Starting Insulin Treatment in Type 2 Diabetes

Type 2 diabetes is a disorder of glucose metabolism characterized by chronic hyperglycemia. Initially type 2 diabetes is characterized by insulin resistance and impaired function of beta cells, leading progressively to insulin deficiency. Type 2 diabetes is treated with diet and other lifestyle changes, and with medication modulating e.g. insulin resistance, liver glucose production and insulin secretion. Injectable insulin is added to the treatment when lifestyle changes and other medication are insufficient to maintain adequate control of hyperglycemia. The aim of the treatment is to remove the symptoms of diabetes and to prevent late complications of diabetes. Insulin was traditionally started at hospital wards, but from the early 1990’s also in outpatient care. The first substudy of this thesis examined retrospectively initiation practices and how successfully insulin treatment was introduced in 1990 – 1996 in Southwestern Finland. This study aimed also at identifying the best methods of controlling plasma glucose. It showed that in the 1990’s the incidence of insulin treatment increased and was initiated more often in outpatient care than previously. The use of combination treatment also increased, first with sulfonylureas and later with metformin as the oral drug. In combination therapy the insulin dose was smaller than with insulin monotherapy. HbA1c improved similarly in middle-aged and older age groups. Weight increase associated with insulin initiation was smaller when combined with oral agents. A prospective insulin initiation study (1994 – 1998) tested the hypothesis that hyperglycemia (fasting and postprandial hyperglycemia) may affect the outcome of insulin initiation. The type of hyperglycemia was determined by the relation of fasting plasma glucose to HbA1c. Treatment was initiated with insulin Lente or human NPH insulin. In patients treated with insulin monotherapy twice daily the decline in HbA1c was markedly greater for postprandial than fasting hyperglycemia patients suggesting that hyperglycemia type has significance in the selection of the insulin regimen. Another insulin initiation study showed that patients with fasting hyperglycemia starting on insulin (2004-2005) were significantly more prone to overweight than patients with postprandial hyperglycemia. Irrespective of the insulin preparation (insulin NPH or insulin glargine), patients with fasting hyperglycemia had a greater weight increase compared to patients with postprandial hyperglycemia. Special attention should be paid to prevention of weight increase in these patients.

Suomi 2014 – kulutus ja elämäntapa: Tutkimusseloste ja aineistojen 1999–2014 vertailua

Julkaisussa tarkastellaan syksyllä 2014 kerättyä Suomi 2014 – kulutus ja elämäntapa -postikyselyaineistoa. Kyselylomake lähetettiin kaikkiaan 3000 suomenkieliselle 18–74-vuotiaalle Suomessa asuvalle. Otantamenetelmänä käytettiin yksinkertaista satun-naisotantaa. Aineistossa olevien tapausten lukumäärä on 1 354 ja aineiston lopullinen vastausprosentti 46. Aineiston keruusta ja tallennuksesta vastasi Turun yliopiston taloussosiologian oppiaine. Aineiston keruun kustannuksiin osallistuivat lisäksi Turun yliopiston ja Jyväskylän yliopiston sosiologian oppiaineet. Julkaisussa esitellään aluksi aineiston keräämisprosessi sekä arvioidaan aineiston katoa ja sen vaikutusta aineiston edustavuuteen. Sen jälkeen esitellään Suomi 2014 -kyselyssä käytettyjä uusia kysymystyyppejä. Julkaisun lopussa tarkastellaan sitä, miten suomalaisten kulutukseen ja elämäntapaan viittaavat asenteet, arvomaailma ja poliittinen suuntautuminen ovat muuttuneet vuosina 1999–2014.

Talo, kartano, puutarha. Kauppahuoneen omistaja Marie Hackman ja hänen kulutusvalintansa varhaismodernissa Viipurissa

Tutkimuksessa keskitytään tutkimaan kuluttamista elämäntavan ja identiteetin muovaajana yhden yksilön elämän kautta. Kuluttamista tutkitaan statuskuluttamisen (conspicious consumption), tilallisuuden ja sukupuolihistorian käsitteistöä hyväksi käyttäen. Tutkimuksen lähteinä on käytetty liikekirjeitä ja tilikirjoja, yksityistä kirjeenvaihtoa, päiväkirjoja ja sanomalehtiä sekä aikalaismuistelmia. Naista lähdemateriaaleista on koottu sekä tilastollista aineistoa että kvalitatiivista, lähilukuun ja mikrohistorialliseen tutkimusotteeseen nojautuvaa tutkimusta. Tutkimus alkaa vuodesta 1799 ja päättyy 1830-luvulle, jolloin seuraava sukupolvi otti vastuun liiketoimista ja lähdeaineistossa tapahtui muutoksia kuluttamisen kirjaamisen suhteen. Tutkimuksen keskeiset käsitteet ovat statuskuluttaminen ja identiteetti. Näitä käsitteitä lähestytään Thorstein Veblenin, Norbert Eliaksen ja Pierre Bourdieun tutkimuksia apuna käyttäen. Tutkimus käsittelee erottautumisen ja jäljittelyn tematiikkaa merkittävimpänä kuluttamisen motivaattoreina. Lisaksi tutkimus nostaa esille hyvän maun ja muodinmukaisuuden kulutusvalintojen taustalla. Statuskuluttaminen kytkeytyy sosiaaliseen kanssakäymiseen. Kuluttamisen kohteet ovat esineitä ja asioita, joita pidetään esillä seurapiireissä. Kuluttaminen tapahtuu seuraelämän ehdoilla, sen mukavoittamiseksi, aseman osoittamiseksi seurapiireissä tai sosiaalisen paineen vuoksi. Tutkimus osoittaa kotitalouden merkityksen kuluttamisen paikkana ja kohteena. Tutkimus myös osoittaa naisten toimintakentän olleen kytköksissä kotitalouden asemaan yhteisössään sekä osoittaa, että sukupuolta pitää tarkastella suhteessa yksilön sosiaaliseen asemaan. Tutkimus osoittaa, että Marie Hackmanin kuluttaminen muuttui ikääntymisen myötä. Aseman osoittaminen oli merkittävämpää nuorena ja aseman ollessa vielä vakiintumattomampi.

Roles of novel biomarkers in progression of cutaneous squamous cell carcinoma

Roles of novel biomarkers was studied in progression of cutaneous squamous cell carcinoma (cSCC) as the most common metastatic skin cancer. The incidence of cSCC is increasing worldwide due to lifestyle changes such as recreational exposure to sunlight and the aging of the population. Because of an emerging need for molecular markers for the progression of cSCC, we set our goal to characterize three distinct novel markers overexpressed in cSCC cells. Our results identified overexpression of serpin peptidase inhibitor clade A member 1 (SerpinA1), EphB2 and absent in melanoma 2 (AIM2) in cSCC cell lines compared with normal human epidermal keratinocytes (NHEKs). Immunohistochemical analysis of SerpinA1, EphB2 and AIM2 revealed abundant tumor cell-specific expression of cytoplasmic SerpinA1 and AIM2 and cytoplasmic and membranous EphB2 in cSCC tumors in vivo. The staining intensity of SerpinA1, EphB2 and AIM2 was significantly stronger in cSCC as compared with carcinoma in situ (cSCCIS) and actinic keratosis (AK). Tumor cell-associated SerpinA1 and EphB2 was noted in chemically induced mouse skin SCC, and the staining intensity was stronger in mouse cSCCs than in untreated skin. AIM2 staining intensity was significantly more abundant in cSCC of organ transplant recipients (OTR) than in sporadic cSCC in vivo. EphB2 knockdown resulted in inhibition of migration in cSCC cells. In addition, knockdown of EphB2 and AIM2 was found to inhibit the proliferation and invasion of cSCC cells and to delay the growth and vascularization of cSCC xenografts in vivo. Altogether, these findings identify SerpinA1 as a novel biomarker for cSCC. In addition, characterization of the roles of EphB2 and AIM2 in the progression of cSCC was implicated them as possible therapeutic targets for the treatment of cSCC particularly in unresectable and metastatic tumors.

Cardiovascular health and fitness after childhood acute lymphoblastic leukaemia

The last few decades have turned childhood acute lymphoblastic leukaemia (ALL) from a virtually incurable disease to a disease with 80–90% survival rates. However, this has not come without a cost. Various late effects of the treatment are nowadays well acknowledged, and the survivors have increased cardiovascular (CV) morbidity and mortality. While the treatment of ALL may have direct toxic effects on various organ systems, lifestyle factors affect the CV risk of the survivors as well. Data on CV health and fitness after treatment with common Nordic protocols since 1986 has been scarce. This thesis aimed to study CV health and fitness and the effects of a 3-month exercise intervention in 16–30-year-old long-term survivors of childhood ALL. Fitness was poor especially in female survivors. One third reported ≤1h of moderate physical activity (PA) weekly. While the levels of other CV risk factors were similar in survivors and controls, attenuations in vascular endothelium and cardiac function were found when using advanced echocardiographic methods. The exercise programme improved fitness, insulin resistance, endothelial function as well as measures of cardiac function. While the results do not allow definite conclusions on whether the subclinical signs of cardiac and vascular endothelial dysfunction are due to the treatment of ALL or sedentary lifestyle/poor fitness after treatment, the results are interesting and emphasize the effects of PA in this population. The results indicate beneficial effects of PA on the heart health in ALL survivors and suggest that they should be encouraged to physically active lifestyle.

Erectile dysfunction in cardiovascular risk population

The inability to achieve and to maintain erection, erectile dysfunction, is a bothersome symptom of elderly men. Moreover, there is a high comorbidity between cardiovascular diseases and erectile dysfunction. However, very little is known concerning the risk factors of ED in apparently healthy men without comorbidities affecting the arteries. A cross-sectional population survey was conducted from August 2005 to September 2007 in two rural towns of Harjavalta and Kokemäki in Finland. Excluding those with previously diagnosed cardiovascular diseases, diabetes or chronic kidney disease, every community-dwelling inhabitant was invited to take part in the survey. Of the 2939 45- to 70-year-old men invited, 2049 responded. Selecting those at risk for cardiovascular diseases, 1000 eligible men were examined. According to the International Index of Erectile Function short form 57% of the studied men reported erectile dysfunction. Increasing age, smoking, depressive symptoms, decreasing pulmonary function, sedentary lifestyle, non-marital status and low education level were associated with increasing risk of erectile dysfunction. However, hypertension, diabetes, obesity, hypercholesterolemia were not associated with erectile dysfunction, although these associations have been described in numerous previous studies. Moreover, erectile dysfunction was not associated with increasing risk of pre-diabetes. In apparently healthy men, increasing age, smoking, depressive symptoms, decreasing pulmonary function, sedentary lifestyle, non-marital status, low education level but not hypertension, obesity, hypercholesterolemia, diabetes or pre-diabetes were associated with increasing risk of erectile dysfunction.

Strategy and Superior Competence of Growth Company

This thesis is an examination of growth company and it's superior competence and performance which is based on existing theories and research findings. The theory framework is a basis for the processing part of the thesis that is utilized and combined into new thoughts and assumptions. The analysis is focused on the strategy's meaning, the content of strategy, strategy management, strategy planning, strategy tools and methods. The most important finding and discovery were that the strategy and superior competence / performance of successful growth company are rather a continuously improving process and a lifestyle than for example annual strategy project and/or separate strategy seasons.

Adopting the Vaadin Java framework to rebuild VTT’s Web Interfaces and Database Applications

With the growth in new technologies, using online tools have become an everyday lifestyle. It has a greater impact on researchers as the data obtained from various experiments needs to be analyzed and knowledge of programming has become mandatory even for pure biologists. Hence, VTT came up with a new tool, R Executables (REX) which is a web application designed to provide a graphical interface for biological data functions like Image analysis, Gene expression data analysis, plotting, disease and control studies etc., which employs R functions to provide results. REX provides a user interactive application for the biologists to directly enter the values and run the required analysis with a single click. The program processes the given data in the background and prints results rapidly. Due to growth of data and load on server, the interface has gained problems concerning time consumption, poor GUI, data storage issues, security, minimal user interactive experience and crashes with large amount of data. This thesis handles the methods by which these problems were resolved and made REX a better application for the future. The old REX was developed using Python Django and now, a new programming language, Vaadin has been implemented. Vaadin is a Java framework for developing web applications and the programming language is extremely similar to Java with new rich components. Vaadin provides better security, better speed, good and interactive interface. In this thesis, subset functionalities of REX was selected which includes IST bulk plotting and image segmentation and implemented those using Vaadin. A code of 662 lines was programmed by me which included Vaadin as the front-end handler while R language was used for back-end data retrieval, computing and plotting. The application is optimized to allow further functionalities to be migrated with ease from old REX. Future development is focused on including Hight throughput screening functions along with gene expression database handling

Multicultural Belonging. Individuals across cultures, languages and places

The article-based doctoral dissertation deals with adult individuals in Western societies who were born into multilingual and multicultural families and have parents of different nationalities. The study’s participants grew up outside their parents’ countries of origin and relate to a multitude of bonds that link them across various cultures, languages and places. The study explores the social dimension of cultural belonging and examines diverse approaches that enable the participants to create notions of belonging and identification despite possessing at times contradictory transnational allegiances. The works offers new perspectives on transnational belonging and makes a timely contribution to discussions in the fields of cultural heritage studies, ethnology and transnational studies. The dissertation combines qualitative research methods with an insider perspective. The empirical material is based on semi-structured interviews with fifteen participants, among which are also the author’s siblings. The study addresses the relevance of the author’s personal situatedness and her multi-faceted roles as well as ethical concerns related to the methodological approach of insider research. The social dimension of cultural identities affect both the participants’ identification with their multiple attachments and language use in everyday life. The key research findings present interrelated discussions of the participants’ notion of being a mixture, the importance of family bonds and multilingualism, a specific mixed family lifestyle, the notion of non-belonging and the study participants’ sense of otherness as a means of creating communality with others. The study discusses the participants’ various life strategies of flexible relativising, juggling with multiple affiliations, the approach of “blending in” and their sense of ironic nation-ness for constructing a coherent sense of belonging. The author argues that multicultural belonging is inextricably connected to an association with multiple languages, cultures and places. Multicultural belonging is relational and depends on the context, social relationships and locations. The study proposes that multicultural belonging creates a tolerant understanding of membership and enables experiences of cosmopolitanism and selected notions of allegiance.

Yrityskulttuurin rooli monikulttuurisessa yrityksessä

Kandidaatintutkielma käsittelee yrityskulttuurin roolia monikulttuurisessa toimintaympäristössä. Ilmiötä tutkitaan olemassa olevan teorian sekä empiirisen aineiston kautta. Empiriassa tutkimuskohteena toimii suomalainen lifestyle-myymälä Marimekko.Tutkimuksen tulokseksi saatiin yrityskulttuurin merkittävimmät roolit ja niiden ilmentyminen yrityksen toiminnassa.

Sedentary behaviour and health with special reference to obesity and fatty liver in early midlife. The Cardiovascular risk in Young Finns Study

Background: Physical inactivity and positive energy balance pose a risk to health. They increase the risk of obesity and associated non-communicable diseases. Recently, also sedentary behaviour has been associated with obesity and non-communicable diseases. Nevertheless, it has been unclear which type of sedentary behaviour is the most harmful. It is also unknown whether the relationship of sedentary behaviour with obesity is truly independent of other factors, for example physical activity and diet. Longitudinal data are limited, and the direction of causality and the mechanism of action are still unknown. Aims: The aim of this study was 1) to identify the type of sedentary behaviour having the strongest association with obesity, 2) to explore the causal relationship of sedentary behaviour and weight increase, and 3) to additionally, investigate the relationship of sedentary behaviour with fatty liver. These were studied in cross-sectional and/or longitudinal settings using data from the Cardiovascular Risk in Young Finns Study. Special emphasis was put on the evaluation of a wide range of other lifestyle factors and risks for obesity and fatty liver. Subjects: 2,060 subjects (aged 33-50 years in 2011, of which 55 % were female) from the Cardiovascular Risk in Young Finns Study participating in follow-ups in 2001, 2007, and 2011. Measures: Self-reported time spent in various types of sedentary behaviour (I), or TV viewing time (I-III). Measured body weight, height and waist circumference (I-III), and genetic variants for high BMI (I). Fasting plasma concentrations of gamma-glutamyltransferase enzyme and triglyceride, calculated Fatty Liver Index (based on gamma-glutamyltransferase and triglyceride concentration, BMI and waist circumference), and the amount of intrahepatic fat measured with ultrasound (III). Self-reported leisure-time physical activity and active commuting, occupational physical activity, energy intake, diet, alcohol consumption, smoking, socioeconomic status, and sleep duration as possible confounders were considered (I-III). Results: TV viewing is the sedentary behaviour type that has the strongest association with obesity. Sedentary behaviour (TV viewing) precedes weight increase, and not the other way around. Sedentary behaviour (TV viewing) is associated with increased risk of fatty liver. Conclusions: Sedentary behaviour (especially high TV viewing time) is associated with increased risks of obesity and fatty liver. Intervention studies are needed to assess whether reduction of TV time would prevent obesity and fatty liver.

Expressing the self in postmodern travel consumption: a case study of students

The study approaches student travel from the perspective of postmodern consumption. The background is in the observation that the student travel market has a vast potential, but it is not necessarily capitalized upon to the extent it could. This might partly have to do with the peculiarities of postmodernity: consumption is characterized by unpredictability and abstract motives. The research questions are built around what constitutes student travel consumption and how can students be categorized according to motivation, behaviour and values. Also identity and expressiveness are present and it is evaluated, if travel services facilitate these background is the observation that the student travel market has a vast potential, but it is not necessarily capitalized upon to the extent it could be. This might partly have to do with the peculiarities of postmodernity: consumption is characterized by unpredictability and abstract motives. The research questions are built around what constitutes student travel consumption and how can students be categorized according to motivation, behaviour and values. Also identity and expressiveness are present and it is evaluated whether travel services facilitate these constructs. The topic is approached by discovering the key concepts such as self-identity. This was done in order to create survey questions that reflect the underlying theories. The survey was sent to chosen student groups of Turku School of Economics. The data was analyzed using statistical methods, mainly principal component analysis, in order to categorize students’ motives and behaviour into distinct profiles. The findings indicate that students have a high level of awareness in their travel consumption choices. Travel services seem to facilitate identity and lifestyle expressiveness, one central dimension of postmodernity. Psychographics such as motivation seem to work well as a segmentation criteria when it comes to the student traveler market. Travel offers students an opportunity for relaxation, escape, enjoyment and gaining new experiences and social contacts. Furthermore, the enjoyment of the travel experience extends to the pre- and post-trip time.

Promoting Healthy Lifestyles with Personalized, APOE Genotype Based Health Information: The Effects on Psychological-, Health Behavioral and Clinical Factors

There is an increasing demand for individualized, genotype-based health advice. The general population-based dietary recommendations do not always motivate people to change their life-style, and partly following this, cardiovascular diseases (CVD) are a major cause of death in worldwide. Using genotype-based nutrition and health information (e.g. nutrigenetics) in health education is a relatively new approach, although genetic variation is known to cause individual differences in response to dietary factors. Response to changes in dietary fat quality varies, for example, among different APOE genotypes. Research in this field is challenging, because several non-modifiable (genetic, age, sex) and modifiable (e.g. lifestyle, dietary, physical activity) factors together and with interaction affect the risk of life-style related diseases (e.g. CVD). The other challenge is the psychological factors (e.g. anxiety, threat, stress, motivation, attitude), which also have an effect on health behavior. The genotype-based information is always a very sensitive topic, because it can also cause some negative consequences and feelings (e.g. depression, increased anxiety). The aim of this series of studies was firstly to study how individual, genotype-based health information affects an individual’s health form three aspects, and secondly whether this could be one method in the future to prevent lifestyle-related diseases, such as CVD. The first study concentrated on the psychological effects; the focus of the second study was on health behavior effects, and the third study concentrated on clinical effects. In the fourth study of this series, the focus was on all these three aspects and their associations with each other. The genetic risk and health information was the APOE gene and its effects on CVD. To study the effect of APOE genotype-based health information in prevention of CVD, a total of 151 volunteers attended the baseline assessments (T0), of which 122 healthy adults (aged 20 – 67 y) passed the inclusion criteria and started the one-year intervention. The participants (n = 122) were randomized into a control group (n = 61) and an intervention group (n = 61). There were 21 participants in the intervention Ɛ4+ group (including APOE genotypes 3/4 and 4/4) and 40 participants in the intervention Ɛ4- group (including APOE genotypes 2/3 and 3/3). The control group included 61 participants (including APOE genotypes 3/4, 4/4, 2/3, 3/3 and 2/2). The baseline (T0) and follow-up assessments (T1, T2, T3) included detailed measurements of psychological (threat and anxiety experience, stage of change), and behavioral (dietary fat quality, consumption of vegetables, - high fat/sugar foods and –alcohol, physical activity and health and taste attitudes) and clinical factors (total-, LDL- HDL cholesterol, triglycerides, blood pressure, blood glucose (0h and 2h), body mass index, waist circumference and body fat percentage). During the intervention six different communication sessions (lectures on healthy lifestyle and nutrigenomics, health messages by mail, and personal discussion with the doctor) were arranged. The intervention groups (Ɛ4+ and Ɛ4-) received their APOE genotype information and health message at the beginning of the intervention. The control group received their APOE genotype information after the intervention. For the analyses in this dissertation, the results for 106/107 participants were analyzed. In the intervention, there were 16 participants in the high-risk (Ɛ4+) group and 35 in the low-risk (Ɛ4-) group. The control group had 55 participants in studies III-IV and 56 participants in studies I-II. The intervention had both short-term (≤ 6 months) and long-term (12 months) effects on health behavior and clinical factors. The short-term effects were found in dietary fat quality and waist circumference. Dietary fat quality improved more in the Ɛ4+ group than the Ɛ4- and the control groups as the personal, genotype-based health information and waist circumference lowered more in the Ɛ4+ group compared with the control group. Both these changes differed significantly between the Ɛ4+ and control groups (p<0.05). A long-term effect was found in triglyceride values (p<0.05), which lowered more in Ɛ4+ compared with the control group during the intervention. Short-term effects were also found in the threat experience, which increased mostly in the Ɛ4+ group after the genetic feedback (p<0.05), but it decreased after 12 months, although remaining at a higher level compared to the baseline (T0). In addition, Study IV found that changes in the psychological factors (anxiety and threat experience, motivation), health and taste attitudes, and health behaviors (dietary, alcohol consumption, and physical activity) did not directly explain the changes in triglyceride values and waist circumference. However, change caused by a threat experience may have affected the change in triglycerides through total- and HDL cholesterol. In conclusion, this dissertation study has given some indications that individual, genotypebased health information could be one potential option in the future to prevent lifestyle-related diseases in public health care. The results of this study imply that personal genetic information, based on APOE, may have positive effects on dietary fat quality and some cardiovascular risk markers (e.g., improvement in triglyceride values and waist circumference). This study also suggests that psychological factors (e.g. anxiety and threat experience) may not be an obstacle for healthy people to use genotype-based health information to promote healthy lifestyles. However, even in the case of very personal health information, in order to achieve a permanent health behavior change, it is important to include attitudes and other psychological factors (e.g. motivation), as well as intensive repetition and a longer intervention duration. This research will serve as a basis for future studies and its information can be used to develop targeted interventions, including health information based on genotyping that would aim at preventing lifestyle diseases. People’s interest in personalized health advices has increased, while also the costs of genetic screening have decreased. Therefore, generally speaking, it can be assumed that genetic screening as a part of the prevention of lifestyle-related diseases may become more common in the future. In consequence, more research is required about how to make genetic screening a practical tool in public health care, and how to efficiently achieve long-term changes.

Cholesterol, cardiovascular disease and statin use in older persons

Older age increases the risk of developing a chronic atherosclerotic cardiovascular disease (CVD), such as coronary heart disease. Complications of CVDs, myocardial infarction or stroke often lead to loss of functional capacity or premature death. Dyslipidemia, high serum levels of total or low-density lipoprotein cholesterol (LDL-c) and low levels of high-density lipoprotein cholesterol (HDL-c), is among the most important modifiable risk factors for CVDs; it can be treated with lifestyle modifications, and with lipid-lowering drugs, primarily statins. In older persons, however, the association of cholesterol levels with cardiovascular and all-cause mortality has been inconsistent in previous studies. Furthermore, the beneficial effects of statins in older persons without previous CVD are still somewhat unclear, and older persons are more prone to adverse effects from statins. This thesis presents a prospective cohort study (TUVA), exploring associations of cholesterol levels with mortality and the changes in cholesterol levels of a 70-year-old population in long-term follow-up. Further, prevalence of CVDs, risk factors and preventive medication use in the TUVA cohort is compared with respective prevalences in another age-matched cohort (UTUVA) 20 years later in order to examine the changes in cardiovascular risk over time. Additionally, to evaluate statin use patterns among older persons, an observational register study was conducted covering the total Finnish population aged 70 and older during 2000-2008. Based on individual-level data retrieved from national health registries, the population was classified into low, moderate and high risk groups according to estimated CVD risk. The prevalence, incidence and persistence of statin use among the risk groups was then evaluated based upon yearly statin purchases tracked from the Prescription Register. The prospective cohort study demonstrated that low total cholesterol, LDL-c and HDL-c were associated with higher mortality in a cohort of home-dwelling 70-year-olds. However, after adjusting for traditional cardiovascular risk factors and cancer this association disappeared. Further, low total cholesterol seemed to be protective, whereas low HDL-c strongly predicted increased risk of CVD death. Cholesterol levels of those elderly who remained available for follow-up and were still home-dwelling at the age of 85 seemed to improve with advancing age. Compared to the TUVA cohort, the later born UTUVA cohort had less CVDs and their risk factors were better controlled, which was reflected in the higher use of preventive medications such as statins and antihypertensives. The register studies confirmed that statin use has increased significantly during 2000-2008 among older persons, especially among the oldest (80+) age groups and among those at high risk for cardiovascular events. Two-thirds of new statin users persisted with their use during the four years of follow-up; the most discontinuations were made during the first year of use. In conclusion, statins are commonly used among older age groups in Finland. Most of the older statin users had a high cardiovascular event risk, indicating that the treatment is well directed towards those who are likely to benefit from it the most. No age-limits should be put on the screening and treatment of dyslipidemia in older persons, but the benefits and adverse effects of statin treatment should be carefully weighed based on an individual assessment of the person’s general health status and functional capacity. Physicians should pay more attention to medication adherence, especially when prescribing preventive medications.

Analysis of Automotive Cybersecurity - Attack surfaces and users’ privacy concerns

Modern automobiles are no longer just mechanical tools. The electronics and computing services they are shipping with are making them not less than a computer. They are massive kinetic devices with sophisticated computing power. Most of the modern vehicles are made with the added connectivity in mind which may be vulnerable to outside attack. Researchers have shown that it is possible to infiltrate into a vehicle’s internal system remotely and control the physical entities such as steering and brakes. It is quite possible to experience such attacks on a moving vehicle and unable to use the controls. These massive connected computers can be life threatening as they are related to everyday lifestyle. First part of this research studied the attack surfaces in the automotive cybersecurity domain. It also illustrated the attack methods and capabilities of the damages. Online survey has been deployed as data collection tool to learn about the consumers’ usage of such vulnerable automotive services. The second part of the research portrayed the consumers’ privacy in automotive world. It has been found that almost hundred percent of modern vehicles has the capabilities to send vehicle diagnostic data as well as user generated data to their manufacturers, and almost thirty five percent automotive companies are collecting them already. Internet privacy has been studies before in many related domain but no privacy scale were matched for automotive consumers. It created the research gap and motivation for this thesis. A study has been performed to use well established consumers privacy scale – IUIPC to match with the automotive consumers’ privacy situation. Hypotheses were developed based on the IUIPC model for internet consumers’ privacy and they were studied by the finding from the data collection methods. Based on the key findings of the research, all the hypotheses were accepted and hence it is found that automotive consumers’ privacy did follow the IUIPC model under certain conditions. It is also found that a majority of automotive consumers use the services and devices that are vulnerable and prone to cyber-attacks. It is also established that there is a market for automotive cybersecurity services and consumers are willing to pay certain fees to avail that.