Perusterveydenhuollon ja erikoissairaanhoidon k��yt��n seuranta ja ennakointi kuntan��k��kulmasta

<b>Follow-up of utilisation and prediction of primary health care and hospital care from the municipality point of view. </b> Planning, follow-up, and evaluation of primary health care within municipality entail comprehensive information about factors that influence health. In addition to populationbased research, various statistical data and registries serve as sources of information. The present study examined utilisation of primary health care and hospital care with the existing databases, registries, and categorization of Diagnosis Related Groups (DRGs) from the municipality (purchaser) point of view. Research involving the cases of Paimio, Sauvo, and Turku as examples of municipalities pointed out that, even in the small municipalities, it is possible to assess and predict health services to be offered to the inhabitants by following databases and registries. Health-related databases and registries include a plenty of possible uses that have not adequately been employed at the level of municipality. Descriptive futures research and community analysis formed the framework of the study. Descriptive futures research may be used to establish predictions based on past developmental traditions, and quantitative time trend analyses may be employed to make estimations about future events. Community analysis will assist in making conclusions about population- based health care needs, in assessing the functionality or effectiveness of the health care system, and in appropriately targeting limited resources. The aim of the present study was to describe the health service profile so that the arrangements and planning of health services as well as the contract negotiations of hospital care become easier within municipalities. Another aim was to assess the application of Hilmo (registry for posting hospital care periods), Aitta and Sotka (statistical databases) for the purposes of resource planning in the procurement of hospital care. A third aim was to evaluate how the system of the DRGs adapts in the prediction of retaining health services within short (1-year), intermediate (5-year) and long range (10-15-year) intervals. The findings indicated that the follow-up of primary health care utilisation combined with follow-up of hospital care utilisation allows municipalities to plan and predict health services when databases are applied. Information about the past contacts with the databases has indicated that the health care culture and incidence of disease change rather slowly in the area of investigation. For the purposes of health care research, it is recommended that methods of application used in making predictions about health care utilisation need to be further developed

Vitamin B12 Deficiency in the aged: Laboratory Diagnosis, Prevalence and Clinical Profile

<B>B₁₂-vitamiinin puute i��kk��ill��: laboratoriodiagnostiikka, yleisyys ja yhteys sairastavuuteen</b> <b>Tausta:</b> B12-vitamiinin puute on yleist�� i��kk��ill�� ja se tulisi todeta riitt��v��n varhaisessa vaiheessa palautumattomien vaurioiden est��miseksi. On ep��selv���� pit��isik�� diagnostiikka kohdistaa tiettyihin riskiryhmiin vai mahdollisesti seuloa valikoimatonta vanhusv��est����. My��sk����n yksimielisyytt�� laboratoriotutkimusten valinnasta ei ole. <b>Tavoitteet: </b>Tutkimuksen tarkoituksena oli evaluoida uutta HoloTC RIA menetelm���� ja tuottaa viitearvot sille, selvitt���� B12-vitamiinin puutteen yleisyys, yhteys sairastavuuteen ja mahdolliset riskitekij��t suomalaisessa vanhusv��est��ss��, arvioida munuaisfunktion vaikusta B12-vitamiinin puutteen laboratoriotutkimuksiin ja n��iden perusteella ehdottaa suomalaiseen terveydenhuoltoon sopivaa laboratoriotutkimusstrategiaa. <b>Aineisto ja menetelm��t:</b> Liedon i��kk����t -tutkimuksen vanhusaineisto on edustava otos yhden kunnan yli 65-vuotiaasta v��est��st��, yhteens�� 1260 henkil����. Tutkittavat k��viv��t l����k��rintarkastuksessa, ja heist�� on k��ytett��viss�� runsaasti laboratoriotutkimuksia sek�� tiedot sairauksista, ruokavaliosta, l����kkeiden ja vitamiinivalmisteiden k��yt��st��, dementiaseula ja depressiokysely. Viitearvoaineistoa varten ker��ttiin n��ytteet 84 vapaaehtoisesta terveest�� aikuisesta ja menetelm��evaluaatiota varten 107 sairaalapotilaasta. <b>Tulokset:</b> HoloTC RIA menetelm��n toistettavuus oli hyv�� manuaalimenetelm��ksi. 95%:n viitev��li holotranskobalamiinille oli 37-171 pmol/l. Kaikilla tutkittavilla, joilla oli muilla laboratoriotutkimuksilla osoitettu todenn��k��inen B12-vitamiinin puute, my��s holotranskobalamiini oli viitealueen alarajaa pienempi. Suurentuneella kystatiini C-pitoisuudella osoitettu munuaisten vajaatoiminta korreloi voimakkaasti homokysteiinin (rs=0.53, p<0.001) ja metyylimalonihapon (rs=0.27, p<0.001) pitoisuuksiin, mutta ei kokonais-B12-vitamiinin (rs=- 0.04, p=0.227) tai holotranskobamiinin (rs=-0.01, p=0.817) pitoisuuksiin. Suomalaisessa vanhusv��est��ss�� B12-vitamiinin puutteen prevalenssi oli 12%. Kokonais- B12-vitamiinin pitoisuus oli matala (<150 pmol/l) 6%:lla. Miessukupuoli (OR 1.9, 95% CI 1.2-2.9), ik�� ���75 (OR 2.2, 95% CI 1.4-3.4) ja maitotuotteiden v��ltt��minen (OR 2.3, 95% CI 1.2-4.4) lis��siv��t B12-vitamiinin puutteen riski��, mutta anemia (OR 1.3, 95% CI 0.7-2.3) tai makrosytoosi (OR 1.2, 95% CI 0.6-2.7) eiv��t. <b>P����telm��t: </b>Diagnosoimaton B12-vitamiinin puute on yleist�� i��kk��ill��, mutta kliinisesti merkityksellist�� spesifist�� riskiryhm���� ei l��ydy. Koska anemian ja makrosytoosin puuttuminen ei poissulje B12-vitamiinin puutetta ja munuaisten vajaatoiminta heikent���� metabolisten merkkiaineiden k��ytt��kelpoisuutta, kokonais-B12-vitamiinia suositellaan ensisijaiseksi laboratoriotutkimukseksi ep��ilt��ess�� B12-vitamiinin puutetta ja tarvittaessa varmentavina tutkimuksina k��ytet����n homokysteiini�� ja holotranskobalamiinia.

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.

Computing the diameter of Coxeter groups

This thesis addresses the problem of computing the minimal and maximal diameter of the Cayley graph of Coxeter groups. We first present and assert relevant parts of polytope theory and related Coxeter theory. After this, a method of contracting the orthogonal projections of a polytope from Rd onto R2 and R3, d �� 3 is presented. This method is the Equality Set Projection algorithm that requires a constant number of linearprogramming problems per facet of the projection in the absence of degeneracy. The ESP algorithm allows us to compute also projected geometric diameters of high-dimensional polytopes. A representation set of projected polytopes is presented to illustrate the methods adopted in this thesis.

Free PAPP-A: a Novel Marker in Acute Coronary Syndrome Patients

In recent years, one important objective of cardiovascular research has been to find new markers that would improve the risk stratification and diagnosis of patients presenting with symptoms of acute coronary syndrome (ACS). Pregnancy-associated plasma protein A (PAPP-A) is a large metalloproteinase involved in insulin-like growth factor signalling. It is expressed in various tissues and seems to be involved in many physiological and pathological processes, such as folliculogenesis, bone formation, wound healing, pregnancy and atherosclerosis. The aim of this thesis was to investigate PAPP-A in ACS patients. Circulating concentrations of PAPP-A had been previously shown to be elevated in ACS. In this study it was revealed that the form of PAPP-A causing this elevation was the free noncomplexed PAPP-A. Thus, the form of PAPP-A in the circulation of ACS patients differed from the complexed PAPP-A form abundantly present in the circulation during pregnancy. A point-of-care method based on time-resolved immunofluorometric assays was developed, which enabled the rapid detection of free PAPP-A. The method was found to perform well with serum and heparin plasma samples as well as with heparinized whole blood samples. With this method the concentrations of free PAPP-A in healthy individuals were shown to be negligible. When the clinical performance of the method was evaluated with serum samples from ACS patients, it was shown that the free PAPP-A concentration in the admission sample was an independent predictor of myocardial infarction and death. Moreover, as a prognostic marker, free PAPP-A was revealed to be superior to total PAPPA, i.e. the combination of free and complexed PAPP-A, which has been measured by the other groups in this field. As heparin products are widely used as medication in ACS patients, the effect of heparin products on free PAPP-A molecule and circulating concentrations were also investigated in this study. It was shown that intravenous administration of low molecular weight or unfractionated heparin elicits a rapid release of free PAPP-A into the circulation in haemodialysis patients and patients undergoing angiography. Moreover, the interaction between PAPP-A and heparin was confirmed in gel filtration studies. Importantly, the patients included in the clinical evaluation of the free PAPP-A detection method developed had not received any heparin product medication before the admission sample and thus the results were not affected by the heparin effect. In conclusion, free PAPP-A was identified as a novel marker associated with ACS. The point-of-care methods developed enable rapid detection of this molecule which predicts adverse outcome when measured in the admission sample of ACS patients. However, the effect revealed of heparin products on circulating PAPP-A concentrations should be acknowledged when further studies are conducted related to free or total PAPP-A in ACS.

Autologous Stem Cell Transplantation In Multiple Myeloma

<b>Background.</b> Multiple myeloma (MM) is the second most common hematologic malignancy after lymphomas In Finland: the annual incidence of MM is approximately 200. For three decades the median survival remained at 3 to 4 years from diagnosis until high-dose melphalan treatment supported by autologous stem cell transplantation (ASCT) became the standard of care for newly diagnosed MM since the mid 1990���s and the median survival increased to 5 ��� 6 years. This study focuses on three important aspects of ASCT, namely 1) stem cell mobilization, 2) single vs. double ASCT as initial treatment, and 3) the role of minimal residual disease (MRD) for longterm outcome. <b>Aim.</b> The aim of this series of studies was to evaluate the outcomes of MM patients and the ASCT procedure at the Turku University Central Hospital, Finland. First, we tried to identify which factors predict unsuccessful mobilization of autologous stem cells. Second, we compared the use of short-acting granulocyte-colony stimulating factor (GCSF) with long-acting G-CSF as mobilization agents. Third, one and two successive ASCTs were compared in 100 patients with MM. Fourth, for patients in complete response (CR) after stem cell transplantation (SCT), patient-specific probes for quantitative allele-specific oligonucleotide polymerase-chain reaction (qASO-PCR) measurements were designed to evaluate MRD and its importance for long-term outcome. <b>Results.</b> The quantity of previous chemotherapy and previous interferon use were significant pre-mobilization factors that predicted mobilization failure, together with some factors related to mobilization therapy itself, such as duration and degree of cytopenias and occurrence of sepsis. Short-acting and long-acting G-CSF combined with chemotherapy were comparable as stem cells mobilizers. The progression free (PFS) and overall survival (OS) tended to be longer after double ASCT than after single ASCT with a median follow-up time of 4 years, but this difference disappeared as the follow-up time increased. qASO-PCR was a good and sensitive divider of the CR patients into two prognostic groups: MRD low/negative (��� 0.01%) and MRD high (>0.01%) groups with a significant difference in PFS and suggestively also in OS. Conclusions. When the factors prediciting a poor outcome of stem cell mobilization prevail, it is possible to identify those patients who need specific efforts to maximize the mobilization efficacy. Long-acting pegfilgrastim is a practical and effective alternative to short-acting filgrastim for mobilization therapy. There is no need to perform double ASCT on all eligible patients. MRD assessment with qASO-PCR is a sensitive method for evaluation of the depth of the CR response and can be used to predict long-term outcome after ACST.

Health Related Quality of Life after Childhood Cancer - A Finnish Nationwide survey

The purpose of this Finnish epidemiological nationwide cross-sectional study was to evaluate the Health Related Quality of Life (HRQL) of young people that have survived childhood cancer at least four years after cancer diagnosis. The study aims were (1) to increase knowledge and understanding about the relationship between childhood cancer and its treatment and HRQL of childhood cancer survivors and (2) to identify survivors who need and could benefit from ongoing long-term follow-up, as well as (3) to identify what kind of aftercare the childhood cancer survivors will possibly need. HRQL and fatigue of currently still young survivors of extracranial childhood malignancies were evaluated with self-reports and parent proxy reports. HRQL was measured with age-appropriate generic instruments: PedsQL���, SF-36, 15D, 16D and 17D. Fatigue for children and adolescents aged below 18 years was measured with the PedsQL��� Multidimensional Fatigue Scale Finnish version. PedsQL��� parent-proxy and the PedsQL��� Multidimensional Fatigue Scale Parentproxy instruments were used to assess the perception of the parents on HRQL and fatigue of their children and adolescents. Postal-survey questionnaires were mailed to 852 childhood cancer survivors aged 11-27 years and their randomly selected gender-, age and living-place matched controls, as well as under 18-year-old children��s parents. A total of 474 survivors, 595 controls, 209 survivor���s parent and 253 control���s parent replied. The mean age of survivors at the time of the study was 18.4 years. The mean length of survival was 12.3 years, and the mean age at diagnosis 5.5 years. The most of the Finnish childhood cancer survivors evaluated that their HRQL as good. Survivors rated their HRQL equal or higher than their controls. The only dimension where the survivors scored poorer than the controls was the 15D mobility dimension. Survivors of childhood cancer did not suffer from significant fatigue. There were subgroups of childhood cancer survivors who had poorer level of HRQL, and suffered from fatigue more than the reference group. The demographic factors that associated with poorer HRQL were female gender, greater weight, living alone, need of remedial education, an additional non-cancer diagnosis, survivors with siblings, and self-reported unhappiness. Disease-related factors that associated with poorer HRQL were higher age at the time of diagnosis, the diagnosis of Wilms tumor, neuroblastoma, or osteosarcoma, and treatment with stem cell transplantation. The factors associated with more fatigue in survivors were male gender, older age at evaluation, the need of remedial education at school, lower overall average grade in the latest school marks report, length of survival more than 10 years, lower HRQL-scores, and a sarcoma diagnosis. However, all the used demographic and disease related factors explained only about one third of the variation in the HRQL scores. In open questions, the survivors were most worried about their physical health, but were also worried about their mental health, cancer inheritance, late-effects, and fertility and relapse issues. It seems that there are subgroups of survivors who need and could benefit from ongoing long-term follow-up. In the future, the survivors of childhood cancer need more information about their physical and mental health, as well as on their cancer inheritance, possible late-effects including fertility issues, and on the risk of relapse.

Application of morphometry, static DNA ploidy analysis, and steroid receptor expression in diagnosis and prognosis of Libyan breast cancer

The aim of this study was to describe the demographic, clinicopathological, biological and morphometric features of Libyan breast cancer patients. The supporting value of nuclear morphometry and static image cytometry in the sensitivity for detecting breast cancer in conventional fine-needle aspiration biopsies were estimated. The findings were compared with findings in breast cancer in Finland and Nigeria. In addation, the value of ER and PR were evaluated. There were 131 histological samples, 41 cytological samples, and demographic and clinicopathological data from 234 Libyan patients. The Libyan breast cancer is dominantly premenopausal and in this feature it is similar to breast cancer in sub-Saharan Africans, but clearly different from breast cancer in Europeans, whose cancers are dominantly postmenopausal in character. At presention most Libyan patients have locally advanced disease, which is associated with poor survival rates. Nuclear morphometry and image DNA cytometry agree with earlier published data in the Finnish population and indicate that nuclear size and DNA analysis of nuclear content can be used to increase the cytological sensitivity and specificity in doubtful breast lesions, particularly when free cell sampling method is used. Combination of the morphometric data with earlier free cell data gave the following diagnostic guidelines: Range of overlap in free cell samples: 55 ��m2 -71 ��m2. Cut-off values for diagnostic purposes: Mean nuclear area (MNA) >54 ��m2 for 100% detection of malignant cases (specificity 84 %), MNA < 72 ��m2 for 100% detection of benign cases (sensitivity 91%). Histomorphometry showed a significant correlation between the MNA and most clinicopathological features, with the strongest association observed for histological grade (p <0.0001). MNA seems to be a prognosticator in Libyan breast cancer (Pearson���s test r = - 0.29, p = 0.019), but at lower level of significance than in the European material. A corresponding relationship was not found in shape-related morphometric features. ER and PR staining scores were in correlation with the clinical stage (p= 0.017, and 0.015, respectively), and also associated with lymph node negative patients (p=0.03, p=0.05, respectively). Receptor-positive (HR+) patients had a better survival. The fraction of HR+ cases among Libyan breast cancers is about the same as the fraction of positive cases in European breast cancer. The study suggests that also weak staining (corresponding to as few as 1% positive cells) has prognostic value. The prognostic significance may be associated with the practice to use antihormonal therapy in HR+ cases. The low survival and advanced presentation is associated with active cell proliferation, atypical nuclear morphology and aneuploid nuclear DNA content in Libyan breast cancer patients. The findings support the idea that breast cancer is not one type of disease, but should probably be classified into premenopausal and post menopausal types.

Sotilaslent��j��n fyysinen suorituskyky sek�� ty��per��iset tuki- ja liikuntaelinoireet

Kirjallisuudesta v��littyy useitten vuosikymmenten ajalta tiet��mys sotilaslent��misen fyysisest�� kuormittavuudesta. G-voimista aiheutuva kuormittuminen n��ytt���� johtavan joko akuutisti tai pitk��aikaisesti lent��j��n tuki- ja liikuntaelimist��n toimintakyky�� alentaviin ongelmiin. Erityisesti on selvitetty niskan alueen ty��per��isten ongelmien synty��, jolloin on havaittu lentotoiminnan fyysisen kuormittavuuden johtavan ennenaikaiseen rakenteelliseen rappeumaan, haittaa aiheuttavan oireen lis��ksi. Kansainv��lisen kirjallisuuden mukaan ammatista johtuvista eli ty��per��isist�� oireista k��rsii v��hint����n 2/3 kaikista sotilaslent��jist��. Tietyin edellytyksin lent��jien kaularangan alueen rappeuma on Suomessa hyv��ksytty ammattitaudiksi vuodesta 1995 alkaen. On arveltu, ett�� hyv��st�� fyysisest�� suorituskyvyst�� olisi apua tuki- ja liikuntaelin (TULE)-oireilun ennaltaehk��isemisess�� ja toimintakyvyn yll��pit��misess��. Tutkimusn��ytt�� t��st�� on lent��jien osalta ollut toistaiseksi eritt��in niukkaa. T��m��n tutkimuksen tavoitteena oli selvitt���� suomalaisten sotilaslent��jien ty��per��isen TULE-oireilun esiintyvyytt��, oireista koetun haitan tasoa, lent��jien fyysisen kunnon tasoja virkauran aikana ja n��itten kaikkien v��lisi�� yhteyksi�� sek�� ty��per��isen TULE-oireen merkityst�� sotilaan toimintakykyyn. Tutkimus jakautui kahteen osaan. Poikkileikkauksena lentotoimintaper��isi�� TULE-oireita kartoitettiin kyselytutkimuksella, johon vastasi vuositarkastuksen yhteydess�� 267 lent��j���� vuosina 2004-2005. Joukosta poimittiin ne 195 lent��j����, jotka olivat suorittaneet yleissotilaalliset kuntotestit puolen vuoden sis��ll�� kyselyyn vastaamisesta, ja mitatut testitulokset yhdistettiin kyselytutkimusaineistoon. T��ss�� aineistossa toteutettiin fyysisesti erilailla kuormittuvien lent��j��ryhmien v��lisi�� vertailuja fyysisen kunnon, TULE-esiintyvyyden ja koetun haitan suhteen. Poikkileikkausosassa tutkittiin my��s lent��jien virkauran aikaisia tasoeroja yleissotilaallisissa kuntotesteiss�� (n=195) verrattuna muihin suomalaisiin sotilaisiin. Lis��ksi (N=289) selvitettiin ilmailul����ketieteellisen tarkastuksen yhteydess�� mitattuja, ns. ammatillisia fyysisi�� erityisominaisuuksia eri ik��luokissa. Pitkitt��isosassa seurattiin 67:n Hawk-suihkuharjoituskoneella aloittaneen Ilmavoimien sotilaslent��jien lentouran aikaista lentotoimintaper��isten TULE-oireitten esiintyvyytt�� vuosien 1996 ja 2008 v��lill��. Lis��ksi tutkittiin lent��jien kontakteja ty��terveyshuoltoon, oireen aiheuttamaa lentokelvottomuusaikaa, ty��n kuormituksen kumulatiivista kertym���� lentotuntien lis����ntyess�� ja TULE-oireiden esiintyvyyden kannalta kriittisi�� ajankohtia lentouran aikana. Tulokset osoittivat, ett�� kaikki seurannassa olleet suomalaiset sotilaslent��j��t kokivat jonkinasteisen lentotoimintaper��isen TULE-oireen uransa aikana. Niskan ammattitautiluokituksen tasoisen ongelman esiintyvyys oli 4 % koko lent��j��populaatiosta ja 10 % suihkuharjoituskonevaiheen jo l��p��isseist��, mutta vastaavanlaisia TULE-ongelmia, ilman riitt��v���� n��ytt���� ammattitaudista, esiintyi l��hes joka kolmannella sotilaslent��j��ll��. Alasel��n osalta lent��j��t oireilivat l��hes samassa m����rin, mutta n��it�� oireita ei toistaiseksi ole mahdollista m����ritt���� ammattitaudiksi. Lent��j��t k��viv��t varsin v��h��n valittamassa oireistaan ty��terveyshuoltoon, jossa k��yt��neen vasta silloin, kun oire jo selv��sti heikent���� ty��teht��viss�� vaadittavaa toimintakyky��. Merkitt��vin lentotoimintaper��isten oireitten esiintymisen kasvu ajoittui 200 Hawk-lentotunnin kohdalle, jolloin koneella saavutetaan er����nlainen optimaalinen G-indeksi eli taktisen liikehtelyn G-tasoylitysten vaihtelu. T��m��n j��lkeen lent��j��t ovat erityisen alttiina akuuteille lennonaikaisille TULE-ongelmille. Oireitten esiintyminen kasvoi eksponentiaalisesti noin 600 lentotuntiin asti. Monimuuttujamallien mukaan ty��per��isen TULE-oireen esiintyvyysriski�� v��hensiv��t alaraajojen hyv�� motoriikka, korkeat valintapisteet ja korkea kaulan fleksion voimataso maksimaalisessa isometrisess�� testiss��. Yleissotilaallisilla kuntotasoilla ei ollut yhteytt�� oireiluun, mutta lihaskunnoltaan voimakkaimmat lent��j��t k��rsiv��t tilastollisesti merkitt��v��sti v��hemm��n haittaa lentotoimintaper��isist�� TULE-oireistaan. Yleissotilaallisissa kuntotesteiss�� lent��j��t olivat parempia kuin muut suomalaiset sotilaat. Aktiivisimman lentouran aikana, 30-40-vuotiaina, lent��jien fyysinen suorituskyky oli normaaliv��est����n n��hden vain keskim����r��inen ja urheilijoihin n��hden keskim����r��ist�� heikompi. K��yt��nn��ss�� lent��j��t eiv��t kyenneet yll��pit��m����n valintavaiheen fyysist�� suorituskyky����n edes kadettivaiheen loppuun asti. Huomattavaa oli lis��ksi, ett�� aktiivisen lentouran p����tytty�� fyysinen kunto n��ytti jossain m����rin palautuvan kohti l��ht��tasoa lent��jien ik����ntymisest�� huolimatta. Lent��jien valintavaiheen aikana mitatun fyysisen suorituskyvyn tason s��ilyminen aktiivisen lentopalveluksen loppuun asti vaatisi lent��jien fyysisen toimintakyvyn yll��pidon ja kehitt��misen tehostamista koulutuksen ja ty��uran eri vaihessa. T��h��n tavoitteeseen n��hden Ilmavoimien fyysisen kasvatuksen j��rjestelyt vaikuttivat alimitoitetuilta. Operatiivisesti huolestuttavaa oli Ilmavoimien ohjaajien fyysisen suorituskyvyn heikentyminen silloin, kun heid��n taitojensa puolesta olisi pit��nyt olla suorituskykyisimpi�� taisteluteht��viins��. My��s lent��j��n terveytt�� ja toimintakyky�� pit��isi pysty�� reaaliaikaisemmin seuraamaan koko lentouran aikana. Ilmavoimille suositellaan moniammatillista l��hestymist�� sotilaslent��jien toimintakyvyn yll��pit��miseen ja terveysriskien hallintaan yhdess�� liikunnan, ty��terveyshuollon, lentoturvallisuusalan ja operatiivisen suunnittelun asiantuntijoitten kanssa. Lis��ksi suositellaan avoimempaa ja eettisesti kest��v��mp���� suhtautumista ammattiin liittyvien terveysongelmien kuvaamiseen sek�� fyysisen kunnon kysymyksiin jo lent��jien rekrytointivaiheessa.

Collaborative information behaviour : a case study of two research groups

The aim of the licentiate thesis is to examine researchers' information practices in research groups. The researchers were involved with study communication and media related issues within Social Sciences and Humanities Faculties. The theoretical framework of the study comprises the new holistic models of information seeking (for example: Meho and Tibbo, 2003; Seld��n, 1999) and the collective aspects of information behaviour (Prekop, 2002 ; Talja, 2002; Talja and Hansen, 2006). The research questions are: 1. How do scholars seek information in research groups? 2 What kind of collaborative information behaviour occurs in the research groups? The research data was gathered by interviews and observations. Three meetings of a research group at the University of Tampere were observed during the autumn of 2004. The group members and the group leader of the research group were interviewed in the spring of 2005. The research group members and the group leader of a research group at the University of Jyv��skyl�� were interviewed in the autumn of 2005. Altogether, two research group leaders and eight researchers were interviewed. The significance of the research group for information seeking is more important in closeknit research groups than in rather loose research groups. The significance of the research group for information seeking can be at least threefold. First, research group members can inform the group about relevant information resources and potential library or other information services. Second, the research group can to some extent compensate for the information seeking systems of libraries by distributing material and information resources. Third, information seeking can be carried out in collaboration in research groups. The significance of the research group was found to be most important in informing about new information services and marketing library systems. Recommendations from colleagues were often needed to mobilize researchers into using new library services. The significance of colleagues in informing about library services is in line with earlier studies. The present study showed that sometimes information from colleagues was regarded as more important than information distributed directly by the local library. A culture of information sharing, including mutual trust, seemed mainly to be reflected in collaboration and collaborative information seeking in the research groups studied. The timing of the onset of individual research seemed to be related to the information sharing culture and social networks in research groups. The simultaneous onset of the research work by group members seemed to promote the growth of unbiased collaboration, also in information seeking.

Beauty for Sale - An Empirical Study of Appearance-Related Consumption in Finland

This study examines appearance-related consumption in Finland. The theoretical portion discusses appearance-related consumption, on one hand from a consumer culture perspective, as both a possibility and responsibility for everyone; and on the other hand, from the point of view of behaviour and attitudes associated with sociodemographic and lifestyle-related factors. The empirical part of the study concentrates on the following aspects: 1) Finns��� appearance-related consumption patterns, attitudes towards appearance-related consumption and attending to one���s looks through consumption, as well as general changes in consumption patterns and attitudes; 2) gender differences in attitudes and consumption patterns, and their possible changes over time, and; 3) other differences among population groups in attitudes and consumption patterns, and their possible changes over time. The following dissertation utilises data from seven different nationally representative surveys. Data include Finnish Household Budget surveys from 1998 (N=4 359), 2001 (N=5 495) and 2006 (N=4 007), as well as, The Everyday Life and Well-being Survey (N=908) collected in 2011, and Finland 1999 (N=2 417), Finland 2004 (N=3 574) and Finland 2009 (N=1 202) surveys. The study indicates that Finns��� relationship to appearance-related consumption is, generally, somewhat inconsistent. In Finland, a significant share of a household���s total spending, around the EU average, is allocated to products and services related to appearance. In addition, at an attitudinal level, physical appearance is important to most Finnish consumers. However, in many respects, these attitudes reflect a certain reservation towards appearance-related consumption practices. The number of those consumers who see themselves as truly dedicated to attending to their looks through consumption is quite small, whereas the amount of those willing to take a reserved or even negative attitude towards appearance-related consumption is clearly higher. Attitudes towards attending to one���s looks and the importance of appearance-related consumption had not changed during the past decade. Study shows that at present, appearance-related consumption is a form of consumption that is particularly important to women, younger consumers, people with middle or higher income, and those with normal weight. Gender is in the key role when explaining appearance-related consumption and contrary to common belief, gender differences seem to have stayed quite stable. The results also indicate that, to some extent, differences between younger and older age groups might be diminishing.

Toward a Reliable Classifier For Arrhythmia Diagnosis

Illnesses related to the heart are one of the major reasons for death all over the world causing many people to lose their lives in last decades. The good news is that many of those sicknesses are preventable if they are spotted in early stages. On the other hand, the number of the doctors are much lower than the number of patients. This will makes the auto diagnosing of diseases even more and more essential for humans today. Furthermore, when it comes to the diagnosing methods and algorithms, the current state of the art is lacking a comprehensive study on the comparison between different diagnosis solutions. Not having a single valid diagnosing solution has increased the confusion among scholars and made it harder for them to take further steps. This master thesis will address the issue of reliable diagnosing algorithm. We investigate ECG signals and the relation between different diseases and the heart���s electrical activity. Also, we will discuss the necessary steps needed for auto diagnosing the heart diseases including the literatures discussing the topic. The main goal of this master thesis is to find a single reliable diagnosing algorithm and quest for the best classifier to date for heart related sicknesses. Five most suited and most well-known classifiers, such as KNN, CART, MLP, Adaboost and SVM, have been investigated. To have a fair comparison, the ex-periment condition is kept the same for all classification methods. The UCI repository arrhythmia dataset will be used and the data will not be preprocessed. The experiment results indicates that AdaBoost noticeably classifies different diseases with a considera-bly better accuracy.

University students��� regulation of learning and text processing ��� examples from medical and teacher education

The general aim of the thesis was to study university students��� learning from the perspective of regulation of learning and text processing. The data were collected from the two academic disciplines of medical and teacher education, which share the features of highly scheduled study, a multidisciplinary character, a complex relationship between theory and practice and a professional nature. Contemporary information society poses new challenges for learning, as it is not possible to learn all the information needed in a profession during a study programme. Therefore, it is increasingly important to learn how to think and learn independently, how to recognise gaps in and update one���s knowledge and how to deal with the huge amount of constantly changing information. In other words, it is critical to regulate one���s learning and to process text effectively. The thesis comprises five sub-studies that employed cross-sectional, longitudinal and experimental designs and multiple methods, from surveys to eye tracking. Study I examined the connections between students��� study orientations and the ways they regulate their learning. In total, 410 second-, fourth- and sixth-year medical students from two Finnish medical schools participated in the study by completing a questionnaire measuring both general study orientations and regulation strategies. The students were generally deeply oriented towards their studies. However, they regulated their studying externally. Several interesting and theoretically reasonable connections between the variables were found. For instance, self-regulation was positively correlated with deep orientation and achievement orientation and was negatively correlated with non-commitment. However, external regulation was likewise positively correlated with deep orientation and achievement orientation but also with surface orientation and systematic orientation. It is argued that external regulation might function as an effective coping strategy in the cognitively loaded medical curriculum. Study II focused on medical students��� regulation of learning and their conceptions of the learning environment in an innovative medical course where traditional lectures were combined wth problem-based learning (PBL) group work. First-year medical and dental students (N = 153) completed a questionnaire assessing their regulation strategies of learning and views about the PBL group work. The results indicated that external regulation and self-regulation of the learning content were the most typical regulation strategies among the participants. In line with previous studies, self-regulation wasconnected with study success. Strictly organised PBL sessions were not considered as useful as lectures, although the students��� views of the teacher/tutor and the group were mainly positive. Therefore, developers of teaching methods are challenged to think of new solutions that facilitate reflection of one���s learning and that improve the development of self-regulation. In Study III, a person-centred approach to studying regulation strategies was employed, in contrast to the traditional variable-centred approach used in Study I and Study II. The aim of Study III was to identify different regulation strategy profiles among medical students (N = 162) across time and to examine to what extent these profiles predict study success in preclinical studies. Four regulation strategy profiles were identified, and connections with study success were found. Students with the lowest self-regulation and with an increasing lack of regulation performed worse than the other groups. As the person-centred approach enables us to individualise students with diverse regulation patterns, it could be used in supporting student learning and in facilitating the early diagnosis of learning difficulties. In Study IV, 91 student teachers participated in a pre-test/post-test design where they answered open-ended questions about a complex science concept both before and after reading either a traditional, expository science text or a refutational text that prompted the reader to change his/her beliefs according to scientific beliefs about the phenomenon. The student teachers completed a questionnaire concerning their regulation and processing strategies. The results showed that the students��� understanding improved after text reading intervention and that refutational text promoted understanding better than the traditional text. Additionally, regulation and processing strategies were found to be connected with understanding the science phenomenon. A weak trend showed that weaker learners would benefit more from the refutational text. It seems that learners with effective learning strategies are able to pick out the relevant content regardless of the text type, whereas weaker learners might benefit from refutational parts that contrast the most typical misconceptions with scientific views. The purpose of Study V was to use eye tracking to determine how third-year medical studets (n = 39) and internal medicine residents (n = 13) read and solve patient case texts. The results revealed differences between medical students and residents in processing patient case texts; compared to the students, the residents were more accurate in their diagnoses and processed the texts significantly faster and with a lower number of fixations. Different reading patterns were also found. The observed differences between medical students and residents in processing patient case texts could be used in medical education to model expert reasoning and to teach how a good medical text should be constructed. The main findings of the thesis indicate that even among very selected student populations, such as high-achieving medical students or student teachers, there seems to be a lot of variation in regulation strategies of learning and text processing. As these learning strategies are related to successful studying, students enter educational programmes with rather different chances of managing and achieving success. Further, the ways of engaging in learning seldom centre on a single strategy or approach; rather, students seem to combine several strategies to a certain degree. Sometimes, it can be a matter of perspective of which way of learning can be considered best; therefore, the reality of studying in higher education is often more complicated than the simplistic view of self-regulation as a good quality and external regulation as a harmful quality. The beginning of university studies may be stressful for many, as the gap between high school and university studies is huge and those strategies that were adequate during high school might not work as well in higher education. Therefore, it is important to map students��� learning strategies and to encourage them to engage in using high-quality learning strategies from the beginning. Instead of separate courses on learning skills, the integration of these skills into course contents should be considered. Furthermore, learning complex scientific phenomena could be facilitated by paying attention to high-quality learning materials and texts and other support from the learning environment also in the university. Eye tracking seems to have great potential in evaluating performance and growing diagnostic expertise in text processing, although more research using texts as stimulus is needed. Both medical and teacher education programmes and the professions themselves are challenging in terms of their multidisciplinary nature and increasing amounts of information and therefore require good lifelong learning skills during the study period and later in work life.

Ethical leadership as a way to promote work-related well-being

The purpose of this study was to clarify the connections of ethical leadership with the work-related well-being of employees. Additionally, the role of occupational health care in ethical leadership that promotes work-related well- being was analyzed. The objective of the study was to produce knowledge to support the development of ethical leadership and work-related well-being as well as to find ways for occupational health care to support organizations in these actions. The target groups of this study consisted of the managers (N=43) and employees (N=336) working in one organization in the Finnish energy industry. The population was studied in November 2014 using census. The data was gathered with two different web-based surveys containing structured and open questions. The survey for managers consisted of background questions and statements concerning ethical leadership, work-related well-being and occupational health care. The employee questionnaire consisted of questions about background and statements about work-related well-being and ethical leadership. The structured questions were analyzed with SPSS Statistical Program and the open questions using inductive content analysis. At least 80 % of the managers saw their actions as ethical in all but one part of ethical leadership. The work-related well-being of the employees was found best in the area of ability to work (91 % agreed) and lowest in the area of experience of ethical leadership (67 % agreed). The results showed a strong positive connection between ethical leadership and all the components of work- related well-being. The managers and employees were generally quite happy with the services of occupational health care but managers saw some problems with the collaboration with occupational health care. Several ways to improve work-related well-being and collaboration with occupational health care were found. One of the most important things was thought to be offering ways to maintain ability to work and making these actions visible. Investing in ethical leadership and work-related well-being is extremely important for the success of an organization and the societal benefits cannot be forgotten either. The role of occupational health care in promoting the health and well-being of employees is substantial. Occupational health care should offer managers more tools to recognize difficult situations and acting in them as well as encourage managers to seek help from occupational health care without hesitation in problematic situations of leadership.

Ethical leadership as a way to promote work-related well-being

The purpose of this study was to clarify the connections of ethical leadership with the work-related well-being of employees. Additionally, the role of occupational health care in ethical leadership that promotes work-related well- being was analyzed. The objective of the study was to produce knowledge to support the development of ethical leadership and work-related well-being as well as to find ways for occupational health care to support organizations in these actions. The target groups of this study consisted of the managers (N=43) and employees (N=336) working in one organization in the Finnish energy industry. The population was studied in November 2014 using census. The data was gathered with two different web-based surveys containing structured and open questions. The survey for managers consisted of background questions and statements concerning ethical leadership, work-related well-being and occupational health care. The employee questionnaire consisted of questions about background and statements about work-related well-being and ethical leadership. The structured questions were analyzed with SPSS Statistical Program and the open questions using inductive content analysis. At least 80 % of the managers saw their actions as ethical in all but one part of ethical leadership. The work-related well-being of the employees was found best in the area of ability to work (91 % agreed) and lowest in the area of experience of ethical leadership (67 % agreed). The results showed a strong positive connection between ethical leadership and all the components of work- related well-being. The managers and employees were generally quite happy with the services of occupational health care but managers saw some problems with the collaboration with occupational health care. Several ways to improve work-related well-being and collaboration with occupational health care were found. One of the most important things was thought to be offering ways to maintain ability to work and making these actions visible. Investing in ethical leadership and work-related well-being is extremely important for the success of an organization and the societal benefits cannot be forgotten either. The role of occupational health care in promoting the health and well-being of employees is substantial. Occupational health care should offer managers more tools to recognize difficult situations and acting in them as well as encourage managers to seek help from occupational health care without hesitation in problematic situations of leadership.