Social-class inequalities in ill health - the contribution of physical workload

Tutkimuksen aiheita olivat yhteiskuntaluokkien väliset erot sairastavuudessa ja alentuneessa toimintakyvyssä, sekä fyysisen työkuormituksen ja joidenkin muiden työolojen vaikutus sairastavuuteen. Empiirisestä työstä on raportoitu myös neljässä kansainvälisissä tieteellisissä aikakauskirjoissa julkaistussa artikkelissa. Tässä julkaistu yhteenveto sisältää tulosten yhteenvedon lisäksi myös tutkimusta koskevien käsitteellisten ja teoreettisten kysymysten sekä tutkimustradition kriittisen katsauksen. Työn päätavoitteita olivat 1) tutkia fyysisesti kuormittavan työn, ja jossain määrin muiden työolojen osuutta yhteiskuntaluokkien välisiin eroihin sairaudessa ja toimintakyvyn alentuneisuudessa; 2) tutkia työn fyysisen kuormittavuuden, työhön liittyvien vaikutusmahdollisuuksien ja hallinnan (decision latitude), luokka-aseman, iän ja sukupuolen yhteisvaikutuksia heikentyneeseen terveydentilaan; sekä 3) tutkia missä määrin mekaanisten työaltisteiden ja tuki- ja liikuntaelinsairastavuuden välinen yhteys voi selittää yhteiskuntaluokkien välisiä eroja heikentyneessä yleisessä terveydentilassa. Tutkittavat olivat keski-ikäisiä Helsingin kaupungin työntekijöitä. Analyysit perustuivat poikittaisasetelmaan, ja käytetty aineisto oli Helsinki Health Studyn vuosien 2000 ja 2002 välillä kerättyä aineistoa. Analyyseihin käytetyssä aineistossa oli 3740:stä 8002:een tutkittavaa. Tulosten perusteella fyysisillä (sekä fysikaalisilla) työoloilla on merkittävä vaikutus yhteiskuntaluokkien välisiin eroihin yleisessä sairastavuudessa, toimintakyvyn heikentymisessä, tuki- ja liikuntaelinsairastavuudessa sekä itsearvioidussa terveydentilassa. Naisilla lähes puolet heikentyneen toimintakyvyn ja koetun terveydentilan luokkaeroista vaikutti olevan selitettävissä fyysisellä työkuormituksella. Hallintamahdollisuuksien ei havaittu merkittävästi muuttavan fyysisen kuormituksen vaikutusta toimintakykyyn. Fyysisen kuormittavuuden terveysvaikutus voimistui kasvavan iän mukaan enemmän naisilla kuin miehillä. Osa, mutta ei koko fyysisen kuormituksen vaikutus yhteiskuntaluokkien eroihin heikentyneessä terveydessä vaikutti välittyvän tuki- ja liikuntaelinsairastavuuden kautta. Terveys ja sairaus eivät ole yhtenäisiä tiloja, ja siksi monet eri sosiaalisesti ja rakenteellisesti määräytyvät olosuhteet todennäköisesti vaikuttavat yhteiskunnallisten terveyserojen syntymiseen. Fyysis-materiaalisten olojen vaikutusta terveyserojen syntyyn nyky-yhteiskunnassa on mahdollisesti aliarvioitu. Yhteiskuntaluokkien väliset erot fyysis-materiaalisissa olosuhteissa eivät ole kadonneet, ja nämä erot todennäköisesti vaikuttavat terveyserojen syntyyn.

Death in the Bolivian High Plateau : Burials and Tiwanaku Society

My Ph.D. dissertation presents a multi-disciplinary analysis of the mortuary practices of the Tiwanaku culture of the Bolivian high plateau, situated at an altitude of c. 3800 m above sea level. The Tiwanaku State (c. AD 500-1150) was one of the most important pre-Inca civilisations of the South Central Andes. The book begins with a brief introductory chapter. In chapter 2 I discuss methodological and theoretical developments in archaeological mortuary studies from the late 1960s until the turn of the millennium. I am especially interested in the issue how archaeological burial data can be used to draw inferences on the social structure of prehistoric societies. Chapter 3 deals with the early historic sources written in the 16th and 17th centuries, following the Spanish Conquest of the Incas. In particular, I review information on how the Incas manifested status differences between and within social classes and what kinds of burial treatments they applied. In chapter 4 I compare the Inca case with 20th century ethnographic data on the Aymara Indians of the Bolivian high plateau. Even if Christianity has affected virtually every level of Aymara religion, surprisingly many traditional features can still be observed in present day Aymara mortuary ceremonies. The archaeological part of my book begins with chapter 5, which is an introduction into Tiwanaku archaeology. In the next chapter, I present an overview of previously reported Tiwanaku cemeteries and burials. Chapter 7 deals with my own excavations at the Late Tiwanaku/early post-Tiwanaku cemetery site of Tiraska, located on the south-eastern shore of Lake Titicaca. During the 1998, 2002, and 2003 field seasons, a total of 32 burials were investigated at Tiraska. The great majority of these were subterranean stone-lined tombs, each containing the skeletal remains of 1 individual and 1-2 ceramic vessels. Nine burials have been radiocarbon dated, the dates in question indicating that the cemetery was in use from the 10th until the 13th century AD. In chapter 8 I point out that considerable regional and/or ethnic differences can be noted between studied Tiwanaku cemetery sites. Because of the mentioned differences, and a general lack of securely dated burial contexts, I feel that at present we can do no better than to classify most studied Tiwanaku burials into three broad categories: (1) elite and/or priests, (2) "commoners", and (3) sacrificial victims and/or slaves and/or prisoners of war. On the basis of such indicators as monumental architecture and occupational specialisation we would expect to find considerable status-related differences in tomb size, grave goods, etc. among the Tiwanaku. Interestingly, however, such variation is rather modest, and the Tiwanaku seem to have been a lot less interested in expending considerable labour and resources in burial facilities than their pre-Columbian contemporaries of many parts of the Central Andes.

Hautamuistomerkki elämän ja kuoleman tulkitsijana : Heikki Häiväojan, Kain Tapperin ja Matti Peltokankaan tekemät hautamuistomerkit 1952-2002

Grave sculpture as interpreter of life and death. Grave sculptures done by Heikki Häiväoja, Kain Tapper and Matti Peltokangas 1952-2002. The thoughts of Philippe Ariès and Erwin Panofsky on western funeral art constitute the starting point of this study. These scholars speak about the 20th century as a period of decline regarding western funeral art. The reason for this situation lies, according to them, in the fact that death has been rejected and become a private affair in modern society. Especially Panofsky sees an important reason for the decay of funeral art also in the separation of death from religion. In this study, I approach the view of Ariès and Panofsky from the angle of Finnish funeral art. The subject of the study is grave sculptures of three Finnish sculptors: Heikki Häiväoja, Kain Tapper and Matti Peltokangas, from 1952 to 2002. (The analysis of the grave sculptures has been performed with the Iconology of Erwin Panofsky. The analysis has been deepened by the ideas of a graveyard as a semiotic text according to Werner Enninger and Christa Schwens. In order to confirm their argumentation, they analyse the graveyard text with the model of communicative functions of Roman Jakobson and verify that the graveyard is a cultural text according to Juri Lotman.) Results of the study In the grave sculptures of the sculptors, different worldviews appear alongside Christian thoughts indicating a new stage in the tradition of funeral art. In the grave sculptures characterised as Christian, the view of life after death is included. In these memorials the direction of life is prospective, pointing to the life beyond. Death is a border, beyond which one is unable to see. Nevertheless the border is open or marked by the cross. On this open border, death is absence of pain, glory and new unity. In memorials with different worldviews, the life beyond is a possibility which is not excluded. Memorials interpret life retrospectively; life is a precious memory which wakens grief and longing. Many memorials have metaphysical and mystic features. In spite of democratization the order and valuation of social classes appear in some memorials. The old order also materializes in the war memorials relating the same destiny of the deceased. Different burial places, nevertheless, do not indicate social inequality but are rather signs of diversity. The sculptors' abstract means of modern funeral art deepen the handling of the subject matter of death and reveal the mystery of it. Grave sculptures are a part of Finnish and sacral modern art, and there is an interaction between funeral art and modern art. Modern art acquires a new dimension, when grave sculptures become a part of its field. Grave sculptures offer an alternative to anonymous burying. The memorial is a sign of the end of life; it gives death significance and publicity and creates a relation to the past of the society. In this way, grave sculptures are a part of the chain of memory of the western funeral art, which extends throughout Antiquity until ancient Egypt. (In this study I have spoken of funeral art as a chain of memory using the thoughts of Danièle Hervieu-Léger.) There are no signs of decay in the grave sculptures, on the contrary the tradition of funeral art continues in them as a search for the meaning of life and death and as an intuitive interpretation of death. As such, grave sculptures are part of the Finnish discussion of death.

Primary Fallopian tube carcinoma:occurrence, risk and prognostic factors

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

School and choice : Anethnography of a primary school with bilingual classes

Based on a one-year ethnographic study of a primary school in Finland with specialised classes in Finnish and English (referred to as bilingual classes by research participants), this research traces patterns of how nationed, raced, classed and gendered differences are produced and gain meaning in school. I examine several aspects of these differences: the ways the teachers and parents make sense of school and of school choice; the repertoires of self put forward by teachers, parents and pupils of the bilingual classes; and the insitutional and classroom practices in Sunny Lane School (pseudonym). My purpose is to examine how the construction of differentness is related to the policy of school choice. I approach this questions from a knowledge problematic, and explore connections and disjunctions between the interpretations of teachers and those of parents, as well as between what teachers and parents expressed or said and the practices they engaged in. My data consists of fieldnotes generated through a one-year period of ethnographic study in Sunny Lane School, and of ethnographic interviews with teachers and parents primarily of the bilingual classes. This data focuses on the initial stages of the bilingual classes, which included the application and testing processes for these classes, and on Grades 1─3. In my analysis, I pursue poststructural feminist theorisations on questions of knowledge, power and subjectivity, which foreground an understanding of the constitutive force of discourse and the performative, partial, and relational nature of knowledge. I begin by situating my ethnographic field in relation to wider developments, namely, the emergence of school choice and the rhetoric of curricular reform and language education in Finland. I move on from there to ask how teachers discuss the introduction of these specialised classes, then trace pupils paths to these classes, their parents goals related to school choice, teachers constructions of the pupils and parents of bilingual classes, and how these shape the ways in which school and classroom practices unfold. School choice, I argue, functioned as a spatial practice, defining who belongs in school and demarcating the position of teachers, parents and pupils in school. Notions of classed and ethnicised differences entered the ways teachers and parents made sense of school choice. Teachers idealised school in terms of social cohesiveness and constructed social cohesion as a task for school to perform. The hopes parents iterated were connected to ensuring their children s futurity, to their perceptions of the advantages of fluency in English, but also to the differences they believed to exist between the social milieus of different schools. Ideals such as openmindedness and cosmopolitanism were also articulated by parents, and these ideals assumed different content for ethnic majority and minority parents. Teachers discussed the introduction of bilingual classes as being a means to ensure the school s future, and emphasised bilingual classes as fitting into the rubric of Finnish comprehensive schooling which, they maintained, is committed to equality. Parents were expected to accommodate their views and adopt the position of the responsible, supportive parent that was suggested to them by teachers. Teachers assumed a posture teachers of appreciating different cultures, while maintaining Finnishness as common ground in school. Discussion on pupils knowledge and experience of other countries took place often in bilingual classes, and various cultural theme events were organized on occasion. In school, pupils are taught to identify themselves in terms of cultural belonging. The rhetoric promoted by teachers was one of inclusiveness, which was also applied to describe the task of qualifying pupils for bilingual classes, qualifying which pupils can belong. Bilingual classes were idealised as taking a neutral, impartial posture toward difference by ethnic majority teachers and parents, and the relationship of school choice to classed advantage, for example, was something teachers, as well as parents, preferred not to discuss. Pupils were addressed by teachers during lessons in ways that assumed self responsibility and diligence, and they assumed the discursive category of being good, competent pupils made available to them. While this allowed them to position themselves favourably in school, their participation in a bilingual class was marked by the pressure to succeed well in school.

Why Don't Students Talk? Causes of Foreign Language Communication Apprehension in English Classes: A Comparison of High Apprehensive and Low Apprehensive Upper Secondary Students.

OBJECTIVES. Oral foreign language skills are an integral part of one's social, academic and professional competence. This can be problematic for those suffering from foreign language communication apprehension (CA), or a fear of speaking a foreign language. CA manifests itself, for example, through feelings of anxiety and tension, physical arousal and avoidance of foreign language communication situations. According to scholars, foreign language CA may impede the language learning process significantly and have detrimental effects on one's language learning, academic achievement and career prospects. Drawing on upper secondary students' subjective experiences of communication situations in English as a foreign language, this study seeks, first, to describe, analyze and interpret why upper secondary students experience English language communication apprehension in English as a foreign language (EFL) classes. Second, this study seeks to analyse what the most anxiety-arousing oral production tasks in EFL classes are, and which features of different oral production tasks arouse English language communication apprehension and why. The ultimate objectives of the present study are to raise teachers' awareness of foreign language CA and its features, manifestations and impacts in foreign language classes as well as to suggest possible ways to minimize the anxiety-arousing features in foreign language classes. METHODS. The data was collected in two phases by means of six-part Likert-type questionnaires and theme interviews, and analysed using both quantitative and qualitative methods. The questionnaire data was collected in spring 2008. The respondents were 122 first-year upper secondary students, 68 % of whom were girls and 31 % of whom were boys. The data was analysed by statistical methods using SPSS software. The theme interviews were conducted in spring 2009. The interviewees were 11 second-year upper secondary students aged 17 to 19, who were chosen by purposeful selection on the basis of their English language CA level measured in the questionnaires. Six interviewees were classified as high apprehensives and five as low apprehensives according to their score in the foreign language CA scale in the questionnaires. The interview data was coded and thematized using the technique of content analysis. The analysis and interpretation of the data drew on a comparison of the self-reports of the highly apprehensive and low apprehensive upper secondary students. RESULTS. The causes of English language CA in EFL classes as reported by the students were both internal and external in nature. The most notable causes were a low self-assessed English proficiency, a concern over errors, a concern over evaluation, and a concern over the impression made on others. Other causes related to a high English language CA were a lack of authentic oral practise in EFL classes, discouraging teachers and negative experiences of learning English, unrealistic internal demands for oral English performance, high external demands and expectations for oral English performance, the conversation partner's higher English proficiency, and the audience's large size and unfamiliarity. The most anxiety-arousing oral production tasks in EFL classes were presentations or speeches with or without notes in front of the class, acting in front of the class, pair debates with the class as audience, expressing thoughts and ideas to the class, presentations or speeches without notes while seated, group debates with the class as audience, and answering to the teacher's questions involuntarily. The main features affecting the anxiety-arousing potential of an oral production task were a high degree of attention, a large audience, a high degree of evaluation, little time for preparation, little linguistic support, and a long duration.