Fuzzy subgroups, algebraic and topological points of view and complex analysis

Fuzzy subsets and fuzzy subgroups are basic concepts in fuzzy mathematics. We shall concentrate on fuzzy subgroups dealing with some of their algebraic, topological and complex analytical properties. Explorations are theoretical belonging to pure mathematics. One of our ideas is to show how widely fuzzy subgroups can be used in mathematics, which brings out the wealth of this concept. In complex analysis we focus on Möbius transformations, combining them with fuzzy subgroups in the algebraic and topological sense. We also survey MV spaces with or without a link to fuzzy subgroups. Spectral space is known in MV algebra. We are interested in its topological properties in MV-semilinear space. Later on, we shall study MV algebras in connection with Riemann surfaces. In fact, the Riemann surface as a concept belongs to complex analysis. On the other hand, Möbius transformations form a part of the theory of Riemann surfaces. In general, this work gives a good understanding how it is possible to fit together different fields of mathematics.

Strategic groupsin the European energy industry

Strategisten ryhmien teoria tarjoaa mahdollisuuden keskitason analyysiin yritysten ja toimialan välillä yritysten kilpailullisen aseman tarkasteluun. Strategiset ryhmät ovat samalla toimialalla toimivia yrityksiä, joilla on samanlaiset strategiset ominaisuudet, jotka kilpailevat samanlaisilla perusteilla tai jotka toteuttavat samanlaista strategiaa. Tässä tutkimuksessa strategisten ryhmien teoriaa on käytetty eurooppalaisten energiayritysten ryhmittelyyn. Tutkimuksessa oli mukana 104 energia-alan yritystä, jotka jaettiin viiteen strategiseen pääryhmään yritysten maantieteellisen toiminta-alueen ja koon mukaan. Jokainen ryhmä edustaa erilaista strategiaa. Muita strategisia ominaisuuksia, joita ovat diversifikaatioaste, tuotantoteknologia ja omistusmuoto, käytettiin muodostamaan alaryhmiä edellisistä pääryhmistä. Muodostettuja strategisia ryhmiä käytettiin seuraavaksi suoristuskykyerojen tutkimiseen ryhmien välillä. Suorituskykyä kuvaaviksi muuttujiksi valittiin liikevoitto-%, koko pääoman tuottoaste, vakavaraisuus-% ja current ratio. Tulokset osoittavat, että energiayritykset voidaan jakaa ryhmiin valittujen strategisten ominaisuuksien perusteella. Nämä yritysten strategiset valinnat eivät vaikuta merkittävästi yritysten taloudelliseen suorituskykyyn valittujen suorituskykymuuttujien osalta. Monikansalliset jättiläisyritykset ovat suorituskyvyltään heikoimpia ja eurooppalaiset suuryritykset parhaita ryhmiä, mutta erot eivät ole tilastollisesti merkittäviä. Ainut merkittävä ero suorituskykymuuttujissa oli vakavaraisuudessa monikansallisten ja eurooppalaisten suurten yritysten välillä. Muut suorituskykymuuttujat eivät eronneet ryhmien välillä tilastollisesti merkittävästi. Tilastollisesti merkittäviä eroja ei löydetty myöskään alaryhmien välillä.

Factors Related to Study Success at Lappeenranta University of Technology

Tutkimuksen avulla selvitettiin opintomenestykseen liittyviä tekijöitä Lappeenrannan teknillisessä korkeakoulussa (LTKK). Tutkimus liittyi opetuksen ja oppimisen kehitystyöhön tuotantotalouden osastolla. Tutkimuksen viitekehyksen muodosti oppimistuloksia selittävä malli, joka on laadittu Tynjälän (1999) kokoaman mallin perusteella. Tutkimuksen perusjoukko muodostui LTKK:n läsnä olevista perusopiskelijoista lukuun ottamatta jatko- ja vaihto-opiskelijoita. Opiskelijat jaettiin ositetulla otannalla ryhmiin, joissa suoritettiin yksinkertainen satunnaisotanta. Otoskoko oli 645 opiskelijaa. Tiedonkeruumenetelmänä oli Internet-kysely. Aineisto analysoitiin useiden kvantitatiivisten ja kvalitatiivisten menetelmien avulla. Tutkimuksen tuloksia voidaan pitää luotettavina ja tutkimuksen avulla saatiin tärkeää ja hyödyllistä tietoa opintomenestyksestä ja oppimisprosesseista. Tulosten perusteella merkittävimmät oppimistuloksiin positiivisesti liittyvät tekijät ovat syväsuuntautunut opiskelustrategia ja luottaminen omiin kykyihin, ja negatiiviset tekijät ovat oppimisen itsesäätelyn puute, omien kykyjen epäily ja pintasuuntautunut opiskelustrategia. Merkitysorientoituneet, itsesäätelykykyiset opiskelijat menestyivät LTKK:ssa parhaiten.

Predictors and Correlates of Substance Use among Young Men. The Longitudinal “From a Boy to a Man” Birth Cohort Study.

Substance use is one of our most important public health problems. Studying risk factors in a longitudinal study setting helps to identify subgroups of young people at greater risk for substance-use-related problems, and to facilitate targeted prevention efforts. The aim of this thesis was to study childhood predictors and correlates of substance-use-related outcomes among young men in a longitudinal, nationwide birth cohort study. The study population included 10% of all Finnish-speaking boys born in Finland in 1981 (n=2946, 97% of the target population). In 1989, at age eight, valid measures of psychiatric symptoms (Rutter questionnaires and Children’s Depression Inventory) were obtained from parents, teachers and the boys themselves. In 1999, at age 18, boys were reached at their obligatory military call-up (n=2348, 80% of the boys attending the study in 1989). Self-reports of substance use, psychopathology, adaptive functioning (Young Adult Self-Report), and mental health service use were obtained through questionnaires. Information about psychiatric diagnoses from the Military Register (age 18-23 years) and information about offending from the National Police Register (age 16-20 years) were collected in early adulthood (92% of the 1989sample). Boys with childhood conduct, hyperactive, and comorbid conduct-emotional problems had elevated rates of substance use and substance-use-related crime in early adulthood. Depressive symptoms predicted daily smoking, especially among boys of low-educated fathers. Emotional problems predicted lower occurrence of drunkenness-related alcohol use and smoking. Teacher reports on boys’ problem behaviour had the best predictive power for later substance use. At age 18, frequent drunkenness associated with delinquency, smoking and illicit drug use, and having friends. Occasional drunkenness associated with better psychosocial functioning in general compared to boys with frequent drunkenness or without drunkenness-related alcohol use. Illicit drug use without drug offending was not predicted by childhood psychiatric symptoms, but 22% of boys with illicit drug use had a psychiatric diagnosis in early adulthood. Drug offenders, in turn, had psychiatric problems both in childhood and in adulthood. Psychiatric disorders were common among young men with substance-use-related crime. Recidivist crime associated strongly with having a substance use disorder diagnosis according to the Military Register. At age 18, frequent drunkenness was common among boys entering mental health services, but entering substance use treatment was non-existent. According to the findings of this thesis, substance-use-related outcomes accumulate in boys having psychiatric problems both in childhood and in early adulthood. Targeted early interventions in school health care systems, particularly for boys with childhood hyperactive, conduct, and comorbid conduct-emotional problems are recommended. Psychiatric problems and risky behaviours, such as delinquency should always be assessed alongside substance use. Specialized and multidisciplinary care are required for young men who have multiple or complex needs, for instance, for young men with drug offending and recidivist crime. Integrating a substance use treatment perspective with other services where young men are encountered is emphasized.

Ohjauksen ja neuvonnan vaikutukset sepelvaltimoiden ohitusleikkauspotilaiden terveyskäyttäytymiseen, terveyteen ja toimintakykyyn

Effects of counseling and guidance on health behavior, health, and functional abilities of coronary artery bypass (cab) patients Hospital periods of heart patients are brief and full of activity today, and for that reason, the meaning of counseling and guidance becomes emphasized. The present intervention study started based on observations of staff members at the heart organization. According to these observations, there were gaps in counseling and guidance intended for coronary artery bypass (CAB) patients. The purpose of the present intervention study was to describe and evaluate the program on counseling and guidance organized for patients who were referred to CAB operations. More specifically, the study was to assess its short-term (3-month), intermediate (6-month), and long-term (12-month) effects on health behavior, health, and functional abilities of CAB patients of any age on one hand and elderly on the other, as well as on their mortality. The data consisted of those individuals having coronary heart disease (CHD) and living in Uusimaa (n = 365) who went through their first CAB operation at the Helsinki University Hospital between May 7th, 1998 and December 31st, 2001. Based on the need of urgency, they were divided into two groups: 1) surgery with regular referral procedure (non-acute) or 2) surgery in the acute phase of CHD. Randomization into an intervention and a control group was separately carried out within these two groups. A subgroup was formed by including those 65 years or older who were operated on with regular referral procedure. Data on health behavior, health, and functional abilities were gathered with survey questionnaires. Times and causes of death were examined January 1st, 1998 through December 31st, 2004. Intervention included counseling and guidance in small groups. The intervention of the non-acutely operated patients was implemented prior to and following surgery, whereas the intervention of the acutely operated patients was implemented after surgery alone. The control group received regular health care services. Counseling and guidance contributed in positive terms to the frequency of alcohol use among non-acutely operated men and to the frequencies of exercise and functional ability among women. The intervention was also capable of having an effect on the exercise frequencies of elderly and acutely operated men. The present intervention did not have an effect on the body mass index, whereas it had barely a slight effect on the health status of the CAB patients. The findings of the intervention and generalizations resulting from them must be viewed critically because the data analysis utilized a multi-testing situation, many variables, and several subgroups. The study did not involve intention to treat analysis. Additionally, a loss of patients was great especially among the elderly and acutely operated patients.

Molecular profiling of human endometrium and endometriosis

Endometriosis is a common hormone-dependent gynecological disease leading to severe menstrual and/or chronic pelvic pain with or without subfertility. The disease is defined by the presence of endometrium-like tissue outside the uterine cavity, primarily on the pelvic peritoneum, ovaries and infiltrating organs of the peritoneal cavity. The current tools for diagnosis and treatment of endometriosis need to be improved to ensure reliable diagnosis and effective treatment. In addition, endometriosis is associated with increased risk of ovarian cancer and, therefore, the differential diagnosis between the benign and malignant ovarian cysts is of importance. The long-term objective of the present study was to support the discovery of novel tools for diagnosis and treatment of endometriosis. This was approached by exploiting genome-wide expression analysis of endometriosis specimens. A novel expression profiling -based classification of endometriosis indicated specific subgroups of lesions partially consistent with the clinical appearance, but partially according to unknown factors. The peritoneum of women with endometriosis appeared to be altered in comparison to that of healthy control subjects, suggesting a novel aspect on the pathogenesis of the disease. The evaluation of action and metabolism of sex hormones in endometrium and endometriosis tissue indicated a novel role of androgens in regulation of the tissues. In addition, an enzyme involved in androgen and neurosteroid metabolism, hydroxysteroid (17beta) dehydrogenase 6, was found to be highly up-regulated in endometriosis tissue as compared to healthy endometrium. The enzyme may have a role in the pathogenesis of endometriosis or in the endometriosis associated pain generation. Finally, a new diagnostic biomarker, HE4, was discovered distinguishing patients with ovarian endometriotic cysts from those with malignant ovarian cancer. The information acquired in this study enables deeper understanding of endometriosis and facilitates the development of improved diagnostic tools and more specific treatments of the disease

Koulutetut maahanmuuttajat työmarkkinoilla. Tutkimus korkeakoulututkinnon suorittaneiden maahanmuuttajien työllistymisestä ja työurien alusta Suomessa

Maahanmuuttajien määrä on Suomessa merkittävämmin lisääntynyt vasta 1990- ja 2000-luvuilla. Vuonna 2010 Suomessa asui lähes 170 000 ulkomaan kansalaista. Tavallisimmin Suomeen muutetaan avioliiton, paluumuuton tai pakolaisuuden vuoksi. Pieni, joskin kasvava joukko muuttaa työn tai opiskelun vuoksi. Myös kansalaisuuksien, koulutustaustojen, ammattien jne. kirjo muuttajien joukossa on suuri. Ulkomaan kansalaisten lisääntyessä Suomessa on jouduttu kohtaamaan monenlaisia maahanmuuttoon liittyviä haasteita, joista työllistymiseen liittyvät kysymykset eivät ole vähäisimpiä. Tutkimuksessa tarkastellaan lähtömaassaan korkeakoulututkinnon suorittaneiden maahanmuuttajien työllistymistä ja työuran alkua Suomessa. Tutkimuksen tarkoituksena on selvittää, miten korkeakoulutetut maahanmuuttajat ovat Suomessa työllistyneet, minkälaisia heidän työuriensa alut ovat Suomessa olleet ja miten he ovat onnistuneet uudessa maassa hyödyntämään lähtömaassa hankkimaansa koulutusta. Lisäksi tutkimuksessa tarkastellaan, miten maahanmuuttajien lähtömaan erilaiset elämäntilanteet, olosuhteet ja valinnat ovat vaikuttaneet työuran muotoutumiseen Suomessa. Tutkimuksen aineisto muodostuu kysely- sekä haastatteluaineistosta. Kyselyaineiston (n=99) tarkoituksena on luoda määrällistä kuvaa korkeakoulutettujen maahanmuuttajien työllistymisestä Suomessa. Numerotietojen taakse jää kuitenkin näkymättömiin tieto maahanmuuttajien yksilöllisistä kokemuksista liittyen työllistymiseen ja työuran muotoutumiseen uudessa maassa. Toisena aineistona hyödynnettävän elämäkerrallisen haastatteluaineiston (n=20) kautta on mahdollista tehdä näkyväksi ne tutkittavien yksilölliset työ- ja koulutusuraan liittyvät valinnat, joita maahanmuuttajat ovat tehneet niin lähtömaassa kuin Suomessa sekä ne tilanteet ja olosuhteet, joissa tutkittavat ovat lähtömaassa eläneet ja joiden pohjalta he ovat tulleet Suomeen ja Suomen työmarkkinoille. Aineistoissa mukana olevat maahanmuuttajat olivat pääosin avioliiton, paluumuuton sekä pakolaisuuden vuoksi Suomeen tulleita. Vain muutama oli tullut työn vuoksi. Maahanmuuttajien työmarkkina-asemaa selitetään usein maahanmuuttajien resursseilla, kuten kielitaidolla, koulutuksella, työkokemuksella, sosiaalisten suhteiden ja verkostojen laadulla ja määrällä jne. Myös maahanmuuttajiin kohdistuvilla syrjivillä ja ennakkoluuloisilla asenteilla on keskeinen merkitys työllistymisessä. Koulutuksen ollessa yksi keskeisimmistä työmarkkina-asemaa määräävistä tekijöistä, tulisi koulutettujen maahanmuuttajien sijoittua hankitun tutkinnon oikeuttamiin tehtäviin. Tutkimuksessa kuitenkin havaittiin, että työllistyminen oli maahanmuuttajilla vaikeaa hyvästä koulutuksesta huolimatta. Kyselyaineistoon vastanneista vain muutama (6 %) oli työssä heti Suomeen muuttovuoden lopussa, kolme vuotta Suomessa asuttuaan työssä oli runsas kolmannes (35 %) ja aineistonkeruuhetkellä eli vuonna 2004 työssä oli 38 % vastaajista. Työsuhteet olivat tutkittavilla useimmiten määräaikaisia ja kestoltaan lyhyitä. Lisäksi työurat koostuivat runsaasta työttömyydestä sekä koulutukseen osallistumisesta. Myönteistä kuitenkin oli, että mikäli korkeakoulutetut maahanmuuttajat onnistuivat Suomessa työllistymään, vastasi työ usein joko kokonaan tai ainakin osittain hankittua korkeakoulututkintoa. Korkeakoulutettujen maahanmuuttajien työuran alut Suomessa voidaan tyypitellä kolmeen ryhmään, joista kukin jakaantui vielä kahteen alaryhmään siten, että kaiken kaikkiaan saatiin kuusi erilaista työuran alun tyyppiä: koulutusta vastaava vakaa ja vakiintuva ura, koulutusta osittain vastaava sekaura ja laskeva ura sekä koulutusta vastaamaton sisääntuloura ja työttömän ura . Haastatteluaineiston kautta tarkastellaan korkeakoulutettujen maahanmuuttajien yksilöllisiä elämänuria lähtien liikkeelle korkeakoulutettujen maahanmuuttajien lähtömaassa tekemistä ura- ja ammatinvalinnoista jatkuen Suomeen muuton kautta aina työuran muotoutumiseen Suomessa. Haastatteluja toisistaan erottelevina keskeisinä teemoina olivat toisaalta pärjääminen Suomessa ja suomalaisilla työmarkkinoilla toisaalta elämän muotoutuminen lähtömaassa ja nimenomaan siellä tehdyt ura- ja ammatinvalinnat ja niihin liittyvät kokemukset ja elämäntilanteet. Näiden kriteerien pohjalta aineisto jakaantui kolmeen ryhmään, jotka nimettiin pärjääjiksi, harhailijoiksi ja sinnittelijöiksi. Pärjääjien kertomukset muotoutuivat tietyllä tavalla myönteisen kehän kautta: niin lähtömaassa tehdyt ammatinvalinnat kuin työuran muotoutuminen Suomessa tapahtuivat suhteellisen vaivattomasti. Useimmiten työt Suomessa vastasivat lähtömaassa hankittua koulutusta. Omiin uravalintoihin oltiin myöhemmin myös tyytyväisiä. Harhailijoille oman paikan löytyminen oli puolestaan hankalampaa. Leimallista tälle ryhmälle oli tietynlainen valintojen vaikeus sekä tyytymättömyys omiin aikaisemmin tehtyihin ratkaisuihin. Jotkut harmittelivat nuorena tekemiään uravalintoja niin, että päättivät Suomessa hankkia kokonaan uuden ammatin. Muutto Suomeen merkitsi useimmille ammatillisen aseman laskua. Sinnittelijät kertoivat jo lähtökohdiltaan kahteen muuhun ryhmään nähden hyvin erilaista tarinaa. Tämän ryhmän lähes koko elämä lähtömaassa oli sodan ja levottomuuksien sävyttämää. Tämä näkyi myös ammatinvalinnassa: opiskelupaikka oli saatettu valita esimerkiksi sen perusteella, missä oli milloinkin turvallista opiskella. Myös Suomeen muutto erosi kahdesta aikaisemmasta ryhmästä, sillä lähtö entisestä kotimaasta oli tapahtunut usein hyvinkin yllättäen vailla etukäteissuunnittelua tilanteiden kärjistyttyä nopeasti. Suomessa työelämään pääseminen oli kaikille sinnittelijöille vaikeaa ja haastatteluhetkellä useilla vielä hyvin alkutekijöissä. Hyväkään koulutus ei aina takaa maahanmuuttajille työtä uudessa maassa, sillä hankittua tutkintoa ja osaamista ei ole helppo siirtää maasta toiseen. Pahimmassa tapauksessa vieraassa maassa suoritettu korkeakoulututkinto voi kokonaan mitätöityä uudessa maassa ja korkeakoulututkinnon myötä hankittu osaaminen menettää täysin arvonsa. Kyse on niin yksilön kuin yhteiskunnankin resurssien tuhlaamisesta tilanteessa, jossa maassa pysyvästi asuvat koulutetut maahanmuuttajat työskentelevät tavalla tai toisella koulutustaan vastaamattomissa epävakaissa töissä, työmarkkinoiden laitamilla tai ovat kokonaan työmarkkinoiden ulkopuolella.

Eating disorders, weight perception, and dieting in adolescence

Background: Eating disorders are serious psychiatric disorders, which usually have their onset in adolescence. Body dissatisfaction and dieting, both common among adolescents, are recognised risk factors for eating disorders. The aim of the present study was to assess the prevalence of eating disorders in the general adolescent population, assess the risk of developing eating disorders in subgroups of dieters, and analyse longitudinal concomitants of incorrect weight perception. Method: A prospective follow-up study on 595 adolescents, aged 15 at baseline, was conducted in western Finland. The study comprised questionnaires directed at the whole study population and subsequent personal interviews with adolescents found to be screen-positive for eating disorders, at both baseline and three-year follow-up. Results: The lifetime prevalence rates for 18 year old females were 2.6 % for anorexia nervosa, 0.4 for bulimia nervosa, and 9.0 % for eating disorder not otherwise specified (EDNOS). No prevalent case of DSM-IV eating disorders was found among the male participants. Eating disorders, as well as depressive symptoms, social anxiety, and low self-esteem, was more prevalent among females who perceived themselves as being overweight, despite being normal or underweight, when compared to females with a correct weight perception. An incorrect weight perception was associated in males with social anxiety. Female adolescents dieting due to psychological distress, rather than vanity or overweight, had a fifteen-fold risk of developing an eating disorder. Conclusions: Eating disorders are common among female adolescents, and adolescents choosing to diet due to psychological distress show a markedly increased risk of developing an eating disorder. Promotion of general well-being as well as the prevention of body dissatisfaction and misdirected dieting, accompanied by early detection and proper treatment of eating disorders, is needed to reduce the incidence of and facilitate recovery in adolescents suffering from eating disorders.

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.

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

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

The prognostic and predictive value of selected biomarkers in colorectal cancer

Tissue-based biomarkers are studied to receive information about the pathologic processes and cancer outcome, and to enable development of patient-tailored treatments. The aim of this study was to investigate the potential prognostic and/or predictive value of selected biomarkers in colorectal cancer (CRC). Group IIA secretory phospholipase A2 (IIA PLA2) expression was assessed in 114 samples presenting different phases of human colorectal carcinogenesis. Securin, Ki-67, CD44 variant 6 (CD44v6), aldehyde dehydrogenase 1 (ALDH1) and β-catenin were studied in a material including 227 rectal carcinoma patients treated with short-course preoperative radiotherapy (RT), long-course preoperative (chemo)RT (CRT) or surgery only. Epidermal growth factor receptor (EGFR) gene copy number (GCN), its heterogeneity in CRC tissue, and association with response to EGFR-targeted antibodies cetuximab and panitumumab were analyzed in a cohort of 76 metastatic CRC. IIA PLA2 expression was decreased in invasive carcinomas compared to adenomas, but did not relate to patient survival. High securin expression after long-course (C)RT and high ALDH1 expression in node-negative rectal cancer were independent adverse prognostic factors, ALDH1 specifically in patients treated with adjuvant chemotherapy. The lack of membranous CD44v6 in the rectal cancer invasive front associated with infiltrative growth pattern and the risk of disease recurrence. Heterogeneous EGFR GCN increase predicted benefit from EGFR-targeted antibodies, also in the chemorefractory patient population. In summary, high securin and ALDH1 protein expression independently relate to poor outcome in subgroups of rectal cancer patients, potentially because of resistance to conventional chemotherapeutics. Heterogeneous increase in EGFR GCN was validated to be a promising predictive factor in the treatment of metastatic CRC.

Tapaustutkimus aineettoman pääoman merkityksestä puupolttoaineiden liiketoiminnassa

Tutkimuksessa selvitetään yhden puupolttoaineorganisaation aineettoman pääoman keskeisimmät tekijät ja niiden välinen dynamiikka laadullisilla tutkimusmenetelmillä. Selvityksen teoreettisen taustan muodostaa tietojohtamisen kirjallisuus, jonka perusteella tietopääoman tekijät on jaettu kolmeen ryhmään: inhimillisiin, rakenne- ja suhdetekijöihin. Puupolttoaineiden liiketoiminta perustuu yksinkertaisen raaka-aineen eli puun hankkimiseen ja toimittamiseen voimalaitoksille eri muodoissa. Liiketoiminnan kannattavuus ja yrityksen asema markkinoilla pohjaa pääosin aineettoman pääoman laaja-alaiseen hyödyntämiseen ja kehittämiseen. Tutkimuksen kohteena on suuren metsäteollisuusyrityksen puunhankintaorganisaatio ja sen puupolttoaineiden liiketoimintayksikkö, jonka arvonmuodostusta ja aineettoman pääoman tekijöitä tutkimuksessa analysoidaan. Tutkimustulokset osoittavat, että puupolttoaineiden liiketoiminnan kannattavuus perustuu henkilöstön vahvaan osaamiseen ja organisaation dynaamisiin johtamismalleihin, joilla voidaan vahvistaa aineettomien tekijöiden yhteisvaikutusta. Haasteena puupolttoainetoiminnassa on aineettoman pääoman tekijöiden suhteuttaminen nopeasti kehittyviin operatiivisiin toimintamalleihin sekä valtiollisiin tukimekanismeihin.

The Effects of the Breast Cancer Mammography Screening Programme in Women aged 40 to 84 years in Turku, Finland (1987-2009)

The objective of this thesis was to evaluate whether a more extensive mammography screening programme (TurkuMSP) conducted by the city of Turku, had an effect on breast cancer (BC) incidence, survival, or mortality in years 1987 to 2009. Despite the fact that some studies have suggested a 20 percent reduction in BC mortality due to mammography screening, there are findings of harm to subjects, which are claimed to negate the benefits of screening. Thus, the aims of this study are most pertinent. A total of 176 908 screening examinations were performed in 36 000 women aged 40−74 during the years 1987−1997. In all, 685 primary BCs were found in the screened women, either screen-detected (n=531) or during screening intervals (n=154). Survival and BC recurrence rate of women with screen-detected BC was compared to 184 women with clinical BCs detected among individuals who did not take part in the screening. The invitation interval, which may influence the outcome, was studied in the age group 40 to 49 by inviting those born in even calendar years annually for mammography screening and those born in odd years, triennially. In addition, BC incidence and mortality in the total female population of Turku aged 40 to 84 years was compared with the respective figures of Helsinki and the rest of Finland, both during the pre-screening era (1976-1986) and the screening era (1987-2009). The study was designed to compare women by age groups, because women aged 50 to 59 were generally screened in all of Finland, whereas only in Turku women aged 40 to 49 and 60 to 74 were screened in addition. Data regarding cancer recurrence were derived from the Finnish Cancer Registry and data on deaths were collected from Statistics Finland. In survival analyses, screened women with invasive BC had a significantly higher survival rate than the women with clinical BC. The survival benefit started to appear already during the first follow-up years and was evident in all age groups. A marginal survival extension was also seen in screened women when BC had spread to ipsilateral axillary nodes already at diagnosis. Recurrence-free survival rate after BC treatment was significantly more favorable among the screened women compared with women with BC found clinically. The screening invitation interval did not significantly influence BC mortality in the subset of women aged 40 to 49 years. There were no consistent differences in the changes of BC incidence between Turku and the comparison areas during the screening era. In Turku, the BC mortality incidence in women aged 55−69 years was significantly lower during the screening era (from 1987 to 1997) compared with the pre-screening era, whereas no such change was found in the city of Helsinki or Tampere. When comparing the changes in incidence-based BC mortality during years 1987 to 2009 in Turku to those of Helsinki and the rest of Finland, there was a suggestion of more than 20 percent lower mortality in Turku among oldest age group (75-84 years) compared with the reference residential areas, but the differences were not consistently significant. Interpretation of the study results should be made with caution because there were no random control groups, and on the other hand, the number of cases in subgroups was fairly low to yield definite conclusions. Also due to the many statistical analyses, some of the findings may be due to chance. The results are, however, suggestive for a decrease of BC mortality in the elderly age groups due to wide mammography screening. This finding needs confirmation in further studies before recommending an expansion of mammography screening to women up to the age of 74 years

Bariatric and Post-Bariatric Surgery: from Metabolic Surgery to Plastic Surgery Indications

Background: Controversy exists concerning indications and outcomes of major bariatric surgery procedures. Massive weight loss after bariatric surgery leads to excess skin with functional and aesthetic impairments. The aim of this study was to investigate the major bariatric surgery procedures and their outcomes in two specific subgroups of morbidly obese patients, ≥55-year-olds and the superobese. Further aims were to evaluate whether the preoperative weight loss correlates with laparoscopic gastric bypass complications. The prevalence and impact of excess skin and the desire for body contouring after bariatric surgery were also studied. Patients and Methods: Data from patients who underwent Laparoscopic Adjustable Gastric Banding (LAGB) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) at Vaasa Central Hospital were collected and postoperative outcomes were evaluated according to the BMI, age and preoperative weight loss. Patients who had undergone bariatric surgery procedures were asked to complete a questionnaire to estimate any impairment due to redundant skin and to analyse each patient’s desire for body contouring by area. Results: No significant difference was found in operative time, hospital stay, or overall early postoperative morbidity between LAGB and LRYGB. Mean excess weight loss percents (EWL%) at 6 and 12 months after LRYGB were significantly higher. A significant difference was found in operative time favouring patients <55 years. Intraoperative complications were significantly more frequent in the group aged >55 years. No significant difference was detected in overall postoperative morbidity rates. A significant difference was found in operative time and hospital stay favouring all patients who lost weight preoperatively. Most patients reported problems with redundant skin, especially on the abdomen, upper arms and rear/buttocks, which impaired daily physical activity in half of them. Excess skin was significantly associated with female gender, weight loss and ΔBMI. Patients with a WL >20 kg, ΔBMI ≥10 kg/m2 and an EWL % > 50 showed a significantly surplus skin discomfort (p < 0.001). Most patients desired body contouring surgery, with high or very high desire for waist/abdomen (62.2%), upper arm (37.6%), chest/breast (28.3%), and rear/buttock (35.6%) contouring. Conclusions: LRYGB is effective and safe in superobese (BMI >50) and elderly (>55 years) patients. A preoperative weight loss >5% is recommended to improve the outcomes and reduce complications. A WL >20 kg, ΔBMI ≥10 kg/m2 and an EWL % > 50 are associated with a higher functional discomfort due to redundant skin and to a stronger desire for body contouring plastic surgery.

Congenital upper limb defects in Finland 1993-2005

Background: Interest in limb defects has grown after the thalidomide tragedy in the 1960s. As a result, congenital malformation registries, monitoring changes in birthprevalence and defect patterns, have been established in several countries. However, there are only a few true population based studies on birth prevalence of upper limb defects. The burden of hospital care among these children, specifically in terms of the number of admissions and total time spent in hospital, is also unknown. Aims and Methods: This study is based on information gathered from the Finnish Register of Congenital malformations (FRM) and the Finnish Hospital Discharge Register (FHDR). A total of 417 children born between 1993 and 2005 with an upper limb defect were gathered from the FRM. The upper limb defects were classified using the International Federation of Societies for Surgery of the Hand -classification that enables comparison with previous and future studies. Birth and live birth prevalence, sex and side distribution, frequency of associated anomalies as well as the proportion of perinatal and infant deaths according to the different subtypes were calculated. The number of hospital admissions, days spent in hospital, number and type of surgical operations were collected from the FHDR. Special features of two subgroups, radial ray defects (RRD) and constriction band syndrome (CBS), were explored. Results: Upper limb defects were observed in 417 of 753 342 consecutive births and in 392 of 750 461 live births. Birth prevalence was 5.5 per 10 000 births and 5.2 per 10 000 live births. Multiple anomalies or a known syndrome was found in 250 cases (60%). Perinatal mortality was 139 per 1000 births and infant mortality 135 per 1000 live births (overall Finnish perinatal mortality <5 per 1000 births and infant mortality 3.7 per 1000 live births). Altogether, 138 infants had RRD and 120 (87%) of these had either a known syndrome or multiple major anomalies. The proportion of perinatal deaths in RRD group was 29% (40/138) and infant deaths 35% (43/123). Fifty-one children had CBS in upper limbs. Fifteen of these (29%) had other major anomalies associated with constriction rings. The number of hospital admissions per year of children with congenital upper limb defects was 11-fold and the time spent in hospital 13-fold as compared with the general paediatric population. Conclusions: Birth prevalence of congenital upper limb defects was 5.5 per 10 000 births and 5.2 per 10 000 live births. RRD was especially associated with other major anomalies and high mortality. Nearly one third of the children with CBS also had other major anomalies suggesting different aetiologies inside the group. The annual burden of hospital care of children with congenital upper limb defects was at least 11-fold as compared with the general paediatric population.