Ylirajaisia suhteita : Helsingin olympialaiset, Armi Kuusela ja ylikansallinen historia

In 1952 Helsinki hosted the Summer Olympic Games and Armi Kuusela, the current “Maiden of Finland”, was at the same time crowned Miss Universe. In popular history writing, these events have been designated as a crucial turning point – the end of an era marked by war and deprivation and the beginning of a modern, Western nation. Symptomatically, both events were marked by Finnish women’s sexual relationships with foreign men. The Olympics were shadowed by a concern over Finnish women’s “undue friendliness” with the Olympic guests, and Armi Kuusela's world tour was cut short by her surprise marriage in Tokyo and subsequent emigration to the Philippines. This study is an inquiry into the Helsinki Olympics and the public persona of Armi Kuusela from the point of view of transnational heterosexuality and the constitution of Finnish national identity. Methodologically the two main components of the study are intersectionality, defined here as a focus on the mutual histories and effects of discourses of gender, sexuality, race and nation; and transnational history as a way of exploring the ways that both nations and sexual subjects are embedded in global relations of power. The analysis proceeds by way of contextual and intertextual readings of various sources. Part one, centering on the Olympics, involves a campaign mounted by certain women’s organizations before the Games in order to educate young women about the potential dangers of the forthcoming international event as well as magazine and newspaper articles published during and after the Games concerning the encounter between young Finnish women and foreign, especially “Southern,” men. It places the debates during the Olympics within the framework of wartime understandings of women’s sexuality; the history of the concept of decency (siveellisyys); post-war population policy; the intersectional histories of conceptions pertaining to race and sexuality; and finally, the post-war concerns over women’s migration from rural areas to the capital city and their potential emigration abroad. Part two deals with the persona of Armi Kuusela and the public reception of her world tour and marriage, based on material from both Finland and the Philippines (newspapers, magazines, advertisements, books and films). It examines the persona of Armi Kuusela as a figure of national import in terms of the East/West divide; the racialized images of different geographic climates and Oriental “Others;” the meaning of whiteness in the Philippines; the significance of class and colonial history for the domestication of sexual and racial transgressions implied by an unconventional transnational marriage; as well as the cultural logics of transnational desire and its possible meanings for women in 1950s Finland. The study develops two arguments. First, it suggests that instead of being purely oppositional to national discourses, transnational desire may also be viewed as a product of these very discourses. Second, it claims that the national significance of both the Olympics and the persona of Armi Kuusela was due to the new points of comparison they both offered for national identity construction. In comparison with the sexualized Southern men at the Olympics and the racialized Orient in the representations of Armi Kuusela’s travels and marriage, Finland emerged as part of the civilized North, placed firmly within the perimeters of Western Europe. As such, both events mark a “whitening” of the Finnish people as well as a distancing from their previous designations in racial hierarchies. At the same time, however, the process of becoming a white nation inevitably meant complying with and reproducing racial hierarchies, rather than simply abolishing them.

Meän tapa puhua : Tornionlaakso pellolaisnuorten subjektiivisena paikkana ja murrealueena

This folk linguistic and human geographic study deals with dialect awareness, dialect use and place attachment. The study discusses theoretical and methodological issues current in sociolinguistics suggesting that the study of attitudes should be regarded as a core area in the study of variation and change. Furthermore, it is suggested that instead of putting effort into improving mental mapping methodology (adopted into folk linguistics from behavioural geography of the 1960 s), the more up-to-date thinking of space in geography should be adopted. The region and the dialect are treated as perceptual constructs in the study. The dialect perceptions of high school seniors in the Finnish Tornio Valley are examined trough a triangulation method involving a questionnaire, interviews and dialect recognition test as the research methods. The h in non-initial syllables (e.g. lähethä(ä)n, saunhaan ~ sauhnaan let s go into sauna ) turns out, expectedly, as the most salient feature in the dialect awareness of the locals and in terms of local identity construction. This feature is no longer heard in most of the present dialects of Finnish but is still thriving in the Tornio Valley in the cross-border dialect area. The metathetic variant (saunhaan > sauhnaan into sauna , käymhään > käyhmään to go ) is a characteristic feature of the Tornio Valley dialect. However, individual differences have long been found in the use of the h. This study challenges the essentialist variationist view of social categories (gender) by analysing variation from a quantitative but emic and human geographic point of view. The study shows that the variation of the h is statistically significantly patterned in terms of the degree of feeling of insideness vs. outsideness. New light is shed on the gender differences found in earlier sociolinguistic studies: differences in dialect use between and inside gender groups are illuminated by the fact that, in this case, it is young women who are generally less attached to the local community than young men, but this does not hold for all the individuals. The ideological motivation for preservation of the h seems to be based on the imagined community of Tornio Valley covering both the Swedish and the Finnish valley area. The general image of the dialect area and it s speakers, the shared cognitive dialect boundaries of the locals and the particularly deep level of awaress of the linguistic variation of the h are notable resources of the Tornio valley identity. Hyperdialectic forms analogical to the most frequently attested metathetic forms are found in the interview data, predicting that in this dialect the h will be maintained also in the future.

Vääränikäisiä äitejä? : Ikä ja äitiyden yhteiskunnalliset ehdot

This dissertation reports on research on the contradictions between “right-aged” motherhood accordant with normative life-course and the motherhood of a woman who lives her life according to her own choices and options. The focus of this study is to analyse and interpret the motherhood of women who have become mothers for the first time both at a very young age (under 20) and at an older age (in their 40s), from the viewpoint of life-course, age and social class. The study discusses motherhood both as an experience and as a socially-constructed phenomenon. Research questions are the following: How do mothers at different ages talk about pregnancy and motherhood as a part of their life-course? What meanings do mothers at different ages give to age, growing up and adulthood? How is social class constructed in the speech of different-aged mothers? This dissertation includes five articles and a summary chapter. The theoretical starting points for the study are Finnish critical family studies, Finnish feminist social policy studies and Anglo-American feminist motherhood studies. Additionally, this study draws on sociological age studies and new sociological social class studies. The methodological approach is discursive-materialistic. This approach recognises issues related to language, cultural representation and subjectivity, but it also aims to locate them in their social and historical context. The data is drawn from twenty-four interviews of different-aged mothers and articles collected from popular magazines on babies and parenting. In the interview data, different issues related to motherhood are constructed due not only to the women’s age, but also their social background. Social class becomes visible in the relationship between the interviewed women and nuclear family, expert knowledge or money and livelihood. In this study, social class and age are intertwined. It is almost impossible to analytically distinguish which of the mothers’ experiences are related to class and which are related to age. In this study, young motherhood is shown as quite positive. Even though the interviewed young women did not usually plan to have a child, it was not a great shock either. In the young mothers’ speech, motherhood appears as a natural part of the life-course and growing up. The conditions young mothers suggested as necessary to good motherhood do not depend on standard of living, education or social background. A young age is seen as a resource, not as an obstacle to good motherhood. Postponing one’s motherhood is associated with materialism and a career-oriented lifestyle. The older mothers in this study rarely reported having postponed their motherhood on purpose. Some of them explained the delay with extended studies or financial insecurity caused by part-time unemployment. Others recounted they had been insecure about their abilities to cope with a child or lacked a suitable partner. Some of them may have wanted a child much earlier in life, given the right circumstances. In the older mothers’ speech, motherhood is strongly associated with adult life, permanent employment and a (heterosexual) nuclear family.

Kuluttajuuden rakentuminen nuorten kertomuksissa

This study examines the narrative construction of consumerism in Finnish consumer culture in the early 21st century. The objects of the study are consumer life stories and essays on environmentally friendly consumption, written by 15-19-year-old high school students. Moreover, group discussions were used as additional research material. The data was gathered at five high schools in different areas of Finland. Young people's consumer narratives are interpreted through cultural stories and consumer ethos such as self-control, gratification and green consumerism. The narrative research approach is used to analyse what types of consumer positions these young people construct in stories on their own consumer history, and what kinds of ideas and thought patterns they construct on green consumerism. The study creates a multifaceted image of young people as agents in consumer society. They construct archetypical stories of wastrels and scrooges, as well as prudent and environmentally friendly consumers. Consumption and expenditure are however mostly a continuous battle between self-control and giving in to gratification. This reality is illustrated among other things by clever expressions invented by young people, such as Carefree Pennywise, Prudent Hedonist and Wasteful Scrooge. In their narratives, young people also analyse the usefulness - or uselessness - of their decisions on consumption, as well as develop themselves into controlling and sensible consumers. This kind of virtuous consumer allows him/herself the joy and the gratification of consumption, as long as these are "kept in check". One's view of expenditure and consumption is not permanent. Consumerism may alter with time. A wastrel may grow up to be a young person in control of their desires, or a thrifty child may awaken to the pleasures of consumption in their teens. Consumerism may also be polyphonic: it may simultaneously - and even uncomplicatedly - be constructed upon the discourses of wastefulness, prudence, gratification and green consumerism. Young people allow for gratification to form a part of green consumerism, too: it is not simply restrictive self-denial. They also see many hurdles in the way of green consumerism, such as the elevated price of ecological products, and the difficulties of green consumer practices. The stories also show the gender division in green consumerism. For young men, ecological considerations offer elements for the construction of consumerism only on the very rare occasion, whereas striving for day-to-day green practices is typical for young women.

Preterm Birth and Surgical Treatment of the Uterine Cervix

Cervical cancer is the second most common cancer among women globally. Most, probably all cases, arise through a precursor, cervical intraepithelial neoplasia (CIN). Effective cytological screening programmes and surgical treatments of precancerous lesions have dramatically reduced its prevalence and related mortality. Although these treatments are effective, they may have adverse effects on future fertility and pregnancy outcomes. The aim of this study was to evaluate the effects of surgical treatment of the uterine cervix on pregnancy and fertility outcomes, with the focus particularly on preterm birth. The general preterm birth rates and risk factors during 1987–2005 were studied. Long-term mortality rates of the treated women were studied. In this study, information from The Medical Birth Register (MBR), The Hospital Discharge Register (HDR), The Cause-of-Death Register (CDR), and hospital records were used. Treatments were performed during 1987–2003 and subsequent deliveries, IVF treatments and deaths were analyzed. The general preterm birth rate in Finland was relatively stable, varying from 5.1% to 5.4% during the study period (1987 to 2005), although the proportion of extremely preterm births had decreased substantially by 12%.The main risk factor as regards preterm birth was multiplicity, followed by elective delivery (induction of delivery or elective cesarean section), primiparity, in vitro fertilization treatment, maternal smoking and advanced maternal age. The risk of preterm birth and low birth weight was increased after any cervical surgical treatment; after conization the risk of preterm birth was almost two-fold (RR 1.99, 95% CI 1.81– 2.20). In the conization group the risk was the highest for very preterm birth (28–31 gestational weeks) and it was also high for extremely preterm birth (less than 28 weeks). In this group the perinatal mortality was also increased. In subgroup analysis, laser ablation was not associated with preterm birth. When comparing deliveries before and after Loop conization, we found that the risk of preterm birth was increased 1.94-fold (95% CI 1.10–3.40). Adjusting for age, parity, or both did not affect our results. Large or repeat cones increased the risk of preterm birth when compared with smaller cones, suggesting that the size of the removed cone plays a role. This was corroborated by the finding that repeat treatment increased the risk as much as five-fold when compared with the background preterm birth rate. We found that the proportion of IVF deliveries (1.6% vs. 1.5%) was not increased after treatment for CIN when adjusted for year of delivery, maternal age, or parity. Those women who received both treatment for CIN and IVF treatment were older and more often primiparous, which explained the increased risk of preterm birth. We also found that mortality rates were 17% higher among women previously treated for CIN. This excess mortality was particularly seen as regards increased general disease mortality and alcohol poisoning (by 13%), suicide (by 67%) and injury death (by 31%). The risk of cervical cancer was high, as expected (SMR 7.69, 95% CI 4.23–11.15). Women treated for CIN and having a subsequent delivery had decreased general mortality rate (by -22%), and decreased disease mortality (by -37%). However, those with preterm birth had increased general mortality (SMR 2.51, 95% CI 1.24–3.78), as a result of cardiovascular diseases, alcohol-related causes, and injuries. In conclusion, the general preterm birth rate has not increased in Finland, as in many other developed countries. The rate of extremely preterm births has even decreased. While other risk factors of preterm birth, such as multiplicity and smoking during pregnancy have decreased, surgical treatments of the uterine cervix have become more important risk factors as regards preterm birth. Cervical conization is a predisposing factor as regards preterm birth, low birth weight and even perinatal mortality. The most frequently used treatment modality, Loop conization, is also associated with the increased risk of preterm birth. Treatments should be tailored individually; low-grade lesions should not be treated at all among young women. The first treatment should be curative, because repeat treatments are especially harmful. The proportion of IVF deliveries was not increased after treatment for CIN, suggesting that current treatment modalities do not strongly impair fertility. The long-term risk of cervical cancer remains high even after many years post-treatment; therefore careful surveillance is necessary. In addition, accidental deaths and deaths from injury were common among treated women, suggesting risk-taking behavior of these women. Preterm birth seems be associated with extremely high mortality rates, due to cardiovascular, alcohol-related and injury deaths. These women could benefit from health counseling, for example encouragement in quitting smoking.

Tyttöjen toinen koti : Etnografinen tutkimus tyttökulttuurista ratsastustalleilla

Horseback riding is a popular activity in Finland, especially among young women and girls. For centuries, however, horse husbandry and horse culture in Finland had been dominated by men. Nowadays it is mainly the girls who ride as a hobby and take care of the horses. The stable has evolved into an important social sphere for girls, a semi-public room of their own where they spend time together. A study of the girl culture in the riding stable offers a unique perspective as well as new information on becoming a girl and a young woman in Finland. The subject of my research is the girl culture and girls communities at the horseback riding stables. In this thesis I discuss what kind of girl-cultural sphere the stable is, how girls organize their community, and what different aspects and meanings the hobby entails for girls while they are actively engaged in the hobby. I focus on the construction of gender and girlhood and examine how these gender constructions can be theorized as gender tradition. The research material consists of the interviews of 22 stable girls from different parts of Finland and an observation period at one of the stables. The informants were from 13 to 27 years of age. The theoretical background is based on the anthropological study of folklore, girls studies, feminist theory and post-humanist viewpoints. I am interested in how girls culture and girlhood are produced performatively in the interview narration and participant observation. I concentrate on four aspects of this culture: 1) what girls do at the stable, and what kind of relationships they create with horses; 2) social relations focusing on the ways girls construct their own groups, the way their hierarchy is constructed and how they use power; 3) the norms and social control regarding social behaviour; and 4) the reasons girls give for their involvement in the hobby, and girls interest in horses in general. In this girl culture, gender norms and boundaries are not only stretched or transgressed, but the culture also re-produces the hierarchical and stereotypical ideas of gender. The traditions of gender express both the hegemonic gender system and those ideas of gender which girls resist, at least momentarily. Constructions of gender and gender tradition are constituted at the intersections of historical and contemporary expectations of what it means to be a girl. Conscious of these societal demands, girls support, reproduce, challenge, and make comments on them.

Domestic labour relations in India : Vulnerability and gendered life courses in Jaipur

This study explores labour relations between domestic workers and employers in India. It is based on interviews with both employers and workers, and ethnographically oriented field work in Jaipur, carried out in 2004-2007. Combining development studies with gender studies, labour studies, and childhood studies, it asks how labour relations between domestic workers and employers are formed in Jaipur, and how female domestic workers trajectories are created. Focusing on female part-time maids and live-in work arrangements, the study analyses children s work in the context of overall work force, not in isolation from it. Drawing on feminist Marxism, domestic labour relations are seen as an arena of struggle. The study takes an empirical approach, showing class through empiria and shows how paid domestic work is structured and stratified through intersecting hierarchies of class, caste, gender, age, ethnicity and religion. The importance of class in domestic labour relations is reiterated, but that of caste, so often downplayed by employers, is also emphasized. Domestic workers are crucial to the functioning of middle and upper middle class households, but their function is not just utilitarian. Through them working women and housewives are able to maintain purity and reproduce class disctinctions, both between poor and middle classes and lower and upper middle classes. Despite commodification of work relations, traditional elements of service relationships have been retained, particularly through maternalist practices such as gift giving, creating a peculiar blend of traditional and market practices. Whilst employers of part-time workers purchase services in a segmented market from a range of workers for specific, traditional live-in workers are also hired to serve employers round the clock. Employers and workers grudgingly acknowledged their dependence on one another, employers seeking various strategies to manage fear of servant crime, such as the hiring of children or not employing live-in workers in dual-earning households. Paid domestic work carries a heavy stigma and provide no entry to other jobs. It is transmitted from mothers to daughters and working girls were often the main income providers in their families. The diversity of working conditions is analysed through a continuum of vulnerability, generic live-in workers, particularly children and unmarried young women with no close family in Jaipur, being the most vulnerable and experienced part-time workers the least vulnerable. Whilst terms of employment are negotiated informally and individually, some informal standards regarding salary and days off existed for maids. However, employers maintain that workings conditions are a matter of individual, moral choice. Their reluctance to view their role as that of employers and the workers as their employees is one of the main stumbling blocks in the way of improved working conditions. Key words: paid domestic work, India, children s work, class, caste, gender, life course

Choosing the Arranged One, Arranging the Chosen One – Imagining an Indian Modernity: Reconciling Love, Marriage and Family On and Off the Screen

This is a study on the changing practices of kinship in Northern India. The change in kinship arrangements, and particularly in intermarriage processes, is traced by analysing the reception of Hindi popular cinema. Films and their role and meaning in people´s lives in India was the object of my research. Films also provided me with a methodology for approaching my other subject-matters: family, marriage and love. Through my discussion of cultural change, the persistence of family as a core value and locus of identity, and the movie discourses depicting this dialogue, I have looked for a possibility of compromise and reconciliation in an Indian context. As the primary form of Indian public culture, cinema has the ability to take part in discourses about Indian identity and cultural change, and alleviate the conflicts that emerge within these discourses. Hindi popular films do this, I argue, by incorporating different familiar cultural narratives in a resourceful way, thus creating something new out of the old elements. The final word, however, is the one of the spectator. The “new” must come from within the culture. The Indian modernity must be imaginable and distinctively Indian. The social imagination is not a “Wild West” where new ideas enter the void and start living a life of their own. The way the young women in Dehra Dun interpreted family dramas and romantic movies highlights the importance of family and continuity in kinship arrangements. The institution of arranged marriage has changed its appearance and gained new alternative modes such as love cum arranged marriage. It nevertheless remains arranged by the parents. In my thesis I have offered a social description of a cultural reality in which movies act as a built-in part. Movies do not work as a distinct realm, but instead intertwine with the social realities of people as a part of a continuum. The social imagination is rooted in the everyday realities of people, as are the movies, in an ontological and categorical sense. According to my research, the links between imagination and social life were not so much what Arjun Appadurai would call global and deterritorialised, but instead local and conventional.

Playing "Nordic": The Women of Niskavuori, Agri/Culture, and Imagining Finland on the Third Reich Stage

The theatrical censorship of the Third Reich considered the playwright's race and politics alongside the content of the drama. Given the political stigma of its "leftist" author, it is rather surprising that Hella Wuolijoki's Niskavuoren naiset opened in 1938 at the Staatliches Schauspielhaus in Hamburg. The play ran for fourteen performances before being closed by the Reichsdramaturgie, apparently at the instigation of Finnish critics. Yet this was not the end of the play's or its author's fortunes in the Third Reich, as the possibility of staging the play was raised several times over the next four years, coming to a close in 1942. Playing "Nordic" examines the ideological and theatrical background of this extended "cultural performance," as a means to reopening and reconstructing the work of the 1938 Die Frauen auf Niskavuori. Written by a Finnish, northern, "Nordic" author, and preoccupied with the dynamics of rural culture in an increasingly urbanized world, Niskavuoren naiset was understood in the Third Reich to illustrate and reinforce the racial, agri/cultural themes of Blut und Boden ("veri ja maa"). Playing "Nordic" examines this thematic relationship in three phases. The first phase uses archival materials to investigate the Reichsdramaturgie's understanding of the play and its author, and its ongoing discussion of Wuolijoki from 1937 to 1942. Play evaluator Sigmund Graff's description of Niskavuoren naiset as hamsunartig, or "Hamsun-esque," inspires the second phase of the dissertation, which first elaborates the meanings of Blut und Boden through a reading of contemporary "racial" theory and anthropology, and then assesses the representation of Finland within this discourse, one of the dominant cultural paradigms of the Third Reich. Imaging Finland for German audiences, the play stood among analogous, continued efforts to represent Finland and the rural life in the Third Reich, colored by Blut und Boden: art and agricultural exhibitions, essays and propaganda literature, mass demonstrations of the peasantry. This wider framework for the performance of "Finland" materializes the abstract or theoretical program of Blut und Boden in its everyday performed meanings; as such it provides the essential background for reading the Hamburg production of Die Frauen auf Niskavuori, which sustains the third and final phase. The German translation and the Hamburg photographic record are compared with the Helsinki premiere to assess the impact of Blut und Boden on the representation of Wuolijoki's play in the Third Reich. The journalistic critical response illuminates the effect that the dramatic complex of rural and racial values - generically identified as Bauerndrama in the Third Reich - had on the reception of the play; at the same time, both visual and critical documents also suggest possible moments of theatrical dissent in the Hamburg production. Playing "Nordic" undertakes a documentary and cultural reading of the changing theatrical meanings of Wuolijoki's Niskavuoren naiset as it crossed the frontier from Finland to the stage of the Third Reich. It also provides a model for the ways theatrical signification operates within a network of cultural and ideological meanings, suggesting the ideological work of theatrical production depends on, reinforces, and contests that tissue of values. Although Finnish criticism of Niskavuoren naiset has assumed the play's Blut und Boden resonance contributed to Wuolijoki's success in the Third Reich, this study shows a considerably more complex situation. This revealing production dramatizes the changing uses of plays in a politicized national and transnational context. As part of the framing of "Nordic" identity on the wider stage of the Third Reich, Die Frauen auf Niskavuori exemplifies the conjunction of concurrent - sometimes independent, sometimes interlocking - "racial" and national ideologies.

Oral Health among Young Adults and the Middle-aged in Iran

The aim of the present study was to assess oral health and treatment needs among adult Iranians according to socio-demographic status, smoking, and oral hygiene, and to investigate the relationships between these determinants and oral health. Data for 4448 young adult (aged 18) and 8301 middle-aged (aged 35 to 44) Iranians were collected in 2002 as part of a national survey using the World Health Organization (WHO) criteria for sampling and clinical diagnoses, across 28 provinces by 33 calibrated examiners. Gender, age, place of residence, and level of education served as socio-demographic information, smoking as behavioural and modified plaque index (PI) as the biological risk indicator for oral hygiene. Number of teeth, decayed teeth (DT), filled teeth (FT), decayed, missing, filled teeth (DMFT), community periodontal index (CPI), and prosthodontic rehabilitation served as outcome variables of oral health. Mean number of DMFT was 4.3 (Standard deviation (SD) = 3.7) in young adults and 11.0 (SD = 6.4) among middle-aged individuals. Among young adults the D-component (DT = 70%), and among middle-aged individuals the M-component (60%) dominated in the DMFT index. Among young adults, visible plaque was found in nearly all subjects. Maximum (max) PI was associated with higher mean number of DT, and higher periodontal treatment needs. A healthy periodontium was a rare condition, with 8% of young adults and 1% of middle-aged individuals having a max CPI = 0. The majority of the CPI findings among young adults consisted of calculus (48%) and deepened periodontal pockets (21%). Respective values for middle-aged individuals were 40% and 53%. Having a deep pocket (max CPI = 4) was more likely among young adults with a low level of education (Odds ratio (OR) = 2.7, 95% Confidence interval (CI) = 1.9–4.0) than it was among well-educated individuals. Among middle-aged individuals, having calculus or a periodontal pocket was more likely in men (OR = 1.8, 95% CI = 1.6–2.0) and in illiterate subjects (OR = 6.3, 95% CI = 5.1–7.8) than it was for their counterparts. Among young adults, having 28 teeth was more (p < 0.05) prevalent among men (72% vs. 68% for women), urban residents (71% vs. 67% for rural residents), and those with a high level of education (73% vs. 60% for those with a low level). Among middle-aged individuals, having a functional dentition was associated with younger age (OR = 2.0, 95% CI = 1.7−2.5) and higher level of education (OR = 1.8, 95% CI = 1.6−2.1). Of middle-aged individuals, 2% of 35- to 39-year-olds and 5% of those aged 40 to 44 were edentulous. Among the dentate subjects (n = 7,925), prosthodontic rehabilitation was more prevalent (p < 0.001) among women, urban residents, and those with a high level of education than it was among their counterparts. Among those having 1 to 19 teeth, a removable denture was the most common type of prosthodontic rehabilitation. Middle-aged individuals lacking a functional dentition were more likely (OR = 6.0, 95% CI = 4.8−7.6) to have prosthodontic rehabilitation than were those having a functional dentition. In total, 81% of all reported being non-smokers, and 32% of men and 5% of women were current smokers. Heavy smokers were the most likely to have deepened periodontal pockets (max CPI ≥ 3, OR = 2.9, 95% CI = 1.8−4.7) and to have less than 20 teeth (OR = 2.3, 95% CI = 1.5−3.6). The findings indicate impaired oral health status in adult Iranians, particularly those of low socio-economic status and educational level. The high prevalence of dental plaque and calculus and considerable unmet treatment needs call for a preventive population strategy with special emphasis on the improvement of oral self-care and smoking cessation to tackle the underlying risk factors for oral diseases in the Iranian adult population.

Young Men s Sexual Behaviour in Finland and Estonia : Opportunities for prevention of sexually transmitted infections

Background: The incidence of sexually transmitted infections (STIs) in most EU states has gradually increased and the rate of newly diagnosed HIV cases has doubled since 1999. STIs differ in their clinical features, prognosis and transmission dynamics, though they do share a common factor in their mode of transmission −that is, human behaviour. The evolvement of STI epidemiology involves a joint action of biological, epidemiological and societal factors. Of the more immediate factors, besides timely diagnosis and appropriate treatment, STI incidence is influenced by population patterns of sexual risk behaviour, particularly the number of sexual partners and the frequency of unprotected intercourse. Assessment of sexual behaviour, its sociodemographic determinants and time-trends are important in understanding the distribution and dynamic of STI epidemiology. Additionally, in the light of the basic structural determinants, such as increased level of migration, changes in gender dynamics and impacts from globalization, with its increasing alignment of values and beliefs, can reveal future challenges related to STI epidemiology. STI case surveillance together with surveillance on sexual behaviour can guide the identification of preventive strategies, assess their effectiveness and predict emerging trends. The objective of this study was to provide base line data on sexual risk behaviour, self-reported STIs and their patterns by sociodemographic factors as well as associations of sexual risk behaviour with substance use among young men in Finland and Estonia. In Finland national population based data on adult men s sexual behaviour is limited. The findings are discussed in the context of STI epidemiology as well as their possible implications for public health policies and prevention strategies. Materials and Methods: Data from three different cross-sectional population-based surveys conducted in Finland and Estonia, during 1998 2005, were used. Sexual behaviour- and health-related questions were incorporated in two surveys in Finland; the Health 2000, a large scale general health survey, focussed on young adults, and the Military health behavioural survey on military conscripts participating in the mandatory military training. Through research collaboration with Estonia, similar questions to the Finnish surveys were introduced to the second Estonian HIV/AIDS survey, which was targeted at young adults. All surveys applied mail-returned, anonymous, self-administered questionnaires with multiple choice formatted answers. Results: In Finland, differences in sexual behaviour between young men and women were minor. An age-stratified analysis revealed that the sex-related difference observed in the youngest age group (18 19 years) levelled off in the age group 20 24 and almost disappeared among those aged 25 29. Marital status was the most important sociodemographic correlate for sexual behaviour for both sexes, singles reporting higher numbers of lifetime-partners and condom use. This effect was stronger for women than for men. However, of those who had sex with casual partners, 15% were married or co-habiting, with no difference between male and female respondents. According to the Military health behavioural survey, young men s sexual risk behaviour in Finland did not markedly change over a period of time between 1998 and 2005. Approximately 30−40% of young men had had multiple sex partners (more than five) in their lifetime, over 20% reported having had multiple sex partners (at least three) over the past year and 50% did not use a condom in their last sexual intercourse. Some 10% of men reported accumulation of risk factors, i.e. having had both, multiple sex partners and not used a condom in their last intercourse, over the past year of the survey. When differences and similarities were viewed within Finland and Estonia, a clear sociodemographic patterning of sexual risk behaviour and self-reported STIs was found in Finland, but a somewhat less consistent trend in Estonia. Generally, both, alcohol and drug use were strong correlates for sexual risk behaviour and self-reported STIs in Finland and Estonia, having a greater effect on engagement with multiple sex partners rather than unprotected intercourse or self-reported STIs. In Finland alcohol use, relative to drug use, was a stronger predictor of sexual risk behaviour and self-reported STIs, while in Estonia drug use predicted sexual risk behaviour and self-reported STIs stronger than alcohol use. Conclusions: The study results point to the importance for prevention of sexual risk behaviour, particularly strategies that integrate sexual risk with alcohol and drug use risks. The results point to the need to focus further research on sexual behaviour and STIs among young people; on tracking trends among general population as well as applying in-depth research to identify and learn from vulnerable and high-risk population groups for STIs who are exposed to a combination of risk factors.

Serum uric acid and metabolic risk factors in three ethnic groups: Asian Indians and Creoles in Mauritius and Chinese in Qingdao, China

In humans with a loss of uricase the final oxidation product of purine catabolism is uric acid (UA). The prevalence of hyperuricemia has been increasing around the world accompanied by a rapid increase in obesity and diabetes. Since hyperuricemia was first described as being associated with hyperglycemia and hypertension by Kylin in 1923, there has been a growing interest in the association between elevated UA and other metabolic abnormalities of hyperglycemia, abdominal obesity, dyslipidemia, and hypertension. The direction of causality between hyperuricemia and metabolic disorders, however, is unceartain. The association of UA with metabolic abnormalities still needs to be delineated in population samples. Our overall aims were to study the prevalence of hyperuricemia and the metabolic factors clustering with hyperuricemia, to explore the dynamical changes in blood UA levels with the deterioration in glucose metabolism and to estimate the predictive capability of UA in the development of diabetes. Four population-based surveys for diabetes and other non-communicable diseases were conducted in 1987, 1992, and 1998 in Mauritius, and in 2001-2002 in Qingdao, China. The Qingdao study comprised 1 288 Chinese men and 2 344 women between 20-74, and the Mauritius study consisted of 3 784 Mauritian Indian and Mauritian Creole men and 4 442 women between 25-74. In Mauritius, re-exams were made in 1992 and/or 1998 for 1 941 men (1 409 Indians and 532 Creoles) and 2 318 non pregnant women (1 645 Indians and 673 Creoles), free of diabetes, cardiovascular diseases, and gout at baseline examinations in 1987 or 1992, using the same study protocol. The questionnaire was designed to collect demographic details, physical examinations and standard 75g oral glucose tolerance tests were performed in all cohorts. Fasting blood UA and lipid profiles were also determined. The age-standardized prevalence in Chinese living in Qingdao was 25.3% for hyperuricemia (defined as fasting serum UA > 420 μmol/l in men and > 360 μmol/l in women) and 0.36% for gout in adults between 20-74. Hyperuricemia was more prevalent in men than in women. One standard deviation increase in UA concentration was associated with the clustering of metabolic risk factors for both men and women in three ethnic groups. Waist circumference, body mass index, and serum triglycerides appeared to be independently associated with hyperuricemia in both sexes and in all ethnic groups except in Chinese women, in whom triglycerides, high-density lipoprotein cholesterol, and total cholesterol were associated with hyperuricemia. Serum UA increased with increasing fasting plasma glucose levels up to a value of 7.0 mmol/l, but significantly decreased thereafter in mainland Chinese. An inverse relationship occurred between 2-h plasma glucose and serum UA when 2-h plasma glucose higher than 8.0 mmol/l. In the prospective study in Mauritius, 337 (17.4%) men and 379 (16.4%) women developed diabetes during the follow-up. Elevated UA levels at baseline increased 1.14-fold in risk of incident diabetes in Indian men and 1.37-fold in Creole men, but no significant risk was observed in women. In conclusion, the prevalence of hyperuricemia was high in Chinese in Qingdao, blood UA was associated with the clustering of metabolic risk factors in Mauritian Indian, Mauritian Creole, and Chinese living in Qingdao, and a high baseline UA level independently predicted the development of diabetes in Mauritian men. The clinical use of UA as a marker of hyperglycemia and other metabolic disorders needs to be further studied. Keywords: Uric acid, Hyperuricemia, Risk factors, Type 2 Diabetes, Incidence, Mauritius, Chinese

The brain serotonin transporter binding in young adults; methodological considerations and association with Bulimia Nervosa and acquired obesity

The neurotransmitter serotonin (5-HT) modulates many functions important for life, e.g., appetite and body temperature, and controls development of the neural system. Disturbed 5-HT function has been implicated in mood, anxiety and eating disorders. The serotonin transporter (SERT) controls the amount of effective 5-HT by removing it from the extracellular space. Radionuclide imaging methods single photon emission tomography (SPET) and positron emission tomography (PET) enable studies on the brain SERTs. This thesis concentrated on both methodological and clinical aspects of the brain SERT imaging using SPET. The first study compared the repeatability of automated and manual methods for definition of volumes of interest (VOIs) in SERT images. The second study investigated within-subject seasonal variation of SERT binding in healthy young adults in two brain regions, the midbrain and thalamus. The third study investigated the association of the midbrain and thalamic SERT binding with Bulimia Nervosa (BN) in female twins. The fourth study investigated the association of the midbrain and hypothalamic/thalamic SERT binding and body mass index (BMI) in monozygotic (MZ) twin pairs. Two radioligands for SERT imaging were used: [123I]ADAM (studies I-III) and [123I]nor-beta-CIT (study IV). Study subjects included young adult MZ and dizygotic (DZ) twins screened from the FinnTwin16 twin cohort (studies I-IV) and healthy young adult men recruited for study II. The first study validated the use of an automated brain template in the analyses of [123I]ADAM images and proved automated VOI definition more reproducible than manual VOI definition. The second study found no systematic within-subject variation in SERT binding between scans done in summer and winter in either of the investigated brain regions. The third study found similar SERT binding between BN women (including purging and non-purging probands), their unaffected female co-twins and other healthy women in both brain regions; in post hoc analyses, a subgroup of purging BN women had significantly higher SERT binding in the midbrain as compared to all healthy women. In the fourth study, MZ twin pairs were divided into twins with higher BMI and co-twins with lower BMI; twins with higher BMI were found to have higher SERT binding in the hypothalamus/thalamus than their leaner co-twins. Our results allow the following conclusions: 1) No systematic seasonal variation exists in the midbrain and thalamus between SERT binding in summer and winter. 2) In a population-based sample, BN does not associate with altered SERT status, but alterations are possible in purging BN women. 3) The higher SERT binding in MZ twins with higher BMIs as compared to their leaner co-twins suggests non-genetic association between acquired obesity and the brain 5-HT system, which may have implications on feeding behavior and satiety.

The effect of blood glucose on the vasculature in young patients with type 1 diabetes

Background. Patients with type 1 diabetes are at markedly increased risk of vascular complications. In this respect it is noteworthy that hyperglycaemia that is shown to cause endothelial dysfunction, has clearly been shown to be a risk factor for diabetic microvascular disease. However, the role of hyperglycaemia as a predictor of macrovascular disease is not as clear as for microvascular disease, although type 1 diabetes itself increases the risk of cardiovascular disease substantially. Furthermore, it is not known whether it is the short-term or the long-term hyperglycaemia that confers possible risk. In addition, the role of glucose variability as a predictor of complications is to a large extent unexplored. Interestingly, although hyperglycaemia increases the risk of pre-eclampsia in women with type 1 diabetes, it is unclear whether pre-eclampsia, a condition characterized by endothelial dysfunction, is also a risk factor for microvascular complication, diabetic nephropathy. Aims. This doctoral thesis investigated the role of acute hyperglycaemia and glucose variability on arterial stiffness and cardiac ventricular repolarisation in male patients with type 1 diabetes as well as in healthy male volunteers. The thesis also explored whether acute hyperglycaemia leads to an inflammatory response, endothelial dysfunction and oxidative stress. Finally, the role of pre-eclampsia, as a predictor of diabetic nephropathy in type 1 diabetes was examined. Subjects and methods. In order to study glucose variability and the daily glycaemic control, 22 male patients with type 1 diabetes, without any diabetic complications, were monitored for 72-h with a continuous glucose monitoring system. At the end of the 72-h glucose monitoring period a 2-h hyperglycaemic clamp was performed both in the patients with type 1 diabetes and in the 13 healthy age-matched male volunteers. Blood pressure, arterial stiffness and QT time were measured to detect vascular changes during acute hyperglycaemia. Blood samples were drawn at baseline (normoglycaemia) and during acute hyperglycaemia. In another patient sample, women with type 1 diabetes were followed during their pregnancy and restudied eleven years later to elucidate the role of pre-eclampsia and pregnancy-induced hypertension as potential risk factors for diabetic nephropathy. Results and conclusions. Acute hyperglycaemia increased arterial stiffness as well as caused a disturbance in the myocardial ventricular repolarisation, emphasizing the importance of a strict daily glycaemic control in male patients with type 1 diabetes. An inflammatory response was also observed during acute hyperglycaemia. Furthermore, a high mean daily blood glucose but not glucose variability per se is associated with arterial stiffness. While glucose variability in turn correlated with central blood pressure, the results suggest that the glucose metabolism is closely linked to the haemodynamic changes in male patients with uncomplicated type 1 diabetes. Notably, the results are not directly applicable to females. Finally, a history of a pre-eclamptic pregnancy, but not pregnancy-induced hypertension was associated with increased risk of diabetic nephropathy.

Anger is associated with subclinical atherosclerosis in low SES but not in higher SES men and women

We investigated the associations of anger and cynicism with carotid artery intima-media thickness (IMT) and whether these associations were moderated by childhood or adulthood socioeconomic status (SES). The participants were 647 men and 893 women derived from the population-based Cardiovascular Risk in Young Finns Study. Childhood SES was measured in 1980 when the participants were aged 3-18. In 2001, adulthood SES, anger, cynicism, and IMT were measured. There were no associations between anger or cynicism and IMT in the entire population, but anger was associated with thicker IMT in participants who had experienced low SES in childhood. This association persisted after adjustment for a host of cardiovascular risk factors. It is concluded that the ill health-effects of psychological factors such as anger may be more pronounced in individuals who have been exposed to adverse socioeconomic circumstances early in life.