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Insight-lehden numerossa 26 (Maaliskuu 2013) julkaistu artikkeli.

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

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

“THE PATIENT SURVIVED DESPITE THE TREATMENT”. A study of Finnish health policy and New Public Management. Case: The Government Resolution on the Health 2015 public health programme.

Internationally, Finland has been among the most respected countries during several decades in terms of public health. WHO has had the most significant influence on Finnish health policy and the relationship has traditionally been warm. However, the situation has slightly changed in the last 10-20 years. The objectives of Finnish national health policy have been to secure the best possible health for the population and to minimize disparities in health between different population groups. Nevertheless, although the state of public health and welfare has steadily improved, the socioeconomic disparities in health have increased. This qualitative case study will demonstrate why health is political and why health matters. It will also present some recommendations for research topics and administrative reforms. It will be argued that lack of political interest in health policy leads to absence of health policy visions and political commitment, which can be disastrous for public health. This study will investigate how Finnish health policy is defined and organised, and it will also shed light on Finnish health policy formation processes and actors. Health policy is understood as a broader societal construct covering the domains of different ministries, not just Ministry of Social Affairs and Health (MSAH). The influences of economic recession of the 1990s, state subsidy reform in 1993, globalisation and the European Union will be addressed, as well. There is not much earlier Finnish research done on health policy from political science viewpoint. Therefore, this study is interdisciplinary and combines political science with administrative science, contemporary history and health policy research with a hint of epidemiology. As a method, literature review, semi-structured interviews and policy analysi will be utilised. Institutionalism, policy transfer, and corporatism are understood as the theoretical framework. According to the study, there are two health policies in Finland: the official health policy and health policy generated by industry, media and various interest organisations. The complex relationships between the Government and municipalities, and on the other hand, the MSAH and National Institute for Health and Welfare (THL) seemed significant in terms of Finnish health policy coordination. The study also showed that the Investigated case, Health 2015, does not fulfil all necessary criteria for a successful public health programme. There were also several features both in Health 2015 and Finnish health policy, which can be interpreted in NPM framework and seen having NPM influences.

The Use of Systematic Value Strategies in Separating the Winners from the Losers: Evidence from the Finnish Markets

This study examines the Magic Formula and ERP5 value strategies in the Finnish stocks markets. Magic Formula ranks stocks based on EV/EBIT and ROA and ERP5 based on EV/EBIT, ROA, P/B and five-year trailing ROA. The purpose of the study is to examine whether the value strategies can be used to generate excess returns over the market index. The data has been collected from the Datastream database for the sample period from May 1997 to May 2010 and consists of the companies listed on the main list of Helsinki Stock Exchange. This study confirms the findings of previous research that value premium exists in the Finnish stock markets and that systematic value strategies can be used to form portfolios that outperform the market index with lower volatility.

Diversification benefits for a Finnish non-industrial private forest investor: Real Estate Investment Trusts in the USA

This thesis examined both domestic and international forest investment options for a Finnish non-industrial private forest investor. The focus was on forest-based investment instruments. The influence of movements of currency exchange rates on foreign returns were also taken into account. Annual data from 1995 to 2011 was used. The main portfolio optimization model in this study was the Mean-Variance model but the results were also validated by using the Value at Risk and Expected Shortfall models. In addition, the exchange rate risk hedging was established by using one-week-maturity forward contracts. The results suggested that 75 % of the total wealth should be invested in Finnish private forests and the rest, 25 %, to a US REIT, in this case Rayonier. With hedging, the total return on the portfolio was 7.21 % (NIPF 5.3%) with the volatility of 6.63 % (NIPF 7.9%). Taxation supported US investments in this case. As a conclusion, a Finnish private forest investor may, as evidenced, benefit in diversifying a portfolio using REITs in the US.

Battled nerves : Finnish soldiers' war experience, trauma, and military psychiatry, 1941–44

I min avhandling undersöker jag av kriget framkallade psykiska störningar hos finländska soldater under fortsättningskriget. Vilka var de psykiskt invalidiserade soldaterna och hurudana var deras traumatiska erfarenheter? Vilken var den bredare upplevelsevärlden vid fronten där störningarna uppstod, och hur kan man förklara att majoriteten av soldaterna ändå klarade sig utan mentala rubbningar i denna av våld präglade miljö? Hur förhöll sig Finlands armé i allmänhet och den krigspsykiatri som utvecklades under kriget specifikt till soldaternas psykiska störningar? Som Matti Ponteva redan 1977 utredde, det totala antalet psykiatriska soldatpatienter under fortsättningskriget var ca 15 700 män. I min undersökning betonar jag att den siffran omfattar endast en del av fenomenet: långt ifrån alla finländska soldater som uppvisade psykiska symptom förpassades från fronten i psykiatrisk vård. De finländska psykiatrerna hade före vinterkriget inte kommit i direkt kontakt med av krig orsakade psykiska störningar. Deras kunskaper kom nästan uteslutande från den tyska krigspsykiatrin, där den ledande tanken framför allt efter första världskriget var att förklara psykiska störningar med soldaternas personliga brister och svagheter. Slutligen resonerar jag, varför synen på soldaternas psykiska störningar på ett så markant sätt skilde sig från synen på andra krigsskador. Att soldater stupade eller sårades fysiskt kunde framställas som yttringar av manligt hjältemod och offervillighet. Att brytas ner psykiskt av kriget blev däremot en tom symbol för våldet och saknade annat innehåll än uttryckligen en meningslöshet. Psykiska störningar associerades med ett moraliskt fördömande och ett stigma av skam, och förutom att man tenderade att förneka och marginalisera deras existens försökte man göra en skillnad mellan dem och den egentliga krigsupplevelsen. Det har varit problematiskt att inkludera de psykiskt rubbade soldaterna i den nationella historieskrivningen fram till våra dagar.

Entrepreneurship, Service Innovation, International Expansion and Performance in SMEs: Empirical Evidence from Finnish ICT Industry

The thesis aims to clarify the mixed results of prior literature regarding the performance impacts of entrepreneurship and human capital through service innovation and international expansion. The thesis examines the factors affecting degree of internationalization (DOI) and performance in ICT SMEs. These factors are entrepreneurial orientation (EO), human capital and service innovation (SI). The data was collected via questionnaire from Finnish ICT SMEs. The results suggest that EO consist of three dimensions that have different impact in DOI and SI. Also DOI has inverted U-shaped relationship with international performance, whereas DOI-profitability relationship is linear. The results of the study suggest that SMEs should not blindly increase their DOI, and that strategic focus is important.

Finnish cleantech SMEs in China: Challenges and solutions

The rapid economic growth in China has resulted in environmental challenges ranging from air pollution to water-related issues. Thus supporting clean technology, or cleantech, that encompasses industries that focus on alternative energy, pollution and recycling, power supplies and conservation has become one of the focal points in the Chinese economic policy for the next decade. Simultaneously, the Finnish government has initiated programs to support the internationalisation of domestic cleantech companies in an attempt to spiral the industry into one of the pillars of Finnish economic growth. This study concentrates on the conjunction of these two themes and studies the challenges faced by Finnish cleantech SMEs in the Chinese market. Consequently, the study answers the following sub questions: 1. What human and financial resource-based challenges do Finnish cleantech SMEs face in the Chinese market and what are their solutions? 2. What knowledge-based challenges do Finnish cleantech SMEs face in the Chinese market and how can these difficulties be resolved? 3. What network-based challenges do Finnish cleantech SMEs face in the Chinese market, how do they relate to the resource- and knowledge-based challenges, and how can these difficulties be resolved? This qualitative study is conducted by analysing four semi structured interviews collected from four Finnish SMEs that operate in China. The findings of the study indicate that in human resources the most important challenges are related to the hiring and retaining of employees. In contrast to extant academic literature results distinguish salary and social status as the main solutions to this challenge. Regarding financial resources it is discovered that cleantech companies enjoy a benign business environment in China and benefit from the Chinese government’s support for cleantech industry. Challenges related to knowledge resources can be grouped into categories with the most interesting knowledge flows being the stream of local market knowledge into to the foreign parent company and the outward flow of manufacturing and business practice information into the target venture. The challenge related to the first flow is gathering relevant information and the main solutions are clustering at the foreign location and hiring knowledge prior to internationalisation. Regarding the second flow the main challenge is related to intellectual property rights and the most interesting solution is the purposeful transformation of explicit knowledge into tacit knowledge. Finally, it is discovered that networks, called guanxi in China, greatly affect the business processes. Within the guanxi system there is the concept of face which was found to affect employee propensity to stay as well as, as a novel academic result, employees’ knowledge sharing intention.

Finnish buyers’ perceptions of Indian textile and clothing suppliers: Country of origin in focus

Choosing the right supplier is crucial for long-term business prospects and profitability. Thus organizational buyers are naturally very interested in how they can select the right supplier for their needs. Likewise, suppliers are interested in knowing how their customers make purchasing decisions in order to effectively sell and market to them. From the point of view of the textile and clothing (T&C) industry, regulatory changes and increasing low-cost and globalization pressures have led to the rise of low-cost production locations India and China as the world’s largest T&C producers. This thesis will examine T&C trade between Finland and India specifically in the context of non-industrial T&C products. Its main research problem asks: what perceptions do Finnish T&C industry buyers hold of India and Indian suppliers? B2B buyers use various supplier selection models and criteria in making their purchase decisions. A significant amount of research has been done into supplier selection practices, and in the context of international trade, country of origin (COO) perceptions specifically have garnered much attention. This thesis uses a mixed methods approach (online questionnaire and in-depth interviews) to evaluate Finnish T&C buyers’ supplier selection criteria, COO perceptions of India and experiences of Indian suppliers. It was found that the most important supplier selection criteria used by Finnish T&C buyers are quality, reliability and cost. COO perceptions were not found to be influential in purchasing process. Indian T&C suppliers’ strengths were found to be low cost, flexibility and a history of traditional T&C expertise. Their weaknesses include product quality and unreliable delivery times. Overall, the main challenges that need to be overcome by Indian T&C companies are logistical difficulties and the cost vs. quality trade-off. Despite positive perceptions of India for cost, the overall value offered by Indian T&C products was perceived to be low due to poor quality. Unreliable delivery time experiences also affected buyer’s reliability perceptions of Indian suppliers. The main limiting factors of this thesis relate to the small sample size used in the research. This limits the generalizability of results and the ability to evaluate the reliability and validity of some of the research instruments.

Developing Service-based Solutions for Water Treatment in Finnish Mining Industry

The aim of this master’s thesis is to analyze the mining industry customers' current and future needs for the water treatment services and discover new business development opportunities in the context of mine water treatment. In addition, the study focuses on specifying service offerings needed and evaluate suitable revenue generation models for them. The main research question of the study is: What kind of service needs related to water treatment can be identified in the Finnish mining industry? The literature examined in the study focused on industrial service classification and new service development process as well as the revenue generation of services. A qualitative research approach employing a case study method was chosen for the study. The present study uses customer and expert interviews as primary data source, complemented by archival data. The primary data was gathered by organizing total of 13 interviews, and the interviews were analyzed by using qualitative content analysis. The abductive-logic was chosen as the way of conducting scientific reasoning in this study. As a result, new service proposals were developed for Finnish mine industry suppliers. The main areas of development were on asset efficiency services and process support services. The service needs were strongly associated with suppliers’ know-how of water treatment process optimization, cost-effectiveness as well as on alternative technologies. The study provides an insight for managers that wish to pursue a water treatment services as a part of their business offering.

Finnish stock market reaction to quarterly earnings announcements

This thesis examines the stock market reactions to quarterly earnings announcements. The study covers the OMX Helsinki 25 index companies for the years 2007–2010. The stock market response to quarterly earnings announcements is tested by employing the event study –methodology and daily stock returns of Finnish listed companies. The thesis provides evidence that stock prices react to earnings announcements that exceed or fall below analyst forecasts. The most liquid stocks earn higher returns around positive earnings news than less traded stocks, which supports the evidence from previous studies. This thesis finds evidence for the authorization to sell stocks short reducing the post–earnings announcement drift induced by negative earnings news. In addition, the market’s reaction to earnings announcements seems to quicken during economic turmoil.

Local Embeddedness and Knowledge Acquisition and How They Affect Finnish Business Operations in Russia

This pilot project aims examine the factors of the Finnish subsidiaries local embeddedness, their knowledge creation capabilities and the transfer mechanisms of new practices in the context of the Russian market. The research is designed as a multiple case study conducted with a qualitative approach. The empirical data consists of the interviews of the four Finnish case companies operating in the Kaluga region and three local partner companies. The deductive and inductive approaches were employed to conduct the analysis of the data. The propositions for the future study were developed in the conclusive chapters of the research, where we propose that the factor of the economy growth and industrialization matters in terms of subsidiaries’ role dedication, their knowledge creation capabilities, and direction of the knowledge flow within the local environment.

The Role of a firm’s mindset in international success - case study of Finnish marine industry firms

This thesis investigates the influence of a firm’s mindset on international success in the context of the Finnish marine industry. The study draws theoretical wisdom from organisational behaviour and strategic management literatures. The research aim set for this study was to identify and categorise existing strategic types based on mindsets found in the marine industry SMEs, and to link the influence of mindsets with success by examining the role of mindsets in a firm’s performance. Mindsets of firms were conceptualised as aggregate collections of perceptions that influence how the surrounding environment is discerned by the members of the firm. Mindsets are idiosyncratic to firms and therefore important firm-specific resources which influence decision-making and can be observed through the strategic behaviour of firms. Qualitative case study method was applied which was further supported by quantitative data on the financial performance of the ten case firms. Taxonomy based on the dimension of mindsets and prediction was developed to demonstrate four ideal types of firms identified within the marine industry. It was found that all of the case firms emphasised adaptation in their strategy while planning was emphasised to a varying degree. Moreover, two different methods of adapting were found; proactive and reactive. Firms which plan in the long-term and adapt proactively constantly investigate whether their plans are synchronous with the realities of the market; by having an open mindset, a firm’s perception of the reality of the market is enabling the firm to develop value creating strategies which are superiorly informed.This finding was supported by the financial data and led to the proposition that having an open mindset and placing a high level of emphasis on prediction may have a positive influence on international success. Also, it was proposed that concentrating only on exploiting business opportunities in the present time and not exploring any addition opportunities can have a negative influence on the firm’s performance, even if the mindset of the firm is open.