Issues in socially desirable responding and personality research

The four studies presented in this dissertation were designed to examine the influence of socially desirable responding (SDR) on personality research outcomes. The assessment of personality relies heavily on the use of self-report questionnaires. Their validity could be threatened by people being dishonest in their self-descriptions and ascribing more desirable traits to themselves than would be warranted by their behaviour. Scales designed to detect SDR have been around for half a century, but their status continues to be debated. Paulhus (1991) Balanced Inventory of Desirable Responding (BIDR) is perhaps the most prominent of the scales developed to distinguish between those individuals who have distorted their responses and those who have not. The first two studies included in this dissertation mostly deal with the properties of the BIDR. The other two studies are less focused on SDR scales and investigate, more generally, the potential effects of SDR on two phenomena that are of central interest to the general personality discourse personality stability over time and volunteering as participants in psychological research. The data of Studies I and II showed that Paulhus BIDR scales, designed to be indicators of SDR, are not pure measures both the communion management and self-deceptive enhancement scales are, at once, measures of response bias and measures of more substantive individual differences in behaviour. The data further suggested that the communion management and self-deceptive enhancement scales of the BIDR are somewhat accurate measures of communal and agentic bias, respectively. No evidence for a suppressor model of SDR, and only weak evidence for a moderator model, was found in those studies. Concerning research on personality stability, some data in Study I suggested that SDR may add reliable and common variance to a personality questionnaire administered at two different points in time, thus artificially inflating the test-retest correlation of that questionnaire. Furthermore, Study III demonstrated that the maturity-stability hypothesis may be in part, but not entirely, a product of SDR. Study IV suggested that some of the observed personality differences between research volunteers and nonvolunteers may be due to heightened SDR of volunteers. However, those personality differences were by no means exclusively attributable to differences in SDR. In sum, the work presented in this thesis reveals some ambiguity regarding the effects of SDR on personality research, as is true of much of the previous research on SDR. Clear-cut conclusions are difficult to reach, as the data were neither fully consistent with the view that SDR can be ignored, nor with the view that SDR needs to be controlled in some way. The struggle to understand the influence of SDR on personality research continues.

Onko varhaisen tuen päiväkoti mahdollinen? : Tutkimus varhaiskasvatuksen yhteisöllisestä kehittämisestä

Is the early childhood day care facility possible? The research considering communal development of the early education. In Finland mothers and fathers look after 400 000 pre-school children. Half of these attend day care facilities, in which 50 000 staff are employed. The aim of this research is to develop co-operation practices within the day care centre. This research refines and expands my own interest in and knowledge of day care management and content development. The basis of the research draws upon ethnographic material covering the period 1999–2005. The day care centre chosen as a central informant was the first suburban centre founded in 1963, and it provided a rich local and welfare state research perspective. It became clear that the day care facility’s co-operation practices formed the basis of bringing up children and at the same time produced a new multi-operational and multi-layered community for child participation. Adult day care centre workers bringing up the children as a professional work and solutions defining the conditions for the work are expressed in a child’s upbringing. This obviously has an impact in where as the development of communities. From the human and community scientific point of view, the group of youngest children will take up a future position as key players in communities as essential actors and reformers. The research was carried out as multiphase and multiscientific practical research and iterative data formation. The results verified that the co-operation between parents and day care staff produces important benefits for all the stakeholders. However, the day care staff has difficulties in implementing the benefits. During the research process, it became clear that conceptually day care staff saw the practices as ”very important, but not easily realised in practice”. As a result this demanded further research to address this issue and to extend this to the carefacility’s co-operation practises and their communal and social conditions. The research looks at the carefacility’s co-operation with key stakeholders. At the same time it undertakes an analytical and historical examination of carefacilitys’s with an experimental focus as two day care centres chosen as experimental objects. The results of the research showed that the benefits gained by children were determined by the day care centre’s socio-political structure and the parent’s resources. The research framework categorised early childhood education as generational and gender based structures. As part of the research, the strains endemic to these formations have been examined. The system for bringing up children was created as part of a so called welfare state project by implemented by the Day Care Act in year 1973. The law secured the subjective right for every pre-school child to have access to day care facilities. The law also introduced a labour and sosiopolitical phase and the refinement of the day care facility’s education-care concept. The latest phase that started during the early 1990´s was called the market-based social services strategy. As a result of this phase, state support was limited and the screening function of the law was relaxed. This new strategy resulted in a divisive and bureaucratic social welfare system, that individualised and segregated children and their parents, leaving some families outside the communal and welfare state benefit net. The modern day care centre is a hybrid of different aims. Children spend longer and more irregular time in day care. The families are multicultural and that requires more training for the staff. The work in day care has been enhanced, for example he level of education for the staff has been lowered and productivity has been improved. However, administrative work and different kinds of support and net work functions together with the continuous change have taken over from the work done face to face with children. Staff experiences more pressure as the management and the work load has increased. Consequently the long-term planning and daily implementation of the nuclear task of the day care facility is difficult to control. This will have an effect on both motivation and manageability of the work. Overall quality of the early childhood upbringing has been weakened. The possibilities for the near future were tested in the two day care centres chosen as an experi-ment objects. The analysis of these experiments showed that generative interaction work will benefit everyone: children, parents and employees. The main results of the research are new concepts of an early support day care centre, which can be empirically and theoretically possi-ble for development the near future. Key words: Day care facility’s co-operation practises, early childhood education as generational structure, child’s multi-operational and multi-layered community, multi-subjective operator, generative interaction work, communal composition.

Widening Perspectives of Teacher Education : Studies on theory-practice relationship, reflection, research and professional development

This dissertation examined the research-based teacher education at the University of Helsinki from different theoretical and practical perspectives. Five studies focused on these perspectives separately as well as overlappingly. Study I focused on the reflection process of graduating teacher students. The data consisted of essays the students wrote as their last assignment before graduating, where their assignment was to examine their development as researchers during their MA thesis research process. The results indicated that the teacher students had analysed their own development thoroughly during the process and that they had reflected on theoretical as well as practical educational matters. The results also pointed out that, in the students’ opinion, personally conducted research is a significant learning process. -- Study II investigated teacher students’ workplace learning and the integration of theory and practice in teacher education. The students’ interviews focused on their learning of teacher’s work prior to education. The interviewees’ responses concerning their ‘surviving’ in teaching prior to teacher education were categorized into three categories: learning through experiences, school as a teacher learning environment, and case-specific learning. The survey part of the study focused on integration of theory and practice within the education process. The results showed that the students who worked while they studied took advantage of the studies and applied them to work. They set more demanding teaching goals and reflected on their work more theoretically. -- Study III examined practical aspects of the teacher students’ MA thesis research as well as the integration of theory and practice in teacher education. The participants were surveyed using a web-based survey which dealt with the participants’ teacher education experiences. According to the results, most of the students had chosen a practical topic for their MA thesis, one arising from their work environment, and most had chosen a research topic that would develop their own teaching. The results showed that the integration of theory and practice had taken place in much of the course work, but most obviously in the practicum periods, and also in the courses concerning the school subjects. The majority felt that the education had in some way been successful with regards to integration. -- Study IV explored the idea of considering teacher students’ MA thesis research as professional development. Twenty-three teachers were interviewed on the subject of their experiences of conducting research about their own work as teachers. The results of the interviews showed that the reasons for choosing the MA thesis research topic were multiple: practical, theoretical, personal, professional reasons, as well as outside effect. The objectives of the MA thesis research, besides graduating, were actual projects, developing the ability to work as teachers, conducting significant research, and sharing knowledge of the topic. The results indicated that an MA thesis can function as a tool for professional development, for example in finding ways for adjusting teaching, increasing interaction skills, gaining knowledge or improving reflection on theory and/or practice, strengthening self-confidence as a teacher, increasing researching skills or academic writing skills, as well as becoming critical and being able to read scientific and academic literature. -- Study V analysed teachers’ views of the impact of practitioner research. According to the results, the interviewees considered the benefits of practitioner research to be many, affecting teachers, pupils, parents, the working community, and the wider society. Most of the teachers indicated that they intended to continue to conduct research in the future. The results also showed that teachers often reflected personally and collectively, and viewed this as important. -- These five studies point out that MA thesis research is and can be a useful tool for increasing reflection doing with personal and professional development, as well as integrating theory and practice. The studies suggest that more advantage could be taken of the MA thesis research project. More integration of working and studying could and should be made possible for teacher students. This could be done in various ways within teacher education, but the MA thesis should be seen as a pedagogical possibility.

Semanttisen webin ontologisen tekstiilikäsitteistön kehittäminen ja liittäminen museoiden luettelointitietoihin

DEVELOPING A TEXTILE ONTOLOGY FOR THE SEMANTIC WEB AND CONNECTING IT TO MUSEUM CATALOGING DATA The goal of the Semantic Web is to share concept-based information in a versatile way on the Internet. This is achievable using formal data structures called ontologies. The goal of this re-search is to increase the usability of museum cataloging data in information retrieval. The work is interdisciplinary, involving craft science, terminology science, computer science, and museology. In the first part of the dissertation an ontology of concepts of textiles, garments, and accessories is developed for museum cataloging work. The ontology work was done with the help of thesauri, vocabularies, research reports, and standards. The basis of the ontology development was the Museoalan asiasanasto MASA, a thesaurus for museum cataloging work which has been enriched by other vocabularies. Concepts and terms concerning the research object, as well as the material names of textiles, costumes, and accessories, were focused on. The research method was terminological concept analysis complemented by an ontological view of the Semantic Web. The concept structure was based on the hierarchical generic relation. Attention was also paid to other relations between terms and concepts, and between concepts themselves. Altogether 977 concept classes were created. Issues including how to choose and name concepts for the ontology hierarchy and how deep and broad the hierarchy could be are discussed from the viewpoint of the ontology developer and museum cataloger. The second part of the dissertation analyzes why some of the cataloged terms did not match with the developed textile ontology. This problem is significant because it prevents automatic ontological content integration of the cataloged data on the Semantic Web. The research datasets, i.e. the cataloged museum data on textile collections, came from three museums: Espoo City Museum, Lahti City Museum and The National Museum of Finland. The data included 1803 textile, costume, and accessory objects. Unmatched object and textile material names were analyzed. In the case of the object names six categories (475 cases), and of the material names eight categories (423 cases), were found where automatic annotation was not possible. The most common explanation was that the cataloged field was filled with a long sentence comprised of many terms. Sometimes in the compound term, the object name and material, or the name and the way of usage, were combined. As well, numeric values in the material name cataloging field prevented annotation and so did the absence of a corresponding concept in the ontology. Ready-made drop-down lists of materials used in one cataloging system facilitated the annotation. In the case of naming objects and materials, one should use terms in basic form without attributes. The developed textile ontology has been applied in two cultural portals, MuseumFinland and Culturesampo, where one can search for and browse information based on cataloged data using integrated ontologies in an interoperable way. The textile ontology is also part of the national FinnONTO ontology infrastructure. Keywords: annotation, concept, concept analysis, cataloging, museum collection, ontology, Semantic Web, textile collection, textile material

Linnunkiikut ja kallen kaulukset : Kotitekoiset kuukautissiteet 1900-luvun alkupuolen Suomessa

The aim of this thesis was to study what kind of home-made menstrual pads were used in the early 20th century in Finland, how the home-made pads were made and which techniques and materials were used. The use and taking care of menstrual pads were also explored. The history of menstrual pads has been studied in Sweden, Germany and United States but none of those studies has concentrated on home-made pads. Instead, there are many studies about womanhood and menstruation. In many studies home-made menstrual pads are only briefly mentioned. Menstrual pads were not commonly used in Finland at the beginning of the 20th century, but already in the 1940s the use of menstrual pads had become common in every stratum of society. Home-made menstrual pads were used even until the 1960s. In Finland, factory-made disposable menstrual pads became common only in the 1930s and they were only slowly accepted. The study material consisted of nine interviews, three archival inquiries, health care guidebooks from 1893 to 1943 and authentic menstrual pads, menstrual belts and other objects related to them. The interviewed women were born between 1915 and 1939. The narrative approach was used in the study and it also guided the analysis. The interview and archival data were studied according to the basic rules of oral history studies. Literature consisted of publications from several disciplines. The extensive primary material played the most important role in this study. The reconstructions of the menstrual pads were made according to the interviewed women s advice. In Finland there were innumerable variations of home-made menstrual pads. The pads were most commonly crocheted and knitted either by hand or by knitting machine. Pads were also sewn of cloth, old bed linen or old underwear. The menstrual pads were self-made or made by a female relative. Word of mouth was important in spreading information on how to make pads, because there were hardly any instructions available. The biggest pads were 54 cm long and 13 cm wide. The most widely used pad model was a rectangle, which had triangle-shaped ends with a buttonhole or a loop. The pad was attached to the menstrual belt or to the buttons of the suspender belt. Knitted and crocheted pads had one, two or three layers. In sewn pads, there could be even more layers. Cellulose wadding or pieces of cloth could be placed inside the pad to increase the absorption ability. The experiences of the comfort of self-made pads varied. The crocheted and sewn pads were found chafing, knitted ones were found soft and comfortable. The menstrual pads were laborious to wash and boil in lye water. Therefore disposable pads made everyday life easier. The home-made menstrual pads were part of a unique tradition of handicrafts and folk culture. Hand-made pads were one of the most common handicraft products and were a part of every woman s life. Even so, the menstrual pads were unnoticeable. The large number of variations was probably caused by the silence around menstrual topics and by the lack of instructions for making pads. Variations are also explained by the uniqueness of every handicraft product. In Finland the home-made pads were used until relatively recent times. This was caused by the conditions of wartime and the following years and the rarity of commercial pads. Furthermore, until the late 20th century Finland was an agricultural society where all innovations spread slowly. Home-made menstrual pad was a secret handicraft of women and every woman needed to know how to make it by herself.

Ateljeevaatteen valmistuksen työtavat Salon Kaarlo Forsmanin tuotannossa

The objective of the present study was to increase knowledge about the atelier culture of recent history, especially about the ways in which atelier clothes were made. I look at the ways of dress-making in the production of a renowned atelier, Salon Kaarlo Forsman. I also give a general outline of the atelier. The studying method I used was triangulation, which is a typical approach in case studies of recent history. My data include 23 dresses by the Salon Forsman, theme interviews of four of the Salon workers and one mannequin, data from my research work, as well as press material and archives. The basis of the analysis of these materials was a theme frame that I had put together with the help of pre-understanding. I then completed and defined the theme frame on the basis of the analysis of the data. I also analyzed the dresses in the fashion photos in the press material. Salon Kaarlo Forsman represents a certain cultural period, the years 1937-1986, and a place where a woman could have individual clothes made for her, from hats to fur coats. The atelier was particularly known for embroidery with beads, draping, and fantastic cuttings designed by the owner, fashion designer Kaarlo Forsman. I draw an outline of the work and practices of the atelier, but also that of Kaarlo Forsman’s life work, as he had a great influence on the sewing methods atelier clothes. Mr. Forsman was able to stretch the first period of modern fashion well into the third period by refusing new, labor-saving methods and sticking to individually designer clothes to the end of his enterprise. The crucial practices in the atelier that I present in this study are fitting, designing, finishing and sewing, as well as beading and the decoration of dresses. I compare the activity, practices and dress-making methods in the Forsman atelier to that of Haute Couture in Paris, which served as model for Finnish fashion houses. I point out the similarities and differences.

Kummimaatilatoiminta opettajien ja maatilojen sekä innovaatiotutkimuksen näkökulmista

Tutkimuksen tarkoituksena on selvittää Finfood - Suomen Ruokatieto ry:n alullepanemassa kummimaatilatoiminnassa mukana olleiden opettajien ja maatilojen käsityksiä ja kokemuksia toiminnasta sekä tarkastella kummimaatilatoimintaa innovaationa. Kummimaatilatoiminta liittyy Finfoodin internetissä julkaisemaan oppimateriaaliin suomalaisen ruoan tiestä. Kummimaatilatoiminnan tavoitteena on, että mahdollisimman monella peruskoululuokalla olisi oma kummimaatila, missä luokka voisi vierailla vuosittain, joka säilyisi luokalla mahdollisimman pitkään ja jonka kanssa luokka suunnittelee oman yhteistyönsä. Kummimaatilatoiminnan avulla pyritään omakohtaisten kokemusten ja elämysten kautta lisäämään nuorten tietoa maaseudun elämästä. Tutkimuksen tausta -osassa tarkastellaan koulun ja yhteiskunnan muiden tahojen yhteistyötä, esitellään tutkimuksia koulun ja teollisuusyritysten yhteistyöstä sekä koulun ja maatalouden yhteistyöhön liittyvää materiaalia. Lisäksi tarkastellaan innovaatiota ja innovaation diffuusiota. Koska kummimaatilatoiminta on uusi toimintamuoto, jossa toisena osapuolena on koulu, tutkimuksessa käsitellään myös kasvatuksen muutoksia (educational change). Tutkimusta käsitellään tapaus- ja toimintatutkimuksena. Tutkimusaineistona ovat kummimaatilatoiminnan alkuvaiheessa syksyllä 1997 mukaan lähteneiden seitsemän opettajan ja kuuden maatilan teemahaastattelut. Tutkimuksessa on haastateltu myös Finfoodin edustajaa. Aineisto kerättiin kevään ja syksyn 1998 aikana. Innovaatiotarkastelun pohjana ovat lisäksi tutkijan omat kokemukset toiminnasta sekä erilaiset kokoukset ja keskustelut. Opettajien ja maatilojen kokemuksista selvitettiin heidän toiminnan aloittamiseen johtaneita motiivejaan, toiminnalle asettamiaan tavoitteita, toiminnassa havaitsemiaan ongelmia sekä käsityksiä toiminnan onnistumisen avaintekijöistä ja toiminnan kehittämisestä. Suuria näkemyseroja ei opettajien ja maatilojen kokemusten välillä ollut. Osapuolet pitivät maaseutua tärkeänä ja halusivat tarjota lapsille kokemuksia elämästä siellä. Yhteisenä tavoitteena opettajilla ja maatiloilla oli, että toiminta olisi mahdollisimman laajaa, ei pelkkiä retkipäiviä maalle. Opettajat korostivat myös vierailujen toiminnallisuutta. Maatilat toivoivat voivansa lisätä toiminnalla myös omaa tietämystään ja ammattitaitoaan. Käytännön asiat kuten matkat olivat eniten ongelmia aiheuttaneita asioita. Muina mahdollisina ongelmina mainittiin asenteet ja tiedotus. Toiminnan avaintekijöinä pidettiin suunnittelua, molempien osapuolten motivoituneisuutta ja aktiivisuutta, vierailujen toiminnallisuutta, tiedottamista ja toiminnan laajentamista. Kehittämisideat liittyivät toiminnan laajentamiseen ja monipuolistamiseen. Tämän tutkimuksen perusteella kummimaatilatoimintaa on ryhdytty kehittämään niin, että koko koululla yksittäisen luokan sijaan on yhteinen kummimaatila. Innovaatiotarkastelu osoitti, että kummimaatilatoiminnan kehittäminen ja levittäminen on pitkä prosessi, jossa koordinaattorin rooli on tärkeä. Osallistujien sitoutuminen toimintaan, osallistujien tukeminen sekä heidän kokemustensa hyödyntäminen on myös tärkeää. Tärkeimmät lähteet tutkimuksen taustateorian kannalta olivat Rogersin, Fullanin ja Hargreavesin teokset. Avainsanat: kummimaatilatoiminta, innovaatio, innovaation diffuusio, muutos Keywords: godfarms, farm visits, innovation, diffusion of innovation, educational change

Cholesterol Disturbances in Inherited Neurodegenerative Diseases : Studies on Npc1, Ppt1 and Ctsd deficient mice

The central nervous system (CNS) is the most cholesterol-rich organ in the body. Cholesterol is essential to CNS functions such as synaptogenesis and formation of myelin. Significant differences exist in cholesterol metabolism between the CNS and the peripheral organs. However, the regulation of cholesterol metabolism in the CNS is poorly understood compared to our knowledge of the regulation of cholesterol homeostasis in organs reached by cholesterol-carrying lipoprotein particles in the circulation. Defects in CNS cholesterol homeostasis have been linked to a variety of neurodegenerative diseases, including common diseases with complex pathogenetic mechanisms such as Alzheimer s disease. In spite of intense effort, the mechanisms which link disturbed cholesterol homeostasis to these diseases remain elusive. We used three inherited recessive neurodegenerative disorders as models in the studies included in this thesis: Niemann-Pick type C (NPC), infantile neuronal ceroid lipofuscinosis and cathepsin D deficiency. Of these three, NPC has previously been linked to disturbed intracellular cholesterol metabolism. Elucidating the mechanisms with which disturbances of cholesterol homeostasis link to neurodegeneration in recessive inherited disorders with known genetic lesions should shed light on how cholesterol is handled in the healthy CNS and help to understand how these and more complex diseases develop. In the first study we analyzed the synthesis of sterols and the assembly and secretion of lipoprotein particles in Npc1 deficient primary astrocytes. We found that both wild type and Npc1 deficient astrocytes retain significant amounts of desmosterol and other cholesterol precursor sterols as membrane constituents. No difference was observed in the synthesis of sterols and the secretion of newly synthesized sterols between Npc1 wild type, heterozygote or knockout astrocytes. We found that the incorporation of newly synthesized sterols into secreted lipoprotein particles was not inhibited by Npc1 mutation, and the lipoprotein particles were similar to those excreted by wild type astrocytes in shape and size. The bulk of cholesterol was found to be secreted independently of secreted NPC2. These observations demonstrate the ability of Npc1 deficient astrocytes to handle de novo sterols, and highlight the unique sterol composition in the developing brain. Infantile neuronal ceroid lipofuscinosis is caused by the deficiency of a functional Ppt1 enzyme in the cells. In the second study, global gene expression studies of approximately 14000 mouse genes showed significant changes in the expression of 135 genes in Ppt1 deficient neurons compared to wild type. Several genes encoding for enzymes of the mevalonate pathway of cholesterol biosynthesis showed increased expression. As predicted by the expression data, sterol biosynthesis was found to be upregulated in the knockout neurons. These data link Ppt1 deficiency to disturbed cholesterol metabolism in CNS neurons. In the third study we investigated the effect of cathepsin D deficiency on the structure of myelin and lipid homeostasis in the brain. Our proteomics data, immunohistochemistry and western blotting data showed altered levels of the myelin protein components myelin basic protein, proteolipid protein and 2 , 3 -cyclic nucleotide 3 phosphodiesterase in the brains of cathepsin D deficient mice. Electron microscopy revealed altered myelin structure in cathepsin D deficient brains. Additionally, plasmalogen-derived alkenyl chains and 20- and 24-carbon saturated and monounsaturated fatty acids typical for glycosphingolipids were found to be significantly reduced, but polyunsaturated species were significantly increased in the knockout brains, pointing to a decrease in white matter. The levels of ApoE and ABCA1 proteins linked to cholesterol efflux in the CNS were found to be altered in the brains of cathepsin D deficient mice, along with an accumulation of cholesteryl esters and a decrease in triglycerols. Together these data demonstrate altered myelin architecture in cathepsin D deficient mice and link cathepsin D deficiency to aberrant cholesterol metabolism and trafficking. Basic research into rare monogenic diseases sheds light on the underlying biological processes which are perturbed in these conditions and contributes to our understanding of the physiological function of healthy cells. Eventually, understanding gained from the study of disease models may contribute towards establishing treatment for these disorders and further our understanding of the pathogenesis of other, more complex and common diseases.

Associations among Emdogain®, human oral carcinoma cells and oral proteolytic enzymes

The Enamel matrix derivative Emdogain® (EMD) is a commercially available tissue extract preparation of porcine enamel origin. Studies have shown EMD to be clinically useful in promoting periodontal regeneration. EMD has been widely used in periodontal therapy for over ten years, but the mechanism of its action and the exact composition are not completely clear. EMD is predominantly amelogenin (>90%). However, unlike amelogenin, EMD has a number of growth factor-like effects and it has been shown to enhance the proliferation, migration and other cellular functions of periodontal ligament fibroblasts and osteoblasts. In contrast, the effects of EMD on epithelial cell lines and in particular on oral malignant cells have not been adequately studied. In addition, EMD has effects on the production of cytokines by several oral cell lines and the product is in constant interaction with different oral enzymes. Regardless of the various unknown properties of EMD, it is said to be clinically safe in regenerative procedures, also in medically compromised patients. The aim of the study was to examine whether gingival crevicular fluid (GCF), which contains several different proteolysis enzymes, could degrade EMD and alter its biological functions. In addition, the objective was to study the effects of EMD on carcinogenesis-related factors, in particular MMPs, using in vitro and in vivo models. This study also aimed to contribute to the understanding of the composition of EMD. GCF was capable of degrading EMD, depending on the periodontal status, with markedly more degradation in all states of periodontal disease compared to healthy controls. EMD was observed to stimulate the migration of periodontal ligament fibroblasts (PLF), whereas EMD together with GCF could not stimulate this proliferation. In addition, recombinant amelogenin, the main component of EMD, decreased the migration of PLFs. A comparison of changes induced by EMD and TGF-β1 in the gene profiles of carcinoma cells showed TGF-β1 to regulate a greater number of genes than EMD. However, both of the study reagents enhanced the expression of MMP-10 and MMP-9. Furthermore, EMD was found to induce several factors closely related to carcinogenesis on gene, protein, cell and in vivo levels. EMD enhanced the production of MMP-2, MMP-9 and MMP-10 proteins by cultured carcinoma cells. In addition, EMD stimulated the migration and in vitro wound closure of carcinoma cells. EMD was also capable of promoting metastasis formation in mice. In conclusion, the diseased GCF, containing various proteases, causes degradation of EMD and decreased proliferation of PLFs. Thus, this in vitro study suggests that the regenerative effect of EMD may decrease due to proteases present in periodontal tissues during the inflammation and healing of the tissues in vivo. Furthermore, EMD was observed to enhance several carcinoma-related factors and in particular the production of MMPs by benign and malignant cell lines. These findings suggest that the clinical safety of EMD with regard to dysplastic mucosal lesions should be further investigated.

Restorative treatment practices and dentist-related factors

This study aimed at elucidating real-life aspects of restorative treatment practices. In addition, dentists' views and perceptions of and variation in restorative treatment practices with respect to dentist-related factors were evaluated. Reasons for placement and replacement of restoration, material selection, posterior restoration longevity, and the use of local anesthesia were assessed on two cross-sectional data sets. Data from the Helsinki Public Dental Service (PDS) included details on 3057 restorations performed by dentists (n=134) during routine clinical work in 2001. The other PDS data from Vantaa were based on 205 patient records of young adults containing information on 1969 restorations investigated retrospectively from 1994-1996 backwards; 51 dentists performed the restorations. In addition, dentists’ self-reported use of local anesthesia and estimates of restoration longevity were investigated by means of a nationwide questionnaire sent to 592 general dental practitioners selected by systematic sampling from the membership list of the Finnish Dental Association in 2004. All data sets included some background information on dentists such as gender, year of birth or graduation, and working sector. In PDS in 2001, primary caries was the reason for placement of restoration more often among patients aged under 19 years than among older patients (p<0.001). Among patients over 36 years of age, replacements represented the majority. Regarding dentist-related factors, replacements of restorations were made by younger dentists more frequently than by older dentists (p<0.001). In PDS in 1994-1996, the replacement rate of posterior restorations was greater among female dentists than among male dentists (p=0.01), especially for amalgams (p=0.008). The mean age of replaced posterior restoration among young adults was 8.9 (SD 5.2) years for amalgam and 2.4 (SD 1.4) years for tooth-colored restorations, the actual replacement rate for all existing posterior restorations being 7% in PDS in 1994-1996. Of all restorative materials used, a clear majority (69%) were composites in PDS in 2001. Local anesthesia was used in 48% of cases and more frequently for older patients (55%) than for patients aged under 13 years (35%) (p<0.001). Younger dentists more often used local anesthesia for primary restoration than did the older dentists (p<0.001), especially for primary teeth (p=0.005). Working sector had an impact on dentists’ self-reported use of local anesthesia and estimates of restoration longevity; public sector dentists reported using local anesthesia more frequently than private sector dentists for Class II (p=0.04) and for Class III restorations (p=0.01). Private sector dentists gave longer estimates of posterior composite longevity than public sector dentists (p=0.001). In conclusion, restorative treatment practices seem to vary according to patient age and also dentist-related factors. Replacements of restorations are common for adults. For children, clear underuse of local anesthesia prevails.

Early-onset depressive disorders,related mental health disorders and substance use-A prospective : longitudinal study of Finnish twins born 1983-1987

Early-onset psychiatric illnesses effects scatter to academic achievements as well as functioning in familial and social environments. From a public health point of view, depressive disorders are the most significant mental health disorders that begin in adolescence. Using prospective and longitudinal design, this study aimed to increase the understanding of early-onset depressive disorders, related mental health disorders and developing substance use in a large population-derived sample of adolescent Finnish twins. The participants of this study, FinnTwin12, an ongoing longitudinal population-based study, came from Finnish families with twins born in 1983-87 (exhaustive of five birth cohorts, identified from Finland s Central Population Register). With follow-up ongoing at age 20-24, this thesis assessed adolescent mental health in the first three waves, starting from baseline age 11-12 to follow-ups at age 14 and 17½. Some 5600 twins participated in questionnaire assessments of a wide range of health related behaviors. Mental health was further assessed among an intensively studied subsample of 1852 adolescents, who completed also professionally administered interviews at age 14, which provided data for full DSM-IV/III-R (Diagnostic and Statistical Manual for Mental Health disorders, 4th and 3rd editions) diagnoses. The participation rates of the study were 87-92%. The results of the study suggest, that the diagnostic criteria for major depressive disorder (MDD) may not capture youth with clinically significant early-onset depressive conditions outside clinical settings. Milder cases of depression, namely adolescents fulfilling the diagnostic criteria for minor depressive disorder, a qualitatively similar condition to MDD with fewer symptoms are also associated with marked suicidal thoughts, plans and attempts, recurrences and a high degree of comorbidity. Prospectively and longitudinally, early-onset depressive disorders were of substantial importance in the context of other mental health disorders and substance use behaviors: These data from a large population-derived sample established a substantial overlap between early-onset depressive disorders and attention deficit hyperactivity disorder in adolescent females, both of them significantly predictive for development of substance use among girls. Only in females baseline DSM-IV ADHD symptoms were strong predictors of alcohol abuse and dependence and illicit drug use at age 14 and frequent alcohol use and illicit drug use at age 17.½ when conduct disorder and previous substance use were controlled for. Early-onset depressive disorders were also prospectively and longitudinally associated to daily smoking behavior, smokeless tobacco use, frequent alcohol use and illicit drug use and eating disorders. Analysis of discordant twins suggested that these predictive associations were independent of familial confounds, such as family income, structure and parental models. In sum, early-onset depressive disorders predict subsequent involvement of substance use and psychiatric morbidity. A heightened risk for substance use is substantial also among those depressed below categorical diagnosis of MDD. Whether early recognition and interventions among these young people hold potential for substance use prevention further in their lives has potential public health significance and calls for more research. Data from this population-derived sample with balanced representation of boys and girls, suggested that boys and girls with ADHD behaviors may differ from each other in their vulnerability to substance use and depressive disorders: the data suggest more adverse substance use outcome for girls that was not attenuated by conduct disorder or previous substance use. Further, the prospective associations of early-onset depressive disorders and future elevated levels of addictive substance use is not explained by familial factors supporting future substance use, which could have important implications for substance use prevention.

Evidence-based perspective on CP rehabilitation : Reviews on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices

This thesis utilises an evidence-based approach to critically evaluate and summarize effectiveness research on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices in children and adolescents with cerebral palsy (CP). It aims to assess the methodological challenges of the systematic reviews and trials, to evaluate the effectiveness of interventions in current use, and to make suggestions for future trials Methods: Systematic reviews were searched from computerized bibliographic databases up to August 2007 for physiotherapy and physiotherapy-related interventions, and up to May 2003 for orthotic devices. Two reviewers independently identified, selected, and assessed the quality of the reviews using the Overview Quality Assessment Questionnaire complemented with decision rules. From a sample of 14 randomized controlled trials (RCT) published between January 1990 and June 2003 we analysed the methods of sampling, recruitment, and comparability of groups; defined the components of a complex intervention; identified outcome measures based on the International Classification of Functioning, Disability and Health (ICF); analysed the clinical interpretation of score changes; and analysed trial reporting using a modified 33-item CONSORT (Consolidated Standards of Reporting Trials) checklist. The effectiveness of physiotherapy and physiotherapy-related interventions in children with diagnosed CP was evaluated in a systematic review of randomised controlled trials that were searched from computerized databases from January 1990 up to February 2007. Two reviewers independently assessed the methodological quality, extracted the data, classified the outcomes using the ICF, and considered the level of evidence according to van Tulder et al. (2003). Results: We identified 21 reviews on physiotherapy and physiotherapy-related interventions and five on orthotic devices. These reviews summarized 23 or 5 randomised controlled trials and 104 or 27 observational studies, respectively. Only six reviews were of high quality. These found some evidence supporting strength training, constraint-induced movement therapy or hippotherapy, and insufficient evidence on comprehensive interventions. Based on the original studies included in the reviews on orthotic devices we found some short-term effects of lower limb casting on passive range of movement, and of ankle-foot orthoses on equinus walk. Long term effects of lower limb orthoses have not been studied. Evidence of upper limb casting or orthoses is conflicting. In the sample of 14 RCTs, most trials used simple randomisation, complemented with matching or stratification, but only three specified the concealed allocation. Numerous studies provided sufficient details on the components of a complex intervention, but the overlap of outcome measures across studies was poor and the clinical interpretation of observed score changes was mostly missing. Almost half (48%) of the applicable CONSORT-based items (range 28 32) were reported adequately. Most reporting inadequacies were in outcome measures, sample size determination, details of the sequence generation, allocation concealment and implementation of the randomization, success of assessor blinding, recruitment and follow-up dates, intention-to-treat analysis, precision of the effect size, co-interventions, and adverse events. The systematic review identified 22 trials on eight intervention categories. Four trials were of high quality. Moderate evidence of effectiveness was established for upper extremity treatments on attained goals, active supination and developmental status, and of constraint-induced therapy on the amount and quality of hand use and new emerging behaviours. Moderate evidence of ineffectiveness was found for strength training's effect on walking speed and stride length. Conflicting evidence was found for strength training's effect on gross motor function. For the other intervention categories the evidence was limited due to the low methodological quality and the statistically insignificant results of the studies. Conclusions: The high-quality reviews provide both supportive and insufficient evidence on some physiotherapy interventions. The poor quality of most reviews calls for caution, although most reviews drew no conclusions on effectiveness due to the poor quality of the primary studies. A considerable number of RCTs of good to fair methodological and reporting quality indicate that informative and well-reported RCTs on complex interventions in children and adolescents with CP are feasible. Nevertheless, methodological improvement is needed in certain areas of the trial design and performance, and the trial authors are encouraged to follow the CONSORT criteria. Based on RCTs we established moderate evidence for some effectiveness of upper extremity training. Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most physiotherapy interventions is available to guide clinical practice. Well-designed trials are needed, especially for focused physiotherapy interventions.

Living arrangements and health

In line with major demographic changes in other Northern European and North American countries and Australia, being nonmarried is becoming increasingly common in Finland, and the proportion of cohabiters and of persons living alone has grown in recent decades. Official marital status no longer reflects an individual s living arrangement, as single, divorced and widowed persons may live alone, with a partner, with children, with parents, with siblings, or with unrelated persons. Thus, more than official marital status, living arrangements may be a stronger discriminator of one s social bonds and health. The general purpose of this study was to deepen our current understanding of the magnitude, trends, and determinants of ill health by living arrangements in the Finnish working-age population. Distinct measures of different dimensions of poor health, as well as an array of associated factors, provided a comprehensive picture of health differences by living arrangements and helped to assess the role of other factors in the interpretation of these differences . Mortality analyses were based on Finnish census records at the end of 1995 linked with cause-of-death registers for 1996 2000. The data included all persons aged 30 and over. Morbidity analyses were based on two comparable cross-sectional studies conducted twenty years apart (the Mini-Finland Survey in 1978 80 and the Health 2000 Survey in 2000 01). Both surveys were based on nationally representative samples of Finns aged 30 and over, and benefited from high participation rates. With the exception of mortality analyses, this study focused on health differences among the working-age population (mortality in age groups 30-64 and 65 and over, self-rated health and mental health in the age group 30-64, and unhealthy alcohol use in the age group 30-54). Compared with all nonmarried groups, married men and women exhibited the best health in terms of mortality, self-rated health, mental health and unhealthy alcohol use. Cohabiters did not differ from married persons in terms of self-rated health or mental health, but did exhibit excess unhealthy alcohol use and high mortality, particularly from alcohol-related causes. Compared with the married, persons living alone or with someone other than a partner exhibited elevated mortality as well as excess poor mental health and unhealthy alcohol use. By all measures of health, men and women living alone tended to be in the worst position. Over the past twenty years, SRH had improved least among single men and women and widowed women, and most among cohabiting women. The association between living arrangements and health has many possible explanations. The health-related selection theory suggests that healthy people are more likely to enter and maintain a marriage or a consensual union than those who are unhealthy (direct selection) or that a variety of health-damaging behavioural and social factors increase the likelihood of ill health and the probability of remaining without a partner or becoming separated from one s partner (indirect selection). According to the social causation theory, marriage or cohabitation has a health-promoting effect, whereas living alone or with others than a partner has a detrimental effect on health. In this study, the role of other factors that are mainly assumed to reflect selection, appeared to be rather modest. Social support, which reflects social causation, contributed only modestly to differences in unhealthy alcohol use by living arrangements, but had a larger effect on differences in poor mental health. Socioeconomic factors and health-related behaviour, which reflect both selection and causation, appeared to play a more important role in the excess poor health of cohabiters and of persons living alone or with someone other than a partner, than of married persons. Living arrangements were strongly connected to various dimensions of ill health. In particular, alcohol consumption appeared to be of great importance in the association between living arrangements and health. To the extent that the proportion of nonmarried persons continues to grow and their health does not improve at the same rate as that of married persons, the challenges that currently nonmarried persons pose to public health will likely increase.

Socioeconomic Status, Occupational Factors and Lifestyle as Predictors of Hospitalisation for Back Disorders

The aim of this dissertation was to examine the determinants of severe back disorders leading to hospital admission in Finland. First, back-related hospitalisations were considered from the perspective of socioeconomic status, occupation, and industry. Secondly, the significance of psychosocial factors at work, sleep disturbances, and such lifestyle factors as smoking and overweight was studied as predictors of hospitalisation due to back disorders. Two sets of data were used: 1) the population-based data comprised all occupationally active Finns aged 25-64, and included hospitalisations due to back disorders in 1996 and 2) a cohort of employees followed up from 1973 to 2000 having been hospitalised due to back disorders. The results of the population-based study showed that people in physically strenuous industries and occupations, such as agriculture and manufacturing, were at an increased risk of being hospitalised for back disorders. The lowest hospitalisation rates were found in sedentary occupations. Occupational class and the level of formal education were independently associated with hospitalisation for back disorders. This stratification was fairly consistent across age-groups and genders. Men had a slightly higher risk of becoming hospitalised compared with women, and the risk increased with age among both genders. The results of the prospective cohort study showed that psychosocial factors at work such as low job control and low supervisor support predicted subsequent hospitalisation for back disorders even when adjustments were made for occupational class and physical workload history. However, psychosocial factors did not predict hospital admissions due to intervertebral disc disorders; only admissions due to other back disorders. Smoking and overweight predicted, instead, only hospitalisation for intervertebral disc disorders. These results suggest that the etiological factors of disc disorders and other back disorders differ from each other. The study concerning the association of sleep disturbances and other distress symptoms with hospitalisation for back disorders revealed that sleep disturbances predicted subsequent hospitalisation for all back disorders after adjustment for chronic back disorders and recurrent back symptoms at baseline, as well as for work-related load and lifestyle factors. Other distress symptoms were not predictive of hospitalisation.

Effect of waiting time on health outcomes and service utilization : A prospective randomized study on patients admitted to hospital for hip or knee replacement

Although the principle of equal access to medically justified treatment has been promoted by official health policies in many Western health care systems, practices do not completely meet policy targets. Waiting times for elective surgery vary between patient groups and regions, and growing problems in the availability of services threaten equal access to treatment. Waiting times have come to the attention of decision-makers, and several policy initiatives have been introduced to ensure the availability of care within a reasonable time. In Finland, for example, the treatment guarantee came into force in 2005. However, no consensus exists on optimal waiting time for different patient groups. The purpose of this multi-centre randomized controlled trial was to analyse health-related quality of life, pain and physical function in total hip or knee replacement patients during the waiting time and to evaluate whether the waiting time is associated with patients health outcomes at admission. This study also assessed whether the length of waiting time is associated with social and health services utilization in patients awaiting total hip or knee replacement. In addition, patients health-related quality of life was compared with that of the general population. Consecutive patients with a need for a primary total hip or knee replacement due to osteoarthritis were placed on the waiting list between August 2002 and November 2003. Patients were randomly assigned to a short waiting time (maximum 3 months) or a non-fixed waiting time (waiting time not fixed in advance, instead the patient followed the hospitals routine practice). Patients health-related quality of life was measured upon being placed on the waiting list and again at hospital admission using the generic 15D instrument. Pain and physical function were evaluated using the self-report Harris Hip Score for hip patients and a scale modified from the Knee Society Clinical Rating System for knee patients. Utilization measures were the use of home health care, rehabilitation and social services, physician visits and inpatient care. Health and social services use was low in both waiting time groups. The most common services used while waiting were rehabilitation services and informal care, including unpaid care provided by relatives, neighbours and volunteers. Although patients suffered from clear restrictions in usual activities and physical functioning, they seemed primarily to lean on informal care and personal networks instead of professional care. While longer waiting time did not result in poorer health-related quality of life at admission and use of services during the waiting time was similar to that at the time of placement on the list, there is likely to be higher costs of waiting by people who wait longer simply because they are using services for a longer period. In economic terms, this would represent a negative impact of waiting. Only a few reports have been published of the health-related quality of life of patients awaiting total hip or knee replacement. These findings demonstrate that, in addition to physical dimensions of health, patients suffered from restrictions in psychological well-being such as depression, distress and reduced vitality. This raises the question of how to support patients who suffer from psychological distress during the waiting time and how to develop strategies to improve patients initiatives to reduce symptoms and the burden of waiting. Key words: waiting time, total hip replacement, total knee replacement, health-related quality of life, randomized controlled trial, outcome assessment, social service, utilization of health services