Publishing in the Networked World: Transforming the Nature of Communication, 14th International Conference on Electronic Publishing 16-18 June 2010, Helsinki, Finland

The title of the 14th International Conference on Electronic Publishing (ELPUB), “Publishing in the networked world: Transforming the nature of communication”, is a timely one. Scholarly communication and scientific publishing has recently been undergoing subtle changes. Published papers are no longer fixed physical objects, as they once were. The “convergence” of information, communication, publishing and web technologies along with the emergence of Web 2.0 and social networks has completely transformed scholarly communication and scientific papers turned to living and changing entities in the online world. The themes (electronic publishing and social networks; scholarly publishing models; and technological convergence) selected for the conference are meant to address the issues involved in this transformation process. We are pleased to present the proceedings book with more than 30 papers and short communications addressing these issues. What you hold in your hands is a by-product and the culmination of almost a Year long work of many people including conference organizers, authors, reviewers, editors and print and online publishers. The ELPUB 2010 conference was organized and hosted by the Hanken School of Economics in Helsinki, Finland. Professors Turid Hedlund of Hanken School of Economics and Yaşar Tonta of Hacettepe University Department of Information Management (Ankara, Turkey) served as General Chair and Program Chair, respectively. We received more than 50 submissions from several countries. All submissions were peer-reviewed by members of an international Program Committee whose contributions proved most valuable and appreciated. The 14th ELPUB conference carries on the tradition of previous conferences held in the United Kingdom (1997 and 2001), Hungary (1998), Sweden (1999), Russia (2000), the Czech Republic (2002), Portugal (2003), Brazil (2004), Belgium (2005), Bulgaria (2006), Austria (2007), Canada (2008) and Italy (2009). The ELPUB Digital Library, http://elpub.scix.net serves as archive for the papers presented at the ELPUB conferences through the years. The 15th ELPUB conference will be organized by the Department of Information Management of Hacettepe University and will take place in Ankara, Turkey, from 14-16 June 2011. (Details can be found at the ELPUB web site as the conference date nears by.) We thank Marcus Sandberg and Hannu Sääskilahti for copyediting, Library Director Tua Hindersson – Söderholm for accepting to publish the online as well as the print version of the proceedings. Thanks also to Patrik Welling for maintaining the conference web site and Tanja Dahlgren for administrative support. We warmly acknowledge the support in organizing the conference to colleagues at Hanken School of Economics and our sponsors.

Between Herbals et alia: Intertextuality in Medieval English Herbals

This study reports a corpus-based study of medieval English herbals, which are texts conveying information on medicinal plants. Herbals belong to the medieval medical register. The study charts intertextual parallels within the medieval genre, and between herbals and other contemporary medical texts. It seeks to answer questions where and how herbal texts are linked to each other, and to other medical writing. The theoretical framework of the study draws on intertextuality and genre studies, manuscript studies, corpus linguistics, and multi-dimensional text analysis. The method combines qualitative and quantitative analyses of textual material from three historical special-language corpora of Middle and Early Modern English, one of which was compiled for the purposes of this study. The text material contains over 800,000 words of medical texts. The time span of the material is from c. 1330 to 1550. Text material is retrieved from the corpora by using plant name lists as search criteria. The raw data is filtered through qualitative analysis which produces input for the quantitative analysis, multi-dimensional scaling (MDS). In MDS, the textual space that parallel text passages form is observed, and the observations are explained by a qualitative analysis. This study concentrates on evidence of material and structural intertextuality. The analysis shows patterns of affinity between the texts of the herbal genre, and between herbals and other texts in the medical register. Herbals are most closely linked with recipe collections and regimens of health: they comprise over 95 per cent of the intertextual links between herbals and other medical writing. Links to surgical texts, or to specialised medical texts are very few. This can be explained by the history of the herbal genre: as herbals carry information on medical ingredients, herbs, they are relevant for genres that are related to pharmacological therapy. Conversely, herbals draw material from recipe collections in order to illustrate the medicinal properties of the herbs they describe. The study points out the close relationship between medical recipes and recipe-like passages in herbals (recipe paraphrases). The examples of recipe paraphrases show that they may have been perceived as indirect instruction. Keywords: medieval herbals, early English medicine, corpus linguistics, intertextuality, manuscript studies

Kuvan ja tekstin välissä : Kuvateksti uutiskuvan ja lehtijutun elementtinä

The study focuses on picture captions: their grammar and interplay with photographs and their position as semi-independent elements of the news stories. The research was conducted in the framework of critical discourse analysis, social semiotic visual theory and fennistic syntactical research. The data consist of 441 press photographs, 1,815 captions and a number of news items from Finnish dailies. The generic structure potential of the caption includes the caption headline, the caption proper, i.e. the verbalization of the picture content, and the frame. In the data, 41 per cent of the captions have a headline, and 44 per cent contain a caption proper. Characteristic of the caption proper is omission of the finite verb and the use of the present tense, both of which have decreased in Finnish papers during the 20th century. The caption proper is typically a main clause, and both subordinate clauses and participal phrases occur mostly in the frame. While comparing caption variants attached to the same pictures, the processes and their participants proved to be identified considerably identically, following the news agency captions. Instead, the reader?s interpretations of a picture could be directed by framing it in different ways. For example, the caption may focus on the only person depicted, deal with a whole group, or give an abstract account of the situation. The caption is a paratext, a typographically marked, semi-independent element of a news story. Between the headline and the caption, four semantic relations have been identified. The caption may be a paraphrase of the headline, or a close-up illustrating an abstract headline with a concrete example. If the name of the person depicted is their only common factor, the relation between the caption and the headline is additive. A specifying caption will give more details than the headline. The caption may complete, repeat, or summarize the body copy. Naturally, most captions completing the story verbalize the content of the picture. As the caption is often based on the story, it may even repeat the body copy verbatim. The summarizing function is probably becoming increasingly important, as most Finnish newspapers have abandoned the use of a separate standfirst.

Pain among employees : risk factors and consequences

The overall objective of this study was to gain epidemiological knowledge about pain among employee populations. More specifically, the aims were to assess the prevalence of pain, to identify socio-economic risk groups and work-related psychosocial risk factors, and to assess the consequences in terms of health-related functioning and sickness absence. The study was carried out among the municipal employees of the City of Helsinki. Data comprised questionnaire survey conducted in years 2000-2002 and register data on sickness absence. Altogether 8960 40-60 year old employees participated to the survey (response rate 67%). Pain is common among ageing employees. Approximately 29 per cent of employees reported chronic pain and 15 per cent acute pain, and about seven per cent reported moderately or severely limiting disabling chronic pain. Pain was more common among those with lower level of education or in a low occupational class. -- Psychosocial work environment was associated with pain reports. Job strain, bullying at workplace, and problems in combining work and home duties were associated with pain among women. Among men combining work and home duties was not associated with pain, whereas organizational injustice showed associations. Pain affects functional capacity and predicts sickness absence. Those with pain reported lower level of both mental and physical functioning than those with no pain, physical functioning being more strongly affected than mental. Bodily location of pain or whether pain was acute or chronic had only minor impact on the variation in functioning, whereas the simple count of painful locations was associated with widest variation. Pain accounted for eight per cent of short term (1-3 day) sickness absence spells among men and 13 per cent among women. Of absence spells lasting between four and 14 days pain accounted for 23 per cent among women and 25 per cent among men, corresponding figures for over 14 day absence spells being 37 and 30 per cent. The association between pain and sickness absence was relatively independent of physical and psychosocial work factors, especially among women. The results of this study provide a picture of the epidemiology of pain among employees. Pain is a significant problem that seriously affects work ability. Information on risk groups can be utilized to make prevention measures more effective among those at high risk, and to decrease pain rates and thereby narrow the differences between socio-economic groups. Furthermore, the work-related psychosocial risk factors identified in this study are potentially modifiable, and it should be possible to target interventions on decreasing pain rates among employees.

Trends and Explanations for Socioeconomic Differences in Physical Activity

Very limited scientific knowledge exists on the trends and explanations of socioeconomic differences in physical activity among adults. There is a paucity of studies examining whether determinants vary across socioeconomic position and different life stages. This study examines a) how socioeconomic differences in leisure-time and commuting physical activity have changed in Finland from 1978 to 2002 and b) the contribution of childhood socioeconomic position, adolescence sports and exercise, adulthood socioeconomic position, working conditions and other adulthood health behaviours to socioeconomic differences in leisure-time physical activity. This study utilised three population-based datasets collected by the National Institute for Health and Welfare (THL, formerly National Institute for Public Health): the Health Behaviour and Health among the Finnish Adult Population Study from 1978 to 2002 (N=96 105), the National FINRISK Study 2002 and its physical activity sub-study (N= 9 179), and the Health 2000 Study (N=8 028). Survey information was collected by self-administered questionnaires, interviews at home, and measurements made at the study site. The response rates varied from 69 to 89 per cent. Several socioeconomic measures were linked from the national population registers. Based on the results, those with low income were physically inactive during leisure-time and while commuting from 1978 to 2002. Manual worker women, however, were more physically active commuters compared to their counterparts. Parental socioeconomic position contributed directly to adulthood educational differences in leisure-time physical inactivity but also indirectly through adulthood socioeconomic position (occupation, household income) and other unhealthy behaviours (mainly smoking). Among those with low education participation in competitive sports in youth and among those with high education exercise in late adolescence contributed to leisure-time physical activity in adulthood. Long exposure to physically strenuous working conditions in men and current job strain in women contributed to occupational class differences in leisure-time physical activity. Socioeconomic differences in physical activity have remained similar for twenty years in Finland. Educational career seems to have a strong contribution to physical activity. To adopt a lifelong physically active life-style, one should participate in a range of different sports and exercise in adolescence and in youth, have a low exposure to physically and mentally strenuous working conditions in later life and have other healthy behaviours in later life.

Rural Income Generation and Diversification : A Case Study in Eastern Zambia

Rural income diversification has been found to be rather the norm than the exception in developing countries. Smallholder households tend to diversify their income sources because of the need to manage risks, secure a smooth flow of income, allocate surplus labour, respond to various kinds of market failures, and apply coping strategies. The Agricultural Household Model provides a theoretical rationale for income diversification in that rural households aim at maximising their utility. There are several elements involved, such as agricultural production for their own consumption and markets, leisure activities and income from non-farm sources. The aim of the present study is to enhance understanding of the processes of rural income generation and diversification in eastern Zambia. Specifically, it explores the relationship between household characteristics, asset endowments and income-generation patterns. According to the sustainable- rural-livelihoods framework, the assets a household possesses shape its capacity to seize new economic opportunities. The study is based on two surveys conducted among rural smallholder households in four districts of Eastern Province in Zambia in 1985/86 and 2003. Sixty-seven of the interviewed households were present in both surveys and this panel allows comparison between the two points of time. The initial descriptive analysis is complemented with an econometric analysis of the relationships between household assets and income sources. The results show that, on average, 30 per cent of the households income originated from sources outside their own agriculture. There was a slight increase in the proportion of non-farm income from 1985/86 to 2003, but total income clearly declined mainly on account of diminishing crop income. The land area the household was able to cultivate, which is often dependent on the available labour, was the most significant factor affecting both the household-income level and the diversification patterns. Diversification was, in most cases, a coping strategy rather than a voluntary choice. Measured as income/capita/day, all households were below the poverty line in 2003. The agricultural reforms in Zambia, combined with other trends such as changes in rainfall pattern, the worsening livestock situation and the incidence of human disease, had a negative impact on agricultural productivity and income between 1985/86 and 2003. Sources of non-farm income were closely linked to agriculture either upstream or downstream and the income they generated was not enough to compensate for the decline of agricultural income. Household assets and characteristics had a smaller impact on diversification patterns than expected, which could reflect the lack of opportunities in the remote rural environment.

Suomi ja Euroopan kirkollinen jälleenrakentaminen 1945-1948

The international aid that the Evangelical Lutheran Church of Finland received between 1945 and 1948 is the topic of this historical study, in which the process of reconstruction of the Evangelical Lutheran Church of Finland is examined in a European context. The key questions are related not only to the achievements of the reconstruction programs but also to the purposes and objectives of the donating churches. The study pays particular attention to the changes in the ecclesiastical, political and economic fields after the Second World War and asks how the tense political atmosphere of a divided world affected the reconstruction programs of the churches. It is possible to distinguish three periods within the European church reconstruction process. To begin with, the year 1945 was, in general, the year of organization. Many churches had started planning reconstruction work already during the war, but only after the conflict in Europe had ceased did they have a chance to renew contacts, assess the damage and begin operations. The years 1946 and 1947 were the main years of the work. Large reconstruction organizations from American churches donated money, food, clothes and vitamins worth millions of dollars to the European churches. The work started to diminish as early as 1948, partly because Marshall Plan aid and the rising standard of living had reduced the need for material assistance in many countries and partly because other problems overshadowed the reconstruction work of the World Council of Churches: for example, most WCC resources at this time were directed to refugee programs and to Third World churhces. The most important donors from the Evangelical Lutheran Church of Finland's point of view were the American Section of the Lutheran World Federation, the World Council of Churches and the Churches of Denmark, Sweden and England. The amount of money and value of goods received by the Evangelical Lutheran Church of Finland totaled approximately 2.5 million dollars, from which about 60 per cent came from the Lutheran churches of America. The importance of the Lutheran World Federation was even greater because of the productive financial arrangements that increased the American Lutheran funds. In addition the Evangelical Lutheran Church of Finland imported hundreds of tons of tax-free coffee and sold this to Finns. The money gained was used mostly to rebuild destroyed church buildings and to support the work of different ecclesiastical organizations. Smaller amounts were used for scholarship programs, youth work, and supporting sick and disabled church workers.

Kirkon vai valtion kirjat? : Uskontokuntasidonnaisuuden ongelma Suomen väestökirjanpidossa 1839-1904

The Population Register – run by the Church or the state? The problem posed by the obligation to belong to a religious community in the registration of births and deaths in Finland between 1839 and 1904 The Lutheran Church of Finland is the nation’s largest church; approximately 82 per cent of Finns were members in 2007. The Church ran an official register of its members until 1999, when the state then undertook this task. The registration of births and deaths by the Church has a long history dating back to the 17th century, when Bishop Johannes Gezelius Sr. decreed that all parish members would have to be recorded in parish registers. These registers were used to control how well parish members knew the Christian doctrine and, gradually, also if they were literate. Additionally, the Church attempted to ensure by means of the parish registers that parish members went to Holy Communion annually. Since everyone was a member of the Lutheran Church, the state also took advantage of the parish registers and used them for the purposes of tax collection and conscription. The main research theme of “The Population Register – run by the Church or the state?” goes back to these times. The actual research period covers the years of 1839–1904. At that time Finland was under Russian rule, although autonomous. In the late 19th century the press and different associations in Finland began to engage in public debate, and the country started moving from a submissive society to a civic one. The identity of the Lutheran Church also became more prominent when the Church Act and the General Synod were realised in 1869. A few years earlier, municipal and parish administrations had been separated, but the general registration of births and deaths was left to the Church to see to. In compliance with the constitution of the country, all the inhabitants in principle still had to be Lutheran. In practice, the situation was different. The religious and ideological realms diversified, and the Lutheran concept of religion was no longer acceptable to everyone. The conflict was reflected in the registration of births and deaths, which was linked to the Lutheran Church and its parish registers. Nobody was allowed to leave the Church, there was no civil register, and the Lutheran Church did not consent to record unbaptized children in the parish registers. Therefore such children were left without civil rights. Thus the obligation to belong to a religious community had become a problem in the registration of births and deaths. The Lutheran clergy also appealed to the 1723 privileges, according to which they had been exempted from the drawing up of additional population registers. In 1889 Finland passed the Dissenters Act. By virtue of this act the Baptists and the Methodists left the state Church, but this was not the case with the members of the free churches. The freethinkers had to retain their church membership, as the law did not apply to them. This meant that the unbaptized children of the members of the free churches or those of freethinkers were still not entered in any registers. The children were not able to go to school, work for the state or legally marry. Neither were they able to inherit property, as they did not legally exist. The system of parish registers was created when everyone was required to be a member of the Lutheran Church, but it did not work when liberal attitudes eventually penetrated the sphere of religion, too. The government´s measures to solve the problem were slow and cautious, partly because Finland was part of Russia, partly because there were only about 100 unbaptized children. As the problem group was small and the state´s resources were limited, no general civil register was established. The state accepted the fact that in spite of the problems, the Evangelical Lutheran Church and the congregations of dissenters were the only official establishments to run populations registers in the country, and for social purposes, too. In 1900 the Diet of Finland finally approved a limited civil register, which unbaptized children and unregistered foreigners would be recorded in. Due to political reasons the civil register did not come into existence until 1917, after the actual research period.

Juutalaisvastaisuus suomalaisissa aikakauslehdissä ja kirjallisuudessa 1918-1944

Anti-Semitism existed in Finland during the whole period covered by this study. The immoral acts associated with Jews in the articles were mostly regarded as universal habits, qualities and/or modes of action, that is, unconnected with any particular Finnish Jew. Researchers have tried to explain anti-Semitism in several ways. The theory of Jews as outsiders has been a popular explanation as well as xenophobia, chimerical anti-Semitism and the socio-economic models. The main sources of this study have been over 400 Finnish periodicals and magazines, literature and text books published between 1918 and 1944. This vast number of magazines includes those of the army and the civil guard, religion, humour and the papers of the Finnish extreme right. One can see a distinct foreign and especially German influence in the subjects and phraseology of Finnish anti-Semitic writings between 1918 and 1944. Several known Finnish anti-Semitic writers had some kind of link with Germany. Some Finnish organisations and societies were openly anti-Semitic during this period. There had been cycles in the activity of anti-Semitic writing in Finland, obvious peaks appearing in 1918 1919, 1929 1931, 1933 1938 and 1942 1944. The reason for the 1918 1919 activity was the civil rights which were granted to the Jews in Finland, and the Russian Bolshevik revolution. The worldwide depression from 1929 to 1932 seem to be the reason for new anti-Semitic writing activity. The rise of National Socialism in Germany and the influence this phenomenon had in Finland was the reason for the peak during 1933 1938. During the continuation war 1942 1944 National Socialist Germany was fighting side-by-side with Finland and their anti-Semitic propaganda found easier access to Finland. Of the 433 magazines, journals and newspapers which were used in this study, 71 or 16.4 per cent had at least one article that can be identified as anti-Semitic; especially the magazines of national socialists and other extreme right parties were making anti-Semitic annotations. There were about 50 people known to have written anti-Semitic articles. At least half of these known writers had studied at the university, including as many as 10 priests. Over and above these, there was an even larger number of people who wrote under a pseudonym. The material used suggested that anti-Semitism was not very popular in Finland between 1918 and 1944. Anti-Semitic articles appeared mostly in the magazines of the extreme right, but their circulation was not very large. A proof of the slight influence of these extreme right anti-Semitic ideas is that, beside the tightening of policy towards Jewish immigrants in 1938 and the handing over of eight of these refugees to Germany in 1942, the official policy of Finland never became anti-Semitic. As was stated before, despite the cycles in the number of writings, there does not appear to have been any noticeable change in public opinion. One must also remember that most Finns had not at that period actually met a Jew. The material used suggests that between 1918 and 1944 the so-called Jewish question was seemingly unimportant for most Finns and their attitude to Jews and Jewishness can be described as neutral.

Studies on the Effects of Property Taxation, Rent Control and Housing Allowances

Tämä väitöskirja koostuu asuntomarkkinoiden taloustieteellistä analyysia esittelevästä johdantoluvusta ja kolmesta tutkimuksesta, joissa analysoidaan asuntomarkkinoihin vaikuttavia politiikkatoimenpiteitä. Luvussa 2 tutkitaan Suomen kiinteistöverojärjestelmän vaikutusta asuntorakentamiseen. Vuonna 2001 tehtiin uudistus, jonka myötä kunnat voivat verottaa rakentamatonta asuintonttia korkeammalla veroasteella kuin rakennettua tonttia. Maanomistajan rakentamispäätöksen teoreettisen mallin mukaan rakentamattoman tontin korotettu kiinteistöveron pitäisi nopeuttaa rakentamista, mutta toisaalta myös rakentamiseen investoitu rahamäärä saattaa muuttua. Asuintonttien kiinteistöverojen yleinen taso ei vaikuta maanomistajan käyttäytymiseen, sillä tontin verotusarvo ei riipu rakentamispäätöksestä. Vain rakentamattoman ja rakennetun tontin veroasteiden erolla on merkitystä. Empiiriset tulokset ovat sopusoinnussa teorian kanssa. Tulosten mukaan prosenttiyksikön nousu rakentamattoman ja rakennetun tontin veroasteiden erossa lisää omakotialoitusten määrää viidellä prosentilla lyhyellä aikavälillä. Luvussa 3 analysoidaan vuokrasääntelystä vuokralaisille aiheutuvia hyötyjä ja haittoja. Vuokrasäännellyissä asunnoissa asuvat kotitaloudet hyötyvät vuokrasääntelystä alhaisen vuokran muodossa. Heille saattaa kuitenkin koitua myös haittaa siitä, että toiveita vastaavan asunnon löytäminen on vuokrasääntelytilanteessa vaikeaa, koska vapaille asunnoille on suuri määrä ottajia. Vapaarahoitteisen vuokra-asuntokannan vuokrien sääntely purettiin Suomessa asteittain vuosina 1992–1995. Tutkimuksen empiiriset tulokset viittaavat siihen, että vuokrasääntelyn aiheuttamista suurista eroista halutun ja todellisen asuntokulutuksen välillä koituvat hyvinvointitappiot kumosivat merkittävän osan matalien vuokrien hyödyistä vuokralaisille. Luvussa 4 tutkitaan Suomen asumistukijärjestelmän kannustinvaikutuksia. Asumistuen määrää rajoittavat asunnon pinta-alalle ja neliövuokralle asetetut ylärajat. Neliövuokrarajoite voidaan tulkita asumisen laatua rajoittavana tekijänä. Tutkimuksen teoreettisessa osassa osoitetaan, että asumistukijärjestelmä luo vahvat kannustimet muuttaa asuntoihin, joissa pinta-ala- ja laaturajoitteet purevat. Empiiristen tulosten mukaan asumistukeen oikeutetut kotitaloudet eivät näytä reagoivan kannusteisiin. Tukeen oikeutettujen kotitalouksien asumisvalinnat suhteessa pinta-ala ja laaturajoitteisiin vastaavat muiden kotitalouksien valintoja ja asunnonvaihdon mahdollistama potentiaalinen asumistuen lisäys ei nosta muuttotodennäköisyyttä. Muuttamiseen liittyvät kustannukset ja vajavaiset tiedot tukijärjestelmästä saattavat selittää heikkoa reagointia asumistuen luomiin kannustimiin. Toinen mahdollinen selitys on asumistuen vajaakäyttö. Tutkimuksen mukaan vain 70–80 prosenttia asumistukeen oikeutetuista kotitalouksista nostaa tukea. Asumistuen hyödyntämisen todennäköisyys riippuu koulutustasosta, tuen määrästä ja tulo-odotuksista.

Essential Thrombocythaemia : Diagnosis, Prognostic Aspects, and the Outcome of Finnish patients

Essential thrombocythaemia (ET) is a myeloproliferative disease (MPD) characterized by thrombocytosis, i.e. a constant elevation of platelet count. Thrombocytosis may appear in MPDs (ET, polycythaemia vera, chronic myeloid leukaemia, myelofibrosis) and as a reactive phenomenon. The differential diagnosis of thrombocytosis is important, because the clinical course, need of therapy, and prognosis are different in patients with MPDs and in those with reactive thrombocytosis. ET patients may remain asymptomatic for years, but serious thrombohaemorrhagic and pregnancy-related complications may occur. The complications are difficult to predict. The aims of the present study were to evaluate the diagnostic findings, clinical course, and prognostic factors of ET. The present retrospective study consists of 170 ET patients. Two thirds had a platelet count < 1000 x 109/l. The diagnosis was supported by an increased number of megakaryocytes with an abnormal morphology in a bone marrow aspirate, aggregation defects in platelet function studies, and the presence of spontaneous erythroid and/or megakaryocytic colony formation in in vitro cultures of haematopoietic progenitors. About 70 % of the patients had spontaneous colony formation, while about 30 % had a normal growth pattern. Only a fifth of the patients remained asymptomatic. Half had a major thrombohaemorrhagic complication. The proportion of the patients suffering from thrombosis was as high as 45 %. About a fifth had major bleedings. Half of the patients had microvascular symptoms. Age over 60 years increased the risk of major bleedings, but the occurrence of thrombotic complications was similar in all age groups. Male gender, smoking in female patients, the presence of any spontaneous colony formation, and the presence of spontaneous megakaryocytic colony formation in younger patients were identified as risk factors for thrombosis. Pregnant ET patients had an increased risk of complications. Forty-five per cent of the pregnancies were complicated and 38 % of them ended in stillbirth. Treatment with acetylsalicylic acid alone or in combination with platelet lowering drugs improved the outcome of the pregnancy. The present findings about risk factors in ET as well as treatment outcome in the pregnancies of ET patients should be taken into account when planning treatment strategies for Finnish patients.

Juvenile rheumatoid knee : Management of knee growth disturbances in children with juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is associated with growth disturbances, especially leg length discrepancy (LLD) and knee valgus deformity (KVD). Studies have demonstrated growth plate stimulation with chronic arthritis. In the context of surgical treatment of LLD or KVD of a growing knee, the less invasive procedures, which allow immediate mobilisation, are preferred. Establishment of the skeletal age and the correction potential in the knees of rheumatic children is difficult due to rheumatic changes. In this present work, an analysis of the efficacy, safety and long-term results of temporary epiphyseal arrests performed in Rheumatism Foundation Hospital (Heinola, Finland). The distribution of diagnoses among children (n=71) with JIA and LLD (68 knees) was consistent with the normal oligoarthritis-predominated population of children with JIA. A higher male:female ratio (1:1.7 vs. 1:2.4 in population-based studies (PBS)) and earlier mean onset age (4 vs. 7 years in PBSs) were, however, distinct features in the study population. In most cases the correction was reliable and temporary arrest produced a mean correction of 1mm per month. The time of arrest required, however, varied significantly, probably due to the effect of underlying diseases and medication, and the age of the child. All complications encountered (10%) were minor. The correction achieved persisted in long-term follow-up. KVD (n=112, 177 knees) was associated with a high proportion of polyarthritic disease subtype (45% vs. 12-31% in PBSs), and the male:female distribution was grossly female-dominated (1:4.9 vs. 1:2.4 in PBSs). The early mean onset age (3 vs. 7 years in PBSs) was also notable in this cohort. Successful correction was achieved in 2/3 cases and the mean angular correction was 0.7 degrees per month. The required time of arrest, however, varied considerably. In 13% of knees the paucity of follow-up visits resulted in over-correction to varus. The complication rate (3%) in the knees operated for KVD was considerably lower compared to ten per cent in the management of LLD. Most of the complications related to epiphyseal stapling were reversible. However, the risk of premature closure of growth plates does exist. The number of over-corrections was notably high, with 13% knees turning to varus. The correction achieved persisted in long-term follow-up.