Kuka on potilas? : Suomalaisen sikiöseulontakäytännön sosiaalieettistä tarkastelua

Who is the patient? A social-ethical study of the Finnish practice of prenatal screening. The aim of this study is to examine the Finnish practice of prenatal screening from a social-ethical perspective. Analyzing ethical problems in medicine and medical practice only on a general scale may conceal relevant ethical dilemmas. Previous studies have suggested that many pregnant women view the prenatal screening practices customary in the Finnish maternal care system as intimidating and oppressive. This study analyzes the ethical questions of prenatal screening by focusing on the experiences and decision-making of a pregnant woman. Finnish women s experiences of and decision-making on the most common prenatal screening methods are reflected in the basic principles of biomedical ethics described by Tom L. Beauchamp and James F. Childress in Principles of Biomedical Ethics. To concretize women s experiences I refer to studies of Finnish women s experiences of prenatal screenings. This study shows that the principles of autonomy, non-maleficence and beneficence seem to materialize rather poorly in the Finnish practice of prenatal screening. The main ethical problem with prenatal screening is that the likelihood of a foetal cure is very limited and, upon detection of an affected foetus, the choice is usually whether to continue with the pregnancy or to undergo an abortion. Although informed consent should be required, women s participation in prenatal testing is, in many cases at least, not based on their active decision. Many women experience severe anxiety when they receive a positive screening result and must wait for the final results. Medical studies indicate that long- term anxiety may negatively influence the foetus and the mother-child relationship. This study shows that the practice of prenatal screening as such may cause more harm than benefit to many pregnant women and their foetuses. This study examines the decision-making process of a pregnant woman by using the theory of medical casuistry described in Jonsen, Siegler and Winslade s Clinical Ethics. This study focuses on each of the four points of view recommended by the theory. The main problem seems to be the question of whom the patient of prenatal screening is and whom the practice is intended to benefit: the mother, the foetus, the family or society? This study shows that the concepts of health in Finnish maternal care in general, and of the prenatal screening system in particular, differ considerably. It also demonstrates that the purpose and the aims of prenatal screening, aside from the woman s right to choose, has been expressed neither in Finnish public health programmes nor in the public recommendations of prenatal screening. This study suggests that the practice of prenatal screening is a statement, though unexpressed, of public health policy and as such comprises part of the policy of disability. This study further demonstrates that through a single explicit aim (the woman s right to choose) society actually evades its obligation to women by saddling pregnant women with the entire moral responsibility as well as the possible negative consequences of her choice, such as sorrow, regrets and moral balancing. The study reveals several ethical problems in the Finnish practice of prenatal screening. Such problems should be dealt with as the Finnish practice of prenatal screening advances.

Spatial and temporal determinants of Finnish farmland bird populations

During the past decades agricultural intensification has caused dramatic population declines in a wide range of taxa related to farmland habitats, including farmland birds. In this thesis, I studied how boreal farmland landscape characteristics and agricultural land use affect the abundance and diversity of farmland birds using extensive field data collected by territory mapping of breeding farmland birds in various parts of Finland. My results show that the area and openness of agricultural areas are key determinants of farmland bird abundance and distribution. A landscape composition with enough open farmland combined with key habitats such as farmyards and wetland is likely to provide essential prerequisites for the occurrence of a rich farmland avifauna. In Finland, the majority of large areas suitable for open habitat specialists are located in southern and western parts of the country. However, the diversity of the species with an unfavourable conservation status in Europe (SPECs) had notable hotspot areas in northern and north-western agricultural areas. I found that in boreal agroecosystems farmland birds favour fields with springtime vegetative cover, especially agricultural grasslands and set-asides. Hence, in the spring cereal dominated Finnish agroecosystems it is the absence of field vegetation that may limit populations of many farmland bird species. It is likely that the decrease of crops providing vegetative cover in the spring, such as permanent grasslands, cultivated grass, and autumn-sown cereals, has greatly contributed to the declines of Finnish farmland birds. Grass crops have persistently declined in Finland as a consequence of specialization in crop production and the large-scale decline in livestock husbandry. Small-scale non-crop habitats, especially ditches and ditch margins, are also important for many bird species in the Finnish agroecosystems, but have dramatically declined during the last decades. A major problem for farmland bird conservation in Finland is the conflict between landscape structure and agricultural management. Areas with mixed and cattle farming are virtually absent from the large agricultural plains of southern and south-western Finland, where the landscape structure is more likely to be favourable for rich farmland bird assemblages. On the other hand, mixed and cattle farming is still rather frequent in northern and central parts of the country, where the landscape structure is not suitable for many farmland specialist birds requiring open landscapes. My results provide useful guidelines for farmland bird conservation, and imply that considerable attention needs to be paid to landscape factors when selecting areas for various conservational management actions, such as agri-environment schemes. Actions promoting the abundance of set-asides, grass crops, and ditches would markedly benefit Finnish farmland bird populations. Organic farming may benefit farmland birds, but it is not clear how general its beneficial effect is in boreal agroecosystems. The most urgent action aiming to preserve farmland biodiversity would be to support re-introducing and sustaining cattle farming by environmental subsidies. This would be especially beneficial in the southern parts of Finland, where the landscape characteristics and abundance of agricultural areas are most suitable for farmland birds and where cattle farming is currently rare.

Maternal perception of weight status in first-born Australian toddlers aged 12–16 months – the NOURISH and SAIDI cohorts

Background The preference amongst parents for heavier infants is in contrast to obesity prevention efforts worldwide. Parents are poor at identifying overweight in older children, but few studies have investigated maternal perception of weight status amongst toddlers and none in the Australian setting. Methods Mothers (n = 290) completed a self-administered questionnaire at child age 12–16 months, defining their child's weight status as underweight, normal weight, somewhat overweight or very overweight. Weight-for-length z-score was derived from measured weight and length, and children categorized as underweight, normal weight, at risk overweight or obese (WHO standards). Objective classification was compared with maternal perception of weight status. Mean weight-for-length z-score was compared across categories of maternal perception using one-way ANOVA. Multinomial logistic regression was used to determine child or maternal characteristics associated with inaccurate weight perception. Results Most children (83%) were perceived as normal weight. Twenty nine were described as underweight, although none were. Sixty-six children were at risk of overweight, but 57 of these perceived as normal weight. Of the 14 children who were overweight, only 4 were identified as somewhat overweight by their mother. Compared with mothers who could accurately classify their normal weight child, mothers who were older had higher odds of perceiving their normal weight child as underweight, while mothers with higher body mass index had slightly higher odds of describing their overweight/at risk child as normal weight. Conclusion The leaner but healthy weight toddler was perceived as underweight, while only the heaviest children were recognized as overweight. Mothers unable to accurately identify children at risk are unlikely to act to prevent further excess weight gain. Practitioners can lead a shift in attitudes towards weight in infants and young children, promoting routine growth monitoring and adequate but not rapid weight gain.

The prevalence and correlates of childhood trauma in patients with early psychosis

Objective: To describe the prevalence and demographic, clinical and functional correlates of childhood trauma in patients attending early psychosis clinics. Method: Participants were recruited from outpatients attending four early psychosis services. Exposure to childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Psychopathology was measured using the Positive and Negative Syndrome Scale and the Depression, Anxiety and Stress Scale. Social and vocational functioning and substance use were also assessed. Results: Over three-quarters of the 100 patients reported exposure to any childhood trauma. Emotional, physical and sexual abuse were reported by 54%, 23% and 28% of patients, respectively, while 49% and 42% of patients reported emotional and physical neglect, respectively. Female participants were significantly more likely to be exposed to emotional and sexual abuse. Exposure to childhood trauma was correlated with positive psychotic symptoms and higher levels of depressive, anxiety and stress symptoms; however, it had no impact on social or vocational functioning or recent substance use. Conclusion: Exposure to childhood trauma was common in patients with early psychosis, and associated with increased symptomatology. Existing recommendations that standard clinical assessment of patients with early psychosis should include inquiry into exposure to childhood trauma are supported.

Stadilaispojat, rikokset ja lastensuojelu : Viisi tapaustutkimusta kuudelta vuosikymmeneltä

Societal reactions to norm breaking behavior of children reveal, how we understand childhood, the relations between generations and communitie's ratio of tolerance. In Finland the children that repeatedly commit crimes receive social service measures that are based on Child Welfare Act. In the city of Helsinki (Stadi in the slang of Helsinki) existed an agency specifically established for ill-behaving children until the 1980's, agter which an unified agency for the maltreated and maladjusted children was founded. Through five boys' welfare cases, this research aims at defining what kind of positions, social relations and structures are constructed in the social dynamics of these children's everyday lives. The cases cover different decades from the 1940s to the present. At the same time the cases reflect the child welfare and societal practices, and reveal how the communities have participated in constructing deviance in different eras. The research is meta-theoretically based on critical realism and specifically on Roy Bhaskar's transformative model of social activity. The cases are analyzed in the framework of Edwin M. Lemert's societal reaction theory. Thus the focus of the study is on the wide structural context of the institutional and societal definitions of deviance. The research is methodologically based on a qualitative multiple case study research. The primary data consist of classified child welfare case files collected from the archives of the city of Helsinki. The data of the institutional level consist of the annual reports from 1943 to 2004 and the ordinances from 1907 onwards, and of various committee documents produced in the law-making process of child welfare, youth and criminal legislation of the 20th century. Empirical finding are interpreted in a dialogue with previous historical and child welfare research, contemporary literature and studies on the urban development. The analysis is based on Derek Layder's model of adaptive theory. The research forms a viewpoint to the historical study of child welfare, in which the historical era, its agents and the dynamics of their mutual relations are studied through an individual level reconstruction based on the societal reaction theory. The case analyses reveal how the positions of the children form differently in the different eras of child welfare practices. In the 1940s the child is positioned as a psychopath and a criminal type. The measures are aimed at protecting the community from the disturbed child, and at adjusting the individual by isolation. From 1960s to 1980s the child is positioned as a child in need of help and support. The child becomes a victim, a subject that occupies rights, and a target of protection. In the turn of the millennium a norm breaking child is positioned as a dangerous individual that, in the name of the community safety, has to be confined. The case analyses also reveal the prevailing academic and practical paradigms of the time. Keywords: childhood, youth, child protection, child welfare, delinquency, crime, deviance, history, critical realism, case study research

Kansallisen konsensuskulttuurin jäljillä : Globalisaatioajan Suomi Helsingin Sanomissa

The dissertation analyzes Finnish consensual culture in public discussion and journalism in Helsingin Sanomat (HS). The consensual Finnish political culture has evolved and persisted over a long period of time and it has been affected by historical circumstances as well as the dynamics of political and journalistic structures and actors. A historical chronology is drawn in the study regarding the nature and development of consensus culture in 20th century Finland. This political culture is traced by looking at public discussion on globalization at the turn of the millennium. Globalization as a concept has been contested and various societal actors have given different meanings to it. This research looks at how the globalization discussion in HS during the years 1992-2004 constructs consensus. Helsingin Sanomat (and its predecessor Päivälehti) has been an important actor in Finnish journalism and the public sphere almost since its founding 120 years ago. The history of the paper is tightly connected to Finland s general political history and history of the public sphere. Moreover, the paper s connections to the societal elite have always been close. The central question in this research was to see how the globalization discussion in HS evolved in relation to consensus as well as legitimate controversies. As a result it is stated that the globalization question has clearly divided the Finnish societal actors. The most powerful societal elites (government, most civil servants, corporate sector) had a profile of being pro globalization. They communicated their globalization strategy as a national, unified way of thinking. Other elites which have been losing their influence (the president, labor union, part of members of parliament), as well as civil society actors tried to bring forward conflicting views in relation to globalization. The paper did give some room to these elements, but on the other hand it also tried to keep up the consensual discussion culture especially in the editorial section. In line with its traditions Helsingin Sanomat strived to create national unity. At the same time it did not give adequate attention to the changes brought about by globalization to the positions and roles of various elites and civil society actors. In this discussion HS seemed more like a medium of the state than as a critical and independent actor. Journalism has an important role in upholding and also reviving the Finnish political culture and public discussion. From this point of view it is problematic if the area of so called legitimate controversy in broad societal questions like globalization becomes very limited. As the Finnish elites are small and there is no considerable competition between them, journalism should actively bring up controversial issues. This task becomes complicated, however, if the elite circles are closed up and no initiatives come from their ranks. Political decision making as well as democracy can suffer, if issues are not brought to the public agenda.

Kuka kasvattaa, kuka opettaa? : Genealoginen tutkimus perheen ja koulun välisen kasvatusvastuun politiikasta

FAMILIES AND SCHOOLS AND THE POLITICS OF RESPONSIBILITIES - a genealogical study on family and school as carers and educators of the child population in modern society This study aims to uncover the politics behind such discourses in the media which have claimed the family to be totally responsible for children and which ignore the various responsibilities accorded to the state in matters concerning the child population. Using Max Weber s and Michael Mann s theorizing on the history of power relationships, feminist social history on patriarchy and Foucauldian power analytic concept of dispositif the study traces two competing child policies which have influenced the historical formation of modern generational order in Western societies. One of them is based on the interests of the hegemonic bourgeois elite and the other on the interests of the non-elite population, which were expressed during the phase of building the welfare state in Finland in the 1960 1980 s. The central strategies of the bourgeois child policy are 1) to construct the childhood years as a time for preparation and formation of the individual according to the interests of the elite, 2) to construct the family as the sole site of holistic care and responsibility of children in society, and 3) compulsory schooling of children of the non-elite population in state organized schools. To implement these strategies the elite uses strategically patriarchal cultural formations/dispositifs in modernized versions. The result has been the formation of a sexually divided and hierarchical order of care and education, where, on the one hand, there is the less important feminine care of children done by mothers at home and, on the other, the real education of the school, where children are made the object of authoritarian shaping and where the needs and the personal experiences of the child are ignored. The welfare order of care and education is based on the ethos of welfare society, where the state and the families are seen to share the responsibility for the child population. In this vein, families and schools are seen as partners who both have a caring attitude to children s welfare and learning. The study shows that discourses and terminology in the mainstream educational policy texts in Finland create a chaotic linguistic game which makes it difficult to have a rational discussion about the roles of family and school in the holistic care and education of children. This has opened the door to political discourses where familist interpretations of the question of responsibility are claimed to be based on law.

Humanitaarisuuden varjossa : Poliittiset tekijät lastensiirroissa Ruotsiin sotiemme aikana ja niiden jälkeen

The evacuation of Finnish children to Sweden during WW II has often been called a small migration . Historical research on this subject is scarce, considering the great number of children involved. The present research has applied, apart from the traditional archive research, the framework of history-culture developed by Rüsen in order to have an all-inclusive approach to the impact of this historical event. The framework has three dimensions: political, aesthetic and cognitive. The collective memory of war children has also been discussed. The research looks for political factors involved in the evacuations during the Winter War and the Continuation War and the post-war period. The approach is wider than a purely humanitarian one. Political factors have had an impact in both Finland and Sweden, beginning from the decision-making process and ending with the discussion of the unexpected consequences of the evacuations in the Finnish Parliament in 1950. The Winter War (30.11.1939 13.3.1940) witnessed the first child transports. These were also the model for future decision making. The transports were begun on the initiative of Swedes Maja Sandler, the wife of the resigned minister of foreign affairs Rickard Sandler, and Hanna Rydh-Munck af Rosenschöld , but this activity was soon accepted by the Swedish government because the humanitarian help in the form of child transports lightened the political burden of Prime Minister Hansson, who was not willing to help Finland militarily. It was help that Finland never asked for and it was rejected at the beginning. The negative response of Minister Juho Koivisto was not taken very seriously. The political forces in Finland supporting child transports were stronger than those rejecting them. The major politicians in support belonged to Finland´s Swedish minority. In addition, close to 1 000 Finnish children remained in Sweden after the Winter War. No analysis was made of the reasons why these children did not return home. A committee set up to help Finland and Norway was established in Sweden in 1941. Its chairman was Torsten Nothin, an influential Swedish politician. In December 1941 he appealed to the Swedish government to provide help to Finnish children under the authority of The International Red Cross. This plea had no results. The delivery of great amounts of food to Finland, which was now at war with Great Britain, had automatically caused reactions among the allies against the Swedish imports through Gothenburg. This included the import of oil, which was essential for the Swedish navy and air force. Oil was later used successfully to force a reduction in commerce between Sweden and Finland. The contradiction between Sweden´s essential political interests and humanitarian help was solved in a way that did not harm the country´s vital political interests. Instead of delivering help to Finland, Finnish children were transported to Sweden through the organisations that had already been created. At the beginning of the Continuation War (25.6.1941 27.4.1945) negative opinion regarding child transports re-emerged in Finland. Karl-August Fagerholm implemented the transports in September 1941. In 1942, members of the conservative parties in the Finnish Parliament expressed their fear of losing the children to the Swedes. They suggested that Finland should withdraw from the inter-Nordic agreement, according to which the adoptions were approved by the court of the country where the child resided. This initiative failed. Paavo Virkkunen, an influential member of the conservative party Kokoomus in Finland, favoured the so-called good-father system, where help was delivered to Finland in the form of money and goods. Virkkunen was concerned about the consequences of a long stay in a Swedish family. The risk of losing the children was clear. The extreme conservative party (IKL, the Patriotic Movement of the Finnish People) wanted to alienate Finland from Sweden and bring Finland closer to Germany. Von Blücher, the German ambassador to Finland, had in his report to Berlin, mentioned the political consequences of the child transports. Among other things, they would bring Finland and Sweden closer to each other. He had also paid attention to the Nordic political orientation in Finland. He did not question or criticize the child transports. His main interest was to increase German political influence in Finland, and the Nordic political orientation was an obstacle. Fagerholm was politically ill-favoured by the Germans, because he had a strong Nordic political disposition and had criticised Germany´s activities in Norway. The criticism of child transports was at the same time criticism of Fagerholm. The official censorship organ of the Finnish government (VTL) denied the criticism of child transports in January 1942. The reasons were political. Statements made by members of the Finnish Parliament were also censored, because it was thought that they would offend the Swedes. In addition, the censorship organ used child transports as a means of active propaganda aimed at improving the relations between the two countries. The Finnish Parliament was informed in 1948 that about 15 000 Finnish children still remained in Sweden. These children would stay there permanently. In 1950 the members of the Agrarian Party in Finland stated that Finland should actively strive to get the children back. The party on the left (SKDL, the Democratic Movement of Finnish People) also focused on the unexpected consequences of the child transports. The Social Democrats, and largely Fagerholm, had been the main force in Finland behind the child transports. Members of the SKDL, controlled by Finland´s Communist Party, stated that the war time authorities were responsible for this war loss. Many of the Finnish parents could not get their children back despite repeated requests. The discussion of the problem became political, for example von Born, a member of the Swedish minority party RKP, related this problem to foreign policy by stating that the request to repatriate the Finnish children would have negative political consequences for the relations between Finland and Sweden. He emphasized expressing feelings of gratitude to the Swedes. After the war a new foreign policy was established by Prime Minister (1944 1946) and later President (1946 1956) Juho Kusti Paasikivi. The main cornerstone of this policy was to establish good relations with the Soviet Union. The other, often forgotten, cornerstone was to simultaneously establish good relations with other Nordic countries, especially Sweden, as a counterbalance. The unexpected results of the child evacuation, a Swedish initiative, had violated the good relations with Sweden. The motives of the Democratic Movement of Finnish People were much the same as those of the Patriotic Movement of Finnish People. Only the ideology was different. The Nordic political orientation was an obstacle to both parties. The position of the Democratic Movement of Finnish People was much better than that of the Patriotic Movement of Finnish People, because now one could clearly see the unexpected results, which included human tragedy for the many families who could not be re-united with their children despite their repeated requests. The Swedes questioned the figure given to the Finnish Parliament regarding the number of children permanently remaining in Sweden. This research agrees with the Swedes. In a calculation based on Swedish population registers, the number of these children is about 7 100. The reliability of this figure is increased by the fact that the child allowance programme began in Sweden in 1948. The prerequisite to have this allowance was that the child be in the Swedish population register. It was not necessary for the child to have Swedish nationality. The Finnish Parliament had false information about the number of Finnish children who remained in Sweden in 1942 and in 1950. There was no parliamentary control in Finland regarding child transports, because the decision was made by one cabinet member and speeches by MPs in the Finnish Parliament were censored, like all criticism regarding child transports to Sweden. In Great Britain parliamentary control worked better throughout the whole war, because the speeches regarding evacuation were not censored. At the beginning of the war certain members of the British Labour Party and the Welsh Nationalists were particularly outspoken about the scheme. Fagerholm does not discuss to any great extent the child transports in his memoirs. He does not evaluate the process and results as a whole. This research provides some possibilities for an evaluation of this sort. The Swedish medical reports give a clear picture of the physical condition of the Finnish children when arriving in Sweden. The transports actually revealed how bad the situation of the poorest children was. According to Titmuss, similar observations were made in Great Britain during the British evacuations. The child transports saved the lives of approximately 2 900 children. Most of these children were removed to Sweden to receive treatment for illnesses, but many among the healthy children were undernourished and some suffered from the effects of tuberculosis. The medical inspection in Finland was not thorough. If you compare the figure of 2 900 children saved and returned with the figure of about 7 100 children who remained permanently in Sweden, you may draw the conclusion that Finland as a country failed to benefit from the child transports, and that the whole operation was a political mistake with far-reaching consequenses. The basic goal of the operation was to save lives and have all the children return to Finland after the war. The difficulties with the repatriation of the children were mainly psychological. The level of child psychology in Finland at that time was low. One may question the report by Professor Martti Kaila regarding the adaptation of children to their families back in Finland. Anna Freud´s warnings concerning the difficulties that arise when child evacuees return are also valid in Finland. Freud viewed the emotional life of children in a way different from Kaila: the physical survival of a small child forces her to create strong emotional ties to the person who is looking after her. This, a characteristic of all small children, occurred with the Finnish children too, and it was something the political decision makers in Finland could not see during and after the war. It is a characteristic of all little children. Yet, such experiences were already evident during the Winter War. The best possible solution had been to limit the child transports only to children in need of medical treatment. Children from large and poor families had been helped by organising meals and by buying food from Denmark with Swedish money. Assisting Finland by all possible means should have been the basic goal of Fagerholm in September 1941, when the offer of child transports came from Sweden. Fagerholm felt gratitude towards the Swedes. The risks became clear to him only in 1943. The war children are today a rather scattered and diffuse group of people. Emotionally, part of these children remained in Sweden after the war. There is no clear collective memory, only individual memories; the collective memory of the war children has partly been shaped later through the activities of the war child associations. The main difference between the children evacuated in Finland (for example from Karelia to safer areas with their families) and the war children, who were sent abroad, is that the war children lack a shared story and experience with their families. They were outsiders . The whole matter is sensitive to many of such mothers and discussing the subject has often been avoided in families. The war-time censorship has continued in families through silence and avoidance and Finnish politicians and Finnish families had to face each other on this issue after the war. The lack of all-inclusive historical research has also prevented the formation of a collective awareness among war children returned to Finland or those remaining permanently abroad.. Knowledge of historical facts will help war-children by providing an opportunity to create an all-inclusive approach to the past. Personal experiences should be regarded as part of a large historical entity shadowed by war and where many political factors were at work in both Finland and Sweden. This means strengthening of the cognitive dimension discussed in Rüsen´s all-inclusive historical approach.

Depression and Cognition in Type 2 Diabetes from a Life Course Perspective

Background: Type 2 diabetes is linked to several complications which add to both physical and mental distress. Depression is a common co-morbidity of diabetes which can occur both as a cause and a consequence of type 2 diabetes. Depression has been shown to correlate with glucose regulation and treating depression might prove beneficial for glucose regulation as well as for mental well being. Another complication which might affect diabetes management is cognitive decline. Several risk factors and complications of diabetes might modify the risk for developing cognitive impairment, which is increased 1.5 times among subjects with type 2 diabetes. Type 2 diabetes, depression and impaired cognitive performance have all been linked to low birth weight. This thesis aimed to explore the effects and interactions of birth weight, depression and cognitive ability in relation to type 2 diabetes from a life course perspective. Subjects and methods: Studies I, II and V were part of the Helsinki Birth Cohort Study. 2003 subjects participated in an extensive clinical examination at an average age of 61 years. A standard glucose tolerance test (OGTT) was performed and depressive symptoms were assessed using the Beck Depression Inventory (BDI). In addition data was obtained from child welfare clinics and national registers. A subset of the cohort (n=1247) also performed a test on cognitive performance (CogState ®) at the average age of 64. Studies III and IV were randomised clinical trials where mildly depressed diabetic subjects were treated with paroxetine or placebo and the effect on metabolic parameters and quality of life was assessed. The first trial included 14 women and lasted 10 weeks, while the second trial included 43 subjects, both men and women, and lasted 6 months. Results: Type 2 diabetes was positively associated with the occurrence of depressive symptoms. Among diabetic subjects 23.6% had depressive symptoms, compared to 16.7% of subjects with normal glucose tolerance (OR = 1.77, p<0.001). Formal mediation analysis revealed that cardiovascular disease (CVD) is likely to act as a mediator in the association. Furthermore, low birth weight was found to modify the association between type 2 diabetes, CVD and depression. The association between BDI score and having type 2 diabetes or CVD was twice as strong in the subgroup with low birth weight (≤ 2500g) compared with the group with birth weight > 2500g (p for interaction 0.058). In the six months long randomised clinical trial (study IV) paroxetine had a transient beneficial effect on glycosylated haemoglobin A1c (GHbA1c) and quality of life when compared to placebo after three months of treatment. In study V we found that subjects with known diabetes had a consistently poorer level of cognitive performance than subjects with normal glucose tolerance in most of the tested cognitive domains. This effect was further amplified among those born with a small birth weight (p for interaction 0.002). Conclusions: Type 2 diabetes is associated with a higher occurrence of depressive symptoms compared to subjects with normal glucose tolerance. This association is especially strong among subjects with CVD and those born with a low birth weight. Treating depressed diabetic subjects with paroxetine has no long term effect on glucose regulation. Physicians should be aware of depression as an important co-morbidity of type 2 diabetes. Both depression and the cognitive decline often seen among diabetic subjects are increased if the subject is born with a low birth weight. Physicians should recognise low birth weight as an additional risk factor and modifier of diabetic complications.

Management of Routine in Two Chinese Kindergartens - An Ethnographic Study

Based on a one-month long ethnographic study conducted in two Chinese kindergartens, this study aims to understand the issue of discipline in the Chinese preschool setting through an examination of practices teachers use to manage everyday routines in the kindergarten. It also seeks to understand teachers’ values behind their choices of practices. Data of this study are comprised of three parts - notes of participant observation in eight classrooms with a focus on teacher-child interaction; interviews with nine teachers and directors of the two kindergartens; and written accounts of four teachers collected after the fieldwork in order to understand the particular practices of teachers’ praising and criticizing children. A grounded theory approach is applied to code and analyze data. Results of analysis are structured as followed. First the concept of routine is clarified based on teachers’ definition of it and observation notes on its main components, namely the timetable of everyday activities; general behavioral rules in the kindergarten; and detailed rules and procedures for various activities in the kindergarten. Then practices for managing routines are examined – how teachers organize children in activities, enforce routines, and restore routines when they are not followed well. After that, the matter of self-control is examined in relation with external control. Then teachers’ perception of their roles as the manager, director and executor of routines is presented in a discourse of control in which the values behind practices are found to be embedded. The next section of analysis examines the role of routine in relation with other activities in the kindergarten. Results indicate that routine which is supposed to be the foundation of other activities is in conflict with other activities. The last section of analysis provides some reflections on the rational of routine management in Chinese kindergartens in relation with the overall goals of Chinese preschool education. It also provides some reflections on the effect current mode of teacher-child interactions may have on children's self construction and their understanding of self in relation with the society. As a conclusion, this study suggests that the current mode of routine management in Chinese kindergartens relies heavily on teachers' control, leaving great room for better acknowledging children's agency.

Una mirada universitaria sobre la anencefalia

Resumen: Un niño con anencefalia, debido a su innegable condición humana, merece ser tratado con respeto y dignidad, como cualquier otro hombre. Por su severa patología y su corta expectativa de vida, es una criatura frágil e indefensa a la que hay que cuidar, y no por ello aplicar tratamiento, hasta que devenga su inevitable muerte. La futilidad de cualquier medida agresiva sustenta la necesidad de proporcionarle calor y cuidados básicos, sin incurrir en tratamientos desproporcionados. Al mismo tiempo, resulta fundamental informar, acompañar y brindar apoyo médico y psicológico a toda la familia, en especial a la madre, para poder superar la muerte del niño. Por último, es preciso establecer que el pronóstico ominoso de una criatura anencefálica jamás justifica el aborto. A partir del estudio de la bibliografía argentina sobre el tema, y desde la perspectiva de un estudiante de medicina, se analizan los textos publicados, añadiendo algunos comentarios éticos actuales sobre los problemas de la anencefalia.

Distribución de "coxiella burnetii" en los rumiantes domésticos y en la fauna silvestre de la Comunidad Atutónoma Vasca. Evaluacióndel efecto del tratamiento antibiótico y de la vacunación en el control de la fiebre Q en rebaños ovinos naturalmente infectados

243 p. : il.

Diseño e implementación de un taller de teatro musical en Educación Primaria

[SPA] Las disciplinas artísticas siempre han sido un campo tan beneficioso como poco utilizado en educación. En esta propuesta de taller de teatro musical en educación primaria se ha indagado en el mundo de la pedagogía teatral y su relación con la música y el juego como técnicas de transmisión de valores y desarrollo de aprendizajes. La puesta en práctica mediante el diseño e implementación de un taller por parte del mediador ha logrado que los alumnos muestren avances significativos en diversos campos como el autoconocimiento corporal o el descubrimiento de nuevos géneros musicales, además de favorecer a la dinámica grupal dentro y fuera del taller. De cara al futuro, este proceso ha abierto las puertas a nuevas propuestas en el ámbito de la dramatización infantil así como al interés formativo del propio educador.

The avifauna of Laguna Llancanelo (Mendoza, Argentina), a South American wetland of international importance

Laguna Llancanelo is a large (40,000 ha), very shallow (less than 3 m deep), inland saline waterbody, located in southern Mendoza, Argentina. A survey of the avifauna was undertaken during 1983 to 1985; field trips were made mostly to the northeastern and central-western sectors of the lagoon, in the months of April, May, September, October and December. Complementary studies were made by an aerial survey and assessments of terrestrial birds in the surroundings of the lagoon. A total of 64 species in 22 families of birds usually associated with aquatic environments were recorded. The best-represented families of aquatic birds in terms of numbers of species were: Anatidae (13 swans, geese, ducks), Scolopacidae (7 sandpipers and other small waders), Ardeidae (6 herons, bitterns, egrets, Podicipedidae (4 grebes), Rallidae (4 rails, coots) and Charadriidae (4 plovers, lapwings). The most abundant nesting birds on the lagoon were: Black-necked swan Cygnus melancoryphus (824), silvery grebe Podiceps occipitalis (202) and black-crowned night heron Nycticorax nycticorax (100).

Mães em UTI neonatal: a experiência da maternidade diante do bebê em situação de risco

Esta pesquisa teve por objetivo compreender as vicissitudes da experiência de tornar-se mãe de um bebê em situação de risco neonatal. Emergiu da experiência da autora no acompanhamento psicológico prestado às mães e familiares de recém-nascidos de alto risco internados em uma Unidade de Terapia Intensiva Neonatal (UTI Neonatal). Foi possível perceber ali que a puérpera que tinha seu filho internado em situação de risco logo após o nascimento vivenciava uma experiência de intenso sofrimento, permeada por conflitos e angústias específicas, tais como: o sentimento de incapacidade pelo parto prematuro e/ou pela malformação fetal, a dor/luto diante da situação de risco e eminência de perda do filho, o medo e a ambivalência na relação afetiva com o bebê. Tais vivências podem representar uma ameaça para a construção do vínculo inicial entre pai/mãe/filho, bem como para a própria saúde psíquica da mulher e do bebê em constituição. Para uma aproximação da experiência subjetiva destas mulheres/mães, optou-se pela pesquisa qualitativa na abordagem psicanalítica. A compreensão do fenômeno foi possibilitada pela análise do discurso das mães que tiveram seus filhos internados na UTI Neonatal, através do método de observação participante dos atendimentos grupais prestados pelo Serviço de Psicologia da instituição, bem como pela análise documental das fichas de acompanhamento psicológico destas mulheres. Participaram do estudo, as mulheres/mães que acompanharam seus filhos internados na UTI Neonatal do Núcleo Perinatal do Hospital Universitário Pedro Ernesto (HUPE), da Universidade do Estado do Rio de Janeiro (UERJ) e que receberam atendimento psicológico grupal: Grupo Mães Presentes durante um período de três meses. A compreensão e interpretação dos aspectos essenciais do fenômeno foram fundamentadas nos pressupostos psicanalíticos da teoria do amadurecimento pessoal de Donald W. Winnicott e em outros autores atuais de referência no campo materno-infantil. Acredita-se que este trabalho servirá de reflexão e contribuição para a construção, na assistência neonatal, de um lugar de acolhimento para a experiência subjetiva dessas mulheres/mães e suas repercussões, a partir de uma perspectiva de cuidado humanizado e integral a saúde, tal como preconizado pelas políticas públicas atuais.