Metabolic syndrome in young adults – prevalence, childhood predictors and association with subclinical atherosclerosis

Background: Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors including central obesity, insulin resistance, impaired glucose tolerance, hypertension and dyslipidemia. The prevalence of MetS is increasing worldwide in all age groups. MetS is associated with increased risk of cardiovascular disease and type 2 diabetes mellitus. Aims: The aim of the present study was to investigate the prevalence, secular trends and childhood predictors of MetS in young adults. Furthermore, the relations between MetS and subclinical atherosclerosis were studied and whether apolipoproteins (apo) B and A-I, C-reactive protein (CRP) and type II secretory phospholipase A2 (sPLA2) were associated with MetS, and to what extent the atherogenicity of MetS was explained by these factors. Participants and Methods: The present thesis is part of the large scale population-based, prospective study, the Cardiovascular Risk in Young Finns Study. The first cross-sectional study was conducted in 1980 and included 3,596 participants aged 3-18 years. Carotid and brachial ultrasound studies were performed for 2,283 of these participants in 2001 and 2,200 of these participants in 2007. Results: The overall prevalence of MetS in young adults aged 24-39 years in 2001 was 10-15 % and 6 years later in 30-45 year-old adults it was 15-23 % depending on the MetS definition used. Between the years 1986 and 2001, MetS prevalence increased from 1.0 % to 7.5 % (p<0.0001) in 24-year-old participants that was mostly driven by the increased central obesity. Participants with MetS had increased carotid intima-media thickness (cIMT) and decreased carotid elasticity compared to those without the syndrome. Impaired brachial flow-mediated dilatation (FMD) was not related to MetS but it modified the relationship between MetS and cIMT (P for interaction 0.023). High levels of apoB, CRP, sPLA2 and low levels of apoA-I associated with MetS in young adults. In prospective analysis both MetS and high apoB predicted (P<0.0001) incident high cIMT, defined as cIMT>90th percentile and/or plaque. The association between MetS and incident high cIMT was attenuated by ~40 % after adjustment with apoB. Conclusions: MetS is common in young adults and increases with age. Screening for risk factors, especially obesity, at an early life stage could help identify children and adolescents at increased risk of developing MetS and cardiovascular disease later in life. MetS identifies a population of young adults with evidence of increased subclinical atherosclerosis. Impaired brachial endothelial response is not a hallmark of MetS in young adults, but the status of endothelial function modifies the association between metabolic risk factors and atherosclerosis. In addition, the atherogenicity of MetS in this population assessed by incident high cIMT appears to be substantially mediated by elevated apoB.

“IF ONLY I COULD�? ~ “THERE IS ALWAYS A LOOPHOLE"? Hope and hopelessness experienced by the severely depressive and nondepressive

The aim of this research was to structure a conceptual model of hope and hopelessness based on dictionary definitions, and to verify this model on the basis of the experiences of the severely depressive and non-depressive elderly. This research has produced a substantive theory of hope and hopelessness which is based on the experiences of the depressive and non-depressive elderly, and on the concept analysis of hope and hopelessness based on English dictionary definitions. The patients who participated in the research were 65 years old and older men and women (n=22) who had been admitted to a psychiatric hospital because of major depression, and another group: the non-depressive elderly (n=21), who were recruited from the pensioners’ clubs. The data were collected in interviews using the Clinical Assessment Tool, developed by Farran, Salloway and Clark (1990) and Farran, Wilken and Popovich (1992), and it produced 553 pages of written text, which were analysed using the ATLAS/ti programme. ATLAS/ti is a tool for analysing qualitative data and is based on Grounded Theory. The medical and nursing records of the depressive elderly completed source triangulation. The concept analysis of hope and hopelessness was made on the basis of the definitions of English dictionaries (n=103), using semantic analysis and the ATLAS/ti programme. The most important hope-promoting factors were human relations, health and managing in everyday living. Autonomy, self-determination and feeling of security were highly appreciated among the elderly. Hopelessness, on the other hand, was most often associated with the same factors: human relations, health and everyday living. Especially, losses of significant others were experienced as strongly hope-diminishing. Old age had brought freedom from duties concerning others, but now, when you finally had an opportunity to enjoy yourself, you could not accomplish anything; you were clasped in the arms of total inability, depression had come. The most obvious difference in the life course of the depressive and nondepressive elderly was the abundance of traumatic experiences in the childhood and youth of the depressive elderly. The continuous circulation of fearful thoughts was almost touchable, and suicidality was described in connection with these thoughts. You were afraid to be awake and also to go to sleep. Managing day by day was the goal. The research produced the Basic Social Process (BSP) of hope: achieving - maintaining - losing, which expresses a continuous balancing between Being without and Being with. The importance of the object of hope was combined with the amount of hope and disappointment. The process of approaching defined the realisation of hope and the process of withdrawal that of losing. Joy and security versus grief and insecurity defined the Being with and Being without. Two core categories were found. The first one “If only I could�? reflects lack of energy, lack of knowledge, lack of courage and lack of ability. The other one “There is always a loophole�? reflects deliberate tracing of possibilities and the belief in finding solutions, and managing.

Virus Infections in Early Childhood, Cow’s Milk Formula Exposure and Genetic Predisposition in the Development of Diabetes-Associated Autoimmunity

Varhaislapsuuden virusinfektioiden, lehmänmaitopohjaisen äidinmaitovastikeen ja geneettisen alttiuden merkitys diabetekseen liittyvän autoimmuniteetin kehittymisessä Tyypin 1 diabetes on autoimmuunisairaus, joka syntyy haiman insuliinia tuottavien beta-solujen tuhouduttua elimistön oman immuunipuolustusjärjestelmän hyökkäyksen seurauksena. Sekä perimän että ympäristötekijöiden arvellaan vaikuttavan tautiprosessiin, mutta taudin tarkkaa syntymekanismia ei tunneta. Tutkimuksen tarkoituksena oli selvittää varhaislapsuuden ympäristötekijöiden vaikutusta beta-soluautoimmuniteetin syntyyn, erityispaino tutkimuksessa oli ympäristötekijöiden yhteisvaikutuksessa sekä geneettisten riskitekijöiden ja ympäristötekijöiden vuorovaikutuksessa. Varhaislapsuudessa sairastettu sytomegalovirus- tai enterovirusinfektio ei lisännyt beta-soluautoimmuniteetin riskiä lapsilla, joilla on geneettisesti kohonnut riski sairastua tyypin 1 diabetekseen. Ennen puolen vuoden ikää sairastettu rotavirusinfektio lisäsi hieman tyypin 1 diabetekseen liittyvän autoimmuniteetin riskiä. Tarkemmassa analyysissa varhaislapsuuden enterovirusinfektio osoittautui kuitenkin autovasta-aineiden muodostumisen riskitekijäksi niiden lasten joukossa, jotka olivat saaneet lehmänmaitopohjaista äidinmaidon vastiketta ensimmäisten elinkuukausien aikana. Tämä löydös viittaa enterovirusinfektion ja lehmänmaitopohjaisen vastikkeen yhteisvaikutukseen tyypin 1 diabetekseen liittyvän autoimmuniteetin synnyssä. Löydösten mukaan PTPN22 geenin C1858T polymorfismi vaikuttaa CD4+ T solujen aktivaatioon ja proliferaatiovasteeseen, 1858T alleeliin liittyy alentunut T-soluresepto-rivälitteinen aktivaatio. 1858T alleelin kantajuuteen liittyy lisäksi lisääntynyt autovasta-aineiden ja kliinisen diabeteksen ilmaantuvuus. Tämä yhteys rajoittui yksilöihin, jotka olivat altistuneet lehmänmaitopohjaiselle vastikkeelle ennen kuuden kuukauden ikää. Tulosten mukaan sekä ympäristötekijöiden väliset yhteisvaikutukset että perimä vaikuttavat yksittäisen ympäristötekijän merkitykseen tyypin 1 diabetekseen liittyvän autoimmuniteetin synnyssä. Nämä yhteisvaikutukset ympäristötekijöiden kesken ja perimän ja ympäristötekijöiden välillä selittävät aiemmin julkaistujen tulosten ristiriittaisuutta tutkimuksissa, joissa on analysoitu vain yhden ympäristötekijän vaikutusta diabeteksen ilmaantuvuuteen.

Berry polyphenol absorption and the effect of northern berries on metabolism, ectopic fat accumulation, and associated diseases

The prevalence of obesity and type 2 diabetes has increased at an alarming rate in developed countries. It seems in the light of current knowledge that metabolic syndrome may not develop at all without NAFLD, and NAFLD is estimated to be as common as metabolic syndrome in western population (23 % occurrence). Fat in the liver is called ectopic fat, which is triacylglycerols within the cells of non-adipose tissue. Serum alanine aminotransferase (ALT) values correlate positively with liver fat proportions, and increased activity of ALT predicts type 2 diabetes independently from obesity. Berries, high in natural bioactive compounds, have indicated the potential to reduce the risk of obesity-related diseases. Ectopic fat induces common endocrine excretion of adipose tissue resulting in the overproduction of inflammatory markers, which further induce insulin resistance by multiple mechanisms. Insulin resistance inducing hyperinsulinemia and lipolysis in adipocytes increases the concentration of free fatty acids and consequently causes further fat accumulation in hepatocytes. Polyphenolic fractions of berries have been shown to reverse inflammatory reaction cascades in in vitro and animal studies, and moreover to decrease ectopic fat accumulation. The aim of this thesis was to explore the role of northern berries in obesity-related diseases. The absorption and metabolism of selected berry polyphenols, flavonol glycosides and anthocyanins, was investigated in humans, and metabolites of the studied compounds were identified in plasma and urine samples (I, II). Further, the effects of berries on the risk factors of metabolic syndrome were studied in clinical intervention trials (III, IV), and the different fractions of sea buckthorn berry were tested for their ability to reduce postprandial glycemia and insulinemia after high-glucose meal in a postprandial study with humans (V). The marked impact of mixed berries on plasma ALT values (III), as well as indications of the positive effects of sea buckthorn, its fractions and bilberry on omental adiposity and adhesion molecules (IV) were observed. In study V, sea buckthorn and its polyphenol fractions had a promising effect on potprandial metabolism after high-glucose meal. In the literature review, the possible mechanisms behind the observed effects have been discussed with a special emphasis on ectopic fat accumulation. The literature review indicated that especially tannins and flavonoids have shown potential in suppressing diverse reaction cascades related to systemic inflammation, ectopic fat accumulation and insulin resistance development.

Immateriellt kulturarv som begrepp och process : folkloristiska perspektiv på kulturarv i Finlands svenskbygder med folkmusik som exempel

Cultural heritage has become something of an in-word in recent times. Intangible cultural heritage, however, is a category that has received relatively little attention. This folkloristic study focuses on intangible cultural heritage as concept and as process. Folkloristics as a scholarly branch emphasizes non-material culture. Consequently, there is a big potential in bringing existing knowledge of folklore together with current scholarly theories concerning cultural heritage in order to expand the understanding of intangible cultural heritage. In this thesis cultural heritage is regarded as a symbolic construct, which is spoken of and discussed in specific ways. The study of intangible cultural heritage (Swe. kulturarv) as concept focuses on this area. For a cultural component to be experienced as intangible cultural heritage it is, however, not enough to discuss it in those terms. Instead, cultural heritage status needs to be acted out during lengthy processes. This is demonstrated by the study of intangible cultural heritage as process. As a consequence performativity appears crucial to an understanding of cultural heritage – when a sufficient number of people speak and act as if a cultural component has a special status, it will also be perceived as cultural heritage. In this dissertation intangible cultural heritage is studied through cultural analysis, more specifically through discourse analysis. The usage of the concept intangible cultural heritage within cultural organizations, in scholarly use and in the Swedish-speaking press in Finland is examined. Traditional music in the Swedish-speaking districts of Finland is used as a case study of intangible cultural heritage as process. The examination concerns how traditional music, an intangible cultural component, has been discussed, transformed, standardized and objectified in a cultural heritage process. Cultural heritage is generally used as a token of value so that certain cultural components, both intangible and tangible, which are discussed in terms of cultural heritage are perceived to be valuable and should therefore be safeguarded. Intangible cultural heritage depends on performance, that is practitioners use their bodies to act out their traditional knowledge through song, handicraft, storytelling and so on. Intangible cultural components can be transmitted to other individuals in a performance situation, and they can also be documented. In Finland documentation and subsequent filing in archives have been associated with safeguarding of intangible cultural heritage. If the aim of safeguarding is to uphold traditional practices, which is the case for among others UNESCO’s programs aimed at intangible cultural heritage, other efforts are called for: forms of safeguarding that support performance and transmission.

“Till gruvhålet som suger och skrämmer” : en studie i Nils Bolanders predikan under åren 1940–1950

The aim of this thesis is to examine the preaching of Nils Bolander during the years 1940–1950. Nils Bolander (1902–1959) was a Swedish minister, later bishop, in the Church of Sweden. Bolander experienced his breakthrough as a preacher and a poet during the years 1940–1950, when he was a pastor of the Engelbrekt congregation in Stockholm. One characteristic of Bolander’s poetry as well as of his sermons is a rich and poetical language. At the same time he also had a clear agenda with his sermons with regard to their contents. The primary research question of this thesis is: What was Bolander’s purpose with his sermons? In this context, two secondary research questions were asked: 1) In what way does the poetical language support and assist the purpose of the sermons? 2) How is Bolander, as an individual and a preacher, engaged in the language and the contents of the sermons? The research material of this study consists of 152 hand-­written sermon manuscripts from church services held by Nils Bolander in Stockholm during the period in question. The method of the study is qualitative research with an abductive approach. Content analysis has formed the primary tool. With regard to the main research question, the purpose of Bolander’s sermons, my study indicated that the purpose was to rouse the listeners from their routine-­like faith and push them towards commitment and active service for God. In Bolander’s theology I found strong influences from Pietism but also some traits usually associated with the theological profile of the Oxford Group. Despite these influences, Nils Bolander’s theology is mainly founded on the Lutheran interpretation of faith. With regard to the secondary research questions concerning the poetical language as well as the role of the preacher my study concludes that the language, the individual and the contents were all connected in Bolander’s preaching and formed a whole that spoke to the audience in various ways.

Nåden och gåvan i Philipp Melanchthons rättfärdiggörelselära 1521-1535

In this thesis Philip Melanchthon’s doctrine of justification is analyzed, especially the aspects of favor and donum in his writings until 1535. The research task is defined in the introduction of the thesis. Researchers agree, that Melanchthon emphasized the forensic aspect of the doctrine of justification, but this is not the case with the effective aspect of his doctrine of justification. Therefore, I have chosen to focus on the concepts of favor (grace) and donum (gift). The thesis begins with an analysis of the first edition of the Loci communes of 1521 in chapter two, and it ends with the second edition from 1535 in chapter seven. Melanchthon’s most important writings from the intervening period are analyzed in chapters three to six. In chapter eight, I describe my final results from the analysis. Although I have focused on how Melanchthon perceived the relationship between favor and donum, I have also taken note of such loci that are associated with his view of justification. I have done this in order to get a clearer picture of Melanchthon’s doctrine of justification, and of the issues which change in his theological thinking over time. In the research overview in chapter one, I divided the researchers in four different groups depending on how they perceive Melanchthon’s doctrine of justification. This classification is of course not comprehensive, since the reality is much more complicated. The main interpretations present in Melanchthon research are: 1. Christ as favor in justification, but donum is excluded from justification. 2. Christ as favor in justification, but the Spirit is donum in justification. 3. Christ as both favor and donum in justification until the early 1530s. 4. Christ as both favor and donum in justification throughout his life. The fourth option is in my opinion the most preferable. The analysis of Melanchthon’s writings shows that he expects both a forensic, and an effective aspect in the doctrine of justification throughout the examined period. Melanchthon strongly emphasizes that justification is by grace alone through faith for Christ’s sake, but also that the Holy Spirit works the justifying faith, and is the gift bestowed on believers in connection with this. Where the opponents according to Melanchthon see deeds, virtues, or a quality in the believer as the cause of the justification, there Melanchthon sees only Christ.

Litteracitet i fem högstadieungdomars en-till-en-datorpraktiker

The study focuses on five lower secondary school pupils’ daily use of their one-toone computers, the overall aim being to investigate literacy in this form of computing. Theoretically, the study is rooted in the New Literacy tradition with an ecological perspective, in combination with socio-semiotic theory in a multimodal perspective. New Literacy in the ecological perspective focuses on literacy practices and place/space and on the links between them. Literacy is viewed as socially based, in specific situations and in recurring social practices. Socio-semiotic theory embodying the multimodal perspective is used for the text analysis. The methodology is known as socio-semiotic ethnography. The ethnographic methods encompass just over two years of fieldwork with participating observations of the five participants’ computing activities at home, at school and elsewhere. The participants, one boy and two girls from the Blue (Anemone) School and two girls from the White (Anemone) School, were chosen to reflect a broad spectrum in terms of sociocultural and socioeconomic background. The study shows the existence of a both broad and deep variation in the way digital literacy features in the participants’ one-to-one computing. These variations are associated with experience in relation to the home, the living environment, place, personal qualities and school. The more varied computer usage of the Blue School participants is connected with the interests they developed in their homes and living environments and in the computing practices undertaken in school. Their more varied usage of the computer is reflected in their broader digital literacy repertoires and their greater number and variety of digital literacy abilities. The Blue School participants’ text production is more multifaceted, covers a wider range of subjects and displays a broader palette of semiotic resources. It also combines more text types and the texts are generally longer than those of the White School participants. The Blue School girls have developed a text culture that is close to that of the school. In their case, there is clear linkage between school-initiated and self-initiated computing activities, while other participants do not have the same opportunities to link and integrate self-initiated computing activities into the school context. It also becomes clear that the Blue School girls can relate and adapt their texts to different communicative practices and recipients. In addition, the study shows that the Blue School girls have some degree of scope in their school practice as a result of incorporating into it certain communicative practices that they have developed in nonschool contexts. Quite contrary to the hopes expressed that one-to-one computing would reduce digital inequality, it has increased between these participants. Whether the same or similar results apply in a larger perspective, on a more structural level, is a question that this study cannot answer. It can only draw attention to the need to investigate the matter. The study shows in a variety of ways that the White School participants do not have the same opportunity to develop their digital literacy as the Blue School participants. In an equivalence perspective, schools have a compensational task to perform. It is abundantly clear from the study that investing in one-to-one projects is not enough to combat digital inequality and achieve the digitisation goals established for school education. Alongside their investments in technology, schools need to develop a didactic that legitimises and compensates for the different circumstances of different pupils. The compensational role of schools in this connection is important not only for the present participants but also for the community at large, in that it can help to secure a cohesive, open and democratic society.