Physical activity and diabetic complications in patients with type 1 diabetes

Type 1 diabetes is associated with the risk for late diabetic complications which are divided into microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (cardiovascular disease, CVD) diseases. The risk for diabetic complication can be reduced by effective treatment, most importantly the glycaemic control. Glycaemia in type 1 diabetes is influenced by the interplay between insulin injections and lifestyle factors such as physical activity and diet. The effect of physical activity in patients with type 1 diabetes is not well known, however. The aim of this thesis was to investigate the physical activity and the physical fitness of patients with type 1 diabetes with special emphasis on glycaemic control and the diabetic complications. The patients included in the study were all part of the nationwide, multicenter Finnish Diabetic Nephropathy (FinnDiane) Study which aims to characterise genetic, clinical, and environmental factors that predispose to diabetic complications in patients with type 1 diabetes. In addition, subjects from the IDentification of EArly mechanisms in the pathogenesis of diabetic Late complications (IDEAL) Study were studied. Physical activity was assessed in the FinnDiane Study in 1945 patients by a validated questionnaire. Physical fitness was measured in the IDEAL Study by spiroergometry (cycle test with measurement of respiratory gases) in 86 young adults with type 1 diabetes and in 27 healthy controls. All patients underwent thorough clinical characterisation of their diabetic complication status. Four substudies were cross-sectional using baseline data and one study additionally used follow-up data. Physical activity, especially the intensity of activities, was reduced in patients affected by diabetic nephropathy, retinopathy, and CVD. Low physical activity was associated with poor glycaemic control, a finding most clear in women and evident also in patients with no signs of diabetic complications. Furthermore, low physical activity was associated with a higher HbA1c variability, which in turn was associated with the progression of renal disease and CVD during follow-up. A higher level of physical activity was also associated with better insulin sensitivity. The prevalence of the metabolic syndrome in type 1 diabetes was also lower the higher the physical activity. The aerobic physical fitness level of young adults with type 1 diabetes was reduced compared with healthy peers and in men an association between higher fitness level and lower HbA1c was observed. In patients with type 1 diabetes, a higher physical activity was associated with better glycaemic control and may thus be beneficial with respect to the prevention of diabetic complications.

Sireenit, floksit ja iirikset- Puu-Käpylän koristekasvit

Puu-Käpylä (“Wooden Käpylä”), a neighbourhood of Helsinki, is the earliest example of the Garden City Movement in Finland. The suburb of valuable wooden architecture was built between 1920 and 1925, with the aim to provide a healthy housing area for working-class families with many children. The houses were erected by a co-operative (Käpylän kansanasunnot, “People?s Dwellings”) and they are protected by the city plan since 1960?s. However, the historical value of the sheltered courtyards has not been investigated. The aim of this study was to survey the garden flora of Puu-Käpylä and to evaluate the authenticity of the courtyard gardens. The survey covered the area of one residential quarter (1.2 ha) with twelve 2-storey semi-detached timber houses arranged around a common yard, which was originally appointed for the tenants? vegetable gardens. The houses are still rented, and each flat is allowed a small lot of the courtyard for cultivation. A complete list was made of all perennial, ornamental plant taxa present in the quarter. Spring bulbs were missed due to the timing of the survey. Generally, the plants were recorded on species level, with the exception of common lilacs, shrub roses, irises and peonies that were thoroughly studied for cultivar identification. It was assumed that plants initially grown in the courtyard could be distinguished by studying Finnish garden magazines, books and nursery catalogues published in the 1920?s and by comparing the present vegetation to surviving documents from the quarter. The total number of ornamental plant taxa identified was 172, of which 17 were trees, 47 shrubs, 7 climbers and 101 herbaceous perennials. The results indicated that a major part of the shrubs, climbers and perennials presumably originated from the 1970?s or later, whereas ca. 70 % of the tree specimens were deemed as original. The survey disclosed a heritage variety of common lilac, resembling cultivar „Prince Notger?, a specific peony taxon, Paeonia humilis Retz., cultivated in Nordic countries since long ago, and a few historic iris varieties. Well-preserved design elements included front gardens on one side of the quarter, a maple alley on another side as well as trees at the garden gates. Old garden books and magazines did not shed much light on the Finnish garden flora commonly used in the period when Puu-Käpylä was built. However, they gave a valuable picture of contemporary planting design. Nursery catalogues offered insight into the assortment of ornamental plants traded in the 1920?s. Conclusions on the authenticity of the current flora were mainly drawn on the basis of old photographs and a vegetation survey map drawn in the 1970?s. This study revealed a need for standardization of syrvey methods applied when investigating garden floras. Uniform survey techniques would make the results comparable and enable a future compilation of data from e.g. historic gardens.

The Protection of Traditional Knowledge Associated with Genetic Resources: The Role of Databases and Registers

"The Protection of Traditional Knowledge Associated with Genetic Resources: The Role of Databases and Registers" ABSTRACT Yovana Reyes Tagle The misappropriation of TK has sparked a search for national and international laws to govern the use of indigenous peoples knowledge and protection against its commercial exploitation. There is a widespread perception that biopiracy or illegal access to genetic resources and associated traditional knowledge (TK) continues despite national and regional efforts to address this concern. The purpose of this research is to address the question of how documentation of TK through databases and registers could protect TK, in light of indigenous peoples increasing demands to control their knowledge and benefit from its use. Throughout the international debate over the protection of TK, various options have been brought up and discussed. At its core, the discussion over the legal protection of TK comes down to these issues: 1) The doctrinal question: What is protection of TK? 2) The methodological question: How can protection of TK be achieved? 3) The legal question: What should be protected? And 4) The policy questions: Who has rights and how should they be implemented? What kind of rights should indigenous peoples have over their TK? What are the central concerns the TK databases want to solve? The acceptance of TK databases and registers may bring with it both opportunities and dangers. How can the rights of indigenous peoples over their documented knowledge be assured? Documentation of TK was envisaged as a means to protect TK, but there are concerns about how documented TK can be protected from misappropriation. The methodology used in this research seeks to contribute to the understanding of the protection of TK. The steps taken in this research attempt to describe and to explain a) what has been done to protect TK through databases and registers, b) how this protection is taking place, and c) why the establishment of TK databases can or cannot be useful for the protection of TK. The selected case studies (Peru and Venezuela) seek to illustrate the complexity and multidisciplinary nature of the establishment of TK databases, which entail not only legal but also political, socio-economic and cultural issues. The study offers some conclusions and recommendations that have emerged after reviewing the national experiences, international instruments, work of international organizations, and indigenous peoples perspectives. This thesis concludes that if TK is to be protected from disclosure and unauthorized use, confidential databases are required. Finally, the TK database strategy needs to be strengthened by the legal protection of the TK itself.

Breathing, swallowing and voice in laryngeal disorsers

The aim of this work was to examine how breathing, swallowing and voicing are affected in different laryngeal disorders. For this purpose, we examined four different patient groups: patients who had undergone total laryngectomy, anterior cervical decompression (ACD), or injection laryngoplasty with autologous fascia (ILAF), and patients with dyspnea during exercise. We studied the problems and benefits related to the automatic speech valve used for the rehabilitation of speech in laryngectomized patients. The device was given to 14 total laryngectomized patients who used the traditional valve especially well. The usefulness of voice and intelligibility of speech were assessed by speech pathologists. The results demonstrated better performance with the traditional valve in both dimensions. Most of the patients considered the automatic valve a helpful additional device but because of heavier breathing and the greater work needed for speech production, it was not suitable as a sole device in speech rehabilitation. Dysphonia and dysphagia are known complications of ACD. These symptoms are caused due to the stretching of tissue needed during the surgery, but the extent and the recovery from them was not well known before our study. We studied two patient groups, an early group with 50 patients who were examined immediately before and after the surgery and a late group with 64 patients who were examined 3 9 months postoperatively. Altogether, 60% reported dysphonia and 69% dysphagia immediately after the operation. Even though dysphagia and dysphonia often appeared after surgery, permanent problems seldom occurred. Six (12 %) cases of transient and two (3 %) permanent vocal cord paresis were detected. In our third study, the long-term results of ILAF in 43 patients with unilateral vocal cord paralysis were examined. The mean follow-up was 5.8 years (range 3 10). Perceptual evaluation demonstrated improved results for voice quality, and videostroboscopy revealed complete or partial glottal closure in 83% of the patients. Fascia showed to be a stable injection material with good vocal results. In our final study we developed a new diagnostic method for exertional laryngeal dyspnea by combining a cardiovascular exercise test with simultaneous fiberoptic observation of the larynx. With this method, it is possible to visualize paradoxal closure of the vocal cords during inspiration, which is a diagnostic criterion for vocal cord dysfunction (VCD). We examined 30 patients referred to our hospital because of suspicion of exercise-induced vocal cord dysfunction (EIVCD). Twenty seven out of thirty patients were able to perform the test. Dyspnea was induced in 15 patients, and of them five had EIVCD and four high suspicion of EIVCD. With our test it is possible to set an accurate diagnosis for exertional laryngeal dyspnea. Moreover, the often seen unnecessary use of asthma drugs among these patients can be avoided.

"Innokas punikki". Hyvinkään punakaartilaisnaiset sisällissodan jälkiselvittelyissä 1918.

Hyvinkääläiset työläisnaiset ottivat vuoden 1918 sisällissotaan osaa punakaartin riveissä ruoanlaittajina, sairaanhoitajina sekä asetta kantaneina sotilaina. Valkokaartia tukemaan saapuneet saksalaissotilaat saavuttivat Hyvinkään huhtikuun 20. päivä, ja pitäjä valloitettiin. Osa hyvinkääläisnaisista oli tässä vaiheessa siirtynyt jo pohjoisemmille rintamille. Valkoiset etenivät kuitenkin voittoisasti kohti pohjoista, ja suurin osa hyvinkääläisnaisista oli antautunut 1. toukokuuta mennessä. Tämä tutkimus tarkastelee Hyvinkään punakaartilaisnaisiin kohdistuneita kuulustelututkimuksia ja toimenpiteitä sisällissodan jälkiselvittelyissä, jotka alkoivat huhtikuussa ja jatkuivat vuoden loppuun saakka. Samalla tuon esiin runsaasti uutta tietoa Hyvinkään punakaartilaisnaisten toimista sisällissodassa sekä heidän taustoistaan. Tärkeimpiä lähteitä tutkimuksessani ovat erilaiset Kansallisarkistossa säilytettävät oikeusasiakirjat: Hyvinkään pitäjän kenttäoikeuksien pöytäkirjat, viralliset esitutkintapöytäkirjat sekä valtiorikosoikeuksien ja valtiorikosylioikeuden aktit. Lisäksi olen etsinyt tietoa sodassa ja sen jälkiselvittelyissä surmansa saaneista punaisista hyvinkääläisnaisista. Tässä tärkeimpinä lähteinäni ovat olleet Suomen Sotasurmat 1914–1922 -projektin nimitiedosto sekä valkokaartin kirjanpidosta löytyneet vangitsemistiedot. Olen hyödyntänyt suuren tietomäärän käsittelyssä tilastollisia menetelmiä. Tarkastelen naisia kuitenkin paljon myös yksilötasolla, sillä juuri yksilötarinat rikastuttavat paikallishistoriallista tutkimusta. Tutkimukseni perusteella punaisiksi luokiteltuja hyvinkääläisnaisia menehtyi sisällissodan jälkiselvittelyissä 27 – heistä suurin osa Lahden ja Hämeenlinnan seudulla, missä viimeiset taistelut käytiin. Menehtyneistä naisista moni oli vasta 16–17-vuotias. Myös hyvinkääläisnaisia joutui suurille vankileireille – tässä yhteydessä tarkastelen kahden naisen vankileirimuistelmia. Kotipaikkakunnalla tutkittiin samanaikaisesti kenttäoikeuksissa 64 hyvinkääläisnaista. Kenttäoikeuksien tehtävänä oli kartoittaa punakaartilaisten toimintaa sekä heidän tietojansa paikkakunnalla ja lähiseuduilla tapahtuneista murhista sekä ryöstöistä. Kenttäoikeuksissa kuulustelluista naisista valtaosa vapautettiin lyhyen vankeuden jälkeen. Jälkiselvittelyjen virallisessa vaiheessa 116 hyvinkääläistä punakaartilaisnaista joutui kuulusteluihin. Heistä vajaa puolet oli toiminut sodan aikana erilaisissa huoltotehtävissä mm. punakaartin ruokalassa. 25 naista oli epäiltynä Hyvinkäällä huhtikuussa perustetussa aseellisessa naiskaartissa toimimisesta. Loput olivat toimineet punaisten hallinnossa tai sairaanhoitotehtävissä kotipaikkakunnalla ja rintamilla. Kuulustelujen perusteella 81 naista sai vuoden 1918 jälkipuoliskolla syytteen valtiorikosoikeudessa; heistä suurin osa avunannosta valtiopetokseen. Tutkimukseni kattaa näin kaikkiaan noin 150 hyvinkääläistä punakaartilaisnaista. Tutkimukseni valottaa heidän toimintaansa sodan aikana sekä arvioi rankaisutoimenpiteiden motiiveja. Tutkimukseni mukaan asetta kantaneisiin naisiin suhtauduttiin jälkiselvittelyissä keskimäärin hyvin ankarasti. Muiden punakaartilaisnaisten osalta rankaisutoimenpiteissä ei ollut yhtenäistä linjaa. Perunankuorinta punakaartin ruokalassa saattoi olla tuomittava rikos siinä missä kaartilaisten matkoilla liikkuminen ja ryöstetyn tavaran kätkeminen.

Functional limitations and quality of life in schizophrenia and other psychotic disorders

There is substantial evidence of the decreased functional capacity, especially everyday functioning, of people with psychotic disorder in clinical settings, but little research about it in the general population. The aim of the present study was to provide information on the magnitude of functional capacity problems in persons with psychotic disorder compared with the general population. It estimated the prevalence and severity of limitations in vision, mobility, everyday functioning and quality of life of persons with psychotic disorder in the Finnish population and determined the factors affecting them. This study is based on the Health 2000 Survey, which is a nationally representative survey of 8028 Finns aged 30 and older. The psychotic diagnoses of the participants were assessed in the Psychoses of Finland survey, a substudy of Health 2000. The everyday functioning of people with schizophrenia is studied widely, but one important factor, mobility has been neglected. Persons with schizophrenia and other non-affective psychotic disorders, but not affective psychoses had a significantly increased risk of having both self-reported and test-based mobility limitations as well as weak handgrip strength. Schizophrenia was associated independently with mobility limitations even after controlling for lifestyle-related factors and chronic medical conditions. Another significant factor associated with problems in everyday functioning in participants with schizophrenia was reduced visual acuity. Their vision was examined significantly less often during the five years before the visual acuity measurement than the general population. In general, persons with schizophrenia and other non-affective psychotic disorder had significantly more limitations in everyday functioning, deficits in verbal fluency and in memory than the general population. More severe negative symptoms, depression, older age, verbal memory deficits, worse expressive speech and reduced distance vision were associated with limitations in everyday functioning. Of all the psychotic disorders, schizoaffective disorder was associated with the largest losses of quality of life, and bipolar I disorder with equal or smaller losses than schizophrenia. However, the subjective loss of qualify of life associated with psychotic disorders may be smaller than objective disability, which warrants attention. Depressive symptoms were the most important determinant of poor quality of life in all psychotic disorders. In conclusion, subjects with psychotic disorders need regular somatic health monitoring. Also, health care workers should evaluate the overall quality of life and depression of subjects with psychotic disorders in order to provide them with the basic necessities of life.

Geochemistry and petrology of the ferropicrite dikes and associated rocks of Vestfjella, western Dronning Maud Land, Antarctica

This study provides insights into the composition and origin of ferropicrite dikes (FeOtot = 13 17 wt. %; MgO = 13 19 wt. %) and associated meimechite, picrite, picrobasalt, and basalt dikes found at Vestfjella, western Dronning Maud Land, Antarctica. The dikes crosscut Jurassic Karoo continental flood basalts (CFB) that were emplaced during the early stages of the breakup of the Gondwana supercontinent ~180 Ma ago. Selected samples (31 overall from at least eleven dikes) were analyzed for their mineral chemical, major element, trace element, and Sr, Nd, Pb, and Os isotopic compositions. The studied samples can be divided into two geochemically distinct types: (1) The depleted type (24 samples from at least nine dikes) is relatively depleted in the most incompatible elements and exhibits isotopic characteristics (e.g., initial εNd of +4.8 to +8.3 and initial 187Os/188Os of 0.1256 0.1277 at 180 Ma) similar to those of mid-ocean ridge basalts (MORB); (2) The enriched type (7 samples from at least two dikes) exhibits relatively enriched incompatible element and isotopic characteristics (e.g., initial εNd of +1.8 to +3.6 and initial 187Os/188Os of 0.1401 0.1425 at 180 Ma) similar to those of oceanic island basalts. Both magma types have escaped significant contamination by the continental crust. The depleted type is related to the main phase of Karoo magmatism and originated as highly magnesian (MgO up to 25 wt. %) partial melts at high temperatures (mantle potential temperature >1600 °C) and pressures (~5 6 GPa) from a sublithospheric, water-bearing, depleted peridotite mantle source. The enriched type sampled pyroxene-bearing heterogeneities that can be traced down to either recycled oceanic crust or melt-metasomatized portions of the sublithospheric or lithospheric mantle. The source of the depleted type represents a sublithospheric end-member source for many Karoo lavas and has subsequently been sampled by the MORBs of the Indian Ocean. These observations, together with the purported high temperatures, indicate that the Karoo CFBs were formed in an extensive melting episode caused mainly by internal heating of the upper mantle beneath the Gondwana supercontinent. My research supports the view that ferropicritic melts can be generated in several ways: the relative Fe-enrichment of mantle partial melts is most readily achieved by (1) relatively low degree of partial melting, (2) high pressure of partial melting, and (3) melting of enriched source components (e.g., pyroxenite and metasomatized peridotite). Ferropicritic whole-rock compositions could also result from accumulation, secondary alteration, and fractional crystallization, however, and caution is required when addressing the parental magma composition.

Methods in general model localization

The aim of this study was to evaluate and test methods which could improve local estimates of a general model fitted to a large area. In the first three studies, the intention was to divide the study area into sub-areas that were as homogeneous as possible according to the residuals of the general model, and in the fourth study, the localization was based on the local neighbourhood. According to spatial autocorrelation (SA), points closer together in space are more likely to be similar than those that are farther apart. Local indicators of SA (LISAs) test the similarity of data clusters. A LISA was calculated for every observation in the dataset, and together with the spatial position and residual of the global model, the data were segmented using two different methods: classification and regression trees (CART) and the multiresolution segmentation algorithm (MS) of the eCognition software. The general model was then re-fitted (localized) to the formed sub-areas. In kriging, the SA is modelled with a variogram, and the spatial correlation is a function of the distance (and direction) between the observation and the point of calculation. A general trend is corrected with the residual information of the neighbourhood, whose size is controlled by the number of the nearest neighbours. Nearness is measured as Euclidian distance. With all methods, the root mean square errors (RMSEs) were lower, but with the methods that segmented the study area, the deviance in single localized RMSEs was wide. Therefore, an element capable of controlling the division or localization should be included in the segmentation-localization process. Kriging, on the other hand, provided stable estimates when the number of neighbours was sufficient (over 30), thus offering the best potential for further studies. Even CART could be combined with kriging or non-parametric methods, such as most similar neighbours (MSN).

Micropillar Array Based Microchips for Electrospray Ionization Mass Spectrometry, Microreactors, and Liquid Chromatographic Separation

This dissertation deals with the design, fabrication, and applications of microscale electrospray ionization chips for mass spectrometry. The microchip consists of microchannel, which leads to a sharp electrospray tip. Microchannel contain micropillars that facilitate a powerful capillary action in the channels. The capillary action delivers the liquid sample to the electrospray tip, which sprays the liquid sample to gas phase ions that can be analyzed with mass spectrometry. The microchip uses a high voltage, which can be utilized as a valve between the microchip and mass spectrometry. The microchips can be used in various applications, such as for analyses of drugs, proteins, peptides, or metabolites. The microchip works without pumps for liquid transfer, is usable for rapid analyses, and is sensitive. The characteristics of performance of the single microchips are studied and a rotating multitip version of the microchips are designed and fabricated. It is possible to use the microchip also as a microreactor and reaction products can be detected online with mass spectrometry. This property can be utilized for protein identification for example. Proteins can be digested enzymatically on-chip and reaction products, which are in this case peptides, can be detected with mass spectrometry. Because reactions occur faster in a microscale due to shorter diffusion lengths, the amount of protein can be very low, which is a benefit of the method. The microchip is well suited to surface activated reactions because of a high surface-to-volume ratio due to a dense micropillar array. For example, titanium dioxide nanolayer on the micropillar array combined with UV radiation produces photocatalytic reactions which can be used for mimicking drug metabolism biotransformation reactions. Rapid mimicking with the microchip eases the detection of possibly toxic compounds in preclinical research and therefore could speed up the research of new drugs. A micropillar array chip can also be utilized in the fabrication of liquid chromatographic columns. Precisely ordered micropillar arrays offer a very homogenous column, where separation of compounds has been demonstrated by using both laser induced fluorescence and mass spectrometry. Because of small dimensions on the microchip, the integrated microchip based liquid chromatography electrospray microchip is especially well suited to low sample concentrations. Overall, this work demonstrates that the designed and fabricated silicon/glass three dimensionally sharp electrospray tip is unique and facilitates stable ion spray for mass spectrometry.

Perinatal mortality and maternal health in rural China

Background and context Since the economic reforms of 1978, China has been acclaimed as a remarkable economy, achieving 9% annual growth per head for more than 25 years. However, China's health sector has not fared well. The population health gains slowed down and health disparities increased. In the field of health and health care, significant progress in maternal care has been achieved. However, there still remain important disparities between the urban and rural areas and among the rural areas in terms of economic development. The excess female infant deaths and the rapidly increasing sex ratio at birth in the last decade aroused serious concerns among policy makers and scholars. Decentralization of the government administration and health sector reform impacts maternal care. Many studies using census data have been conducted to explore the determinants of a high sex ratio at birth, but no agreement has been so far reached on the possible contributing factors. No study using family planning system data has been conducted to explore perinatal mortality and sex ratio at birth and only few studies have examined the impact of the decentralization of government and health sector reforms on the provision and organization of maternal care in rural China. Objectives The general objective of this study was to investigate the state of perinatal health and maternal care and their determinants in rural China under the historic context of major socioeconomic reforms and the one child family planning policy. The specific objectives of the study included: 1) to study pregnancy outcomes and perinatal health and their correlates in a rural Chinese county; 2) to examine the issue of sex ratio at birth and its determinants in a rural Chinese county; 3) to explore the patterns of provision, utilization, and content of maternal care in a rural Chinese county; 4) to investigate the changes in the use of maternal care in China from 1991 to 2003. Materials and Methods This study is based on a project for evaluating the prenatal care programme in Dingyuan county in 1999-2003, Anhui province, China and a nationwide household health survey to describe the changes in maternal care utilization. The approaches used included a retrospective cohort study, cross sectional interview surveys, informant interviews, observations and the use of statistical data. The data sources included the following: 1) A cohort of pregnant women followed from pregnancy up to 7 days after birth in 20 townships in the study county, collecting information on pregnancy outcomes using family planning records; 2) A questionnaire interview survey given to women who gave birth between 2001 and 2003; 3) Various statistical and informant surveys data collected from the study county; 4) Three national household health interview survey data sets (1993-2003) were utilized, and reanalyzed to described the changes in maternity care utilization. Relative risks (RR) and their confidence intervals (CI) were calculated for comparison between parity, approval status, infant sex and township groups. The chi-square test was used to analyse the disparity of use of maternal care between and within urban and rural areas and its trend across the years in China. Logistic regression was used to analyse the factors associated with hospital delivery in rural areas. Results There were 3697 pregnancies in the study cohort, resulting in 3092 live births in a total population of 299463 in the 20 study townships during 1999-2000. The average age at pregnancy in the cohort was 25.9 years. Of the women, 61% were childless, 38% already had one child and 0.3% had two children before the current pregnancy. About 90% of approved pregnancies ended in a live birth while 73% of the unapproved ones were aborted. The perinatal mortality rate was 69 per thousand births. If the 30 induced abortions in which the gestational age was more than 28 weeks had been counted as perinatal deaths, the perinatal mortality rate would have been as high as 78 per thousand. The perinatal mortality rate was negatively associated with the wealth of the township. Approximately two thirds of the perinatal deaths occurred in the early neonatal period. Both the still birth rate and the early neonatal death rate increased with parity. The risk of a stillbirth in a second pregnancy was almost four times that for a first pregnancy, while the risk of early neonatal deaths doubled. The early neonatal mortality rate was twice as high for female as for male infants. The sex difference in the early neonatal mortality rate was mainly attributable to mortality in second births. The male early neonatal mortality rate was not affected by parity, while the female early neonatal mortality rate increased dramatically with parity: it was about six times higher for second births than for first births. About 82% early neonatal deaths happened within 24 hours after birth, and during that time, girls were almost three times more likely to die than boys. The death rate of females on the day of birth increased much more sharply with parity than that of males. The total sex ratio at birth of 3697 registered pregnancies was 152 males to 100 females, with 118 and 287 in first and second pregnancies, respectively. Among unapproved pregnancies, there were almost 5 live-born boys for each girl. Most prenatal and delivery care was to be taken care of in township hospitals. At the village level, there were small private clinics. There was no limitation period for the provision of prenatal and postnatal care by private practitioners. They were not permitted to provide delivery care by the county health bureau, but as some 12% of all births occurred either at home or at private clinics; some village health workers might have been involved. The county level hospitals served as the referral centers for the township hospitals in the county. However, there was no formal regulation or guideline on how the referral system should work. Whether or not a woman was referred to a higher level hospital depended on the individual midwife's professional judgment and on the clients' compliance. The county health bureau had little power over township hospitals, because township hospitals had in the decentralization process become directly accountable to the township government. In the township and county hospitals only 10-20% of the recurrent costs were funded by local government (the township hospital was funded by the township government and the county hospital was funded by the county government) and the hospitals collected user fees to balance their budgets. Also the staff salaries depended on fee incomes by the hospital. The hospitals could define the user charges themselves. Prenatal care consultations were however free in most township hospitals. None of the midwives made postnatal home visits, because of low profit of these services. The three national household health survey data showed that the proportion of women receiving their first prenatal visit within 12 weeks increased greatly from the early to middle 1990s in all areas except for large cities. The increase was much larger in the rural areas, reducing the urban-rural difference from more than 4 times to about 1.4 times. The proportion of women that received antenatal care visits meeting the Ministry of Health s standard (at least 5 times) in the rural areas increased sharply from 12% in 1991-1993 to 36% in 2001-2003. In rural areas, the proportion increase was much faster in less developed areas than in developed areas. The hospital delivery rate increased slightly from 90% to 94% in urban areas while the proportion increased from 27% to 69% in rural areas. The fastest change was found to be in type 4 rural areas, where the utilization even quadrupled. The overall difference between rural and urban areas was substantially narrowed over the period. Multiple logistic regression analysis shows that time periods, residency in rural or urban areas, income levels, age group, education levels, delivery history, occupation, health insurance and distance from the nearest health care facilities were significantly associated with hospital delivery rates. Conclusions 1. Perinatal mortality in this study was much higher than that for urban areas as well as any reported rate from specific studies in rural areas of China. Previous studies in which calculations of infant mortality were not based on epidemiological surveys have been shown to underestimate the rates by more than 50%. 2. Routine statistics collected by the Chinese family planning system proved to be a reliable data source for studying perinatal health, including still births, neonatal deaths, sex ratio at birth and among newborns. National Household Health Survey data proved to be a useful and reliable data source for studying population health and health services. Prior to this research there were few studies in these areas available to international audiences. 3.Though perinatal mortality rate was negatively associated with the level of township economic development, the excess female early neonatal mortality rate contributed much more to high perinatal mortality rate than economic factors. This was likely a result of the role of the family planning policy and the traditional preferences for sons, which leads to lethal neglect of female newborns and high perinatal mortality. 4. The selective abortions of female foetuses were likely to contribute most to the high sex ratio at birth. The underreporting of female births seemed to have played a secondary role. The higher early neonatal mortality rate in second-born as compared to first-born children, particularly in females, may indicate that neglect or poorer care of female newborn infants also contributes to the high sex ratio at birth or among newborns. Existing family planning policy proved not to effectively control the steadily increased birth sex ratio. 5. The rural-urban gap in service utilization was on average significantly narrowed in terms of maternal healthcare in China from 1991 to 2003. This demonstrates that significant achievements in reducing inequities can be made through a combination of socio-economic development and targeted investments in improving health services, including infrastructure, staff capacities, and subsidies to reduce the costs of service utilization for the poorest. However, the huge gap which persisted among cities of different size and within different types of rural areas indicated the need for further efforts to support the poorest areas. 6. Hospital delivery care in the study county was better accepted by women because most of women think delivery care was very important while prenatal and postnatal care were not. Hospital delivery care was more systematically provided and promoted than prenatal and postnatal care by township hospital in the study area. The reliance of hospital staff income on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care, since delivery care generated much profits than prenatal and postnatal care . Recommendations 1. It is essential for the central government to re-assess and modify existing family planning policies. In order to keep national sex balance, the existing practice of one couple one child in urban areas and at-least-one-son a couple in rural areas should be gradually changed to a two-children-a-couple policy throughout the country. The government should establish a favourable social security policy for couples, especially for rural couples who have only daughters, with particular emphasis on their pension and medical care insurance, combined with an educational campaign for equal rights for boys and girls in society. 2. There is currently no routine vital-statistics registration system in rural China. Using the findings of this study, the central government could set up a routine vital-statistics registration system using family planning routine work records, which could be used by policy makers and researchers. 3. It is possible for the central and provincial government to invest more in the less developed and poor rural areas to increase the access of pregnant women in these areas to maternal care services. Central government together with local government should gradually provide free maternal care including prenatal and postnatal as well as delivery care to the women in poor and less developed rural areas. 4. Future research could be done to explore if county and the township level health care sector and the family planning system could be merged to increase the effectiveness and efficiency of maternal and child care. 5. Future research could be done to explore the relative contribution of maternal care, economic development and family planning policy on perinatal and child health using prospective cohort studies and community based randomized trials. Key words: perinatal health, perinatal mortality, stillbirth, neonatal death, sex selective abortion, sex ratio at birth, family planning, son preference, maternal care, prenatal care, postnatal care, equity, China

Vastakkainasettelusta takaisin neuvottelupöytiin - presidentti Ronald Reaganin neuvostosuhteet 1981-1987

Tutkielmassa tutkitaan Yhdysvaltain presidentti Ronald Reaganin (1911-2004) Neuvostoliittoa koskevaa retoriikkaa hänen käyttämissään julkisissa virallisissa puheissa. Tutkimuskohde on valittu siksi, että Reaganin kahden virkakauden välillä tapahtui merkittävä linjanmuutos juuri neuvostosuhteissa ja tämän tutkimuksen tarkoituksena on pyrkiä selittämään retoriikan merkitystä todellisuuteen. Ajanjakso on rajattu periodille 1981-1987, koska juuri tällä periodilla ratkaiseva retoriikan ja turvallisuuspoliittisen linjan muutos suhteessa Neuvostoliittoon tapahtui. Vedenjakajana on vuosi 1985 Reaganin toisen kauden alkaessa ja Mihail Gorbatšovin tullessa valtaan Neuvostoliitossa. Johdon vaihtuminen Neuvostoliitossa ajatellaan usein olevan ratkaiseva tekijä Yhdysvaltain ja Reaganin asenteiden muuttumiselle. Tutkimuksen avulla pyritään avaamaan diplomatian kulisseja, mitä todellisuudessa milloinkin tapahtui ja missä mentiin kilpavarustelun ja aseriisuntaneuvottelujen samanaikaisten ristiriitaisten vuorovaikutusten akanvirroissa. Aiemmassa tutkimuksessa on taustoitettu erityisesti aseriisuntaneuvottelujen historiaa myös Reaganin kolmen edeltäjän ajalta 1969-1981 periodilta sekä kuvattu Reaganin presidenttikauden pääkysymykset Neuvostoliiton suhteen. Aiemmassa tutkimuksessa on esitetty, että Reagan palasi neuvostopolitiikassaan käytännössä liennytyksen linjalle, merkittävänä retorisena erona kuitenkin, ettei tätä termiä virallisesti koskaan käytetty Reaganin aikana. Toisaalta Reagania on pidetty omalaatuisena ja hieman pinnallisena, kuitenkin retorisesti maan historian yhtenä taitavimmista presidenteistä. Reagan jatkoi pitkälti edeltäjänsä Jimmy Carterin jo käynnistämiä asevarusteluhankkeita mutta hän pyrki saamaan uuden alun neuvotteluilmapiiriin omalla täysin edeltäjistään poikkeavalla kovennetulla retoriikallaan. Varsinkin kautensa alkupuolella Reagan joutui hyvin haastavasti retorisesti todistelemaan haluaan rauhaan samalla kun hänen piti perustella uudet mittavat asevarusteluhankkeet omalle kansalleen. Erityisesti kiistanalainen SDI-avaruuspuolustushanke oli presidentin oma aloite, jota oli vaikeinta perustella riittävän uskottavasti kotimaassa ja varsinkin ulkomailla. Tutkielman tutkimusote on kvalitatiivinen ja induktiivinen. Metodina toimii retorinen analyysi. Retorisen pakottamisen mallia käyttämällä on tarkoituksena jäsentää retoriikan ja turvallisuuspolitiikan välistä yhteyttä sekä näin samalla paikantaa puheiden ja todellisuuden välistä kokonaisuutta. Tutkimuksen avulla pyritään tunnistamaan muutoksia retoriikan menetelmissä puheiden sisällä ja etsimään näiden muutosten syy-seuraussuhteita samanaikaisesti tapahtuneisiin kilpavarustelu –ja aseriisuntaprosesseihin. Lähtöoletuksena on että Reaganin kaudella tapahtunut kolmas johtajanvaihdos, Gorbatšovin valtaantulo oli merkittävä tekijä sekä Reaganin retoriikan että politiikan muuttumisessa. Tutkimus nojautuu pitkälti primaariaineistoon presidentti Reaganin virallisten puheiden toimiessa tärkeimpänä lähdemateriaalina. Merkittävin tutkimustulos on, että vuoden 1985 johtajavaihdos Neuvostoliitossa oli merkittävä tekijä Reaganin konkreettisessa suunnan muutoksessa Neuvostoliittoon nähden, mutta retoriikan tasolla tämä muutos ei ollut yhtä selvä. Hänen puheissaan oli vaihtelevia sävyjä sekä ennen että jälkeen Gorbatšovin valtaantulon. Reaganin sävy puheissa pehmeni jonkin verran, mutta kovistelevia sanoja 1985 jälkeenkin oli silti välillä kohtalaisen paljon ja toisaalta jo aiempien neuvostojohtajien aikana hän puhui välillä sovinnollisempaan sävyyn. Muutos retoriikan suhteen on ollut näin ollen varovaisempaa ja vaikeammin kohdistettavissa yhden tietyn tapahtuman seurauksena. Aseriisuntaneuvotteluissa sen sijaan mentiin selvästi eteenpäin johtajien 1985-1986 tapaamisten siivittämänä. Reagan oli retorisen pakottamisen mallin soveltamisessa pääsääntöisesti aloitteellinen osapuoli, joka halusi vaikuttaa merkittävästi muutoksiin erityisesti Neuvostoliiton sisällä.

Eläkejärjestelmät ja maahanmuutto : poliittisen taloustieteen lähestymistapa

Tässä työssä kysymystä kouluttamattoman maahanmuuton mahdollisesta vaikutuksesta eläkkeiden rahoitettavuuteen ja sitä kautta maahanmuuttopolitiikkaan lähestytään poliittisen taloustieteen näkökulmasta. Tarkastellaan siis sitä, mitkä ikä- ja tuloryhmät hyötyvät kouluttamattomasta maahanmuutosta sen mahdollisesti helpottaessa eläkkeiden maksua ja mitkä eivät ja millaiseen poliittiseen tasapainoon tämä johtaa. Äänestettäessä maahanmuuttopolitiikasta yksilö perustaisi mielipiteensä maahanmuuttopolitiikan liberalisoinnista tai tiukentamisesta siihen, miten maahanmuutto vaikuttaisi hänen omaan etuunsa. Maan väestö jaetaan eläkeläisiin sekä koulutettuihin ja kouluttamattomiin työntekijöihin ja tarkastellaan miten maahanmuutto vaikuttaa näiden ryhmien taloudelliseen hyötyyn. Aluksi tarkastellaan lyhyesti millaisia malleja maahanmuutosta ja eläkejärjestelmän olemassaolon vaikutuksista siihen suhtautumiseen on olemassa. Ensimmäisen johdantoluvun jälkeen käsitellään sitä, miten äänestystulos maahanmuuttopolitiikasta muuttuu mallin oletusten muuttuessa. Työssä tarkastellaan Razinin ja Sadkan (1999) hyvin yksinkertaista mallia, joka sisältää yksinkertaisuutensa takia joitain hyvin rajoittavia oletuksia. Sitten käydään läpi Kriegerin (2004) sekä Razinin ja Sadkan (2000) tekemiä laajennuksia, joissa osasta rajoittavia oletuksia luovutaan ja katsotaan millaisiin muutoksiin tämä johtaa. Työssä tarkastellaan myös Kriegerin (2003) mallia äänestystuloksesta neljässä erilaisessa eläkejärjestelmässä. Tamuran (2006) mallia tarkastellaan näkökulman laajentamiseksi edelleen. Tarkastelun kohteena ei enää ole vain eläkejärjestelmä, vaan myös tulonsiirrot matalapalkka-alojen työntekijöille. Työssä tarkasteltujen artikkeleiden pohjalta näyttää siltä, että erilaisissa eläkejärjestelmissä ja erilaisissa talouksissa elävät yksilöt suhtautuvat maahanmuuttoon eri tavoin sen mukaan, minkä verran he saavat hyötyä siitä. Hyödyn määrään vaikuttavat myös maahanmuuttajien ominaisuudet ja eläkejärjestelmän ominaisuudet, varsinkin se, onko eläkemaksu vai eläke-etuus vakio. Koska maahanmuutto vaikuttaa talouden eri ryhmiin eli kouluttamattomiin ja koulutettuihin työntekijöihin sekä eläkeläisiin eri tavoin, useimmiten yksimielisyyttä maahanmuuttopolitiikasta ei synny.

Silva Fennica Vol. 27, 1993.

Julkaistu Silva Fennica Vol. 27(4) -numeron liitteenä.

Change detection and controlling forest information using multi-temporal Landsat TM imagery.

A method was developed for relative radiometric calibration of single multitemporal Landsat TM image, several multitemporal images covering each others, and several multitemporal images covering different geographic locations. The radiometricly calibrated difference images were used for detecting rapid changes on forest stands. The nonparametric Kernel method was applied for change detection. The accuracy of the change detection was estimated by inspecting the image analysis results in field. The change classification was applied for controlling the quality of the continuously updated forest stand information. The aim was to ensure that all the manmade changes and any forest damages were correctly updated including the attribute and stand delineation information. The image analysis results were compared with the registered treatments and the stand information base. The stands with discrepancies between these two information sources were recommended to be field inspected.

Hostility: A prospective study of the genetic and environmental background and associations with cardiovascular risk

Hostility is a multidimensional construct having wide effects on society. In its different forms, hostility is related to a large array of social and health problems, such as criminality, substance abuse, depression, and cardiovascular risks. Identifying and tackling early-life factors that contribute to hostility may have public health significance. Although the variance in hostility is estimated to be 18-50 percent heritable, there are significant gaps in knowledge regarding the molecular genetics of hostility. It is known that a cold and unsupportive home atmosphere in childhood predicts a child s later hostility. However, the long-term effects of care-giving quality on hostility in adulthood and the role of genes in this association are unclear. The present dissertation is part of the ongoing population-based prospective Young Finns study, which commenced in 1980 with 3596 3-18-year-old boys and girls who were followed for 27 years. The specific aims of the dissertation were first to study the antecedents of hostility by looking at 1) the genetic background, 2) the early environmental predictors, and 3) the gene environment interplay behind hostility. As a second aim, the thesis endeavored to examine 4) the association between hostility and cardiovascular risks, and 5) the moderating effect of demographic factors, such as gender and socioeconomic status, on this association. The study found potential gene polymorphisms from chromosomes 7, 14, 17, and 22 suggestively associated with hostility. Of early environmental influences, breastfeeding and early care-giving were found to predict hostility in adulthood. In addition, a serotonin receptor 2A polymorphism rs6313 moderated the effect of early care-giving on later hostile attitudes. Furthermore, hostility was shown to predict cardiovascular risks, such as metabolic syndrome and inflammation. Finally, parental socioeconomic status was found to moderate the association between anger and early atherosclerosis. The new genetic and early environmental antecedents of hostility identified in this research may help in understanding the development of hostility and its health risks, and in planning appropriate prevention. The significance of early influences on this development is stressed. Although the markers studied are individual- and family-related factors, these may be influenced at the societal level by giving accurate information to all individuals concerned and by improving the societal circumstances.