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Insight-lehden numerossa 26 (Maaliskuu 2013) julkaistu artikkeli.

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Kristiina Hormia-Poutasen esitys Jerusalemissa Israelin kansalliskirjastossa 8.9.2011

National Library – Service Centre for All Types of Libraries in Finland

Kristiina Hormia-Poutasen esitys Jerusalemissa 8.9.2011

Fetal alcohol spectrum disorders in Finnish children and adolescents : diagnosis, cognition, behavior, adaptation and brain metabolic alterations

Alcohol consumption during pregnancy can potentially affect the developing fetus in devastating ways, leading to a range of physical, neurological, and behavioral alterations most accurately termed Fetal Alcohol Spectrum Disorders (FASD). Despite the fact that it is a preventable disorder, prenatal alcohol exposure today constitutes a leading cause of intellectual disability in the Western world. In Western countries where prevalence studies have been performed the rates of FASD exceed, for example, autism spectrum disorders, Down’s syndrome and cerebral palsy. In addition to the direct effects of alcohol, children and adolescents with FASD are often exposed to a double burden in life, as their neurological sequelae are accompanied by adverse living surroundings exposing them to further environmental risk. However, children with FASD today remain remarkably underdiagnosed by the health care system. This thesis forms part of a larger multinational research project, The Collaborative Initiative on Fetal Alcohol Spectrum Disorders (the CIFASD), initiated by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) in the U.S.A. The general aim of the present thesis was to examine a cohort of children and adolescents growing up with fetal alcohol-related damage in Finland. The thesis consists of five studies with a broad focus on diagnosis, cognition, behavior, adaptation and brain metabolic alterations in children and adolescents with FASD. The participants consisted of four different groups: one group with histories of prenatal exposure to alcohol, the FASD group; one IQ matched contrast group mostly consisting of children with specific learning disorder (SLD); and two typically-developing control groups (CON1 and CON2). Participants were identified through medical records, random sampling from the Finnish national population registry and email alerts to students. Importantly, the participants in the present studies comprise a group of very carefully clinically characterized children with FASD as the studies were performed in close collaboration with leading experts in the field (Prof. Edward Riley and Prof. Sarah Mattson, Center for Behavioral Teratology, San Diego State University, U.S.A; Prof. Eugene Hoyme, Sanford School of Medicine, University of South Dakota, U.S.A.). In the present thesis, the revised Institute of Medicine diagnostic criteria for FASD were tested on a Finnish population and found to be a reliable tool for differentiating among the subgroups of FASD. A weighted dysmorphology scoring system proved to be a valuable additional adjunct in quantification of growth deficits and dysmorphic features in children with FASD (Study 1). The purpose of Study 2 was to clarify the relationship between alcohol-related dysmorphic features and general cognitive capacity. Results showed a significant correlation between dysmorphic features and cognitive capacity, suggesting that children with more severe growth deficiency and dysmorphic features have more cognitive limitations. This association was, however, only moderate, indicating that physical markers and cognitive capacity not always go hand in hand in individuals with FASD. Behavioral problems in the FASD group proved substantial compared to the typically developing control group. In Study 3 risk and protective factors associated with behavioral problems in the FASD group were explored further focusing on diagnostic and environmental factors. Two groups with elevated risks for behavioral problems emerged: length of time spent in residential care and a low dysmorphology score proved to be the most pervasive risk factor for behavioral problems. The results underscore the clinical importance of appropriate services and care for less visibly alcohol affected children and highlight the need to attend to children with FASD being raised in institutions. With their background of early biological and psychological impairment compounded with less opportunity for a close and continuous caregiver relationship, such children seem to run an especially great risk of adverse life outcomes. Study 4 focused on adaptive abilities such as communication, daily living skills and social skills, in other words skills that are important for gradually enabling an independent life, maintain social relationships and allow the individual to become integrated into society. The results showed that adaptive abilities of children and adolescents growing up with FASD were significantly compromised compared to both typically-developing peers and IQ-matched children with SLD. Clearly different adaptive profiles were revealed where the FASD group performed worse than the SLD group, who in turn performed worse than the CON1 group. Importantly, the SLD group outperformed the FASD group on adaptive behavior in spite of comparable cognitive levels. This is the first study to compare adaptive abilities in a group of children and adolescents with FASD relative to both a contrast group of IQ-matched children with SLD and to a group of typically-developing peers. Finally, in Study 5, through magnetic resonance spectroscopic imaging (MRS) evidence of longstanding neurochemical alterations were observed in adolescents and young adults with FASD related to alcohol exposure in utero 14-20 years earlier. Neurochemical alterations were seen in several brain areas: in frontal and parietal cortices, corpus callosum, thalamus and frontal white matter areas as well as in the cerebellar dentate nucleus. The findings are compatible with neuropsychological findings in FASD. Glial cells seemed to be more affected than neurons. In conclusion, more societal efforts and resources should be focused on recognizing and diagnosing FASD, and supporting subgroups with elevated risk of poor outcome. Without adequate intervention children and adolescents with FASD run a great risk of marginalization and social maladjustment, costly not only to society but also to the lives of the many young people with FASD.

“THE PATIENT SURVIVED DESPITE THE TREATMENT”. A study of Finnish health policy and New Public Management. Case: The Government Resolution on the Health 2015 public health programme.

Internationally, Finland has been among the most respected countries during several decades in terms of public health. WHO has had the most significant influence on Finnish health policy and the relationship has traditionally been warm. However, the situation has slightly changed in the last 10-20 years. The objectives of Finnish national health policy have been to secure the best possible health for the population and to minimize disparities in health between different population groups. Nevertheless, although the state of public health and welfare has steadily improved, the socioeconomic disparities in health have increased. This qualitative case study will demonstrate why health is political and why health matters. It will also present some recommendations for research topics and administrative reforms. It will be argued that lack of political interest in health policy leads to absence of health policy visions and political commitment, which can be disastrous for public health. This study will investigate how Finnish health policy is defined and organised, and it will also shed light on Finnish health policy formation processes and actors. Health policy is understood as a broader societal construct covering the domains of different ministries, not just Ministry of Social Affairs and Health (MSAH). The influences of economic recession of the 1990s, state subsidy reform in 1993, globalisation and the European Union will be addressed, as well. There is not much earlier Finnish research done on health policy from political science viewpoint. Therefore, this study is interdisciplinary and combines political science with administrative science, contemporary history and health policy research with a hint of epidemiology. As a method, literature review, semi-structured interviews and policy analysi will be utilised. Institutionalism, policy transfer, and corporatism are understood as the theoretical framework. According to the study, there are two health policies in Finland: the official health policy and health policy generated by industry, media and various interest organisations. The complex relationships between the Government and municipalities, and on the other hand, the MSAH and National Institute for Health and Welfare (THL) seemed significant in terms of Finnish health policy coordination. The study also showed that the Investigated case, Health 2015, does not fulfil all necessary criteria for a successful public health programme. There were also several features both in Health 2015 and Finnish health policy, which can be interpreted in NPM framework and seen having NPM influences.

Study on measuring Systems of Innovation on National level- case Finland

Innovation improves human affluence and comfort and is key driver of nation’s economic progression. This study focuses on National innovation systems in general and Finnish national innovation system in particular. It is known that innovation process does not work in isolation; rather it is an outcome of role played numerous actors. In this study three aspects are explained- firstly, to define the most important actors of National innovation systems and secondly, a framework to analyze National innovation system. Third aspect of this study highlights and analyzes the key aspects of Finnish National Innovation system. Moreover, during the course of this study emphasis was given on the utmost central processes which are required to come off in innovation system as they can successfully lead towards innovation.

Nuorten mielikuvat Suomen Kansallisteatterista

This thesis is about young people's views and mental images of the Finnish National Theatre (FNT). Research was needed into the views of young people about the FNT. The results would also be useful for FNT's marketing operations. The research was executed as a qualitative interview (based on a structured questionnaire) among 16 young people in January and February 2006. Four different high schools were involved: Ressun Lukio, Mäkelänrinteen Lukio, Kallion Lukio and Helsingin Kaupungin Kuvataidelukio (which together represented art-oriented high schools) and Vuosaaren Lukio. From each high school two boys and two girls were selected for interview. FNT's marketing director was also interviewed. The questions for the interview were formulated in co-operation with the FNT. The structural questionnaire was basically broken down into three different sections. The first section concentrated on the interviewee's hobbies and his/her past and present relationship to theatre. The second section consisted of questions about his/her views on the FNT. There were different sets of questions regarding whether or not the interviewee had visited the FNT. The last section was about the interviewee's use of media. This thesis focuses on the second section of questions. The answers revealed that, out of the group of sixteen, all but one had visited the FNT. Most of them saw the FNT as a traditional and valuable institution which is easier to approach than Finnish National Opera. Eleven of the interviewees reported that the main reason for their visit was a school project, and that without it they probably wouldn't have gone to the FNT at all. The thesis contemplates co-operation between the FNT and schools, and the meaning of art education for children's and young people's positive cultural development.

Maantiede ei ole pysyvää: Euroopan unionin jäsenyyden turvallistaminen Suomen kansallisen identiteettiprojektin valossa

Abstract: Geography is not permanent : the securization of EU membership in the light of the Finnish national identity project

Maantieteellinen tieto ja valtiokehon rakentuminen: autonomian ajan Suomen Kartastot poliittisena toimintana

Abstract: Geographical knowledge and the production of the state body: the Finnish national atlases from the period of autonomy as political action

Kiista kansallisesta identiteettiprojektista

Abstract: Debating the Finnish National Identity Project

Projektisalkkunäkymät teknologiaohjelman päätöksenteon tukena

Tämän diplomityön tavoitteena on kuvata Teknologian kehittämiskeskuksen (Tekes) teknologiaohjelmien päätöksentekoa sekä kehittää teknologiaohjelman päätöksentekoa tukevia tiedon esittämistapoja eli projektisalkkunäkymiä. Työssä käytettiin laadullista tutkimusotetta. Työn toteuttamisessa noudatettiin osallistuvan havainnoinnin toiminta-tutkimuksen periaatteita. Siinä tutkija itse osallistuu havaitun tutkimusongelman ratkaisuun yhdessä tutkimuskohteensa kanssa. Tämän työn empiirinen aineisto kerättiin vuoden 2002 ja 2003 aikana toteutetun teknologiaohjelman ohjaustyökalun pilotointiprojektin yhteydessä. Pilotointiprojektin aikana tehdyt havainnot ja kehittämistyön kuvaus ja tulokset on koottu työn empiriassa esiteltyihin analyyseihin, johtopäätöksiin sekä jatkotoimenpide-ehdotuksiin. Työn tutkimustuloksina voidaan esittää, että teknologiaohjelman päätöksenteko perustuu ohjelman nykytilaan, tulevaisuuteen, projektien hyödyntämispotentiaaliin, haastavuuteen sekä verkottumiseen liittyvien tietojen tarkasteluun. Päätöksenteko jakaantuu ohjelmaorganisaation edustajien johtoryhmän, ohjelmapäällikön ja teknologia-asiantuntijan kesken. Heillä on päätöksentekoon, kommentointiin, esittelyyn sekä tiedoksisaantiin liittyviä rooleja. Nykyisin teknologiaohjelmien päätöksentekokäytännöt vaihtelevat ohjelmittain hyvinkin paljon. Päätöksentekoon kaivataan systematiikkaa sekä objektiivisuutta. Pilotointiprojektissa saatujen kokemusten perusteella visualisoidut projektisalkkunäkymät antavat teknologiaohjelmien päätöksenteolle kaivattua tukea. Salkkunäkymien avulla voidaan tarkastella ohjelman nykytilaa, tulevaisuutta, verkottumista, riskejä sekä tuotto-odotuksia. Salkkunäkymien tuottamisen helpottamiseksi tulisi edelleen kehittää projektikohtaisen tiedon keräämistapoja sekä projektisalkun hallinta-prosesseja.

Hiilidioksidipäästölaskurin kehittäminen toimistoille ja yleisötapahtumille

Diplomityössä on kehitetty websovelluksena toteutettavan ilmastolaskuripalvelun hiilidioksidipäästöjen laskentamoduulit, joiden avulla toimistot ja yleisötapahtumat voivat arvioida omasta toiminnastaan syntyviä hiilidioksidipäästöjä sähkönkulutuksen, lämmönkulutuksen, matkustamisen, kuljetusten ja paperin kulutuksen osalta. Tavoitteena oli kehittää ilmastolaskurista mahdollisimman helppokäyttöinen ja kohderyhmälle hyödyllinen websovellus. Työn kirjallisuusosiossa käsitellään toimistojen ja yleisötapahtumien ympäristövaikutuksia etenkin ilmastonmuutoksen näkökulmasta. Toimistot ja yleisötapahtumat vaikuttavat ilmastonmuutokseen pääasiassa kiinteistöjen sähkön- ja lämmönkulutuksen sekä liikenteen energiankulutuksesta syntyvien hiilidioksidipäästöjen muodossa. Rakennusten energiankulutuksen ja liikenteen yhteys kansalliseen CO2-päästötaseeseen sekä päästöjenvähennystavoitteisiin on merkittävä päästökauppadirektiivin sovellusalan ulkopuolella. Lisäksi tarkastellaan paino- ja paperituotteiden elinkaaren aikaisia ympäristövaikutuksia energiankulutuksen kannalta, sillä paperi on toimistojen ja usein myös tapahtumien merkittävin yksittäinen materiaalivirta. Ilmastolaskuriin kuuluvien hiilidioksidipäästöjen laskentamoduulien kehittämisessä pyrittiin huomioimaan mahdollisimman pitkälle käyttäjien tarpeet ja tiedonsaantimahdollisuudet. Ilmastolaskuri suunniteltiin toimistojen ja yleisötapahtumien ympäristövaikutuksia käsittelevän tutkimustiedon, ilmastolaskuriprojektissa toteutetun esimarkkinakyselyn tulosten, käyttäjähaastatteluista saadun palautteen sekä keskeisesti suunnitteluprosessissa mukana olleen asiantuntijaryhmän antamien kehitysehdotusten perusteella. Työssä on esitetty ilmastolaskurisovelluksen laadulliset kriteerit, tekninen vaatimusmäärittely sekä hiilidioksidipäästöjen laskentaosuuden toteutussuunnitelma, joka sisältää laskentamoduulien käyttöliittymämallit sekä päästölaskentaan liittyvät hiilidioksidipäästökertoimet, oletusarvot, päästölaskentakaavat ja huomautukset.