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

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

Modularity in Health and Social Services: Perspectives on Organization and Management

Organizations that provide health and social services operate in a complex and constantly changing environment. Changes occur, for example, in ageing, technology and biotechnology, and customers’ expectations, as well as the global economic situation. Organizations typically aim to adapt the changes by introducing new organizational structures and managerial practices, such as process and lean management. Only recently has there been an interest in evaluating whether organizations providing health and social services could apply modularity in order to respond to some of the changes. The concept of modularity originates from manufacturing, but is applied in many other disciplines, such as information technology and logistics. However, thus far, the literature concerning modularity in health and social services is scarce. Therefore the purpose of this thesis is to increase understanding concerning modularity and the possibilities to apply modularity in the health and social services context. In addition, the purpose is to shed light on the viewpoints that are worth taking into account when considering the application of modularity in the health and social services context. The aim of the thesis is to analyze the way in which the modular structures are applied in the health and social services context and to analyze what advantages and possible barriers, as well as managerial concerns, might occur if modularity is applied in the health and social services context. The thesis is conducted by using multiple methods in order to provide a broad aspect to the topic. A systematic literature review provided solid ground for pre-understanding the topic and supported the formulation of the research questions. Theoretical reasoning provided a general overview of the special characteristics of the health and social services context and their effect on application of modularity. Empirical studies concentrated on managerial concerns of modularity particularly from the perspective of health and social services for the elderly. Results of the thesis reveal that structures in products, services, processes, and organizations are rather modular in health and social services. They can be decomposed in small independent units, while the challenges seem to occur especially in the compatibility of the services. It seems that health and social services managers have recognized this problem and they are increasingly paying attention to this challenge in order to enhance the flexible compatibility of services. Advantages and possible barriers of modularity are explored in this thesis, and from the theoretical perspective it could be argued that modularity seems to be beneficial in the context of health and social services. In fact, it has the potential to alleviate several of the challenges that the health and social services context is confronting. For example, modular structures could support organizations in their challenging task to respond to customers’ increasing demand for heterogeneous services. However, special characteristics of the health and social services context create barriers and provide significant challenges in application of modularity. For example, asymmetry of information, negative externalities, uncertainty of demand, and rigid regulation prevent managers from extensively drawing benefits from modularity. Results also reveal that modularity has managerial implications in health and social service. Modularity has the potential to promote and support new service development and outsourcing. Results also provide insights into network management and increases managerial understanding of different network management strategies. Standardization in health and social services is extensive due to legislation and recommendations. Modularity provides alternative paths to take an advantage of standardization while still ensuring the quality of the services. Based on this thesis, it can be concluded, both from a theoretical perspective and from empirical results concerning modularity in health and social services, that modularity might fit well and be beneficial. However, the special characteristics of the health and social services context prevent some of the benefits of modularity and complicate its application. This thesis contributes to the academic literature on the organization and management of health and social services by describing modularity as an alternative way for organizing and managing health and social services. In addition, it contributes to the literature of modularity by exploring the applicability of modularity in the context of health and social services. It also provides practical contribution to health and social services managers by evaluating the pros and cons of modularity when applied to health and social services.

Whistleblowing process in Finnish health care

Wrongdoing in health care is harmful action that jeopardizes patient safety and can be targeted at the patient or employees. Wrongdoing can vary from illegal, unethical or unprofessional action to inappropriate behavior in the workplace. Whistleblowing can be considered as a process where wrongdoing is suspected or oberved in health care by health care professionals and disclosed to the party that can influence the wrongful action. Whistleblowing causes severe harm to the whistleblower and to the object of whistleblowing complaint, to their personnel life and working community. The aim of this study was to analyze whistleblowing process in Finnish health care. The overall goal is to raise concern about wrongdoing and whistleblowing in Finnish health care. In this cross-sectional descriptive study the data were collected (n = 397) with probability sampling from health care professionals and members of The Union of Health and Social Care Professionals in Finland Tehy. The data were collected with questionnaire: “Whistleblowing -väärinkäytösten paljastaminen terveydenhuollossa” developed for this study and by using Webropol questionnaire -software during 26.6.-17.7.2015. The data were analyzed statistically. According to the results of this study health care professionals had suspected (67 %) and observed (66 %) wrongdoing in health care, more often than once a month (30%). Mostly were suspected (37 %) and observed (36%) inadequacy of the personnel and least violence toward the patient (3 %). Wrongdoing was whistle blown (suspected 29 %, observed 40 %) primarily inside the organization to the closest supervisor (76 %), face-to-face (88 %). Mostly the whistle was blown on nurses’ wrongdoing (58 %). Whistleblowing act didn’t end the wrongdoing (52 %) and whistleblowing had negative consequences to the whistleblower such as discrimination by the manager (35 %). Respondents with work experience less than ten years (62 %), working in temporary position (75 %) or in management position (88 %) were, more unwilling to blow the whistle. Whistleblowing should be conducted internally, to the closest manager in writing and anonymously. Wrongdoing should be dealt between the parties involved, and written warning should ensue from wrongdoing. According to the results of this study whistleblowing on wrongdoing in health care causes negative consequences to the whistleblower. In future, attention in health care should be paid to preventing wrongdoing and enhancing whistleblowing in order to decrease wrongdoing and lessen the consequences that whistleblowers face after blowing the whistle.

Whistleblowing process in Finnish health care

Wrongdoing in health care is harmful action that jeopardizes patient safety and can be targeted at the patient or employees. Wrongdoing can vary from illegal, unethical or unprofessional action to inappropriate behavior in the workplace. Whistleblowing can be considered as a process where wrongdoing is suspected or oberved in health care by health care professionals and disclosed to the party that can influence the wrongful action. Whistleblowing causes severe harm to the whistleblower and to the object of whistleblowing complaint, to their personnel life and working community. The aim of this study was to analyze whistleblowing process in Finnish health care. The overall goal is to raise concern about wrongdoing and whistleblowing in Finnish health care. In this cross-sectional descriptive study the data were collected (n = 397) with probability sampling from health care professionals and members of The Union of Health and Social Care Professionals in Finland Tehy. The data were collected with questionnaire: “Whistleblowing -väärinkäytösten paljastaminen terveydenhuollossa” developed for this study and by using Webropol questionnaire -software during 26.6.-17.7.2015. The data were analyzed statistically. According to the results of this study health care professionals had suspected (67 %) and observed (66 %) wrongdoing in health care, more often than once a month (30%). Mostly were suspected (37 %) and observed (36%) inadequacy of the personnel and least violence toward the patient (3 %). Wrongdoing was whistle blown (suspected 29 %, observed 40 %) primarily inside the organization to the closest supervisor (76 %), face-to-face (88 %). Mostly the whistle was blown on nurses’ wrongdoing (58 %). Whistleblowing act didn’t end the wrongdoing (52 %) and whistleblowing had negative consequences to the whistleblower such as discrimination by the manager (35 %). Respondents with work experience less than ten years (62 %), working in temporary position (75 %) or in management position (88 %) were, more unwilling to blow the whistle. Whistleblowing should be conducted internally, to the closest manager in writing and anonymously. Wrongdoing should be dealt between the parties involved, and written warning should ensue from wrongdoing. According to the results of this study whistleblowing on wrongdoing in health care causes negative consequences to the whistleblower. In future, attention in health care should be paid to preventing wrongdoing and enhancing whistleblowing in order to decrease wrongdoing and lessen the consequences that whistleblowers face after blowing the whistle.

Patient hand hygiene compliance in the hemodialysis environment

Hand hygiene compliance of patients receiving hemodialysis treatment is a contemporary discussion topic among health care professionals in the Nephrology Clinic of Helsinki University City Hospital. The purpose of the Final Thesis is to review patient hand hygiene in terms of risks its lack entails and based on the evidence based findings to design an end product as a poster. The poster can be utilised in the Nephrology Clinic's nursing environment to educate and motivate patients to pay specifid attention to the importance of hand hygiene. The method used was a systematic literature review. The most important evidence based findings were extracted from the chosen thirteen scientific articles. All articles were searched from the Cumulative Index to Nursing and Allied Health Literature electronic database. The gathered information was then used to build the content of a patient education tool that for this project was defined as a Poster. The findings in this study showed that transmission of bloodborne infections, like Hepatitis B or C virus can occur through a vascular access and that the consequences of this can be very fatal. Additionally, environmental surfaces such as furniture, door knobs and dialysis machine control knobs were all possible infection sources for the patient receiving hemodialysis treatment. Adherence to good hand hygiene behaviour lowered the risk for infections. The end product of this study is a poster that is targeted to patients undergoing hemodialysis treatment. Using a health promotion agenda in the Poster, it is hoped that patients will pay more attention to the importance of hand hygiene and that they will be more motivated to use aseptic methods such as alcohol based hand rubs in the hemodialysis setting.

Using software metrics to increase efficiency in product creation

Opinnäytetyö etsii korrelaatiota ohjelmistomittauksella saavutettujen tulosten ja ohjelmasta löytyneiden virheiden väliltä. Työssä käytetään koeryhmänä jo olemassaolevia ohjelmistoja. Työ tutkii olisiko ohjelmistomittareita käyttämällä ollut mahdollista paikallistaa ohjelmistojen ongelmakohdat ja näin saada arvokasta tietoa ohjelmistokehitykseen. Mittausta voitaisiin käyttää resurssien parempaan kohdentamiseen koodikatselmuksissa, koodi-integraatiossa, systeemitestauksessa ja aikataulutuksessa. Mittaamisen avulla nämä tehtävät saisivat enemmän tietoa resurssien kohdistamiseen. Koeryhmänä käytetään erilaisia ohjelmistotuotteita. Yhteistä näille kaikille tuotteille on niiden peräkkäiset julkaisut. Uutta julkaisua tehtäessä, edellistä julkaisua käytetään pohjana, jonka päällekehitetään uutta lähdekoodia. Tämän takia ohjelmistomittauksessa pitää pystyä erottelemaan edellisen julkaisun lähdekoodi uudesta lähdekoodista. Työssä käytettävät ohjelmistomittarit ovat yleisiä ja ohjelmistotekniikassalaajasti käytettyjä mittaamaan erilaisia lähdekoodin ominaisuuksia, joiden arvellaan vaikuttavan virhealttiuteen. Tämän työn tarkoitus on tutkia näiden ohjelmistomittareiden käytettävyyttä koeryhmänä toimivissa ohjelmistoympäristöissä. Käytännön osuus työstä onnistui löytämään korrelaation joidenkinohjelmistomittareiden ja virheiden väliltä, samalla kuin toiset ohjelmistomittarit eivät antaneet vakuuttavia tuloksia. Ohjelmistomittareita käyttämällä näyttää olevan mahdollista tunnistaa virhealttiit kohdat ohjelmasta ja siten parantaa ohjelmistokehityksen tehokkuutta. Ohjelmistomittareiden käyttö tuotekehityksessäon perusteltavaa ja niiden avulla mahdollisesti pystyttäisiin vaikuttamaan ohjelmiston laatuun tulevissa julkaisuissa.

Henkilöstöraportointi ICT-alan pörssiyrityksissä

Tämän tutkimuksen aiheena on tarkastella ICT-alan pörssiyritysten henkilöstöraportoinnin nykykäytäntöä. Tutkimuksen tarkoituksena on selvittää vapaaehtoisen henkilöstöraportoinnin laatua, laajuutta ja eroavaisuuksia yritysten vuoden 2004 vuosikertomuksissa ja muissa julkaistuissa henkilöstöinformaatiota sisältävissä raporteissa. Tutkimus jakaantuu kahteen päätavoitteeseen. Tutkimuksen ensimmäisenä tavoitteena on esitellä, mitä erilaisia lähestymistapoja ja malleja yrityksen henkilöstöinformaation mittaamiseen ja raportointiin on kirjallisuudessa esitetty. Toisena tavoitteena on selvittää ja kuvata sitä, millaista tutkimuksen kohdeyritysten henkilöstöraportointi tällä hetkellä on. Tutkimus kuuluu laadullisen tutkimuksen piiriin ja on luonteeltaan deskriptiivistä ja ymmärtämään pyrkivää. Lisäksi tutkimuksen voidaan todeta olevan empiirinen - tutkimusmenetelmänä käytetään valmiita aineistoja. Tutkimuksessa tarkastelun kohteeksi valittiin 25 ICT-alan yritystä, jotka on noteerattu vuoden 2004 lopussa Helsingin pörssin päälistalla. Tässä tutkimuksessa henkilöstöraportointia tarkasteltiin henkilöstövoimavarojen laskentatoimen ja osaamispääoman lähestymistapojen kautta. Tutkimuksen perusteella voidaan todeta, että kirjallisuudesta löytyy paljon erilaisia malleja henkilöstöinformaation tuottamiseen, kuten henkilöstötilinpäätös ja erilaiset osaamispääomaraportit. Henkilöstötilinpäätös on organisaation henkilöstöpääoman julkiseen raportointiin tarkoitettu asiakirja. Osaamispääomaraporteissa ei keskitytä pelkästään henkilöstölukuihin, vaan henkilöstön rinnalle haetaan tietoa taloudellisista ja aineettomista prosesseista, asiakkaista ja toimintaympäristöstä. Mallit eivät ole toisiaan poissulkevia, vaan täydentäviä. Osaamispääoma voidaan jakaa inhimilliseen pääomaan sekä sisäisiin ja ulkoisiin rakenteisiin. Henkilöstölaskentatoimi tukee inhimillisen pääoman mittausta ja hallintaa sopivin muutoksin. Tutkimuksen perusteellavoidaan todeta, että ICT-alan pörssiyritysten henkilöstöraportoinnin yleinen taso on kohtuullisen hyvä, mutta henkilöstöraportoinnin laatu ja laajuus vaihtelevat suuresti yritysten välillä. Osa yrityksistä käytti enemmän kvantitatiivista tunnuslukupohjaista raportointia ja osa panosti laadulliseen selostuspohjaiseen informointiin. Ensisijaisena henkilöstöraportointimuotona aineiston yritykset käyttivät vuosikertomusta. Yrityskoko selitti henkilöstöraportoinnin laajuutta. Tutkimustulokset osoittivat, että mitä suurempi sekä liikevaihdolla että henkilöstömäärällä mitattuna yritys on, sitä kattavampaa sen henkilöstöraportointi on.

Assessment of critical competences required in managing end-user driven businesses in a global forest products compa

Työn pääasiallisena tavoitteena on selvittää ydinosaamista, jota tarvitaan kansainvälisen metsäteollisuusyrityksen loppukäyttäjävetoisessa liiketoiminnassa. Lisäksi tavoitteena on laatia kompetenssimalli, jota voidaan käyttää mm. rekrytoinnissa, koulutuksen ja työnkierron suunnittelussa. Tarkoituksena on tarkastella sekä tällä hetkellä että tulevaisuudessa tarvittavia ydinosaamisia. Työ keskittyy myyntihenkilöiden kompetenssien kuvaamiseen. Kirjallisuuden ja asiantuntijoiden haastattelujen avulla on selvitetty. kompetensseihin liittyviä asioita ja käsitteitä, kuten organisaation oppiminen, innovaatiot sekä asiakaslähtöisyys. Tämän jälkeen on kartoitettu case-yrityksen kartonkiyksikön myyntihenkilökunnan kompetensseja. Kompetenssikartoitus on tehty teemahaastattelujen avulla sekä lisäksi on käytetty työn aikana laadittua kompetenssimatriisia. Saatuja tuloksia on verrattu yhden asiakkaan näkemyksiin. Tulosten mukaan kolme tärkeintä tämän hetken kompetenssia ovat: holistinen näkemys asioista, suhteiden rakentaminen ja kielitaito. Tulevaisuuden tärkeimpiä kompetensseja puolestaan ovat: asiakaslähtöisyys, sähköinen kaupankäynti ja suhteiden rakentaminen. Lopuksi on käsitelty yleisiä metsäteollisuuden tulevaisuuden haasteita sekä annettu joitain kehitysideoita kompetenssien kehittämistä varten.

Fluoriditasetarkastelu ja päästöjen hallinta ferrokromi- ja terästeollisuudessa

Työn alkuosassa kartoitettiin AvestaPolarit –yhtiöiden Tornion tehtaiden keskeiset fluoridilähteet kuten fluspaatti, valukuonat, valupulverit ja fluorivetyhappo. Valupulverien ja kuonien haihtumis- ja liukoisuuskäyttäytymistä valaistiin kotimaisten ja kansainvälisten tutkimusten avulla. Tutkimustuloksia sovellettiin pääpiirteittäin Tornion tehtaiden tilanteeseen ottamalla huomioon tekijät, jotka saattoivat lieventää tai vahvistaa fluoridien vaikutusta ympäristöön. Yleisesti fluoridien ympäristö- ja terveysvaikutukset arvioitiin vähäisiksi. Työn kokeellisessa osassa määritettiin Tornion tehtaiden ferrokromitehtaan, terässulaton, kuumavalssaamon ja kylmävalssaamon fluoriditaseet. Jokaisen osastojen syötteiden fluoridipitoisuudet selvitettiin tuottajien ilmoittamien tuotekoostumuksien, spesifikaatioiden ja fluoridianalyysien perusteella. Fluoridien kokonaismäärät laskettiin jokaiselle syötteelle ja ne suhteutettiin kunkin osaston vuoden 2001 tuotantotasoon. Tasetarkastelussa suurimpina fluoridisyötteinä nousivat odotetusti esiin terässulaton käyttämä kuonanmuodostaja-aine fluspaatti (CaF2) ja kylmävalssaamon peittaushappo, 70 prosenttinen fluorivetyhappo (HF). Lisäksi muita merkittäviä syötteitä olivat kylmävalssaamon käyttämä kalkkipitoinen sekakuona ja ferrokromitehtaan sulatuskoksi. Tuotoksien eli päästöjen fluoridipitoisuudet saatiin selville päästömittauksin. Jätevesistä otettiin pääosin viikoittaisia kokoomanäytteitä, jotka analysoitiin tehtaan laboratoriossa. Kaasumaiset tuotokset oli määritetty kertamittauksien perusteella. Kiinteiden tuotoksien eli sakkojen ja kuonien fluoridimittaukset suoritettiin 3 sulatuksen kuonanäytteistä ja sakan vuosinäytteestä. Tuotoksista suurimmat ominaispäästökertoimet olivat juuri terässulaton AOD-konvertterin ja senkkauunin kuonilla ja kylmävalssaamon neutraloidulla regenerointisakalla ja neutralointisakoilla. Näistä ei aiheutunut varsinaista päästöä lähiympäristöön, koska sakat ja kuonat loppusijoitetaan tehtaan kaatopaikalle tai niitä käytetään liukenemattomassa muodossa. Tornion tehtaiden fluoridisyötteiden ja -tuotoksien mittausepätarkkuudet vaikuttivat fluoriditaseeseen. Ferrokromitehtaan fluoridisyötteet olivat kokonaismäärältään selvästi suurempia kuin tuotokset. Terässulaton fluoriditaseen tuotokset olivat suurempia kuin syötteet ja kylmävalssaamon syötteet sekä tuotokset olivat karkeasti arvioiden samaa suuruusluokkaa. Kuumavalssaamon fluoridisyötteet ja -tuotokset olivat mitättömiä. Fluoriditaseen epävarmuustekijöitä voidaan vähentää suorittamalla esimerkiksi useita fluoridimittauksia kaasumaisista päästöistä.

Older consumers adopting information and communication technology: Evaluating opportunities for health care applications

The purpose of this dissertation is to analyse older consumers' adoption of information and communication technology innovations, assess the effect of aging related characteristic, and evaluate older consumers' willingness to apply these technologies in health care services. This topic is considered important, because the population in Finland (as in other welfare states) is aging and thus offers a possibility for marketers, but on the other hand threatens society with increasing costs for healthcare. Innovation adoption has been under research from several aspects in both organizational and consumer research. In the consumer behaviour, several theories have been developed to predict consumer responses to innovation. The present dissertation carefully reviews previous research and takes a closer look at the theory of planned behaviour, technology acceptance model and diffusion of innovations perspective. It is here suggested that there is a possibility that these theories can be combined and complemented to predict the adoption of ICT innovations among aging consumers, taking the aging related personal characteristics into account. In fact, there are very few studies that have concentrated on aging consumers in the innovation research, and thus there was a clear indent for the present research. ICT in the health care context has been studied mainly from the organizational point of view. If the technology is thus applied for the communication between the individual end-user and service provider, the end-user cannot be shrugged off. The present dissertation uses empirical evidence from a survey targeted to 55-79 year old people from one city in Southern-Carelia. The empirical analysis of the research model was mainly based on structural equation modelling that has been found very useful on estimating causal relationships. The tested models were targeted to predict the adoption stage of personal computers and mobile phones, and the adoption intention of future health services that apply these devices for communication. The present dissertation succeeded in modelling the adoption behaviour of mobile phones and PCs as well as adoption intentions of future services. Perceived health status and three components behind it (depression, functional ability, and cognitive ability) were found to influence perception of technology anxiety. Better health leads to less anxiety. The effect of age was assessed as a control variable, in order to evaluate its effect compared to health characteristics. Age influenced technology perceptions, but to lesser extent compared to health. The analyses suggest that the major determinant for current technology adoption is perceived behavioural control, and additionally technology anxiety that indirectly inhibit adoption through perceived control. When focusing on future service intentions, the key issue is perceived usefulness that needs to be highlighted when new services are launched. Besides usefulness, the perception of online service reliability is important and affects the intentions indirectly. To conclude older consumers' adoption behaviour is influenced by health status and age, but also by the perceptions of anxiety and behavioural control. On the other hand, launching new types of health services for aging consumers is possible after the service is perceived reliable and useful.

Customer reference marketing in a business to business context

This study focuses on the phenomenon of customer reference marketing in a business tobusiness (B to B) context. Although customer references are generally considered an important marketing and sales tool, the academic literature has paid surprisingly little attention to the phenomenon. The study suggests that customer references could be viewed as important marketing assets for industrial suppliers, and the ability to build, manage and leverage customer reference portfolios systematically constitutes a relevant marketing capability. The role of customer references is examined in the context of the industrial suppliers' shift towards a solution and project orientation and in the light of the on going changes in the project business. Suppliers in several industry sectors are undergoing a change from traditional equipment manufacturing towards project and solution oriented business. It is argued in this thesis that the high complexity, the project oriented nature and the intangible service elements that characterise many contemporary B to B offerings further increase the role of customer references. The study proposes three mechanisms of customer reference marketing: status transfer, validation through testimonials and the demonstration of experience and prior performance. The study was conducted in the context of Finnish B to B process technology and information technology companies. The empirical data comprises 38 interviews with managers of four case companies, 165 customer reference descriptions gathered from six case companies' Web sites, as well as company internal material. The findings from the case studies show that customer references have various external and internal functions that contribute to the growth and performance of B to B firms. Externally, customer references bring status transfer effects from reputable customers, concretise and demonstrate complex solutions, and provide indirect evidence of experience, previous performance, technological functionality and delivered customer value. They can also be leveraged internally to facilitate organisational learning and training, advance offering development, and motivate personnel. Major reference projects create new business opportunities and can be used as a vehicle for strategic change. The findings of the study shed light on the on going changing orientations in the project business environment, increase understanding of the variety of ways in which customer references can be deployed as marketing assets, and provide a framework of the relevant tasks and activities related to building, managing and leveraging a firm's customer reference portfolio. The findings contribute to the industrial marketing research, to the literature on marketing assets and capabilities and to the literature on projects and solutions. The proposed functions and mechanisms of customer reference marketing bring a more thorough and structured understanding about the essence and characteristics of the phenomenon and give a wide ranging view of the role of customer references as marketing assets for B to B firms. The study suggests several managerial implications for industrial suppliers in order to systematise customer reference marketing efforts.

The Contribution of Mobile Device Manufacturers’ Site Usage to Brand Satisfaction and Loyalty

Recently most of the mobile phone manufacturer companies started to pay extra attention to their websites. This research investigates the sources of value creation on the mobile phone manufacturers’ website and the affect visiting the manufacturers’ website has on brand loyalty and brand satisfaction. The results show a correlation between positive website usage experience, brand loyalty and brand satisfaction. Moreover there is a relation between Novelty, Efficiency, Lock-in and the perceived usefulness the manufacturers’ website has on the mobile phone device. And finally the main reason behind Finnish student’s mobile phone brand loyalty is its country of origin.

Att lära för livet hemma och i skolan : elevers uppfattningar av kost och hälsa, konsumtion och privatekonomi samt hushåll och miljö

The home is an important societal arena for upbringing and learning. A child can experience a feeling of participation in the household he or she belongs to very early in life. In this manner, the home environment constitutes an essential foundation for instruction in the subject of Home Economics. At school, Home Economics pupils should fulfill the intentions that school curriculum has for the subject, that is to say develop the knowledge, skills, and values that allow pupils to be able to take responsibility for their health, finances, comfort, and safety in their close environment. The purpose of this study is twofold. Firstly, the study aims to examine what knowledge and attitudes children and teenagers have acquired from their home environment, close environment, as well as school. Secondly, the study aims to evaluate the effects of instruction in Home Economics, at the 7th grade level, as regards diet and health, consumption and private finances, as well as household and the environment. The study’s methodological foundation focuses on pupils’ understanding of the surrounding world. A phenomenographical approach to the research phenomenon basis itself on the supposition that knowledge is fixed in human beings’ consciousness and experiences. Furthermore, the study stresses individual variations in conjunction with the experienced phenomenon. The empirical portion of the study is based on semistructured interviews of 30 pupils divided into two reference groups. The pupils were interviewed before instruction in the subject of Home Economics started and upon completing instruction. The interview data was analyzed and interpreted in accordance with the “multistage model”. The study results show that upbringing in the home environment is determinative as pertains to understanding of the socio-cultural household environment. Mealtime traditions, for example, are deeply ingrained but nonetheless influenced by lifestyle changes. The study shows that a didactic challenge exists to draw attention to the consequences of poor mealtime habits and stress for everyone raising or educating children and teenagers. Despite good knowledge of what a healthy diet is, the majority of pupils choose fast-food and junk-food when they eat out to save time and money. Studies of pupils’ preparedness for consumption show that a purposeful upbringing in the home in combination with relevant instruction in Home Economics, results in knowledgeable consumers. This study also shows that upbringing in the home environment and instruction in Home Economics requires an intense and conscious focus on the consequences of a household not run in accordance with nature, where the household lifestyle is nonsustainable. Pupils’ understanding is often based on the disregarding of the survival perspective for a comfort perspective. Parents and Home Economics teachers should be able to bring up and teach children and teenagers in a manner that allows children and teenagers to take responsibility for their health, private finances, as well as comfort and safety in the close environment. The method is conscious nurturing and instruction.

Lipotoxicity in Obesity and Coronary Artery Disease. Studies by PET, CT and MR

Lipotoxicity is a condition in which fatty acids (FAs) are not efficiently stored in adipose tissue and overflow to non-adipose tissue, causing organ damages. A defect of adipose tissue FA storage capability can be the primary culprit in the insulin resistance condition that characterizes many of the severe metabolic diseases that affect people nowadays. Obesity, in this regard, constitutes the gateway and risk factor of the major killers of modern society, such as cardiovascular disease and cancer. A deep understanding of the pathogenetic mechanisms that underlie obesity and the insulin resistance syndrome is a challenge for modern medicine. In the last twenty years of scientific research, FA metabolism and dysregulations have been the object of numerous studies. Development of more targeted and quantitative methodologies is required on one hand, to investigate and dissect organ metabolism, on the other hand to test the efficacy and mechanisms of action of novel drugs. The combination of functional and anatomical imaging is an answer to this need, since it provides more understanding and more information than we have ever had. The first purpose of this study was to investigate abnormalities of substrate organ metabolism, with special reference to the FA metabolism in obese drug-naïve subjects at an early stage of disease. Secondly, trimetazidine (TMZ), a metabolic drug supposed to inhibit FA oxidation (FAO), has been for the first time evaluated in obese subjects to test a whole body and organ metabolism improvement based on the hypothesis that FAO is increased at an early stage of the disease. A third objective was to investigate the relationship between ectopic fat accumulation surrounding heart and coronaries, and impaired myocardial perfusion in patients with risk of coronary artery disease (CAD). In the current study a new methodology has been developed with PET imaging with 11C-palmitate and compartmental modelling for the non-invasive in vivo study of liver FA metabolism, and a similar approach has been used to study FA metabolism in the skeletal muscle, the adipose tissue and the heart. The results of the different substudies point in the same direction. Obesity, at the an early stage, is associated with an impairment in the esterification of FAs in adipose tissue and skeletal muscle, which is accompanied by the upregulation in skeletal muscle, liver and heart FAO. The inability to store fat may initiate a cascade of events leading to FA oversupply to lean tissue, overload of the oxidative pathway, and accumulation of toxic lipid species and triglycerides, and it was paralleled by a proportional growth in insulin resistance. In subjects with CAD, the accumulation of ectopic fat inside the pericardium is associated with impaired myocardial perfusion, presumably via a paracrine/vasocrine effect. At the beginning of the disease, TMZ is not detrimental to health; on the contrary at the single organ level (heart, skeletal muscle and liver) it seems beneficial, while no relevant effects were found on adipose tissue function. Taken altogether these findings suggest that adipose tissue storage capability should be preserved, if it is not possible to prevent excessive fat intake in the first place.