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.

Vitamin D deficiency in children with chronic illnesses: Predisposing and protecting factors

This thesis assesses clinical differences in patients with low and high vitamin D levels. The factors analyzed included the underlying disease, body size, age, ethnic background, use of vitamin D supplements and the season when the blood sample was taken. Fifty patients with the lowest and 50 patients with the highest vitamin D concentrations were selected from a cohort of 1351 chronically ill children and adolescents who had had their vitamin D status assessed at Children's Hospital. Protective factors appeared to be the usage of vitamin D supplements and young age, especially age <2 years. Predisposing factors included non-Finnish ethnic background and older age, especially age 12-18 years. High vitamin D values were more prevalent in the summer and autumn and low values in the winter and spring. Patients with non-Finnish background were overrepresented in the low value group. No differences regarding the underlying diseases could be detected. Conclusions: In the Northern latitudes UVB-radiation is insufficient for vitamin D synthesis. Vitamin D recommendations appear to be inadequate to fulfill the needs of chronically ill patients whose requirements for vitamin D are elevated compared to the general population. New guidelines for vitamin D supplementation are needed particularly for those at risk of developing vitamin D deficiency.

Lasten vaikeiden ja stressaavien tilanteiden hallinta yläkouluun siirtymisen vaiheessa

This study examined year seven students´ proactive coping, self-efficacy and social support seeking. Proactive coping was defined as a behaviour where obstacles are seen as a challenge. In proactive coping, individuals set goals, build up resources and regulate their behaviour to achieve the goals. Self-efficacy can be seen as people’s beliefs about their capabilities. Social support seeking was divided into instrumental support seeking and emotional support seeking. According to the theoretical frame of this study self-efficacy and social support seeking were seen as resources to proactive coping (Greenglass 2002). The participants were 445 year seven students (Mo= 13 years) from seven secondary schools. The data was collected in March-May 2008. The survey consisted 37 Likert-scaled items from the Proactive Coping Inventory and from the General Self-Efficacy Scale. The survey consisted of four scales: Proactive Coping, Instrumental Support Seeking, Emotional Support Seeking and General Self-Efficacy. The participants' age, gender and studying in specialist streams were asked as background information. As a result, most of the participants (62 % girls, 38 % boys) reported fairly strong proactive coping: they can see obstacles as a challenge and they set goals and regulate their behaviour to achieve the goals. Most of the participants reported that they seek instrumental and emotional support when having troubles. Girls reported more social support seeking than did boys and the mean difference was statistically significant. Most of the participants had fairly high sense of self-efficacy. However, 4 % of the participants reported that they don’t believe in their capabilities. Some of these participants reported that they neither use proactive coping nor seek informational or emotional support when having troubles. Proactive coping correlated positively with self-efficacy and with social support seeking. In this study self-efficacy and social support seeking explained 47 % of proactive coping. It was discussed that children’s high sense of self-efficacy and social relationships can act as protective factors in transition to secondary school. When supporting children’s self-efficacy and social relationships one also assists children’s proactive coping. Proactive coping can be seen to support children’s personal growth.

Kadonneet pojat : Monitapaustutkimus ESY-poikien kompleksisesta koulu-urasta ja elämänkulusta

Lost boys. A multiple case study of the complex school career and life-course of male students who have attended special classes for the emotionally and behaviourally maladjusted The purpose of this thesis is to describe the school career and the life-course of eight former special-class students from the comprehensive school to their further education and into adulthood. The members of the target group have been students of special classes for pupils with emotional and behavioural difficulties in southern Finland. The interviews were made 1994-1997 at school and for follow-up interviews 2002-2003, when the participants were already adults. Six mothers were also interviewed. The qualitative data was gathered using individual interviews and Adult Attachment Interview. The aim was to explore the life-histories of subjects from early childhood to early adulthood. Information was gathered also from the documents concerning the students´ school attendance. Every single life-history is illustrated as a life-course graphic. The data has been analysed using different frames of reference and combining different theories. In addition to theories considering developmental risk factors and protective factors, the data is considered using theories of control over life, attribution, self-efficacy and identity and attitudes towards education. The experiential living mode of the students has been studied, as well. The results of this study show that the frames of references which are used complement each other. The target students clustered identically in spite of the frames of reference. As a result, the study has illustrated the same phenomenon from different points of view. The results of the study consist of three types of school careers: The winding career, the vicious circle career and the straight career. The three careers differ from each other in developmental risk and protective factors and post-school life-courses of the students. The type of childhood families and especially the fathers´ attention to the school education as well as the free time of their sons was important. Keywords: Pupils with emotional and behavioural difficulties, maladjustment to school, life-course, identity

GATA Transcription Factors in Tissue Homeostasis and Pathology of the Gastrointestinal Tract and Liver

Mammalian gastrointestinal tract and liver are self-renewing organs that are able to sustain themselves due to stem cells present in their tissues. In constant, inflammation-related epithelial damage, vigorous activation of stem cells may lead to their uncontrolled proliferation, and further, to cancer. GATA-4, GATA-5, and GATA-6 regulate cell proliferation and differentiation in many mammalian organs. Lack of GATA-4 or GATA-6 leads to defective endodermal development and cell differentiation. GATA-4 and GATA-5 are considered the ones with tumor suppressive functions, whereas GATA-6 is more related to tumor promotion. In the digestive system their roles in inflammation and tumor-related molecular pathways remain unclear. In this study, we examined the GATA-related molecular pathways involved in normal tissue organization and renewal and in inflammation-related epithelial repair in the gastrointestinal tract and liver. The overall purpose of this study was to elucidate the relation of GATA factors to gastrointestinal and hepatic disease pathology and to evaluate their possible clinical significance in tumor biology. The results indicated distinct expression patterns for GATA-4, GATA-5, and GATA-6 in the human and murine gastrointestinal tract and liver, and their involvement in the regulation of intestine-specific genes. GATA-5 was confined to the intestines of suckling mice, suggesting an association with postnatal enzymatic changes. GATA-4 was upregulated in bowel inflammation concomitantly with TGF-β signaling. In gastrointestinal tumors, GATA-4 was restricted to benign neoplasias of the stomach, while GATA-6 was detected especially at the invasive edges of malignant tumors throughout the gut. In the liver, GATA-4 was upregulated in pediatric tumors along with erythropoietin (Epo), which was detected also in the sera of tumor patients. Furthermore, GATA-4 was enhanced in areas of vigorous hepatic regeneration in patients with tyrosinemia type I. These results suggest a central role for GATA-4 in pediatric tumor biology of the liver. To conclude, GATA-4, GATA-5, and GATA-6 are associated with normal gastrointestinal and hepatic development and regeneration. The appearance of GATA-4 along with TGF-β-signaling in the inflammatory bowel suggests a protective role in the response to inflammation-related epithelial destruction. However, in extremely malignant pediatric liver tumors, GATA-4 function is unlikely to be tumor-suppressing, probably due to the nature of the very primitive multipotent tumor cells. GATA-4, along with its possible downstream factor Epo, could be utilized as novel hepatic tumor markers to supplement the present diagnostics. They could also serve a function in future biological therapies for aggressive pediatric tumors.