assessed. Furthermore, expression of nephrin in lymphoid tissues has been suggested, and this issue was more thoroughly deciphered here. The expression of nephrin in the human lymphoid tissues, and a set of podocyte molecules in the human, mouse and rat pancreas at the gene and protein level were studied by polymerase chain reaction (PCR) -based methods and immunochemical methods. To detect autoantibodies to novel beta cell molecules, specific radioimmunoprecipitation assays were developed. These assays were used to screen a follow-up material of 66 patients with type 1 diabetes and a patient material of 150 diabetic patients with signs of diabetic nephropathy. Nephrin expression was detected in the lymphoid follicle germinal centres, specifically in the follicular dendritic cells. In addition to the previously reported expression of nephrin in the pancreas, expression of the podocyte molecules, densin, filtrin, FAT and alpha-actinin-4 were detected in the beta cells. Circulating antibodies to nephrin, densin and filtrin were discovered in a subset of patients with type 1 diabetes. However, no association of these autoantibodies with the pathogenesis of diabetic nephropathy was detected. In conclusion, the expression of five podocyte molecules in the beta cells of the pancreas suggests some molecular similarities between the two cell types. The novel autoantibodies against shared molecules of the kidney podocytes and the pancreatic beta cells appear to be part of the common autoimmune mechanism in patients with type 1 diabetes. No data suggested that the autoantibodies would be active participants of the kidney injury detected in diabetic nephropathy.

Genotyping for genetic association studies: Methods and applications

In this thesis, two separate single nucleotide polymorphism (SNP) genotyping techniques were set up at the Finnish Genome Center, pooled genotyping was evaluated as a screening method for large-scale association studies, and finally, the former approaches were used to identify genetic factors predisposing to two distinct complex diseases by utilizing large epidemiological cohorts and also taking environmental factors into account. The first genotyping platform was based on traditional but improved restriction-fragment-length-polymorphism (RFLP) utilizing 384-microtiter well plates, multiplexing, small reaction volumes (5 µl), and automated genotype calling. We participated in the development of the second genotyping method, based on single nucleotide primer extension (SNuPeTM by Amersham Biosciences), by carrying out the alpha- and beta tests for the chemistry and the allele-calling software. Both techniques proved to be accurate, reliable, and suitable for projects with thousands of samples and tens of markers. Pooled genotyping (genotyping of pooled instead of individual DNA samples) was evaluated with Sequenom s MassArray MALDI-TOF, in addition to SNuPeTM and PCR-RFLP techniques. We used MassArray mainly as a point of comparison, because it is known to be well suited for pooled genotyping. All three methods were shown to be accurate, the standard deviations between measurements being 0.017 for the MassArray, 0.022 for the PCR-RFLP, and 0.026 for the SNuPeTM. The largest source of error in the process of pooled genotyping was shown to be the volumetric error, i.e., the preparation of pools. We also demonstrated that it would have been possible to narrow down the genetic locus underlying congenital chloride diarrhea (CLD), an autosomal recessive disorder, by using the pooling technique instead of genotyping individual samples. Although the approach seems to be well suited for traditional case-control studies, it is difficult to apply if any kind of stratification based on environmental factors is needed. Therefore we chose to continue with individual genotyping in the following association studies. Samples in the two separate large epidemiological cohorts were genotyped with the PCR-RFLP and SNuPeTM techniques. The first of these association studies concerned various pregnancy complications among 100,000 consecutive pregnancies in Finland, of which we genotyped 2292 patients and controls, in addition to a population sample of 644 blood donors, with 7 polymorphisms in the potentially thrombotic genes. In this thesis, the analysis of a sub-study of pregnancy-related venous thromboses was included. We showed that the impact of factor V Leiden polymorphism on pregnancy-related venous thrombosis, but not the other tested polymorphisms, was fairly large (odds ratio 11.6; 95% CI 3.6-33.6), and increased multiplicatively when combined with other risk factors such as obesity or advanced age. Owing to our study design, we were also able to estimate the risks at the population level. The second epidemiological cohort was the Helsinki Birth Cohort of men and women who were born during 1924-1933 in Helsinki. The aim was to identify genetic factors that might modify the well known link between small birth size and adult metabolic diseases, such as type 2 diabetes and impaired glucose tolerance. Among ~500 individuals with detailed birth measurements and current metabolic profile, we found that an insertion/deletion polymorphism of the angiotensin converting enzyme (ACE) gene was associated with the duration of gestation, and weight and length at birth. Interestingly, the ACE insertion allele was also associated with higher indices of insulin secretion (p=0.0004) in adult life, but only among individuals who were born small (those among the lowest third of birth weight). Likewise, low birth weight was associated with higher indices of insulin secretion (p=0.003), but only among carriers of the ACE insertion allele. The association with birth measurements was also found with a common haplotype of the glucocorticoid receptor (GR) gene. Furthermore, the association between short length at birth and adult impaired glucose tolerance was confined to carriers of this haplotype (p=0.007). These associations exemplify the interaction between environmental factors and genotype, which, possibly due to altered gene expression, predisposes to complex metabolic diseases. Indeed, we showed that the common GR gene haplotype associated with reduced mRNA expression in thymus of three individuals (p=0.0002).