Hipervolemia mais tríplice oclusão vascular no tratamento da lesão traumática da veia cava retro-hepática e veias hepáticas

BACKGROUND: Liver vascular isolation is essential for the treatment of the retrohepatic vena cava and hepatic veins. Triple vessel occlusion (TVO - occlusion of the portal triad, the inferior vena cava above the renal veins and within the pericardium) is the easiest isolation method for the surgeon. Unfortunately, this technique cannot be applied to hypovolemic and/or shock (cardiac arrest) patients as it compromises venous return. OBJECTIVES: Our objective is to demonstrate that in the above mentioned patients, establishing a previous hypervolemic state allows the safe use of TVO. METHODS: The method includes efficient injury tamponade with aggressive fluid replacement until normal blood volume is reached (resuscitation). Normal blood volume is recognized by a return of arterial blood pressure to normal levels, inferior vena cava filling and an increase in aortic wall tension. Following this procedure, hypervolemia is obtained by the rapid additional infusion of 1.500 to 2.000 ml of fluids. TVO in this situation does not alter the heart rhythm and maintains a clear operative field which is essential for hepatotomy, venorrhaphy and or venous ligation. RESULTS: Three patients were successfully operated.

Free Prostate-specific Antigen Forms and Kallikrein-related Peptidase 2: Tools for Prostate Cancer Diagnostics

Prostate-specific antigen (PSA) is a marker that is commonly used in estimating prostate cancer risk. Prostate cancer is usually a slowly progressing disease, which might not cause any symptoms whatsoever. Nevertheless, some cases of cancer are aggressive and need to be treated before they become life-threatening. However, the blood PSA concentration may rise also in benign prostate diseases and using a single total PSA (tPSA) measurement to guide the decision on further examinations leads to many unnecessary biopsies, over-detection, and overtreatment of indolent cancers which would not require treatment. Therefore, there is a need for markers that would better separate cancer from benign disorders, and would also predict cancer aggressiveness. The aim of this study was to evaluate whether intact and nicked forms of free PSA (fPSA-I and fPSA-N) or human kallikrein-related peptidase 2 (hK2) could serve as new tools in estimating prostate cancer risk. First, the immunoassays for fPSA-I and free and total hK2 were optimized so that they would be less prone to assay interference caused by interfering factors present in some blood samples. The optimized assays were shown to work well and were used to study the marker concentrations in the clinical sample panels. The marker levels were measured from preoperative blood samples of prostate cancer patients scheduled for radical prostatectomy. The association of the markers with the cancer stage and grade was studied. It was found that among all tested markers and their combinations especially the ratio of fPSA-N to tPSA and ratio of free PSA (fPSA) to tPSA were associated with both cancer stage and grade. They might be useful in predicting the cancer aggressiveness, but further follow-up studies are necessary to fully evaluate the significance of the markers in this clinical setting. The markers tPSA, fPSA, fPSA-I and hK2 were combined in a statistical model which was previously shown to be able to reduce unnecessary biopsies when applied to large screening cohorts of men with elevated tPSA. The discriminative accuracy of this model was compared to models based on established clinical predictors in reference to biopsy outcome. The kallikrein model and the calculated fPSA-N concentrations (fPSA minus fPSA-I) correlated with the prostate volume and the model, when compared to the clinical models, predicted prostate cancer in biopsy equally well. Hence, the measurement of kallikreins in a blood sample could be used to replace the volume measurement which is time-consuming, needs instrumentation and skilled personnel and is an uncomfortable procedure. Overall, the model could simplify the estimation of prostate cancer risk. Finally, as the fPSA-N seems to be an interesting new marker, a direct immunoassay for measuring fPSA-N concentrations was developed. The analytical performance was acceptable, but the rather complicated assay protocol needs to be improved until it can be used for measuring large sample panels.

Tratamento cirúrgico na recidiva retroperitoneal tardia por carcinoma renal de células claras após nefrectomia radical

Late renal cell carcinoma recurrence in the renal fossa is a rare event. This condition occurs in 1 to 2% of radical nephrectomies. We reported a late recurrence at the renal fossa about four and half years after radical nephrectomy due to a renal cell carcinoma (RCC) without metastasis elsewhere. Diagnosis in an outpatient follow-up was made during an abdominal computed tomography and we observed a retroperitoneal mass in the renal fossa. The excision at the recurrence area was made through a subcostal transversal incision without any difficulty. After 6 months from this second procedure, there was no evidence of recurrence. The surgical aggressive treatment for late retroperitoneal RCC recurrence is a good method in this rare situation. Abdominal computed tomography must be done during long periods of follow-up for patients with radical nephrectomy for RCC to search for late retroperitoneal recurrences.

Damage control surgery: it's evolution over the last 20 years

In less than twenty years, what began as a concept for the treatment of exsanguinating truncal trauma patients has become the primary treatment model for numerous emergent, life threatening surgical conditions incapable of tolerating traditional methods. Its core concepts are relative straightforward and simple in nature: first, proper identification of the patient who is in need of following this paradigm; second, truncation of the initial surgical procedure to the minimal necessary operation; third, aggressive, focused resuscitation in the intensive care unit; fourth, definitive care only once the patient is optimized to tolerate the procedure. These simple underlying principles can be molded to a variety of emergencies, from its original application in combined major vascular and visceral trauma to the septic abdomen and orthopedics. A host of new resuscitation strategies and technologies have been developed over the past two decades, from permissive hypotension and damage control resuscitation to advanced ventilators and hemostatic agents, which have allowed for a more focused resuscitation, allowing some of the morbidity of this model to be reduced. The combination of the simple, malleable paradigm along with better understanding of resuscitation has proven to be a potent blend. As such, what was once an almost lethal injury (combined vascular and visceral injury) has become a survivable one.

Identification of novel regulators for tumor progression in breast cancer

Breast cancer is the most frequent solid tumor among women and the leading cause of cancer related death in women worldwide. The prognosis of breast cancer patients is tightly correlated with the degree of spread beyond the primary tumor. In this thesis, the aim was to identify novel regulators of tumor progression in breast cancer as well as to get insights into the molecular mechanisms of breast cancer progression and metastasis. First, the role of phospholipid remodeling genes and enzymes important for breast cancer progression was studied in breast cancer samples as well as in cultured breast cancer cells. Tumor samples displayed increased de novo synthesized fatty acids especially in aggressive breast cancer. Furthermore, RNAi mediated cell based assays implicated several target genes critical for breast cancer cell proliferation and survival. Second, the role of arachidonic acid pathway members 15-hydroxyprostaglandin dehydrogenase (HPGD) and phospholipase A2 group VII (PLA2G7) in tumorigenesis associated processes was explored in metastatic breast cancer cells. Both targets were found to contribute to epithelial-mesenchymal transition related processes. Third, a high-throughput RNAi lysate microarray screen was utilized to identify novel vimentin expression regulating genes. Methylenetetrahydrofolate dehydrogenase 2 (MTHFD2) was found to promote cellular features connected with metastatic disease, thus implicating MTHFD2 as a potential drug target to block breast cancer cell migration and invasion. Taken together, this study identified several putative targets for breast cancer therapy. In addition, these results provide novel information about the mechanisms and factors underlying breast cancer progression.

Aggression and its Management in Adolescent Forensic Psychiatric Care

The overall goal of this study was to explore and identify good aggression management methods and on that basis to produce recommendations for aggression management in the adolescent forensic setting. The study was conducted in three phases. In Phase I, staff’s (n = 58) perception of adolescent aggressive behaviour and methods to manage it was examined. In Phase II, staff’s (n = 30) perception of treatment settings and treatment interventions available were studied. In Phase III, the effectiveness of an aggression management programme was evaluated. The data were collected during the period 2004-2007. Participants perceived adolescent aggressive behaviour in a similar way and described aggressive behaviour as being a comprehensible phenomenon. Management methods used to control aggressive situations were alike, although the practical solutions varied between the study units, especially regarding coercive methods. Staff members proposed more time and better opportunities to discuss and evaluate the aggression situation in order to improve the methods used. The treatment settings were similar in studied forensic units and interventions were primarily focused on psychological aspects, including management of aggressive behavior. A comprehensive aggression management programme proved to be effective in decreasing incidents of violence. The use of coercive methods in aggression situations decreased and injuries to the staff became less frequent. If staff members intend to apply high quality management methods in aggression situations they have to share a consistent understanding of aggressive behaviour and need to be aware of the various methods available. In addition, they should learn more about assessment methods in order to improve aggression management. International comparison of aggression, methods for managing it and service provision creates a starting point for developing equal care provision and realization within and between European countries.

Imaging of Tumour Microenvironment for the Planning of Oncological Therapies Using Positron Emission Tomography

Tumour cells differ from normal tissue cells in several important ways. These differences, like for example changed energy metabolism, result in altered microenvironment of malignant tumours. Non-invasive imaging of tumour microenvironment has been at the centre of intense research recently due to the important role that this changed environement plays in the development of malignant tumours and due to the role it plays in the treatment of these tumours. In this respect, perhaps the most important characteristics of the tumour microenvironment from this point of view are the lack of oxygen or hypoxia and changes in blood flow (BF). The purpose of this thesis was to investigate the processes of energy metabolism, BF and oxygenation in head and neck cancer and pancreatic tumours and to explore the possibilities of improving the methods for their quantification using positron emission tomography (PET). To this end [18F]EF5, a new PET tracer for detection of tumour hypoxia was investigated. Favourable uptake properties of the tracer were observed. In addition, it was established that the uptake of this tracer does not correlate with the uptake of existing tracers for the imaging of energy metabolism and BF, so the information about the presence of tissue hypoxia cannot therefore be obtained using tracers such as [18F]FDG or [15O]H2O. These results were complemented by the results of the follow-up study in which it was shown that the uptake of [18F]EF5 in head and neck tumours prior to treatment is also associated with the overall survival of the patients, indicating that tumour hypoxia is a negative prognostic factor and might be associated with therapeutic resistance. The influences of energy metabolism and BF on the survival of patients with pancreatic cancer were investigated in the second study. The results indicate that the best predictor of survival of patients with pancreatic cancer is the relationship between energy metabolism and BF. These results suggest that the cells with high metabolic activity in a hypoperfused tissue have the most aggressive phenotype.

Fatal Human herpesvirus 1 (HHV-1) infection in captive marmosets (Callithrix jacchus and Callithrix penicillata) in Brazil: clinical and pathological characterization

Fatal Human herpesvirus 1 (HHV-1) was diagnosed in 12 captive marmosets (Callithrix jacchus and Callithrix penicillata) from metropolitan region of São Paulo, São Paulo State. Clinical signs were variable among the cases, but most affected marmosets presented signs associated with viral epithelial replication: oral, lingual and facial skin ulcers and hypersalivation, and viral replication in the central nervous system: prostration, seizure and aggressive behavior. Consistent microscopic findings were diffuse mild to severe nonsuppurative necrotizing meningoencephalitis with gliosis, vasculitis and neuronal necrosis. Additionally, in the brain, oral cavity, skin, adrenal gland and myoenteric plexus intranuclear inclusion bodies were present. Immunohistochemistry confirmed the presence of the HHV-1 antigen in association with lesions in the brain, oral and lingual mucosa, facial skin, adrenal gland and myoenteric plexus. HHV-1-specific polymerase chain reaction (PCR) analysis of the brain was carried out and the virus was detected in 7/8 infected marmosets. It is concluded that HHV-1 causes widespread fatal infection in marmosets.

Libyan breast cancer: Health services and biology. Diagnosis delay and prognostic value of DNA pploidy, S-phase fraction, and Ki-67 and Bcl-2 immunohistochemistry

The aim of this study was to investigate the diagnosis delay and its impact on the stage of disease. The study also evaluated a nuclear DNA content, immunohistochemical expression of Ki-67 and bcl-2, and the correlation of these biological features with the clinicopathological features and patient outcome. 200 Libyan women, diagnosed during 2008–2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. Also retrospective preclinical and clinical data were collected from medical records on a form (questionnaire) in association with the interview. Tumor material of the patients was collected and nuclear DNA content analysed using DNA image cytometry. The expression of Ki-67 and bcl-2 were assessed using immunohistochemistry (IHC). The studies described in this thesis show that the median of diagnosis time for women with breast cancer was 7.5 months and 56% of patients were diagnosed within a period longer than 6 months. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was also associated with initial breast symptom(s) that did not include a lump, old age, illiteracy, and history of benign fibrocystic disease. The patients who showed diagnosis delay had bigger tumour size (p<0.0001), positive lymph nodes (p<0.0001), and high incidence of late clinical stages (p<0.0001). Biologically, 82.7% of tumors were aneuploid and 17.3% were diploid. The median SPF of tumors was 11% while the median positivity of Ki-67 was 27.5%. High Ki-67 expression was found in 76% of patients, and high SPF values in 56% of patients. Positive bcl-2 expression was found in 62.4% of tumors. 72.2% of the bcl-2 positive samples were ER-positive. Patients who had tumor with DNA aneuploidy, high proliferative activity and negative bcl-2 expression were associated with a high grade of malignancy and short survival. The SPF value is useful cell proliferation marker in assessing prognosis, and the decision cut point of 11% for SPF in the Libyan material was clearly significant (p<0.0001). Bcl-2 is a powerful prognosticator and an independent predictor of breast cancer outcome in the Libyan material (p<0.0001). Libyan breast cancer was investigated in these studies from two different aspects: health services and biology. The results show that diagnosis delay is a very serious problem in Libya and is associated with complex interactions between many factors leading to advanced stages, and potentially to high mortality. Cytometric DNA variables, proliferative markers (Ki-67 and SPF), and oncoprotein bcl-2 negativity reflect the aggressive behavior of Libyan breast cancer and could be used with traditional factors to predict the outcome of individual patients, and to select appropriate therapy.

Virulence properties of Aggregatibacter actinomycetemcomitans biofilm and characterisation of its putative cytokine exploitation

Biofilms are surface-attached multispecies microbial communities that are embedded by their self-produced extracellular polymeric substances. This lifestyle enhances the survival of the bacteria and plays a major role in many chronic bacterial infections. For instance, periodontitis is initiated by multispecies biofilms. The phases of active periodontal tissue destruction and notably increased levels of proinflammatory mediators, such as the key inflammatory mediator interleukin (IL)-1beta, are typical of the disease. The opportunistic periodontal pathogen Aggregatibacter actinomycetemcomitans is usually abundant at sites of aggressive periodontitis. Despite potent host immune system responses to subgingival invaders, A. actinomycetemcomitans is able to resist clearance attempts. Moreover, some strains of A. actinomycetemcomitans can generate genetic diversity through natural transformation, which may improve the species’ adjustment tothe subgingival environment in the long term. Some biofilm forming species are known to bind and sense human cytokines. As a response to cytokines, bacteria may increase biofilm formation and alter their expression of virulence genes. Specific outer membrane receptors for interferon-γ or IL-1β have been characterised in two Gram-negative pathogens. Because little is known about periodontal pathogens’ ability to sense cytokines, we used A. actinomycetemcomitans as a model organism to investigate how the species responds to IL-1beta. The main aims of this thesis were to explore cytokine binding on single-species A. actinomycetemcomitans biofilms and to determine the effects of cytokines on the biofilm formation and metabolic activity of the species. Additionally, the cytokine’s putative internalisation and interaction with A. actinomycetemcomitans proteins were studied. The possible impact of biofilm IL-1beta sequestering on the proliferation and apoptosis of gingival keratinocyte cells was evaluated in an organotypic mucosa co-culture model. Finally, the role of the extramembranous domain of the outer membrane protein HofQ (emHofQ) in DNA binding linked to DNA uptake in A. actinomycetemcomitans was examined. Our main finding revealed that viable A. actinomycetemcomitans biofilms can bind and take up the IL-1β produced by gingival cells. At the sites of pathogen-host interaction, the proliferation and apoptosis of gingival keratinocytes decreased slightly. Notably, the exposure of biofilms to IL-1beta caused their metabolic activity to drop, which may be linked to the observed interaction of IL-1beta with the conserved intracellular proteins DNA binding protein HU and the trimeric form of ATP synthase subunit beta. A Pasteurellaceaespecific lipoprotein, which had no previously determined function, was characterized as an IL-1beta interacting membrane protein that was expressed in the biofilm cultures of all tested A. actinomycetemcomitans strains. The use of a subcellular localisation tool combined with experimental analyses suggested that the identified lipoprotein, bacterial interleukin receptor I (BilRI), may be associated with the outer membrane with a portion of the protein oriented towards the external milieu. The results of the emHofQ study indicated that emHofQ has both the structural and functional capability to bind DNA. This result implies that emHofQ plays a role in DNA assimilation. The results from the current study also demonstrate that the Gram-negative oral species appears to sense the central proinflammatory mediator IL-1beta.

Nuclear morphometry, apoptotic and mitotic indices, and tubular differentiation in Libyan breast cancer

Aims of this study were to evaluate the relations of nuclear morphometry, mitotic and apoptotic indices, and tubular differentiation with clinicopathological features and survival rate in Libyan women. The data were compared with corresponding results on Finnish, and Nigerian female breast cancer patients. Histological samples of breast cancer (BC) from 131 patients were retrospectively studied. Mitotic activity indices (MAI and SMI), apoptotic index (AI), and fraction of fields with tubular differentiation (FTD) were estimated. Samples were also studied by computerized nuclear morphometry, such as mean nuclear area (MNA). Demographic and clinicopathological features were analyzed from 234 patients. The Libyan BC was dominantly premenopausal, and aggressive in behavior. There were statistically significant correlations between the mean nuclear area, fraction of fields with tubular differentiation, apoptotic index and proliferative indices, and most clinicopathological features. The highest significances were shown between lymph node status and the proliferative and apoptotic indices (p=0.003 with SMI, and p=0.005 with AI). There were significant associations between clinical stage and SMI and AI (p=0.002 and 0.009, respectively). The most significant associations with grade were observed with MNA and FTD (p<0.0001 and 0.001, respectively). The proliferative differences between Libyan, Nigerian and Finnish populations were prominent. These indices in Libyan were lower than in Nigerian, but higher than in Finnish patients. The Libyan patients’ AI is slightly higher than in Nigeria, but much higher than in Finland. The differences between countries may be associated with the known variation in the distribution of genetic markers in these populations. The results also indicated that morphometric factors can be reliable prognostic indicators in Libyan BC patients.

Puolueiden keskustelutilaisuuksista mediatapahtumiksi. Television vaaliohjelmat ja niihin liittynyt sanomalehtijulkisuus 1960-luvulta 1980-luvulle

Tässä tutkimuksessa tarkastellaan television vaaliohjelmia ja niihin liittynyttä sanomalehtijulkisuutta 1960-luvun alusta 1980-luvun lopulle. Tarkastelun kohteena ovat sekä eduskunta- että presidentinvaalien vaaliohjelmat. Tutkimusaineisto koostuu Yleisradion hallinto- ja ohjelmaneuvostojen pöytäkirjoista, vaaliohjelmien televisiotallenteista sekä vaaliohjelmia käsittelevistä sanomalehtikirjoituksista. Lehtiaineisto on kerätty Helsingin Sanomista, Ilta-Sanomista, Iltalehdestä, Aamulehdestä, Kansan Uutisista, Suomenmaasta sekä Suomen Sosialidemokraatista. Sanomalehtiaineistoa on täydennetty Yleisradion leikearkistoon kerätyillä lehtileikkeillä. Tutkimuksessa on analysoitu toisaalta television vaaliohjelmien kehitystä ja toisaalta vaaliohjelmiin liittynyttä sanomalehtikirjoittelua. Television vaaliohjelmien kehityksen osalta tutkimuksessa on kuvattu, millä tavoin vaaliohjelmia on eri aikoina tehty ja millaisia poliittisia kiistoja niiden tekemiseen on liittynyt. Sanomalehtiaineiston analyysissa on tarkasteltu sitä, mihin seikkoihin vaaliohjelmia käsittelevissä kirjoituksissa on kiinnitetty huomiota, millä tavoin lehdet ovat suhtautuneet ohjelmien toteutukseen ja millainen rooli ohjelmilla on nähty olleen vaalikampanjoinnissa. Väitöskirjan näkökulma on historiallinen, mikä merkitsee ajallisten kontekstien keskeisyyttä analyysissa. Tutkimuksessa on kiinnitetty huomiota sekä poliittisessa kulttuurissa että mediamaisemassa tapahtuneisiin muutoksiin. Vaaliohjelmat olivat 1960-luvulla tarkkaan säänneltyjä puolueiden välisiä keskustelutilaisuuksia, joissa toimittajilla ei ollut näkyvää roolia. Ohjelmien toteutuksesta vastasivat puoluemandaateilla toimineet Yleisradion ohjelma- ja hallintoneuvoston jäsenet, joten ohjelmien toteutuksen yksityiskohdista vastasivat puolueet. Puolueet riitelivät usein vaaliohjelmien toteutuksesta, mikä osoittaa, että puolueille television vaaliohjelmat olivat tärkeitä poliittisia foorumeita jo 1960-luvulta lähtien. Vaaliohjelmat jakautuivat kahteen erilaiseen ohjelmaformaattiin; vaalitentteihin ja suureen vaalikeskusteluun. Vaalitenteissä kunkin puolueen edustajat olivat vuorollaan ”altavastaajina”, joille muiden puolueiden edustajat esittivät kysymyksiä. Suuri vaalikeskustelu oli perinteisempi paneelikeskustelu, jossa poliitikot selvittivät vuorotellen kantojaan ajankohtaisiin poliittisin kysymyksiin. 1970-luvun puolivälissä vaalitenttien toteutuksessa tapahtui suuria muutoksia, kun toimittajat syrjäyttivät poliitikot vaalitenttien kyselijöinä. Suuri vaalikeskustelu säilyi ennallaan. Sanomalehtien suhtautuminen vaaliohjelmiin oli 1960- ja 1970-luvuilla huomattavasti pidättyvämpää kuin poliitikkojen. Sanomalehdistön näkökulmasta television vaaliohjelmien tärkeimpänä tehtävänä oli puolueiden poliittisten linjausten esittely. Vaaliohjelmia käsittelevissä teksteissä esiteltiin pääasiassa poliitikkojen ohjelmissa pitämiä puheenvuoroja. Puoluelehdissä puheenvuorojen sisältöä arvioitiin aatteellisista lähtökohdista, sitoutumattomissa sanomalehdissä neutraalimmin. Vaaliohjelmien toteutukseen liittynyt kritiikki kohdistui toisaalta poliitikkojen puoluepropagandaan, toisaalta poliitikkojen liialliseen varovaisuuteen. Sanomalehtien suhtautuminen vaaliohjelmiin säilyi ennallaan myös 1970-luvulla, jolloin vaaliohjelmia alettiin tehdä toimittajavetoisesti. Ainoa muutos liittyi vaaliohjelmakritiikkiin, joka kohdistui nyt poliitikkojen ohella myös toimittajiin, joiden katsottiin olleen ohjelmissa liian hyökkääviä. Suurin muutos vaaliohjelmiin liittyneessä kirjoittelussa tapahtui 1980-luvulla. Vaaliohjelmia käsitteleviä kirjoituksia julkaistiin sanomalehdistössä monikertainen määrä 1970-lukuun verrattuna. Samalla myös vaaliohjelmia käsittelevien kirjoitusten näkökulmat alkoivat muuttua, kun ohjelmin visuaalinen ulottuvuus alkoi olla yhä näkyvämmin esillä sanomalehtiin laadituissa analyyseissa. Lehdet alkoivat teettää säännöllisesti erilaisia tutkimuksia poliitikkojen pärjäämisestä ohjelmissa ja kirjoittaa vaalikeskusteluiden voittajista ja häviäjistä. Lisäksi lehtijutuissa arvioitiin poliitikkojen esiintymistä ja vaaliohjelmista välittyviä vaikutelmia. Vuoden 1982 presidentinvaaleissa uusista näkökulmista kirjoittivat erityisesti iltapäivälehdet, mutta vuosikymmenen jälkipuoliskolla samankaltaisia lähestymistapoja omaksuivat myös Helsingin Sanomat ja Aamulehti. Niiden vaaliohjelmia käsittelevissä uutisissa kiinnitettiin yhä useammin huomiota poliitikkojen esiintymiseen, pukeutumiseen ja tunnetiloihin. Puoluelehtien suhtautuminen vaaliohjelmiin säilyi kuitenkin ennallaan, ja myös vaaliohjelmakritiikki säilyi suurelta osin muuttumattomana. 1980-luvun aikana television vaaliohjelmat muuttuivat lehdistön käsittelyssä puolueiden tavoitteita esittelevistä keskustelutilaisuuksista poliitikkojen ja puolue johtajien henkilökohtaisia ominaisuuksia mittaaviksi esiintymiskokeiksi ja suuriksi mediatapahtumiksi, joiden katsottiin toisinaan jopa ratkaisseen vaalin tuloksen. Nostaessaan television vaaliohjelmat kampanjajournalisminsa ytimeen, sanomalehdet vahvistivat television poliittista roolia.

School Bullies’ Quest for Power: Implications for Group Dynamics and Intervention

Bullying is characterized by an inequality of power between perpetrator and target. Findings that bullies can be highly popular have helped redefine the old conception of the maladjusted school bully into a powerful individual exerting influence on his peers from the top of the peer status hierarchy. Study I is a conceptual paper that explores the conditions under which a skillful, socially powerful bully can use the peer group as a means of aggression and suggests that low cohesion and low quality of friendships make groups easier to manipulate. School bullies’ high popularity should be a major obstacle for antibullying efforts, as bullies are unlikely to cease negative actions that are rewarding, and their powerful position could discourage bystanders from interfering. Using data from the Finnish program KiVa, Study II supported the hypothesis that antibullying interventions are less effective with popular bullies in comparison to their unpopular counterparts. In order to design interventions that can address the positive link between popularity and aggression, it is necessary to determine in which contexts bullies achieve higher status. Using an American sample, Study III examined the effects of five classroom features on the social status that peers accord to aggressive children, including classroom status hierarchy, academic level and grade level, controlling for classroom mean levels of aggression and ethnic distribution. Aggressive children were more popular and better liked in fifth grade relative to fourth grade and in classrooms of higher status hierarchy. Surprisingly, the natural emergence of status hierarchies in children’s peer groups has long been assumed to minimize aggression. Whether status hierarchies hinder or promote bullying is a controversial question in the peer relations’ literature. Study IV aimed at clarifying this debate by testing the effects of the degree of classroom status hierarchy on bullying. Higher hierarchy was concrrently associated with bullying and predictive of higher bullying six months later. As bullies’ quest for power is increasingly acknowledged, some researchers suggest teaching bullies to attain the elevated status they yearn for through prosocial acts. Study V cautions against such solutions by reviewing evidence that prosocial behaviors enacted with the intention of controlling others can be as harmful as aggression.

An Alternative American Approach to Repositories

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Kaksi tietä huipulle. Media ja puoluejohtajuus Suomessa naisten noususta populismin aaltoon

Tässä väitöskirjassa tarkastellaan suomalaisen puoluejohtajuuden ja suuren puolueen johtajaksi nousun murroskautta 1980-luvun lopulta 2010-luvulle median ja politiikan vuorovaikutuksen näkökulmasta. Puolueiden johtaminen on myös Suomessa ollut miesten työtä, ja perinteisesti tehtävään on ollut yksi väylä: asettuminen ehdolle puheenjohtajavaalissa ja valituksi tulo puoluekokouksessa. Tarkastelujakson alkupuolella naisia oli Suomessa ensimmäistä kertaa ehdolla suurten puolueiden puheenjohtajavaaleissa. Kauden loppupuolella heitä myös valittiin tuohon tehtävään ja ensimmäiset naiset nousivat pääministeriksi. Tämä historiallinen murros päätti liki satavuotisen perinteen, jossa miehet ovat olleet Suomessa sekä suurten puolueiden että hallitustyön johtajia. Julkisessa keskustelussa kysymys tasa-arvosta jäi toissijaiseksi: naisia alettiin valita puoluejohtajiksi tilanteissa, joissa heidän valintansa nähtiin puolueille edulliseksi. Naisen valinta tulkittiin miehen valintaa merkittävämmäksi symboliseksi viestiksi, johon liitettiin ajatuksia uudistumisesta ja puolueen julkisuuskuvan parantamisesta. Merkille pantavaa on, että naisten ensimmäiset valinnat suurten puolueiden johtajiksi tapahtuivat vaiheessa, jossa puoluejohtajien valta-asema on vahvin kautta suomalaisen poliittisen historian. Tässä valossa näyttää siltä, että valta ei aina pakenekaan naisilta. Vaikka suomalainen yhteiskunta ja suomalaiset naiset ovat monessa mielessä olleet edelläkävijöitä tasa-arvon suhteen, politiikan johtopaikkoja tavoitelleet naiset ovat meilläkin kohdanneet kansainvälisessä tutkimuksessa naisten haasteeksi osoitettuja lasikattoja, pyöröovia ja liukkaita jyrkänteitä. Tutkittavan ajanjakson aikana konkretisoitui myös toinen mahdollinen, joskin poikkeuksellinen reitti suuren puolueen johtajaksi: pienen puolueen nouseminen suurten joukkoon eduskuntavaaleissa. Tämä vaihtoehto toteutui vuonna 2011 perussuomalaisten eduskuntavaalivoiton myötä. Perussuomalaisten nousu eduskunnan pienimmästä puolueesta kolmanneksi suurimmaksi mursi perinteisen kolmen suuren puolueen asetelman. Puolueen menestyksen seuraukset ovat olleet kauaskantoisemmat kuin ehkä ensin ajateltiin: perussuomalaisten vaalivoiton sosiaalidemokraateille, keskustalle, ja kokoomukselle aiheuttama järkytys heijastui myöhemmin myös niiden johtajavaihdoksiin ja -valintoihin. Sekä naisten läpimurrossa että populismin voittokulussa median rooli oli monisyisempi kuin siihen perinteisesti liitetty tiedon välittäjän ja valtaa pitävien toimia kriittisesti seuraavan neljännen valtiomahdin tehtävänkuva. Tutkittavalla jaksolla tiedotusvälineet tekivät onnistuneen intervention politiikan osapuoleksi. Toimittajat ottivat kantaa valintoihin ja ohjeistivat puolueita, ja puolueet taas mukauttivat näkyvyyden maksimoidakseen käytäntöjään median tarpeisiin. 1980-luvun lopulta 2010-luvulle ulottuvalla jaksolla suuren puolueen puoluejohtajaksi valikoitumisen kriteerit muuttuivat, samalla kun median merkitys johtajavalinnoissa ja myös puoluejohtajan käytännön työssä kasvoi. Mediasta tuli aiempaa konkreettisemmin johtajavalintojen ja valtakamppailun areena, ja siihen liittyvät näkökohdat nousivat myös keskeisiksi johtajan taitoja arvioitaessa. Kuka ehdokkaista toisi näkyvyyttä, ”pärjäisi” median paineissa ja vakuuttaisi äänestäjät? Vielä 1980- ja 1990-lukujen taitteessa johtajavalinnat olivat pitkälti puolueorganisaatioiden hallinnoimia prosesseja, joista lehdistö raportoi askeleen jäljessä kulkien. Viimeistään 2000-luvun ensimmäisellä vuosikymmenellä puolueet omaksuivat ajatuksen median hyödyllisyydestä. Tämän strategisen muutoksen myötä puolueet tulivat samalla luovuttaneeksi määriteltyvaltaa oman organisaationsa ulkopuolelle. Kokoomuksen vuoden 2014 johtajavaalissa silmiinpistävää oli pyrkimys sekä hyötyä julkisuudesta että palauttaa valtaa takaisin puolueelle. Politiikan mediajulkisuuden alttius tarttua myyviin poliitikkopersooniin, ilmiöihin, ristiriitoihin ja draamaan sekä vastaavasti populistijohtaja Timo Soinin ja perussuomalaisten kyky tarjota kaikkia näitä auttoivat puolueen suurvoittoon vuoden 2011 eduskuntavaaleissa. Organisaatioltaan pieni ja johtajaansa henkilöityvä puolue sai selvästi poliittista painoarvoaan suuremman julkisuuden, koska kiinnostavuus määritti näkyvyyden ja puolueen nousevasta kannatuksesta tuli yksi vaalien pääaiheista. Median ja politiikan suhteessa tapahtuneet muutokset olivat vauhdittamassa niin naisten nousua suurten puolueiden johtajiksi kuin populistisen johtajuuden läpimurtoa ja perussuomalaisten menestystä. Koska suurten puolueiden johtajista valikoituvat myös pääministerit, näiden muutosten vaikutus ulottuu Suomen poliittisesti vaikutusvaltaisimpaan tehtävään asti.