Cargo Traffic on the Helsinki-Tallinn Route

The twin-city model has found to increase economical activity and well-being. The similar economical, social and cultural background of Finland and Estonia as well as the EU integration give good preconditions to create a twin-city of Helsinki and Tallinn. The relatively long distance between Helsinki and Tallinn is challenging. Therefore, good transport infrastructure and functioning connections are required to form a twin-city of Helsinki and Tallinn. The connections between these cities can be considered also in broader perspective than only from the viewpoint of the twin-city concept. New markets areas have been emerged in Europe due to collapse of planned economy and integration of Europe. Also the transport routes to the markets are changing. The Hel-sinki-Tallinn sea route can be considered as a fast route to the new markets in the Cen-tral and Eastern Europe. The Helsinki-Tallinn sea route is also a potential route to the Western European markets. This study provides an analysis of transport and cargo flows between Finland and Esto-nia for regional and local planners. The main purpose of the study is to clarify the pre-sent situation of the seaborne cargo flows on the Helsinki-Tallinn route and how the cargo flows will develop in the future. The study focuses on the following thematic enti-ties: the Finnish and Estonian seaborne transport system and cargo flows, the structure and volume of the cargo flows on the Helsinki-Tallinn route, the hinterland cargo flows on the Helsinki-Tallinn route and the transport methods used on the Helsinki-Tallinn route. The study was carried out as a desk research, a statistical analysis and an inter-view study during the spring–autumn 2011. The study reveals that during the period 2002–2010 the volume of the seaborne cargo traffic between Finland and Estonia has increased significantly while the trend of the trade volume between Finland and Estonia has remained nearly constant. This indicates that the route via Estonia is increasingly used in the Finnish foreign trade. Because the ports of Helsinki and Tallinn are the main ports in the cargo traffic between Finland and Estonia, the role of the Helsinki-Tallinn route as a sea leg in the hinterland connections of Finland has increased. The growth of the cargo volume on the Helsinki-Tallinn route was estimated to continue on the annual level of 10 % during the next couple of years. In the long run the growth of the cargo volumes depends on the economical and indus-trial development of the former Eastern European countries. If the IMO’s sulphur regu-lations will come in force, the Helsinki-Tallinn route will become one of the main routes also to the Western European markets, besides of the route via Sweden. The study also shows that the fast and reliable connections year round on the Helsinki-Tallinn route have made it possible for service and logistics companies to reconsider their logistics strategies in a new way in the both side of the Gulf of Finland. Anyway, the ropax concept is seen as the only economical profitable solution on the Helsinki-Tallinn route because cargo and passenger traffic are supporting each other. The trucks (vehicle combinations) will remain the main mode of transport on the Helsinki-Tallinn route because general cargo is the main commodity on the route. IMO’s sulphur regula-tions and the changes in the structure of the Finnish industry may create prerequisites for rail road transport in the hinterland connections of Finland. The twin-city model has found to increase economical activity and well-being. The similar economical, social and cultural background of Finland and Estonia as well as the EU integration give good preconditions to create a twin-city of Helsinki and Tallinn. The relatively long distance between Helsinki and Tallinn is challenging. Therefore, good transport infrastructure and functioning connections are required to form a twin-city of Helsinki and Tallinn. The connections between these cities can be considered also in broader perspective than only from the viewpoint of the twin-city concept. New markets areas have been emerged in Europe due to collapse of planned economy and integration of Europe. Also the transport routes to the markets are changing. The Hel-sinki-Tallinn sea route can be considered as a fast route to the new markets in the Cen-tral and Eastern Europe. The Helsinki-Tallinn sea route is also a potential route to the Western European markets. This study provides an analysis of transport and cargo flows between Finland and Esto-nia for regional and local planners. The main purpose of the study is to clarify the pre-sent situation of the seaborne cargo flows on the Helsinki-Tallinn route and how the cargo flows will develop in the future. The study focuses on the following thematic enti-ties: the Finnish and Estonian seaborne transport system and cargo flows, the structure and volume of the cargo flows on the Helsinki-Tallinn route, the hinterland cargo flows on the Helsinki-Tallinn route and the transport methods used on the Helsinki-Tallinn route. The study was carried out as a desk research, a statistical analysis and an inter-view study during the spring–autumn 2011. The study reveals that during the period 2002–2010 the volume of the seaborne cargo traffic between Finland and Estonia has increased significantly while the trend of the trade volume between Finland and Estonia has remained nearly constant. This indicates that the route via Estonia is increasingly used in the Finnish foreign trade. Because the ports of Helsinki and Tallinn are the main ports in the cargo traffic between Finland and Estonia, the role of the Helsinki-Tallinn route as a sea leg in the hinterland connections of Finland has increased. The growth of the cargo volume on the Helsinki-Tallinn route was estimated to continue on the annual level of 10 % during the next couple of years. In the long run the growth of the cargo volumes depends on the economical and indus-trial development of the former Eastern European countries. If the IMO’s sulphur regu-lations will come in force, the Helsinki-Tallinn route will become one of the main routes also to the Western European markets, besides of the route via Sweden. The study also shows that the fast and reliable connections year round on the Helsinki-Tallinn route have made it possible for service and logistics companies to reconsider their logistics strategies in a new way in the both side of the Gulf of Finland. Anyway, the ropax concept is seen as the only economical profitable solution on the Helsinki-Tallinn route because cargo and passenger traffic are supporting each other. The trucks (vehicle combinations) will remain the main mode of transport on the Helsinki-Tallinn route because general cargo is the main commodity on the route. IMO’s sulphur regula-tions and the changes in the structure of the Finnish industry may create prerequisites for rail road transport in the hinterland connections of Finland.

E-PORT. Improving efficiency of Finnish port community by intelligent systems Final report of the Mobile Port project

The management of port-related supply chains is challenging due to the complex and heterogeneous operations of the ports with several actors and processes. That is why the importance of information sharing is emphasised in the ports. However, the information exchange between different port-related actors is often cumbersome and it still involves a lot of manual work and paper. Major ports and port-related actors usually have advanced information systems in daily use but these systems are seldom interoperable with each other, which prevents economies of scale to be reached. Smaller ports and companies might not be equipped with electronic data transmission at all. This is the final report of the Mobile port (MOPO) project, which has sought ways to improve the management and control of port-related sea and inland traffic with the aid of ICT technologies. The project has studied port community systems (PCS) used worldwide, evaluated the suitability of a PCS for the Finnish port operating environment and created a pilot solution of a Finnish PCS in the port of HaminaKotka. Further, the dry port concept and its influences on the transportation system have been explored. The Mobile Port project comprised of several literature reviews, interviews of over 50 port-related logistics and/or ICT professionals, two different kinds of simulation models as well as designing and implementing of the pilot solution of the Finnish PCS. The results of these multiple studies are summarised in this report. Furthermore, recommendations for future actions and the topics for further studies are addressed in the report. The study revealed that the information sharing in a typical Finnish port-related supply chain contains several bottlenecks that cause delays in shipments and waste resources. The study showed that many of these bottlenecks could be solved by building a port community system for the Finnish port community. Almost 30 different kinds of potential services or service entities of a Finnish PCS were found out during the study. The basic requirements, structure, interfaces and operation model of the Finnish PCS were also defined in the study. On the basis of the results of the study, a pilot solution of the Finnish PCS was implemented in the port of HaminaKotka. The pilot solution includes a Portconnect portal for the Finnish port community system (available at https://www.portconnect.fi) and two pilot applications, which are a service for handling the information flows concerning the movements of railway wagons and a service for handling the information flows between Finnish ports and Finland-Russian border. The study also showed that port community systems can be used to improve the environmental aspects of logistics in two different ways: 1) PCSs can bring direct environmental benefits and 2) PCSs can be used as an environmental tool in a port community. On the basis of the study, the development of the Finnish port community system should be continued by surveying other potential applications for the Finnish PCS. It is also important to study if there is need and resources to extend the Finnish PCS to operate in several ports or even on a national level. In the long run, it could be reasonable to clarify whether there would be possibilities to connect the Finnish PCS as a part of Baltic Sea wide, European-wide or even worldwide maritime and port-related network in order to get the best benefit from the system

Entrepreneurial orientation in small and medium-sized enterprises during economic crisis

The economic importance of small and medium-sized enterprises (SMEs) and entrepreneurship has increased significantly in recent decades and entrepreneurial activity and SMEs are deemed vital to economic progress. Therefore, it is justifiable to study how small firms and entrepreneurs can enhance their performance and emergence in the turbulent economic environment. The concept of entrepreneurial orientation (EO) has recently attracted considerable attention in the field of entrepreneurship research. EO generally refers to a firm’s propensity to be innovative, to be proactive and to take risks. A majority of EO studies so far have found that adopting EO associated entrepreneurial behaviors will help firms to create or sustain a high level of performance. This dissertation explores the main drivers and performance implications of EO for SMEs in time of economic crisis. Hence the first objective of this dissertation is to examine the performance implications of EO and to test the role of EO on how firms are treated by the crisis at operative level. The second objective is to expand the prevailing understanding of determinants of EO by exploring the relationship between owner's work related values, attitudes, demographic characteristics, firm’s financial resources and EO. EO was found to be a significant and positive factor behind a firm’s long run growth. Hence it can be said that EO has positive implications for firm performance. But on the other hand, during a time of economic crisis the different dimensions of EO had both positive and negative effects on performance of SMEs. The performance implications varied across different stages of the crisis and were also dependent on what measure was used for measuring the performance. The main drivers of EO in SMEs were the personal work related values of the entrepreneur and his/her prior experience as an entrepreneur. The intrinsic work values related to interest, responsibility, challenge, self-development or intellectual stimulation and values related to status, power, achievement and recognition had a positive effect on the level of EO. On the other hand, extrinsic values related to high income, material possessions, benefits such as generous holidays, job security, and comfort through good working conditions decreased the level of EO

The accumulation of financial and social capital as a means to achieve a sustained competitive advantage for consumer co-operatives

By so far, scholars have discussed how the characteristics of consumer co-operatives (cooperative principles, values and the dual role of members as the users and owners) can potentially give them a competitive advantage over investor-owned firms (IOFs). In addition, concern for the community (as partly derived from locality and regionality) has been seen as a potential source of success for consumer co-operatives. On the other hand, the geographicbound purpose of consumer co-operation causes that consumer co-operative can be regarded as a challenging company form to manage. This is because, according to the purpose of consumer co-operation, co-operatives are obligated to 1) provide the owners with services and goods that are needed and do so at more affordable prices than their competitors do and/or 2) to operate in areas in which competitors do not want to operate (for example, because of the low profitability in certain area of business or region). Thus, consumer co-operatives have to operate very efficiently in order to execute this geographic-bound corporate purpose (e.g. they cannot withdraw from the competition during the declining stages of business). However, this efficiency cannot be achieved by any means; as the acceptance from the important regional stakeholders is the basic operational precondition and lifeline in the long run. Thereby, the central question for the survival and success of consumer co-operatives is; how should the consumer co-operatives execute its corporate purpose so it can be the best alternative to its members in the long run? This question has remained unanswered and lack empirical evidence in the previous studies on the strategic management of consumer cooperation. In more detail, scholars have not yet empirically investigated the question: How can consumer co-operatives use financial and social capital to achieve a sustained competitive advantage? It is this research gap that this doctoral dissertation aims to fulfil. This doctoral dissertation aims to answer the above questions by combining and utilizing interview data from S Group co-operatives and the central organizations in S Group´s network (overall, 33 interviews were gathered), archival material and 56 published media articles/reports. The study is based on a qualitative case study approach that is aimed at theory development, not theory verification (as the theory is considered as nascent in this field of study). Firstly, the findings of this study indicate that consumer co-operatives accumulate financial capital; 1) by making profit (to invest and grow) and 2) by utilizing a network-based organizational structure (local supply chain economies). As a result of financial capital accumulation, consumer co-operatives are able to achieve efficiency gains but also remain local. In addition, a strong financial capital base increases consumer co-operatives´ independence, competitiveness and their ability to participate in regional development (which is in accordance with their geographically bound corporate purpose). Secondly, consumer cooperatives accumulate social capital through informal networking (with important regional stakeholders), corporate social responsibility (CSR) behaviour and CSR reporting, pursuing common good, and interacting and identity sharing. As a result of social capital accumulation, consumer co-operatives are able to obtain the resources for managing; 1) institutional dependencies and 2) customer relations. By accumulating both social and financial capital through the above presented actions, consumer co-operatives are able to achieve sustained competitive advantage. Finally, this thesis provides useful ideas and new knowledge for cooperative managers concerning why and how consumer co-operatives should accumulate financial and social capital (to achieve sustained competitive advantage), while aligning with their corporate purpose.

Data management as a part of performance management: Case study about production reporting development project

Because of the increased availability of different kind of business intelligence technologies and tools it can be easy to fall in illusion that new technologies will automatically solve the problems of data management and reporting of the company. The management is not only about management of technology but also the management of processes and people. This thesis is focusing more into traditional data management and performance management of production processes which both can be seen as a requirement for long lasting development. Also some of the operative BI solutions are considered in the ideal state of reporting system. The objectives of this study are to examine what requirements effective performance management of production processes have for data management and reporting of the company and to see how they are effecting on the efficiency of it. The research is executed as a theoretical literary research about the subjects and as a qualitative case study about reporting development project of Finnsugar Ltd. The case study is examined through theoretical frameworks and by the active participant observation. To get a better picture about the ideal state of reporting system simple investment calculations are performed. According to the results of the research, requirements for effective performance management of production processes are automation in the collection of data, integration of operative databases, usage of efficient data management technologies like ETL (Extract, Transform, Load) processes, data warehouse (DW) and Online Analytical Processing (OLAP) and efficient management of processes, data and roles.

The Russian National Innovation System - an International Perspective

Russia inherited a large research and development (R&D) sector from the Soviet times, and has retained a substantial R&D sector today, compared with other emerging economies. However, Russia is falling behind in all indicators measuring innovative output in comparison with most developed countries. Russia’s innovation performance is disappointing, despite the available stock of human capital and overall investment in R&D. The communist legacy still influences the main actors of the innovation system. The federal state is still the most important funding source for R&D. Private companies are not investing in innovative activities, preferring to “import” innovations embedded in foreign technologies. Universities are outsiders in the innovation system, only a few universities carry out research activities. Nowadays, Russia is a resource-depended country. The economy depends on energy and metals for growth. The Russian economy faces the challenge of diversification and should embrace innovation, and shift to a knowledge economy to remain competitive in the long run. Therefore, Russia has to tackle the challenge of developing an efficient innovation system with its huge potential in science expertise and engineering know-how.

Työhyvinvointiraportointi osana henkilöstöraportointia - Henkilöstöraportoinnin kehittäminen kohdeyrityksessä

Työntekijöitä ja heidän tietojaan ja taitojaan pidetään yhtenä yrityksen tär-keimmistä resursseista. Jatkuvasti muuttuvan toimintaympäristön vuoksi on tärkeää huolehtia työntekijöiden terveydestä ja hyvinvoinnista. Työhyvinvoinnista tarvitaan ajankohtaista tietoa, jotta voidaan seurata henkilöstön kehitystä ja luoda realistinen kuva henkilöstön pitkäaikaiseen suorituskykyyn vaikuttavista tekijöistä. Tutkimuksen tavoitteena on tutkia kohdeyrityksen henkilöstöraportoinnin kehitystarpeita. Tutkimus on rajattu kohdeyrityksen sisäiseen raportointiin ja työhyvinvointiraportointiin. Aineisto kerättiin teemahaastatteluiden ja sähköpostihaastatteluiden avulla. Kohdeyrityksessä on tarve uusille henkilöstötunnusluvuille ja säännölliselle, tarpeeksi usein toteutettavalle henkilöstökyselylle. Lisäksi henkilöstökyselyiden tuloksista ja työhyvinvoinnin kehittämisen toimenpiteistä tarvitaan koko henkilöstölle näkyvää raportointia.

Tapahtumamarkkinointi osana yrityksen markkinointiviestintää

Tämän tutkimuksen tarkoituksena oli laadullisia tutkimusmenetelmiä yhdistelemällä ja relevanttia tieteellistä kirjallisuutta hyödyntämällä selvittää, miten tutkimuksen kohdeyrityksen toteuttamaa tapahtumamarkkinointia voitaisiin kehittää vastaamaan paremmin yrityksen muuttuvia tarpeita. Tähän liittyen tutkittiin kohdeyrityksen näkökulmasta, miten tapahtumamarkkinointi nähdään, ja miten sitä hyödynnetään tällä hetkellä osana yrityksen markkinointiviestintää. Kuluttajan näkökulmaa hyödyntäen pyrittiin selvittämään, mitä vaikutuksia toteutetulla tapahtumamarkkinoinnilla on tapahtumiin osallistuvien yksilöiden kuluttajakäyttäytymiseen ja heidän kokemaansa brändiin. Lopuksi tutkittiin, missä rooleissa tapahtumiin osallistuvat yksilöt ovat kohdeyrityksen tuotteiden kuluttamiseen liittyvässä päätöksentekoprosessissa, ja mitä muita vaikuttajia prosessiin sisältyy. Empiirisiä tutkimustuloksia ja tieteellisessä kirjallisuudessa määriteltyjä parhaita toimintatapoja vertailemalla pyrittiin tunnistamaan eroavaisuuksia ja mahdollisia kehityskohteita. Työ toteutettiin tapaustutkimuksena, jossa tutkittavaa ilmiötä lähestyttiin sekä yrityksen että kuluttajan näkökulmasta. Tutkimuksen laadullinen aineisto kerättiin puolistrukturoitujen haastattelujen avulla, jonka lisäksi tukevana menetelmänä hyödynnettiin havainnointia. Haastattelujen kohteena oli kohdeyrityksen markkinointivastaavan lisäksi 19 järjestettyyn case-tapahtumaan osallistunutta yksilöä. Tulokset paljastivat tiettyjä eroavaisuuksia kohdeyrityksen toteuttaman tapahtumamarkkinoinnin ja alan tieteellisessä kirjallisuudessa määriteltyjen parhaiden toimintatapojen välillä. Tutkimustulokset kohdistivat huomiota myös tapahtumamarkkinoilla saavutettaviin hyötyihin lyhyellä ja pitkällä aikavälillä. Lisäksi tuloksiin perustuen muodostettiin uutta tietoa toiminnan kohteena olevien yksilöiden ku-luttamiseen liittyvästä päätöksentekoprosessista ja siihen sisältyvistä rooleista.

Medborgare, brukare av välfärd eller klient? : en jämförande studie om brukarens inflytande mellan en kommun, ett assistansbolag och ett brukarkooperativ som utför personlig assistans

The focus of this licentiate dissertation is to produce a better understanding of how we may give citi-zen as users a stronger influence over their welfare services and in the long run help to democratize the welfare state. The aim of this project is to analyze what kind of influence a user with a functional dis-order may have in different organizational contexts over his or her personal assistance. This study focuses on the influence a user may have over his or her welfare service, personal assis-tance. A municipality, an assistance firm and a user cooperative are compared with the thesis that the organization that surrounds the users shapes the possibilities the user have to influence his or her per-sonal assistance. The major thesis is thus: Participatory democracy as a model or approach may function differently when the services are delivered in a different way by different organizations – varying organizational forms. There are questions that try to answer if there are outspoken social goals within each organization. Questions regarding influence of the user when she or he is choosing the assistance provider and the users possibility to influence and his or her power to decide who and when anyone works as an assis-tant are asked. The results indicate that there are different sets of internal logic within the organizations that affect their goals and level of user influence. Within the user cooperative the user is considered a citizen and as a user expected to handle the role as work leader for his or her personal assistants. However the user is also a citizen and is expected within the usercooperative to act as a member and citizen to have po-litical influence. The usercooperative aims at influencing the political policy process regarding ques-tions concerning the rights of persons with disabilities. This gives the user a part in collective action as a member of the usercooperative. The other producers of personal assistance, the municipality and the assistance firm gives in this study a similar result as they give the user of personal assistance quite similar models for user influence within the respective organization. Within these organizations the user have chosen to let the organiza-tions handle the role of work leader in the written agreements with the producer and thereby the influ-ence they may have in practice is not so much a case of self-determination as a case of co-influence. The user can be seen as a user within a municipality, a client or consumer within the assistance firm and a citizen within the usercooperative. The results indicate the need for future research where co-production, institutional logic and development of democratic theory through democratic innovations are central aspects of future research.

Michal Kalecki, um pioneiro da teoria econômica do desenvolvimento

Kalecki made important contributions to development economics, which rank him among the founding fathers of this area of our discipline. The objective of this paper is to give an account of his contributions, and in particular of his conception of the peculiarities and the way of functioning of the underdeveloped economies, and of the barriers that limits their capacity for high and sustained long run growth. As most socialist economists of his time, he was skeptic about the possibilities of overcoming underdevelopment under capitalism. However, in contradistinction to other pioneers of development economics, Kalecki did not stress the international forces that hamper development, but put the accent rather in the internal institutions and social and political determinants. In particular, the feudal and semi-feudal conditions in agriculture, the reduced market ensuing from income concentration and widespread monopolization of the economy, and the lack of willingness of entrepreneurs to carry out the necessary investments. Accordingly, his economic policy recommendations emphasized also the domestic aspects involved.

Developing asset management in district heating and cooling business in a large energy company

The purpose of this Master´s Thesis is to develop asset management and its practices in case company. District heating and cooling systems operated by case company around Finland, Sweden, Poland and the Baltics form an enormous-sized asset base where some parts are starting to reach their end of life-cycles. Large-sized asset renewal actions are under discussion and maintenance spending is increasing. Financially justified decisions in changing business environment are needed. Asset management is one of the most important concepts for production organization which operates with capital-intensive production assets. Organizations profitability is highly dependent on assets´ performance. Such assets, like district heating and cooling systems, should be utilized as efficiently as possible within their life-cycles but also maintained and renewed optimally. In this qualitative thesis, empirical interview study was conducted to describe the current situation on how the assets are managed in the case company and to examine the readiness to implement a new, risk-based solution. Asset management revealed to be a very well-known concept. From proposed risk-based asset management point of view, several key observations were made. It was seen as a suitable solution, but further development will be needed. Based on the need and findings, several key processes and frameworks were created and also tested with a case study. Assets` condition monitoring should be improved, which would have a positive impact on event probability assessment. Risk acceptance is also a thing to be discussed further. When the evaluation becomes fluent in single investment cases, portfolio-level expansion should be considered and started. As a result, thesis proposes a solution how risk-based asset management could be performed practically in a capital-intensive case company in order to optimize the maintenance spending in a long run. Created practical framework is made universal: similar principles can be applied into multiple cases in case company but also in other energy companies. Risk-based asset management`s benefits could be utilized best in portfolio-level optimization where the capital would be invested to the most important objects from total risk point of view. Eventually, such approach would allow case company to optimize capital spending in a situation where funds are not adequate to cover all the mandatory needs and prioritization between the investment alternatives will truly be needed.

Analyse des glissements juridiques de la politique canadienne en matière de brevets quant à son objectif d'équilibre entre la promotion des intérêts de l'industrie pharmaceutique novatrice et ceux de l'industrie du médicament générique

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de maîtrise en droit". Ce mémoire a été accepté à l'unanimité et classé parmi les 10% des mémoires de la discipline.

Suivi à long terme de l’efficacité d’un traitement de physiothérapie sur l'incontinence urinaire d'effort persistante en période postnatale

L’incontinence urinaire d’effort (IUE) est une condition fréquente en période postnatale pouvant affecter jusqu’à 77% des femmes. Neuf femmes sur dix souffrant d’IUE trois mois après l’accouchement, vont présenter une IUE cinq ans plus tard. Le traitement en physiothérapie de l’IUE par le biais d’un programme d’exercices de renforcement des muscles du plancher pelvien est reconnu comme étant un traitement de première ligne efficace. Les études ont prouvé l’efficacité de cette approche sur l’IUE persistante à court terme, mais les résultats de deux ECR à long terme n’ont pas démontré un maintien de l’effet de traitement. L’effet d’un programme en physiothérapie de renforcement du plancher pelvien intensif et étroitement supervisé sur l’IUE postnatale persistante avait été évalué lors d’un essai clinique randomisé il y a sept ans. Le but principal de la présente étude était d’évaluer l’effet de ce programme sept ans après la fin des interventions de l’ECR initial. Un objectif secondaire était de comparer l’effet de traitement à long terme entre un groupe ayant fait seulement des exercices de renforcement du plancher pelvien et un groupe ayant fait des exercices de renforcement du plancher pelvien et des abdominaux profonds. Un troisième objectif était d’explorer l’influence de quatre facteurs de risques sur les symptômes d’IUE et la qualité de vie à long terme. Les cinquante-sept femmes ayant complétées l’ECR initial ont été invitées à participer à l’évaluation du suivi sept ans. Vingt et une femmes ont participé à l’évaluation clinique et ont répondu à quatre questionnaires, tandis que dix femmes ont répondu aux questionnaires seulement. L’évaluation clinique incluait un pad test et la dynamométrie du plancher pelvien. La mesure d’effet primaire était un pad test modifié de 20 minutes. Les mesures d’effets secondaires étaient la dynamométrie du plancher pelvien, les symptômes d’IUE mesuré par le questionnaire Urogenital Distress Inventory, la qualité de vie mesurée par le questionnaire Incontinence Impact Questionnaire et la perception de la sévérité de l’IUE mesuré par l’Échelle Visuelle Analogue. De plus, un questionnaire portant sur quatre facteurs de risques soit, la présence de grossesses subséquentes, la v présence de constipation chronique, l’indice de masse corporel et la fréquence des exercices de renforcement du plancher pelvien de l’IUE, venait compléter l’évaluation. Quarante-huit pour-cent (10/21) des participantes étaient continentes selon de pad test. La moyenne d’amélioration entre le résultat pré-traitement et le suivi sept ans était de 26,9 g. (écart-type = 68,0 g.). Il n’y avait pas de différence significative des paramètres musculaires du plancher pelvien entre le pré-traitement, le post-traitement et le suivi sept ans. Les scores du IIQ et du VAS étaient significativement plus bas à sept ans qu’en prétraitement (IIQ : 23,4 vs 15,6, p = 0,007) et (VAS : 6,7 vs 5,1, p = 0,001). Les scores du UDI étaient plus élevés au suivi sept ans (15,6) qu’en pré-traitement (11,3, p = 0,041) et en post-traitement (5,7, p = 0,00). La poursuite des exercices de renforcement du plancher pelvien à domicile était associée à une diminution de 5,7 g. (p = 0,051) des fuites d’urine observées au pad test selon une analyse de régression linéaire. Les limites de cette étude sont ; la taille réduite de l’échantillon et un biais relié au désir de traitement pour les femmes toujours incontinentes. Cependant, les résultats semblent démontrer que l’effet du traitement à long terme d’un programme de renforcement des muscles du plancher pelvien qui est intensif et étroitement supervisé, est maintenu chez environ une femme sur deux. Bien que les symptômes d’IUE tel que mesuré par les pad test et le questionnaire UDI, semblent réapparaître avec le temps, la qualité de vie, telle que mesurée par des questionnaires, est toujours meilleure après sept qu’à l’évaluation initiale. Puisque la poursuite des exercices de renforcement du plancher pelvien est associée à une diminution de la quantité de fuite d’urine au pad test, les participantes devraient être encouragées à poursuivre leurs exercices après la fin d’un programme supervisé. Pour des raisons de logistique la collecte de donnée de ce projet de recherche s’est continuée après la rédaction de ce mémoire. Les résultats finaux sont disponibles auprès de Chantale Dumoulin pht, PhD., professeure agrée à l’Université de Montréal.

Développement et fonctionnement des mécanismes de résonance motrice chez l'humain

La découverte dans le cerveau du singe macaque de cellules visuo-motrices qui répondent de façon identique à la production et la perception d’actes moteurs soutient l’idée que ces cellules, connues sous le nom de neurones-miroirs, encoderaient la représentation d’actes moteurs. Ces neurones, et le système qu’ils forment, constitueraient un système de compréhension moteur; par delà la simple représentation motrice, il est également possible que ce système participe à des processus de haut niveau en lien avec la cognition sociale. Chez l’humain adulte, des études d’imagerie récentes montrent d’importants chevauchements entre les patrons d’activité liés à l’exécution d’actes moteurs et ceux associés à la perception d’actions. Cependant, malgré le nombre important d’études sur ce système de résonance motrice, étonnamment peu se sont penchées sur les aspects développementaux de ce mécanisme, de même que sa relation avec certaines habiletés sociales dans la population neurotypique. De plus, malgré l’utilisation répandue de certaines techniques neurophysiologiques pour quantifier l’activité de ce système, notamment l’électroencéphalographie et la stimulation magnétique transcrânienne, on ignore en grande partie la spécificité et la convergence de ces mesures dans l’étude des processus de résonance motrice. Les études rassemblées ici visent à combler ces lacunes, c'est-à-dire (1) définir l’existence et les propriétés fonctionnelles du système de résonance motrice chez l’enfant humain, (2) établir le lien entre ce système et certaines habiletés sociales spécifiques et (3) déterminer la validité des outils d’investigation couramment utilisés pour mesurer son activité. Dans l’article 1, l’électroencéphalographie quantitative est utilisée afin de mesurer l’activité des régions sensorimotrices chez un groupe d’enfants d’âge scolaire durant la perception d’actions de la main. On y démontre une modulation de l’activité du rythme mu aux sites centraux non seulement lors de l’exécution de tâches motrices, mais également lors de l’observation passive d’actions. Ces résultats soutiennent l’hypothèse de l’existence d’un système de résonance motrice sensible aux représentations visuelles d’actes moteurs dans le cerveau immature. L’article 2 constitue une étude de cas réalisée chez une jeune fille de 12 ans opérée pour épilepsie réfractaire aux médicaments. L’électroencéphalographie intracrânienne est utilisée afin d’évaluer le recrutement du cortex moteur lors de la perception de sons d’actions. On y montre une modulation de l’activité du cortex moteur, visible dans deux périodes distinctes, qui se reflètent par une diminution de la puissance spectrale des fréquences beta et alpha. Ces résultats soutiennent l’hypothèse de l’existence d’un système de résonance motrice sensible aux représentations auditives d’actions chez l’enfant. L’article 3 constitue une recension des écrits portant sur les données comportementales et neurophysiologiques qui suggèrent la présence d’un système de compréhension d’action fonctionnel dès la naissance. On y propose un modèle théorique où les comportements d’imitation néonataux sont vus comme la résultante de mécanismes d’appariement moteurs non inhibés. Afin de mesurer adéquatement la présence de traits empathiques et autistique dans le but de les mettre en relation avec l’activité du système de résonance motrice, l’article 4 consiste en une validation de versions françaises des échelles Empathy Quotient (Baron-Cohen & Wheelwright, 2004) et Autism Spectrum Quotient (Baron-Cohen et al., 2001) qui seront utilisées dans l’article 5. Les versions traduites de ces échelles ont été administrées à 100 individus sains et 23 personnes avec un trouble du spectre autistique. Les résultats répliquent fidèlement ceux obtenus avec les questionnaires en version anglaise, ce qui suggère la validité des versions françaises. Dans l’article 5, on utilise la stimulation magnétique transcrânienne afin d’investiguer le décours temporel de l’activité du cortex moteur durant la perception d’action et le lien de cette activité avec la présence de traits autistiques et empathiques chez des individus normaux. On y montre que le cortex moteur est rapidement activé suivant la perception d’un mouvement moteur, et que cette activité est corrélée avec les mesures sociocognitives utilisées. Ces résultats suggèrent l’existence d’un système d’appariement moteur rapide dans le cerveau humain dont l’activité est associée aux aptitudes sociales. L’article 6 porte sur la spécificité des outils d’investigation neurophysiologique utilisés dans les études précédentes : la stimulation magnétique transcrânienne et l’électroencéphalographie quantitative. En utilisant ces deux techniques simultanément lors d’observation, d’imagination et d’exécution d’actions, on montre qu’elles évaluent possiblement des processus distincts au sein du système de résonance motrice. En résumé, cette thèse vise à documenter l’existence d’un système de résonance motrice chez l’enfant, d’établir le lien entre son fonctionnement et certaines aptitudes sociales et d’évaluer la validité et la spécificité des outils utilisés pour mesurer l’activité au sein de ce système. Bien que des recherches subséquentes s’avèrent nécessaires afin de compléter le travail entamé ici, les études présentées constituent une avancée significative dans la compréhension du développement et du fonctionnement du système de résonance motrice, et pourraient éventuellement contribuer à l’élaboration d’outils diagnostiques et/ou de thérapeutiques chez des populations où des anomalies de ce système ont été répertoriées.

Accès aux médicaments : comment expliquer et améliorer la situation au Brésil

Le Brésil figure parmi les plus grands marchés consommateurs de médicaments. Cependant, le droit à l'accès aux médicaments, prévu dans sa Constitution Fédérale, ne fait pas partie de sa réalité. Cette situation est attribuable à plusieurs facteurs: le Brésil n'est pas capable de répondre à ses besoins internes et la consommation de médicaments n'est pas équilibrée. En réaction à cette constatation, nous analyserons la situation juridique actuelle du Brésil, afin d'indiquer les lacunes et barrières au plein accès aux médicaments et, surtout, de trouver une solution qui pourrait améliorer cette situation. Les organismes gouvernementaux brésiliens jouant un rôle important dans le développement des nouveaux médicaments sont présentés et, ensuite, l'encadrement juridique applicable à la recherche clinique et à l'autorisation de mise en marché des nouveaux médicaments est analysé; un bref survol de la législation applicable aux médicaments génériques est fait. Dans un deuxième moment de l'étude, la question d'accès aux nouveaux médicaments est mise en lumière: la législation brésilienne relative aux brevets, ainsi que le régime de licence obligatoire sont abordés; de plus, nous évaluons la compatibilité de ce régime avec l'Accord sur les ADPIC et nous évoquons les conflits internationaux qu'il a suscités. En vue de trouver des solutions aux difficultés brésiliennes identifiées, nous concluons notre étude avec l'examen de l'initiative canadienne pour favoriser l'accès aux médicaments aux pays du Sud (RCAN). Nous constatons que l'utilisation du RCAM pourrait, à court terme, favoriser l'accès aux médicaments au Brésil et, à moyen terme, aider à réduire les conflits internationaux. Finalement, à long terme, nous croyons que le Brésil pourrait jouer un rôle de leader international en adoptant une loi semblable à celle du Canada et, ainsi, il serait capable d'aider d'autres pays dans le besoin, qui n'ont aucune capacité de production locale, comme par exemple, plusieurs pays en Afrique.