Health-related quality of life in school children: validation of instrument, child self assessment, parent-proxy assessment and school nursing documentation of health check-ups

The aims of this study were to validate an international Health-Related Quality of Life (HRQL) instrument, to describe child self and parent-proxy assessed HRQL at child age 10 to 12 and to compare child self assessments with parent-proxy assessments and school nursing documentation. The study is part of the Schools on the Move –research project. In phase one, a cross-cultural translation and validation process was performed to develop a Finnish version of Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). The process included a two-way translation, cognitive interviews (children n=7, parents n=5) and a survey (children n=1097, parents n=999). In phase two, baseline and follow-up surveys (children n=986, parents n=710) were conducted to describe and compare the child self and parent-proxy assessed HRQL in school children between the ages 10 and 12. Phase three included two separate data, school nurse documented patient records (children n=270) and a survey (children n=986). The relation between child self assessed HRQL and school nursing documentation was evaluated. Validity and reliability of the Finnish version of PedsQL™ 4.0 was good (Child Self Report α=0.91, Parent-Proxy Report α=0.88). Children reported lower HRQL scores at the emotional (mean 76/80) than the physical (mean 85/89) health domains and significantly lower scores at the age of 10 than 12 (dMean=4, p=<0.001). Agreement between child self and parent-proxy assessment was fragile (r=0,4, p=<0.001) but increased as the child grew from age 10 to 12 years. At health check-ups, school nurses documented frequently children’s physical health, such as growth (97%) and posture (98/99%) but seldom emotional issues, such as mood (2/7%). The PedsQLTM 4.0 is a valid instrument to assess HRQL in Finnish school children although future research is recommended. Children’s emotional wellbeing needs future attention. HRQL scores increase during ages between childhood and adolescence. Concordance between child self and parent-proxy assessed HRQL is low. School nursing documentation, related to child health check-ups, is not in line with child self assessed HRQL and emotional issues need more attention.

Applying the principles of life cycle assessment and costing in process modeling to examine profit-making capability

Static process simulation has traditionally been used to model complex processes for various purposes. However, the use of static processsimulators for the preparation of holistic examinations aiming at improving profit-making capability requires a lot of work because the production of results requires the assessment of the applicability of detailed data which may be irrelevant to the objective. The relevant data for the total assessment gets buried byirrelevant data. Furthermore, the models do not include an examination of the maintenance or risk management, and economic examination is often an extra property added to them which can be performed with a spreadsheet program. A process model applicable to holistic economic examinations has been developed in this work. The model is based on the life cycle profit philosophy developed by Hagberg and Henriksson in 1996. The construction of the model has utilized life cycle assessment and life cycle costing methodologies with a view to developing, above all, a model which would be applicable to the economic examinations of complete wholes and which would require the need for information focusing on aspects essential to the objectives. Life cycle assessment and costing differ from each other in terms of the modeling principles, but the features of bothmethodologies can be used in the development of economic process modeling. Methods applicable to the modeling of complex processes can be examined from the viewpoint of life cycle methodologies, because they involve the collection and management of large corpuses of information and the production of information for the needs of decision-makers as well. The results of the study shows that on the basis of the principles of life cycle modeling, a process model can be created which may be used to produce holistic efficiency examinations on the profit-making capability of the production line, with fewer resources thanwith traditional methods. The calculations of the model are based to the maximum extent on the information system of the factory, which means that the accuracyof the results can be improved by developing information systems so that they can provide the best information for this kind of examinations.

Understanding the in vitro dissolution rate of glasses with respect to future clinical applications

Glass is a unique material with a long history. Several glass products are used daily in our everyday life, often unnoticed. Glass can be found not only in obvious applications such as tableware, windows, and light bulbs, but also in tennis rackets, windmill turbine blades, optical devices, and medical implants. The glasses used at present as implants are inorganic silica-based melt-derived compositions mainly for hard-tissue repair as bone graft substitute in dentistry and orthopedics. The degree of glass reactivity desired varies according to implantation situation and it is vital that the ion release from any glasses used in medical applications is controlled. Understanding the in vitro dissolution rate of glasses provides a first approximation of their behavior in vivo. Specific studies concerning dissolution properties of bioactive glasses have been relatively scarce and mostly concentrated to static condition studies. The motivation behind this work was to develop a simple and accurate method for quantifying the in vitro dissolution rate of highly different types of glass compositions with interest for future clinical applications. By combining information from various experimental conditions, a better knowledge of glass dissolution and the suitability of different glasses for different medical applications can be obtained. Thus, two traditional and one novel approach were utilized in this thesis to study glass dissolution. The chemical durability of silicate glasses was tested in water and TRIS-buffered solution at static and dynamic conditions. The traditional in vitro testing with a TRISbuffered solution under static conditions works well with bioactive or with readily dissolving glasses, and it is easy to follow the ion dissolution reactions. However, in the buffered solution no marked differences between the more durable glasses were observed. The hydrolytic resistance of the glasses was studied using the standard procedure ISO 719. The relative scale given by the standard failed to provide any relevant information when bioactive glasses were studied. However, the clear differences in the hydrolytic resistance values imply that the method could be used as a rapid test to get an overall idea of the biodegradability of glasses. The standard method combined with the ion concentration and pH measurements gives a better estimate of the hydrolytic resistance because of the high silicon amount released from a glass. A sensitive on-line analysis method utilizing inductively coupled plasma optical emission spectrometer and a flow-through micro-volume pH electrode was developed to study the initial dissolution of biocompatible glasses. This approach was found suitable for compositions within a large range of chemical durability. With this approach, the initial dissolution of all ions could be measured simultaneously and quantitatively, which gave a good overall idea of the initial dissolution rates for the individual ions and the dissolution mechanism. These types of results with glass dissolution were presented for the first time during the course of writing this thesis. Based on the initial dissolution patterns obtained with the novel approach using TRIS, the experimental glasses could be divided into four distinct categories. The initial dissolution patterns of glasses correlated well with the anticipated bioactivity. Moreover, the normalized surface-specific mass loss rates and the different in vivo models and the actual in vivo data correlated well. The results suggest that this type of approach can be used for prescreening the suitability of novel glass compositions for future clinical applications. Furthermore, the results shed light on the possible bioactivity of glasses. An additional goal in this thesis was to gain insight into the phase changes occurring during various heat treatments of glasses with three selected compositions. Engineering-type T-T-T curves for glasses 1-98 and 13-93 were stablished. The information gained is essential in manufacturing amorphous porous implants or for drawing of continuous fibers of the glasses. Although both glasses can be hot worked to amorphous products at carefully controlled conditions, 1-98 showed one magnitude greater nucleation and crystal growth rate than 13-93. Thus, 13-93 is better suited than 1-98 for working processes which require long residence times at high temperatures. It was also shown that amorphous and partially crystalline porous implants can be sintered from bioactive glass S53P4. Surface crystallization of S53P4, forming Na2O∙CaO∙2SiO2, was observed to start at 650°C. The secondary crystals of Na2Ca4(PO4)2SiO4, reported for the first time in this thesis, were detected at higher temperatures, from 850°C to 1000°C. The crystal phases formed affected the dissolution behavior of the implants in simulated body fluid. This study opens up new possibilities for using S53P4 to manufacture various structures, while tailoring their bioactivity by controlling the proportions of the different phases. The results obtained in this thesis give valuable additional information and tools to the state of the art for designing glasses with respect to future clinical applications. With the knowledge gained we can identify different dissolution patters and use this information to improve the tuning of glass compositions. In addition, the novel online analysis approach provides an excellent opportunity to further enhance our knowledge of glass behavior in simulated body conditions.

But in this twilight our choices seal our fate : the interplay autonomy and dignity in defining the international legal response to the beginning of life

Tutkielman aiheena on kansainvälisen oikeuden kysymys elämän alkamisesta ja elämän alkamisen ajankohdasta. Tutkielma lähestyy aihetta Yhdistyneiden kansakuntien lasten oikeuksien sopimuksen kolmannen lisäpöytäkirjan valossa. Astuessaan voimaan lisäpöytäkirja tulee mahdollistamaan yksilövalitusten käsittelyn erillisessä ihmisoikeuskomiteassa. Koska lasten oikeuksien sopimus jättää määrittelemättä elämän alkamisen ajankohdan, tutkielman perushypoteesina on, miten tuleva komitea ratkaisisi lasten oikeuksien sopimukseen jääneen jännitteen. Tämän hypoteesin ohella tutkielmaa suuntaa olettamus elämän alun määrittymisestä pitkälti oikeusperiaatteisiin rinnastuvien autonomian ja ihmisarvon käsitteiden kautta. Tutkielma lähestyy aihettaan sekä oikeuskäytännön että -kirjallisuuden valossa, sitoutumatta sen tarkemmin mihinkään yksittäiseen oikeustieteelliseen tutkimusmetodiin. Oikeuskäytännön kohdalla tarkastelu perustuu pääosin länsimaisten ylimpien oikeuksien antamille tuomioille kysymyksissä, jotka liittyvät elämän alkamisen tematiikkaan. Tämän ohella, rajatummin, käsitellään pohjoismaista elämän alun sääntelyä. Oikeuskäytännön sekä säädösten tarkastelun keskiössä on ennen kaikkea oikeudellinen argumentaatio sekä esiintuodun argumentaation jännitteisyys. Oikeuskäytännön pohjalta muotoutuu moniääninen ja usein kontekstisidonnainen kuva elämän alusta. Tämän oikeudellisen moniäänisyyden analyysi muodostaa tutkielman keskeisen sisällön. Autonomian ja ihmisarvon käsitteiden merkitystä oikeuskäytännön ja säädösten arvioinnille perustellaan tutkimuksessa yhtäältä niiden merkityksellä tuomioistuinten argumentaatiossa toisaalta periaatteiden saamalla tuella oikeustieteellisessä kirjallisuudessa. Tutkielma suhtautuu kriittisesti autonomian ja ihmisarvon käsitteisiin. Kriittisen luennan tarkoituksena on paljastaa oikeudellisen argumentaation sumeus ja sumeuden oikeudelliselle tulkinnalle aiheuttama epävarmuus. Tulkinnan epävarmuuden seurauksena myös vastaus elämän alulle näyttäytyy tutkielmassa ristiriitaisena ja osin perustelemattomana. Tutkielman keskeinen tulos on ennen kaikkea oikeuden jännitteiden tunnistamisessa sen lähestyessä elämän alun määrittelyä. Tutkielman tulosten pohjalta on mahdollista pyrkiä löytämään muotoutumassa olevan kansainvälisen oikeuden vastaus elämän alulle. Tuon vastauksen vakaus, perusteltavuus ja pysyvyys riippuvat siitä, miten onnistuneesti oikeudellinen argumentaatio kykenee yhdistämään yksilön autonomisen oikeuden päättää elämästään kollektiivin intressiin ylläpitää elämää.