Early diagnosis of breast cancer

The greatest effect on reducing mortality in breast cancer comes from the detection and treatment of invasive cancer when it is as small as possible. Although mammography screening is known to be effective, observer errors are frequent and false-negative cancers can be found in retrospective studies of prior mammograms. In the year 2001, 67 women with 69 surgically proven cancers detected at screening in the Mammography Centre of Helsinki University Hospital had previous mammograms as well. These mammograms were analyzed by an experienced screening radiologist, who found that 36 lesions were already visible in previous screening rounds. CAD (Second Look v. 4.01) detected 23 of these missed lesions. Eight readers with different kinds of experience with mammography screening read the films of 200 women with and without CAD. These films included 35 of those missed lesions and 16 screen-detected cancers. CAD sensitivity was 70.6% and specificity 15.8%. Use of CAD lengthened the mean time spent for readings but did not significantly affect readers sensitivities or specificities. Therefore the use of applied version of CAD (Second Look v. 4.01) is questionable. Because none of those eight readers found exactly same cancers, two reading methods were compared: summarized independent reading (at least a single cancer-positive opinion within the group considered decisive) and conference consensus reading (the cancer-positive opinion of the reader majority was considered decisive). The greatest sensitivity of 74.5% was achieved when the independent readings of 4 best-performing readers were summarized. Overall the summarized independent readings were more sensitive than conference consensus readings (64.7% vs. 43.1%) while there was far less difference in mean specificities (92.4% vs. 97.7%). After detecting suspicious lesion, the radiologist has to decide what is the most accurate, fast, and cost-effective means of further work-up. The feasibility of FNAC and CNB in the diagnosis of breast lesions was compared in non-randomised, retrospective study of 580 (503 malignant) breast lesions of 572 patients. The absolute sensitivity for CNB was better than for FNAC, 96% (206/214) vs. 67% (194/289) (p < 0.0001). An additional needle biopsy or surgical biopsy was performed for 93 and 62 patients with FNAC, but for only 2 and 33 patients with CNB. The frequent need of supplement biopsies and unnecessary axillary operations due to false-positive findings made FNAC (294 ) more expensive than CNB (223 ), and because the advantage of quick analysis vanishes during the overall diagnostic and referral process, it is recommendable to use CNB as initial biopsy method.

Naiset ja naisten puheet kirkolliskokouksen naispappeuskeskusteluissa vuosina 1974-1987

Women and women s words in discussions about the ordination of women in the General Synod between 1974 and 1987. In 1986, the General Synod of the Evangelical Lutheran Church in Finland approved the ordination of women. Prior to that decision, a considerable amount of discussion and debate took place about this renewal in both the Synod and the general public. The different points of view had divided the church and the people, and had placed the church under pressure to resolve the issue as soon as possible. At the same time, the changing climate in people s attitudes toward the church and the changing position of women in society clearly weighed in on this matter. The research material consists of the speeches about the ordination of women given by the women representatives in the General Synod of the Evangelical Lutheran Church in Finland between the years 1974 and 1987. The aim is to determine why these representatives wanted to ordain women as pastors, what kind of women pastors they wanted to have in the congregations, and what they wanted to change in the church through this renewal. The basic methods of the analysis include discourse analysis as well as the new rhetorics and some concepts used by Pierre Bourdieu. A framework, which I named rhetoric patterning, was developed to interpret the results. This framework has facilitated the identification of three effective discourses in the studied argumentation: the folk church discourse, the pastor image discourse and the church image discourse. According to the opinions of the women representatives, the concept of change turned out to be a very decisive factor as the church sought a way to reach its members. To maintain a good and modern image seemed very important for the church to be able to perform its task in the modern era. The women representatives presented the situation of the church in terms of contextual theology and took seriously the membership of all those baptized into the church. They were therefore ready to take into account the opinion of all church members. The problem was that even though the ordination of women was established, the fixed mental schemes of the people and the strong power structures of the church remained untouched. Women were allowed into a new area of church life, but with certain publicly pronounced and unconsciously recognized conditions. Did this change really mean greater equality between women and men, as was intended? Key words: ordination of women, General Synod, contextualization, discourse analysis.

Kahdestaan kotona : Tutkimus vanhoista pariskunnista

In this study, which pertains to the field of social gerontology and family research, I analyse the meaning of everyday life as perceived by elderly couples living at home. I use the ethnographic approach, with the aim of interpreting meanings from the elderly people s personal point of view and to increase understanding of their way of life. The study deepens our conception of what gives purpose to the everyday life of elderly people. The number of elderly couples is growing and, to an increasing extent, a couple will live and cope together to a ripe old age. Such coping can also be viewed as an important resource for society. Ethnography tries to get close to people's life practices. I examine the day-to-day life of elderly couples based on textual data, which I obtained by visiting the homes of 16 couples in a total of five small municipalities in Southern Finland. The couples had married soon after the war or in the early 1950s. I found that the aspiration towards continuity, which unites the concepts of place and home, housework and a long marriage, is the most important notion connecting the discussion themes. The results show that in the opinion of the elderly, the concept of a good life is intertwined with a long marriage spent at home, as well as its values. Old people find that they lead an independent life if they feel that they can hold on to the key features of their way of life. Elderly couples ability to cope with everyday life involves taking care of housework and other tasks around the home together. This means that they support one another and have common goals and aspirations. Daily tasks provide substance in the lives of elderly couples. Each day has its rhythm, and the pace of this rhythm is set by routine and habits. Satisfaction stems from the fact that you can do something you are good at. The couples have also revised the division of housework. Men have learned to perform new tasks around the house when their wives can no longer manage them by themselves. Some tasks are given up. Day-to-day life at home and around the house provides room for men s participation. Mutual support and care between husband and wife can also protect them from having to resort to outside or official help. Old couples integrate their life experiences and memories, as well as present and future risks and opportunities. They wish to carry on their lives as before, and still think that their present life corresponds with their idea of a good life. Key words: elderly couples, continuity theory of aging, everyday life, social gerontology, family research

Työkykyarviokokous moniammatillisen työryhmän päätöksentekotilanteena : Tutkimus vuorovaikutuksesta ja potilaan osallisuudesta

Work capacity assessment meeting as a decision-making situation of a multi-professional team a study on interaction and patient participation Multi-professional working has become an increasingly popular method of work in social and health care. The introduction of the viewpoints of several professionals is seen as a way to enhance the openness and quality of decision-making. However, so far relatively few study results are available on the implementation of this method in actual operations. This study examines one work method, a work capacity assessment meeting, along with medical certificates B and their enclosures written by the doctor to the patient after a meeting. After the theoretical and methodological chapter, providing background information, the study describes the structure of the meeting and the medical certificate as a constructive factor. This is followed by a discussion on the manner of assessing the various domains of the patient s functional capacity and the decision-making based on the assessed factors. Next, the study moves on to examine the effect of patient involvements on the conclusions and decisions that professionals make at the meeting. In conclusion, the study looks into how the voices of the professionals and the customer are transferred to the medical certificate. The material of the study consists of 11 meetings recorded on video, of which eight are work capacity assessment meetings and three are rehabilitation examination meetings. The first type of meeting is attended by a patient and a number of professionals, while the latter is attended only by the professionals. All the patients, whose cases are discussed in the work capacity assessment meetings, have a musculoskeletal disorder, while the rehabilitation meetings are related to patients who all also have some additional problem. The study material also consists of seven medical certificates B, written after a work capacity assessment meeting. For the most part, the material has been collected by the conversation analysis method. Moreover, also discourse analysis and a rhetorical approach were used. By using conversation analysis, it is possible to study closely how interaction is built up at the meeting and to examine how the actors implement their institutional assessment tasks in a co-operation that takes its form turn by turn. The four main findings of the study are as follows: firstly, the meeting is structured to a great extent on the basis of the medical certificate form to various phases of the meeting and the headings of the certificate are seen as communicative affordances at the meeting, directed primarily to the professionals that have assessed the patient s work capacity with various tests. The medical certificate is the ethno-method of the doctor acting as the chairman of the meeting that functions in two directions: it constructs the meeting and constitutes the task of the professionals as they produce contents for it. Secondly, the study describes the ways that are used to assess the different domains of the patient s work capacity, how they are described at the meeting and how a decision is taken when the assessment information has been saturated in the opinion of the team. Thirdly, the study brings up ways, with which the patient can influence the conclusions and decisions made by the professionals at the meeting. The study showed that the patient can affect the preconditions of his or her own future and wellbeing. Fourthly, the study describes how the wealth of expressions at the meeting is transferred to the certificate as an argumentative micro-cosmos, where the patient is classified to be recommended for rehabilitation or disability pension. An important finding is also how objective and subjective information and the voices of actors at the meeting are transferred to the statement in a strategic and intentional manner, with an orientation to the decision that will be taken at the insurance institution. The study results can be utilized in the training of professionals and in developing the operations of organisations performing the assessment of the work capacity of people suffering from musculoskeletal disorders.

Helsingin seudun ruuhkamaksut yritysnäkökulmasta

Congestion of traffic is one of the biggest challenges for urban cities in global perspective. Car traffic and traffic jams are causing major problems and the congestion is predicted to worsen in the future. The greenhouse effect has caused a severe threat to the environment globally. On the other hand from the point of view of companies and other economic parties time and money has been lost because of the congestion of traffic. This work studies some possible traffic payment systems for the Helsinki Metropolitan area introducing three optional models and concentrating on the point of view of the economic parties. Central part of this work is formed by a research questionnaire, which was conducted among companies located in the Helsinki area and where more than 1000 responses were gained. The study researches the approaches of the respondents to the area s current traffic system, its development and urban congestion pricing and the answers are analyzed according to the size, industry and location of the companies. The economic aspect is studied by economic theory of industrial location and by emphasizing the meaning of smoothly running traffic for the economic world. Chapter three presents detailed information about traffic congestion, how today s car-centered society has been formed, what concrete things congestion means for economic life and how traffic congestion can be limited. Theoretically it is examined how urban traffic payment systems are working using examples from London and Stockholm where successful traffic payment experiences exist. The literature review analyzes urban development, increasing car traffic and Helsinki Metropolitan area on a structural point of view. The fourth chapter introduces a case study, which concentrates on Helsinki Metropolitan area s different structures, the congestion situation in Helsinki and the introduction of the traffic payment system clarification. Currently the region is experiencing a phase where big changes are happening in the planning of traffic. The traffic systems are being unified to consider the whole region in the future. Also different advices for the increasing traffic congestion problems are needed. Chapter five concentrates on the questionnaire and theme interviews and introduces the research findings. The respondents overall opinion of the traffic payments is quite skeptical. There were some regional differences found and especially taxi, bus and cargo and transit enterprises shared the most negative opinion. Economic parties were worried especially because of the traffic congestion is causing harm for the business travel and the employees traveling to and from work. According to the respondents the best option from the traffic payment models was the ring model where the payment places would be situated inside the Ring Road III. Both the company representatives and other key decision makers see public transportation as a good and powerful tool to decrease traffic congestion. The only question, which remains, is where to find investors willing to invest in public transportation if economic representatives do not believe in pricing the traffic by for example traffic payment systems.

Jos olisin viisas niin siivoisin : Lasten luovat prosessit päiväkodissa

It has been found usually to talk in the early childhood education in connection with the creativity about arts and skills and about play. In this treatise, the creativity is approached besides play but also from the point of view of the creativity of the everyday. The starting point for the study is the view according to which the creativity is complex interaction between a creative person and an environment. The theoretical body of the study is the Componential theory of creativity of Amabile (1996). The process which is open and product which is new and suitable or acceptable were defined creative. In the opinion of many researchers, the creativity is a phenomenon that has determined in a certain time and place so the creativity is examined from the point of view of the social constructionism. As creative processes in the day nursery it has been defined pretend play, child´s involvement and children´s agentive perception which is based on the Children´s agentive perception theory of Reunamo (2007). The purpose of the study is to clarify how the child's personal factors and the social environment affect the creative processes of children in the day nursery. This Master's thesis is based on the Children' s agentive perception uncovered study led by Jyrki Reunamo (2010) which was carried out in the spring of 2010 in Keski-Uusimaa and in Hämeenlinna and Taiwan. From the study, a name has also been used "on the sources of Orientation", a research project and development project. The study includes the children's evaluation sector, the observation sector, the children's interview sector and the evaluation sector of the pedagogic environment. 891 Children 1-7 year-old by age participated in the study. All the sectors which belong to the study of Reunamo were utilized in this treatise and the Finnish day nurseries or preschool groups which had participated in the study were marked off as the target group. The main component analysis, sum variables, the correlation coefficients, Mann-Whitney s U-test and Kruskall-Wallas test were used for the statistical examination of the quantitative material. In this treatise it was noticed, both the personal properties of the child and a social environment, that they affected all the examined creative processes which also had a significant connection with each other statistically. The definition of creativity was filled best by the participative answers. However, the number of the participative answers was only 8% in the questions concerning adults. That raised the question whether an attempt should be made to have effect so that the children's better participation also in the interaction with the adults would be possible in the educational culture of the day nursery. In the further study, the conscious building of the social environment which supports the creativity from a social constructionism point of view could indeed be an interesting task. The treatise is suitable for an examination of the interaction between the child's person and a social environment especially from the point of view of the creativity.