Teini-ikäisten tyttöjen ruokaturva Zambézian kaupungeissa ja maaseudulla

Johdanto Riittämätön ravinnonsaanti haittaa lasten fyysistä ja psyykkistä kasvua. Se myös heikentää Saharan eteläpuoleisen Afrikan tuottavuutta ja taloudellista kehitystä. Erityisen heikossa asemassa ovat lapset ja hedelmällisessä iässä olevat naiset johtuen nopean kasvun, raskauden ja imetyksen aiheuttamista vaatimuksista. Yleensä ruokaturvattomuus johtuu fyysisestä tai taloudellisesta ruoan hankintamahdollisuuden puuttumisesta ja on näin ollen läheisesti yhteydessä köyhyyteen sekä kestävien elinkeinojen ja turvaverkostojen puuttumiseen. Kaupungistumisen myötä monien afrikkalaisten elinkeinot, ruokatottumukset ja elämäntyyli ovat muuttuneet. Koska elämä kaupungeissa poikkeaa monin tavoin elämästä maaseudulla, myös ruokaturva ja sen taustalla olevat tekijät voivat olla erilaiset kaupungissa ja maaseudulla. Tällöin myös ruokaturvaohjelmat tulee suunnitella asuinpaikan mukaan ja kohdistaa voimavarat tarpeen mukaan. Harvat tutkimukset kuitenkaan tarkastelevat ruokaturvaa yhtä aikaa kaupungissa ja maaseudulla, mistä johtuen ruokaturvan erilaisuudesta näissä eri asuinympäristöissä on vähän tietoa. Tutkimuksen tavoite Tutkimuksen tarkoituksena on selvittää teini-ikäisten tyttöjen ruokaturvan taso Zambézian maakunnan maaseudulla ja kaupungeissa sekä tarkastella onko ruokaturva erilainen maaseudulla ja kaupungeissa. Lisäksi selvitetään mitkä tekijät ovat yhteydessä hyvään ruokaturvaan ja ovatko siihen yhteydessä olevat tekijät erilaisia näissä asuinympäristöissä. Aineisto ja menetelmät Tämä pro gradu -tutkielma on osa suomalais-mosambikilaista yhteistyöprojektia: Teini-ikäisten tyttöjen ravitsemus ja ruokavalio Zambéziassa (Estudo do Estado Nutricional e da Dieta em Raparigas Adolescentes na Zambézia). Tutkimus selvittää 15–18-vuotiaiden teinityttöjen ravitsemustilaa, ruokavaliota ja ruokaturvaa maaseudulla ja kaupunkiympäristössä Zambézian maakunnassa, ennen sadonkorjuuta ja sadonkorjuun jälkeen. Tämä osatutkimus perustuu ennen sadonkorjuuta tammi-helmikuussa 2010 kerättyyn aineistoon (n=277). Ruokaturvaa mitattiin Household Food Insecurity Access Scale (HFIAS) -kyselylomakkeella. Taustatietohaastattelusta poimittiin ruokaturvan kannalta mielenkiintoiset tekijät ja tarkasteltiin niiden yhteyttä ruokaturvaan. Tulokset Ruokaturvan havaittiin olevan huomattavasti parempi maaseudulla kuin kaupungissa. Maaseudulla kotieläimiä omistavat perheet kuuluivat harvemmin huonoon ruokaturvaluokkaan, kuin perheet jotka eivät omistaneet eläimiä. Kaupungissa ylimmässä varallisuustertiilissä olevat perheet kuuluivat keskimmäisessä varallisuustertiilissä olevia harvemmin huonoon ruokaturvaluokkaan. Maaseudun ja kaupungin välillä havaittavaa eroa ruokaturvassa selitti varallisuus. Johtopäätökset Maaseutua ja kaupunkeja tulisi ruokaturvatutkimuksissa käsitellä erillisinä tutkimuskohteina. Erilaiset ruokatottumukset saattavat vaikuttaa koettuun ruokaturvaan kaupungeissa ja maaseudulla. Ruokaturvan taustatekijät ovat myös erilaiset, jolloin ruokaturvattomuuden poistaminen vaatii eri toimintatapoja asuinpaikasta riippuen. Varallisuudella saattaa olla suurempi merkitys ruokaturvan kannalta kaupungeissa kuin maaseudulla. Varallisuuden ja ruokaturvan välisen yhteyden selvittäminen kaupungissa ja maaseudulla vaatii kuitenkin luotettavan varallisuusmittarin. Vuodenaika tulisi ottaa huomioon aiempaa paremmin kun tutkitaan kroonista ruokaturvattomuutta. Ruokaturvatutkimuksissa tulisi kerätä tietoa myös ruokavalion monipuolisuudesta ja tehdä antropometrisiä mittauksia, jotta ruokaturvasta saataisiin kokonaisvaltainen kuva.

Applications of Treatment Effects Models and Semiparametric Estimation

This thesis is composed of an introductory chapter and four applications each of them constituting an own chapter. The common element underlying each of the chapters is the econometric methodology. The applications rely mostly on the leading econometric techniques related to estimation of causal effects. The first chapter introduces the econometric techniques that are employed in the remaining chapters. Chapter 2 studies the effects of shocking news on student performance. It exploits the fact that the school shooting in Kauhajoki in 2008 coincided with the matriculation examination period of that fall. It shows that the performance of men declined due to the news of the school shooting. For women the similar pattern remains unobserved. Chapter 3 studies the effects of minimum wage on employment by employing the original Card and Krueger (1994; CK) and Neumark and Wascher (2000; NW) data together with the changes-in-changes (CIC) estimator. As the main result it shows that the employment effect of an increase in the minimum wage is positive for small fast-food restaurants and negative for big fast-food restaurants. Therefore, it shows that the controversial positive employment effect reported by CK is overturned for big fast-food restaurants and that the NW data are shown, in contrast to their original results, to provide support for the positive employment effect. Chapter 4 employs the state-specific U.S. data (collected by Cohen and Einav [2003; CE]) on traffic fatalities to re-evaluate the effects of seat belt laws on the traffic fatalities by using the CIC estimator. It confirms the CE results that on the average an implementation of a mandatory seat belt law results in an increase in the seat belt usage rate and a decrease in the total fatality rate. In contrast to CE, it also finds evidence on compensating-behavior theory, which is observed especially in the states by the border of the U.S. Chapter 5 studies the life cycle consumption in Finland, with the special interest laid on the baby boomers and the older households. It shows that the baby boomers smooth their consumption over the life cycle more than other generations. It also shows that the old households smoothed their life cycle consumption more as a result of the recession in the 1990s, compared to young households.

Novel Approaches to the Sampling of Atmospheric Aerosols and Determination of Chemical Composition

The Earth s climate is a highly dynamic and complex system in which atmospheric aerosols have been increasingly recognized to play a key role. Aerosol particles affect the climate through a multitude of processes, directly by absorbing and reflecting radiation and indirectly by changing the properties of clouds. Because of the complexity, quantification of the effects of aerosols continues to be a highly uncertain science. Better understanding of the effects of aerosols requires more information on aerosol chemistry. Before the determination of aerosol chemical composition by the various available analytical techniques, aerosol particles must be reliably sampled and prepared. Indeed, sampling is one of the most challenging steps in aerosol studies, since all available sampling techniques harbor drawbacks. In this study, novel methodologies were developed for sampling and determination of the chemical composition of atmospheric aerosols. In the particle-into-liquid sampler (PILS), aerosol particles grow in saturated water vapor with further impaction and dissolution in liquid water. Once in water, the aerosol sample can then be transported and analyzed by various off-line or on-line techniques. In this study, PILS was modified and the sampling procedure was optimized to obtain less altered aerosol samples with good time resolution. A combination of denuders with different coatings was tested to adsorb gas phase compounds before PILS. Mixtures of water with alcohols were introduced to increase the solubility of aerosols. Minimum sampling time required was determined by collecting samples off-line every hour and proceeding with liquid-liquid extraction (LLE) and analysis by gas chromatography-mass spectrometry (GC-MS). The laboriousness of LLE followed by GC-MS analysis next prompted an evaluation of solid-phase extraction (SPE) for the extraction of aldehydes and acids in aerosol samples. These two compound groups are thought to be key for aerosol growth. Octadecylsilica, hydrophilic-lipophilic balance (HLB), and mixed phase anion exchange (MAX) were tested as extraction materials. MAX proved to be efficient for acids, but no tested material offered sufficient adsorption for aldehydes. Thus, PILS samples were extracted only with MAX to guarantee good results for organic acids determined by liquid chromatography-mass spectrometry (HPLC-MS). On-line coupling of SPE with HPLC-MS is relatively easy, and here on-line coupling of PILS with HPLC-MS through the SPE trap produced some interesting data on relevant acids in atmospheric aerosol samples. A completely different approach to aerosol sampling, namely, differential mobility analyzer (DMA)-assisted filter sampling, was employed in this study to provide information about the size dependent chemical composition of aerosols and understanding of the processes driving aerosol growth from nano-size clusters to climatically relevant particles (>40 nm). The DMA was set to sample particles with diameters of 50, 40, and 30 nm and aerosols were collected on teflon or quartz fiber filters. To clarify the gas-phase contribution, zero gas-phase samples were collected by switching off the DMA every other 15 minutes. Gas-phase compounds were adsorbed equally well on both types of filter, and were found to contribute significantly to the total compound mass. Gas-phase adsorption is especially significant during the collection of nanometer-size aerosols and needs always to be taken into account. Other aims of this study were to determine the oxidation products of β-caryophyllene (the major sesquiterpene in boreal forest) in aerosol particles. Since reference compounds are needed for verification of the accuracy of analytical measurements, three oxidation products of β-caryophyllene were synthesized: β-caryophyllene aldehyde, β-nocaryophyllene aldehyde, and β-caryophyllinic acid. All three were identified for the first time in ambient aerosol samples, at relatively high concentrations, and their contribution to the aerosol mass (and probably growth) was concluded to be significant. Methodological and instrumental developments presented in this work enable fuller understanding of the processes behind biogenic aerosol formation and provide new tools for more precise determination of biosphere-atmosphere interactions.

Bacteria colonizing paper machines

Bacteria growing in paper machines can cause several problems. Biofilms detaching from paper machine surfaces may lead to holes and spots in the end product or even break the paper web leading to expensive delays in production. Heat stable endospores will remain viable through the drying section of paper machine, increasing the microbial contamination of paper and board. Of the bacterial species regularly found in the end products, Bacillus cereus is the only one classified as a pathogen. Certain B. cereus strains produce cereulide, the toxin that causes vomiting disease in food poisonings connected to B. cereus. The first aim of this thesis was to identify harmful bacterial species colonizing paper machines and to assess the role of bacteria in the formation of end product defects. We developed quantitative PCR methods for detecting Meiothermus spp. and Pseudoxanthomonas taiwanensis. Using these methods I showed that Meiothermus spp. and Psx. taiwanensis are major biofoulers in paper machines. I was the first to be able to show the connection between end product defects and biofilms in the wet-end of paper machines. I isolated 48 strains of primary-biofilm forming bacteria from paper machines. Based on one of them, strain K4.1T, I described a novel bacterial genus Deinobacterium with Deinobacterium chartae as the type species. I measured the transfer of Bacillus cereus spores from packaging paper into food. To do this, we constructed a green fluorescent protein (GFP) labelled derivative of Bacillus thuringiensis and prepared paper containing spores of this strain. Chocolate and rice were the recipient foods when transfer of the labelled spores from the packaging paper to food was examined. I showed that only minority of the Bacillus cereus spores transferred into food from packaging paper and that this amount is very low compared to the amount of B. cereus naturally occurring in foods. Thus the microbiological risk caused by packaging papers is very low. Until now, the biological function of cereulide for the producer cell has remained unknown. I showed that B. cereus can use cereulide to take up K+ from environment where K+ is scarce: cereulide binds K+ ions outside the cell with high affinity and transports these ions across cell membrane into the cytoplasm. Externally added cereulide increased the growth rate of cereulide producing strains in medium where potassium was growth limiting. In addition, cereulide producing strains outcompeted cereulide non-producing B. cereus in potassium deficient environment, but not when the potassium concentration was high. I also showed that cereulide enhances biofilm formation of B. cereus.

Carbon dioxide and methane exchange between a boreal pristine lake and the atmosphere

Lakes serve as sites for terrestrially fixed carbon to be remineralized and transferred back to the atmosphere. Their role in regional carbon cycling is especially important in the Boreal Zone, where lakes can cover up to 20% of the land area. Boreal lakes are often characterized by the presence of a brown water colour, which implies high levels of dissolved organic carbon from the surrounding terrestrial ecosystem, but the load of inorganic carbon from the catchment is largely unknown. Organic carbon is transformed to methane (CH4) and carbon dioxide (CO2) in biological processes that result in lake water gas concentrations that increase above atmospheric equilibrium, thus making boreal lakes as sources of these important greenhouse gases. However, flux estimates are often based on sporadic sampling and modelling and actual flux measurements are scarce. Thus, the detailed temporal flux dynamics of greenhouse gases are still largely unknown. ----- One aim here was to reveal the natural dynamics of CH4 and CO2 concentrations and fluxes in a small boreal lake. The other aim was to test the applicability of a measuring technique for CO2 flux, i.e. the eddy covariance (EC) technique, and a computational method for estimation of primary production and community respiration, both commonly used in terrestrial research, in this lake. Continuous surface water CO2 concentration measurements, also needed in free-water applications to estimate primary production and community respiration, were used over two open water periods in a study of CO2 concentration dynamics. Traditional methods were also used to measure gas concentration and fluxes. The study lake, Valkea-Kotinen, is a small, humic, headwater lake within an old-growth forest catchment with no local anthropogenic disturbance and thus possible changes in gas dynamics reflect the natural variability in lake ecosystems. CH4 accumulated under the ice and in the hypolimnion during summer stratification. The surface water CH4 concentration was always above atmospheric equilibrium and thus the lake was a continuous source of CH4 to the atmosphere. However, the annual CH4 fluxes were small, i.e. 0.11 mol m-2 yr-1, and the timing of fluxes differed from that of other published estimates. The highest fluxes are usually measured in spring after ice melt but in Lake Valkea-Kotinen CH4 was effectively oxidised in spring and highest effluxes occurred in autumn after summer stratification period. CO2 also accumulated under the ice and the hypolimnetic CO2 concentration increased steadily during stratification period. The surface water CO2 concentration was highest in spring and in autumn, whereas during the stable stratification it was sometimes under atmospheric equilibrium. It showed diel, daily and seasonal variation; the diel cycle was clearly driven by light and thus reflected the metabolism of the lacustrine ecosystem. However, the diel cycle was sometimes blurred by injection of hypolimnetic water rich in CO2 and the surface water CO2 concentration was thus controlled by stratification dynamics. The highest CO2 fluxes were measured in spring, autumn and during those hypolimnetic injections causing bursts of CO2 comparable with the spring and autumn fluxes. The annual fluxes averaged 77 (±11 SD) g C m-2 yr-1. In estimating the importance of the lake in recycling terrestrial carbon, the flux was normalized to the catchment area and this normalized flux was compared with net ecosystem production estimates of -50 to 200 g C m-2 yr-1 from unmanaged forests in corresponding temperature and precipitation regimes in the literature. Within this range the flux of Lake Valkea-Kotinen yielded from the increase in source of the surrounding forest by 20% to decrease in sink by 5%. The free water approach gave primary production and community respiration estimates of 5- and 16-fold, respectively, compared with traditional bottle incubations during a 5-day testing period in autumn. The results are in parallel with findings in the literature. Both methods adopted from the terrestrial community also proved useful in lake studies. A large percentage of the EC data was rejected, due to the unfulfilled prerequisites of the method. However, the amount of data accepted remained large compared with what would be feasible with traditional methods. Use of the EC method revealed underestimation of the widely used gas exchange model and suggests simultaneous measurements of actual turbulence at the water surface with comparison of the different gas flux methods to revise the parameterization of the gas transfer velocity used in the models.

Ruokauskomukset Mosambikin maaseudun raskaana olevilla ja imettävillä naisilla

Ihmisille ympäri maailmaa on tyypillistä valita tiettyjä ruokia suuremmasta valikoimasta syömäkelpoista ruokaa ja luoda mieltymyksiä sekä kieltoja joitakin ruokia kohtaan. Näitä ilmiöitä kutsutaan ruokauskomuksiksi ja ne ovat tärkeä osa kulttuuria. Niiden taustalla on usein terveydelliset perustelut tai sosiaalinen arvostus yhteisössä. Afrikassa on todettu olevan paljon erilaisia ruokauskomuksia, jotka kohdistuvat usein raskaana oleviin ja imettäviin naisiin sekä lapsiin, ryhmään, joka on fysiologisesti erityisen herkässä elämänvaiheessa. Ravitsemustilan tai ruokaturvan ollessa heikko, mahdollisilla ruokauskomuksilla voi olla merkittävät seuraukset erityisesti tämän väestönosan terveydentilaan. Aliravitsemus ja virheravitsemus ovat edelleen suuria ongelmia Afrikassa ja muissa kehittyvissä maissa. Tämän työn tavoitteena oli tutkia laadullisin menetelmin, onko erityisesti raskaana olevilla ja imettävillä naisilla Keski-Mosambikin maaseudulla, Zambézian maakunnassa, ruokauskomuksia, mitä ne mahdollisesti ovat, sekä arvioida voiko ruokauskomuksilla olla ravitsemuksellista merkitystä. Menetelminä oli 5 ryhmähaastattelua kolmessa kylässä ja 10 yksilöhaastattelua kahdessa kylässä. Tutkittavat olivat 12–78-vuotiaita naisia ja heitä oli yhteensä 27. Tulkkaus, tutkimusaiheen sensitiivisyys ja haastattelijan kokemattomuus aiheuttivat haasteita haastatteluiden toteutukseen. Tämän vuoksi menetelmää muokattiin ja se vaihdettiin ryhmähaastattelusta yksilöhaastatteluun tutkimuksen aikana. Ruokauskomukset vaihtelivat sekä kylien välillä että kylien sisällä, joskin niistä löytyi samantyyppisiä pääpiirteitä. Työssä todettiin, että raskaana oleviin ja imettäviin naisiin kohdistui tutkimusalueella ruokauskomuksia. Raskauden aikana tuli välttää pääasiassa proteiinipitoisia ruokia, kuten lihaa ja kalaa ja puolestaan suosia kasvisten, hedelmien ja viljatuotteiden käyttöä. Linnun munien syöntiä sekä suositeltiin että kehotettiin välttämään raskauden aikana. Raskauden aikana ilmeni lisäksi tietoinen tapa vähentää kassavapuuron tai ruuan syömistä kokonaisuudessaan. Imetyksen aikana ei vältetty juuri mitään ruokia, vaan suositeltiin kookosta ja kasviksia. Suurin osa perusteluista liittyi äidin ja lapsen terveyteen. Perustelut voitiin jakaa seuraaviin ryhmiin: lisää äidinmaidon tuotantoa; aiheuttaa vatsakipua äidillä; pitää yllä kuntoa ja estää vatsan kasvua; äidistä tulee vahva, terve ja hän saa vitamiineja; lapsen ulkonäkö muuttuu; lapsesta tulee terve ja vahva; lapsen käyttäytyminen muuttuu; aiheuttaa keskenmenon; aiheuttaa vaikean tai helpon synnytyksen. Ruokauskomukset ja terveysviranomaisilta tullut valistus oli osittain sekoittunut keskenään. Lähes kaikki naiset kertoivat noudattavansa näitä ruokauskomuksia. Muutamat naiset kertoivat suositeltavien ruokien kohdalla, että ruokien saatavuus tekee noudattamisen joskus vaikeaksi. Proteiinipitoisten ruokien välttäminen voi lisätä proteiinialiravitsemuksen riskiä ja syömisen vähentäminen saattaa lisätä riskiä saada riittämättömästi energiaa raskauden aikana. Suositeltavat ruuat todennäköisesti edistävät terveyttä. Tutkielman perusteella voitiin todeta, että vieraassa kulttuurissa tutkiminen vaatii tutkimusmenetelmältä paljon. Tärkeää on menetelmän joustavuus, jotta sitä voi muuttaa tutkimuskentällä toimivampaan ja luotettavampaan muotoon. Johtopäätöksenä todettiin, että suositeltavin menetelmä tutkittaessa ruokauskomuksia tällä tutkimusalueella olisi ollut yksilöhaastattelut, jossa olisi ollut mahdollisimman vähän osallistujia ja osallistujat olisivat olleet samaa sukupuolta ja saman ikäisiä. Terveyden ja ravitsemuksen kannalta on tärkeää, että ruokauskomuksista ollaan tietoisia ja väestön ruokauskomuksia tutkitaan alueittain, koska ne voivat vaihdella merkittävästi jopa kylien tai ihmisryhmien sisällä.

mRNA-binding protein HuR in breast carcinogenesis

Breast cancer is the most common cancer among women. Although its prognosis has improved nowadays, methods to predict the progression of the disease or to treat it are not comprehensive. This thesis work was initiated to elucidate in breast carcinogenesis the role of HuR, a ubiquitously expressed mRNA-binding protein that regulates gene expression posttranscriptionally. HuR is predominantly nuclear, but it shuttles between the nucleus and the cytoplasm, and this nucleocytoplasmic translocation is important for its function as a RNA-stabilizing and translational regulator. HuR has been associated with diverse cellular processes, for example carcinogenesis. The specific aims of my thesis work were to study the prognostic value of HuR in breast cancer and to clarify the mechanisms by which HuR contributes to breast carcinogenesis. My ultimate goal is, by better understanding the role of HuR in breast carcinogenesis, to aid in the discovery of novel targets for cancer therapies. HuR expression and localization was studied in paraffin-embedded preinvasive (atypical ductal hyperplasia, ADH, and ductal carcinoma in situ, DCIS) specimens as well in sporadic and familial breast cancer specimens. Our results show that cytoplasmic HuR expression was already elevated in ADH and remained elevated in DCIS as well as in cancer specimens. Clinicopathological analysis showed that cytoplasmic HuR expression associated with the more aggressive form of the disease in DCIS, and in cancer specimens it proved an independent marker for poor prognosis. Importantly, cytoplasmic HuR expression was significantly associated with poor outcome in the subgroups of small (2 cm) and axillary lymph node-negative breast cancers. HuR proved to be the first mRNA stability protein the expression of which is associated in breast cancer with poor outcome. To explore the mechanisms of HuR in breast carcinogenesis, lentiviral constructs were developed to inhibit and to overexpress the HuR expression in a breast epithelial cell line (184B5Me). Our results suggest that HuR mediates breast carcinogenesis by participating in processes important in cell transformation, in programmed cell death, and in cell invasion. Global gene expression analysis shows that HuR regulates genes participating in diverse cellular processes, and affects several pathways important in cancer development. In addition, we identified two novel target transcripts (connective tissue growth factor, CTGF, and Ras oncogene family member 31, RAB31) for HuR. In conclusion, because cytoplasmic HuR expression in breast cancer can predict the outcome of the disease it could serve in clinics as a prognostic marker. HuR accumulates in the cytoplasm even at its non-invasive stage (ADH and DCIS) of the carcinogenic process and supports functions essential in cell alteration. These data suggest that HuR contributes to carcinogenesis of the breast epithelium.

Improving outcome of childhood bacterial meningitis by simplified treatment : Experience from Angola

Background Acute bacterial meningitis (BM) continues to be an important cause of childhood mortality and morbidity, especially in developing countries. Prognostic scales and the identification of risk factors for adverse outcome both aid in assessing disease severity. New antimicrobial agents or adjunctive treatments - except for oral glycerol - have essentially failed to improve BM prognosis. A retrospective observational analysis found paracetamol beneficial in adult bacteraemic patients, and some experts recommend slow β-lactam infusion. We examined these treatments in a prospective, double-blind, placebo-controlled clinical trial. Patients and methods A retrospective analysis included 555 children treated for BM in 2004 in the infectious disease ward of the Paediatric Hospital of Luanda, Angola. Our prospective study randomised 723 children into four groups, to receive a combination of cefotaxime infusion or boluses every 6 hours for the first 24 hours and oral paracetamol or placebo for 48 hours. The primary endpoints were 1) death or severe neurological sequelae (SeNeSe), and 2) deafness. Results In the retrospective study, the mortality of children with blood transfusion was 23% (30 of 128) vs. without blood transfusion 39% (109 of 282; p=0.004). In the prospective study, 272 (38%) of the children died. Of those 451 surviving, 68 (15%) showed SeNeSe, and 12% (45 of 374) were deaf. Whereas no difference between treatment groups was observable in primary endpoints, the early mortality in the infusion-paracetamol group was lower, with the difference (Fisher s exact test) from the other groups at 24, 48, and 72 hours being significant (p=0.041, 0.0005, and 0.005, respectively). Prognostic factors for adverse outcomes were impaired consciousness, dyspnoea, seizures, delayed presentation, and absence of electricity at home (Simple Luanda Scale, SLS); the Bayesian Luanda Scale (BLS) also included abnormally low or high blood glucose. Conclusions New studies concerning the possible beneficial effect of blood transfusion, and concerning longer treatment with cefotaxime infusion and oral paracetamol, and a study to validate our simple prognostic scales are warranted.

Studies of the Human Transcriptome

Gene expression is one of the most critical factors influencing the phenotype of a cell. As a result of several technological advances, measuring gene expression levels has become one of the most common molecular biological measurements to study the behaviour of cells. The scientific community has produced enormous and constantly increasing collection of gene expression data from various human cells both from healthy and pathological conditions. However, while each of these studies is informative and enlighting in its own context and research setup, diverging methods and terminologies make it very challenging to integrate existing gene expression data to a more comprehensive view of human transcriptome function. On the other hand, bioinformatic science advances only through data integration and synthesis. The aim of this study was to develop biological and mathematical methods to overcome these challenges and to construct an integrated database of human transcriptome as well as to demonstrate its usage. Methods developed in this study can be divided in two distinct parts. First, the biological and medical annotation of the existing gene expression measurements needed to be encoded by systematic vocabularies. There was no single existing biomedical ontology or vocabulary suitable for this purpose. Thus, new annotation terminology was developed as a part of this work. Second part was to develop mathematical methods correcting the noise and systematic differences/errors in the data caused by various array generations. Additionally, there was a need to develop suitable computational methods for sample collection and archiving, unique sample identification, database structures, data retrieval and visualization. Bioinformatic methods were developed to analyze gene expression levels and putative functional associations of human genes by using the integrated gene expression data. Also a method to interpret individual gene expression profiles across all the healthy and pathological tissues of the reference database was developed. As a result of this work 9783 human gene expression samples measured by Affymetrix microarrays were integrated to form a unique human transcriptome resource GeneSapiens. This makes it possible to analyse expression levels of 17330 genes across 175 types of healthy and pathological human tissues. Application of this resource to interpret individual gene expression measurements allowed identification of tissue of origin with 92.0% accuracy among 44 healthy tissue types. Systematic analysis of transcriptional activity levels of 459 kinase genes was performed across 44 healthy and 55 pathological tissue types and a genome wide analysis of kinase gene co-expression networks was done. This analysis revealed biologically and medically interesting data on putative kinase gene functions in health and disease. Finally, we developed a method for alignment of gene expression profiles (AGEP) to perform analysis for individual patient samples to pinpoint gene- and pathway-specific changes in the test sample in relation to the reference transcriptome database. We also showed how large-scale gene expression data resources can be used to quantitatively characterize changes in the transcriptomic program of differentiating stem cells. Taken together, these studies indicate the power of systematic bioinformatic analyses to infer biological and medical insights from existing published datasets as well as to facilitate the interpretation of new molecular profiling data from individual patients.

Preterm birth and risk factors for chronic disease : Helsinki Study of Very Low Birth Weight Adults

Background: The improved prognosis of early preterm birth has created a generation of surviving very low birth weight (< 1500 g, VLBW) infants whose health risks in adulthood are poorly known. Of every 1000 live-born infants in Finland, about 8 are born at VLBW. Variation in birth weight, even within the normal range, relates to considerable variation in the risk for several common adult disorders, including cardiovascular disease and osteoporosis. Small preterm infants frequently exhibit severe postnatal or prenatal growth retardation, or both. Much reason for concern thus exists, regarding adverse health effects in surviving small preterm infants later lives. We studied young adults, aiming at exploring whether VLBW birth and postnatal events after such a birth are associated with higher levels of risk factors for cardiovascular disease or osteoporosis. Subjects and Methods: A follow-up study for VLBW infants began in 1978; by the end of 1985, 335 VLBW survivors at Helsinki University Central Hospital participated in the follow-up. Their gestational ages ranged from 24 to 35 weeks, mean 29.2 and standard deviation 2.2 weeks. In 2004, we invited for a clinic visit 255 subjects, aged 18 to 27, who still lived in the greater Helsinki area. From the same birth hospitals, we also invited 314 term-born controls of similar age and sex. These two study groups underwent measurements of body size and composition, function of brachial arterial endothelium (flow-mediated dilatation, FMD) and carotid artery intima-media thickness (cIMT) by ultrasound. In addition, we measured plasma lipid concentrations, ambulatory blood pressure, fasting insulin, glucose tolerance and, by dual-energy x-ray densitometry, bone-mineral density. Results: 172 control and 166 VLBW participants underwent lipid measurements and a glucose tolerance test. VLBW adults fasting insulin (adjusted for body mass index) was 12.6% (95% confidence interval, 0.8 to 25.8) higher than that of the controls. The glucose and insulin concentrations 120 minutes after 75 g glucose ingestion showed similar differences (N=332) (I). VLBW adults had 3.9 mmHg (1.3 to 6.4) higher office systolic blood pressure, 3.5 mmHg (1.7 to 5.2) higher office diastolic blood pressure (I), and, when adjusted for body mass index and height, 3.1 mmHg (0.5 to 5.5) higher 24-hour mean systolic blood pressure (N=238) (II). VLBW birth was associated neither with HDL- or total cholesterol nor triglyceride concentrations (N=332) (I), nor was it associated with a low FMD or a high cIMT (N=160) (III). VLBW adults had 0.51-unit (0.28 to 0.75) lower lumbar spine Z scores and 0.56-unit (0.34 to 0.78) lower femoral neck Z scores (N=283). Adjustments for size attenuated the differences, but only partially (IV). Conclusions: These results imply that those born at VLBW, although mostly healthy as young adults, already bear several risk factors for chronic adult disease. The significantly higher fasting insulin level in adults with VLBW suggests increased insulin resistance. The higher blood pressure in young adults born at VLBW may indicate they later are at risk for hypertension, although their unaffected endothelial function may be evidence for some form of protection from cardiovascular disease. Lower bone mineral density around the age of peak bone mass may suggest increased risk for later osteoporotic fractures. Because cardiovascular disease and osteoporosis are frequent, and their prevention is relatively cheap and safe, one should focus on prevention now. When initiated early, preventive measures are likely to have sufficient time to be effective in preventing or postponing the onset of chronic disease.

Maskuliinisuuden rakentuminen alakoulussa

Objectives: Inspiration for this study came from the public discourse and concern for boys poor school achievement, as well as from the author s own perceptions. There was an interest to know if this concern is justified and what are its underlying causes. Previous studies have shown that masculinity is one of the key aspects of boys' poor school achievement. The objective of this research is to study the construction of masculinity in primary school and how this construct of masculinity is manifested by school achievement. Based on previous studies, the pursuit of hegemonic masculinity does not fit with good school grades. If a boy succeeds in school, this success must be compensated for by means of different factors demonstrating hegemonic masculinity. Methods: The research material was obtained by using the etnographic method. The research settled itself feministic school-etnographic research field. The research subjects comprised pupils and teachers of a 5th grade comprehensive school class (10-11-year-olds) in the Uusimaa county. There were twenty-nine (29) pupils (18 boys and 11 girls) in this class and five (5) different teachers who taught the class. The research material was composed of field notes and researcher's diary based on researcher's observations, short group discussions with pupils and interviews of five boys. The field notes consisted of twenty-six (26) lessons and also observations of breaks and eating periods. In short group discussions the researcher discussed with all the pupils that were given a permission for interview. The material was analysed with thematic and analytic reading that led to the writing of an analysis. Results and conclusions: The most salient result of this study was that different masculinities are constructed in primary school. The majority of boys aimed at hegemonic masculinity and the school community strongly supported this. This was shown in speech and in behaviour. School success and mainstream masculinity could be compatible, but success also required compensatory aspects. In addition to these observations, the researcher was able to identify a group of boys which truly wanted to achieve well in school and did not care to strive for hegemonic masculinity. Thus, there should be more room and opportunities for different kinds of masculinity in the school environment. Teachers and the overall school environment should support the different ways of being a boy, and it seems there is a need for gender sensitive pedagogy.

Eteva Järvenpään perhepalvelukeskuksen lyhytaikaishoidon suunnittelun kehittäminen

Objectives. The thesis objective was to analyze how person-centred planning is applied to develop short term care in interaction between the disabled children, their families and the workers of the family service centre of Eteva Järvenpää. The thesis contributes to developing the methods of person-centred planning. I applied theoretical frameworks of activity theory and developmental work research, family-based work framework and disability phenomenon. The research questions were: What development needs did the families of disabled children have for the services? How were viewpoints of disabled children, their families and Eteva workers noticed in person-centred planning in the interaction between the disabled children, their families and Eteva workers? What disturbances and development challenges emerged during the person-centred planning? Methods. I first analysed the local history of the disability sector and the short term care to analyse challenges arising from the local history. The actural research material consisted of interviews with four families, two person-centred planning discussions and two discussions where the person-centred planning was reflected by the families.I used interaction voice analysis as defined by the activity theory and developmental work research. From the recorded interviews and discussions I analysed scripts, disturbances, innovation attempts and innovations. From the discussions I analysed also the interaction types (cooperation, coordination and communication). Results and conclusions. As problems, the families considered the scarce resources and the inflexibility of services. The challenges of developing the short term care were how to transfer information from short term care to home, how to develop activities for the children and how to take into account the individual needs of the children in the short term care. Both from the local history analysis and from the family interviews arised the conflict between caring and fulfilling the individual needs. In person-centred planning, the voice of the child was either interpreted by other family members or guided by family members or workers. I modelled the progress of person-centred planning in a two-dimensional coordination. Person-centred planning should be deepened in cooperation between the child, the family and the workers in everyday situations at home and during the short term care. The challenge is to expand person-centred planning to become cross-organizational cooperation connecting the actors of the child s service network in everyday life. Avainsanat Nyckelord - Keywords short term care, activity theory and developmental work research, person-centred planning, disability

Valaistusyhtälö

Tässä tietokonegrafiikan alan tutkielmassa tutkitaan annetun kohteen tai maailman valaistuksen määrittämistä laskennallisesti. Ilmiöt kuvataan fysikaalisesti ja valaistusta mallinnetaan ilmiöitä kuvaavilla yhtälöillä. Yhtälöiden ratkaisu perustuu valonsäteiden etenemisen ja sironnan laskennalliseen seurantaan. Näin johdettua matemaattista mallia tutkitaan ja yhtälöiden ratkaisut muotoillaan tietokoneella laskettavaan muotoon. Lopuksi ohjelmoidaan esiteltyä teoriaa hyödyntävä numeerinen ratkaisija ja esitellään käytetyt menetelmät ja tulokset. Valaistuksen matemaattista mallintamista lähestytään fysikaaliselta pohjalta. Aluksi esitellään valon luonnetta ja yhteyttä sähkömagneettiseen säteilyyn ja ihmisen näköjärjestelmään. Tämän jälkeen paneudutaan valonsäteiden heijastumiseen ja sirontaan ja yleistetään klassiset ideaaliset sirontamallit huomioimaan pinnan hienorakenne sirontajakaumilla. Tutkittu ongelma muotoillaan matemaattisiksi yhtälöiksi jotka ratkaistaan analyyttisesti. Ratkaisu osoittautuu intuitiiviseksi: valaistus saadaan laskemalla valonlähteistä emittoituvan valon kaikkien kertalukujen heijastukset. Analyyttinen ratkaisu muotoillaan rekursiiviseksi ja ratkaistaan todennäköisyyslaskentaan perustuvalla Monte Carlo -integroinnilla, jonka suppenemista nopeutetaan tärkeysotannalla. Numeerinen ratkaisu osoitetaan odotusarvoisesti harhattomaksi ja ratkaisun virheen osoitetaan puolittuvan laskentapisteiden määrän nelinkertaistuessa. Käytettävä todennäköisyyslaskenta esitellään pääpiirteittäin. Numeerinen ratkaisumenetelmä on stokastista säteenseurantaa yleistävä polunseuranta. Maailma määritellään kolmioverkkona ja pintojen normaalit annetaan kolmioiden kärkipisteissä. Kolmioista muodostetaan kuvaus tasopinnalle, josta voidaan tarvittaessa lukea esimerkiksi pinnan tarkemmat normaalit, sirontaominaisuudet tai absorptiospektri. Numeerisen ratkaisun eniten aikaa vievä osuus on valonsäteen seuraavan osumapisteen selvitys maailman pintojen välillä. Ratkaisua nopeutetaan tallentamalla maailman kolmiot tehokkaaseen tietorakenteeseen, kd-puuhun, joka mahdollistaa valonsäteen ja suurten kolmiojoukkojen nopeat leikkaustarkistukset. Kd-puun ajatus ja toteutus esitellään työssä lyhyesti. Lopuksi esitellään ratkaisun eri vaiheet ja teoria käytännössä ja nähdään konkreettisesti eri menetelmien merkitys numeerisen ratkaisijan tuottamaan kuvaan. Lisäksi esitellään tehokas prioriteettijonoon perustuva adaptiivinen menetelmä kuvaan jääneen kohinan pienentämiseksi tutkimalla näytteistyksen otoskeskihajonnan ja keskiarvon suhdetta kuvapisteittäin.

Preterm birth and risk factors for chronic disease : Helsinki Study of Very Low Birth Weight Adults

Background: The improved prognosis of early preterm birth has created a generation of surviving very low birth weight (PIENEMPI KUIN 1500 g, VLBW) infants whose health risks in adulthood are poorly known. Of every 1000 live-born infants in Finland, about 8 are born at VLBW. Variation in birth weight, even within the normal range, relates to considerable variation in the risk for several common adult disorders, including cardiovascular disease and osteoporosis. Small preterm infants frequently exhibit severe postnatal or prenatal growth retardation, or both. Much reason for concern thus exists, regarding adverse health effects in surviving small preterm infants later lives. We studied young adults, aiming at exploring whether VLBW birth and postnatal events after such a birth are associated with higher levels of risk factors for cardiovascular disease or osteoporosis. Subjects and Methods: A follow-up study for VLBW infants began in 1978; by the end of 1985, 335 VLBW survivors at Helsinki University Central Hospital participated in the follow-up. Their gestational ages ranged from 24 to 35 weeks, mean 29.2 and standard deviation 2.2 weeks. In 2004, we invited for a clinic visit 255 subjects, aged 18 to 27, who still lived in the greater Helsinki area. From the same birth hospitals, we also invited 314 term-born controls of similar age and sex. These two study groups underwent measurements of body size and composition, function of brachial arterial endothelium (flow-mediated dilatation, FMD) and carotid artery intima-media thickness (cIMT) by ultrasound. In addition, we measured plasma lipid concentrations, ambulatory blood pressure, fasting insulin, glucose tolerance and, by dual-energy x-ray densitometry, bone-mineral density. Results: 172 control and 166 VLBW participants underwent lipid measurements and a glucose tolerance test. VLBW adults fasting insulin (adjusted for body mass index) was 12.6% (95% confidence interval, 0.8 to 25.8) higher than that of the controls. The glucose and insulin concentrations 120 minutes after 75 g glucose ingestion showed similar differences (N=332) (I). VLBW adults had 3.9 mmHg (1.3 to 6.4) higher office systolic blood pressure, 3.5 mmHg (1.7 to 5.2) higher office diastolic blood pressure (I), and, when adjusted for body mass index and height, 3.1 mmHg (0.5 to 5.5) higher 24-hour mean systolic blood pressure (N=238) (II). VLBW birth was associated neither with HDL- or total cholesterol nor triglyceride concentrations (N=332) (I), nor was it associated with a low FMD or a high cIMT (N=160) (III). VLBW adults had 0.51-unit (0.28 to 0.75) lower lumbar spine Z scores and 0.56-unit (0.34 to 0.78) lower femoral neck Z scores (N=283). Adjustments for size attenuated the differences, but only partially (IV). Conclusions: These results imply that those born at VLBW, although mostly healthy as young adults, already bear several risk factors for chronic adult disease. The significantly higher fasting insulin level in adults with VLBW suggests increased insulin resistance. The higher blood pressure in young adults born at VLBW may indicate they later are at risk for hypertension, although their unaffected endothelial function may be evidence for some form of protection from cardiovascular disease. Lower bone mineral density around the age of peak bone mass may suggest increased risk for later osteoporotic fractures. Because cardiovascular disease and osteoporosis are frequent, and their prevention is relatively cheap and safe, one should focus on prevention now. When initiated early, preventive measures are likely to have sufficient time to be effective in preventing or postponing the onset of chronic disease.

New computational approaches for inelastic x-ray scattering

Inelastic x-ray scattering spectroscopy is a versatile experimental technique for probing the electronic structure of materials. It provides a wealth of information on the sample's atomic-scale structure, but extracting this information from the experimental data can be challenging because there is no direct relation between the structure and the measured spectrum. Theoretical calculations can bridge this gap by explaining the structural origins of the spectral features. Reliable methods for modeling inelastic x-ray scattering require accurate electronic structure calculations. This work presents the development and implementation of new schemes for modeling the inelastic scattering of x-rays from non-periodic systems. The methods are based on density functional theory and are applicable for a wide variety of molecular materials. Applications are presented in this work for amorphous silicon monoxide and several gas phase systems. Valuable new information on their structure and properties could be extracted with the combination of experimental and computational methods.