Very preterm infants in Finland - Use of health care services and economic consequences during the first five years of life

The aim of this thesis was to study the health, the hospitalisations, and the use of communal health care services in very preterm children during the first five years of life. In addition, the effect of very preterm birth and prematurity-related morbidities on the costs of hospitalisations, other health care services and the cost per quality adjusted life years (QALY) were studied. This population-based study included all very preterm children (gestational age (GA) <32 weeks or birth weight<1501g, N=2 064) and full-term controls (GA 37+0−41+6, N=200 609) born in Finland during 2000-2003. The data sources included national register data, costing data from the participating hospitals and parental questionnaires. This study showed that most very preterm infants born in Finland survived without prematurity-related morbidities diagnosed during the first years of life. They required relatively little hospital care after the initial discharge, which accounted for the vast majority of the total four-year hospitalisation costs. However, a minority of children born very preterm later developing morbidities had a long initial length of stay and more re-admissions and outpatient visits during the five-year follow-up period. In particular, the number and costs of non-emergency outpatient visits were considerable in individuals with prematurity-related morbidities. The need and costs of hospitalisations decreased clearly with each follow-up year, even in individuals with morbidities. The health-care related costs during the fifth year of life in children born very preterm without prematurity-related morbidities were close to the costs in infants born healthy at term. The cost per QALY of 19,245 € was at an acceptable level already by four years of age in the very preterm population as a whole. Prematurity-related later morbidities and decreasing GA increased the costs per QALY. As the initial hospital stay accounted for a great majority of the total four-year costs, and the costs of hospitalisation decreased with each follow-up year, the cost per QALY is likely to decrease with age. In conclusion, the majority of costs arising after the initial hospitalisation were associated with morbidities related to prematurity. Therefore offering high-quality neonatal care to prevent later morbidities in very preterm survivors has a long-term impact on the cost per QALY. In addition, this study indicates that when estimating the costs of prematurity after the first year of life, one should calculate not only the hospitalisation costs, but also other costs for social welfare services, primary care, and therapies, as these exceed the hospitalisation costs in very preterm infants during the fifth year of life.

Cuticular and Suberin Polymers of Edible Plants. Analysis by Gas Chromatographic-Mass Spectrometric and Solid State Spectroscopic Methods

Cutin and suberin are structural and protective polymers of plant surfaces. The epidermal cells of the aerial parts of plants are covered with an extracellular cuticular layer, which consists of polyester cutin, highly resistant cutan, cuticular waxes and polysaccharides which link the layer to the epidermal cells. A similar protective layer is formed by a polyaromatic-polyaliphatic biopolymer suberin, which is present particularly in the cell walls of the phellem layer of periderm of the underground parts of plants (e.g. roots and tubers) and the bark of trees. In addition, suberization is also a major factor in wound healing and wound periderm formation regardless of the plants’ tissue. Knowledge of the composition and functions of cuticular and suberin polymers is important for understanding the physiological properties for the plants and for nutritional quality when these plants are consumed as foods. The aims of the practical work were to assess the chemical composition of cuticular polymers of several northern berries and seeds and suberin of two varieties of potatoes. Cutin and suberin were studied as isolated polymers and further after depolymerization as soluble monomers and solid residues. Chemical and enzymatic depolymerization techniques were compared and a new chemical depolymerization method was developed. Gas chromatographic analysis with mass spectrometric detection (GC-MS) was used to assess the monomer compositions. Polymer investigations were conducted with solid state carbon-13 cross polarization magic angle spinning nuclear magnetic resonance spectroscopy (13C CP-MAS NMR), Fourier transform infrared spectroscopy (FTIR) and microscopic analysis. Furthermore, the development of suberin over one year of post-harvest storage was investigated and the cuticular layers from berries grown in the North and South of Finland were compared. The results show that the amounts of isolated cuticular layers and cutin monomers, as well as monomeric compositions vary greatly between the berries. The monomer composition of seeds was found to differ from the corresponding berry peel monomers. The berry cutin monomers were composed mostly of long-chain aliphatic ω-hydroxy acids, with various mid-chain functionalities (double-bonds, epoxy, hydroxy and keto groups). Substituted α,ω-diacids predominated over ω-hydroxy acids in potato suberin monomers and slight differences were found between the varieties. The newly-developed closed tube chemical method was found to be suitable for cutin and suberin analysis and preferred over the solvent-consuming and laborious reflux method. Enzymatic hydrolysis with cutinase was less effective than chemical methanolysis and showed specificity towards α,ω-diacid bonds. According to ₁₃C CP-MAS NMR and FTIR, the depolymerization residues contained significant amounts of aromatic structures, polysaccharides and possible cutan-type aliphatic moieties. Cultivation location seems to have effect on cuticular composition. The materials studied contained significant amounts of different types of biopolymers that could be utilized for several purposes with or without further processing. The importance of the so-called waste material from industrial processes of berries and potatoes as a source of either dietary fiber or specialty chemicals should be further investigated in detail. The evident impact of cuticular and suberin polymers, among other fiber components, on human health should be investigated in clinical trials. These by-product materials may be used as value-added fiber fractions in the food industry and as raw materials for specialty chemicals such as lubricants and emulsifiers, or as building blocks for novel polymers.

Letters from Scandinavia, : on the past and present state of the northern nations of Europe : [William Thomson]. Vol. I[-II].

Digital reproduction, The National Library of Finland, Centre for Preservation and Digitisation, Mikkeli

Letters from Scandinavia, : on the past and present state of the northern nations of Europe : [William Thomson]. Vol. I[-II].

Digital reproduction, The National Library of Finland, Centre for Preservation and Digitisation, Mikkeli

Reglering och förvaltning av produktions- och slaktdjurs välbefinnande : en offentligrättslig undersökning

Djur och djurskyddet hör till ett rättsligt regleringsområde som inte varit föremål för omfattande rättsvetenskaplig forskning i vårt land även om intresset för djurs välbefinnande ökat både i samhället och inom EU. Avhandlingen har avfattats som en artikelavhandling och är en offentligrättslig studie om djurskyddslagstiftningen och förvaltningen av djurskyddsärenden i Finland. Tematiken har behandlats både ur djurens och djurens ägares eller innehavares synvinkel med utgångspunkt i djurskyddslagstiftningen och förvaltningen av djurskyddsärenden i Finland. Forskningen är fokuserad huvudsakligen på skyddet av och välbefinnandet hos produktions- och slaktdjur även om bland annat de begrepp som granskas också berör andra djurkategorier. De övergripande frågeställningarna i avhandlingen är två. För det första, vad är det som avses med djurs välbefinnande och skydd i regleringen av djurskyddet och för det andra, hur realiseras dessa i djurskyddsmyndigheternas förvaltningsverksamhet? I forskningen presenteras och diskuteras bland annat en ny begreppskonstruktion: djurs rättsliga välbefinnande. Den empiriska delen i avhandlingen omfattar förvaltningsverksamheten inom området av djurskydd under åren 1996–2006. Sammanlagt 10468 dokument som upprättats av djurskyddsmyndigheten i samband med verkställandet av djurskyddsövervakning ingår i undersökningen. Forskningen utmynnar i en åtgärdsförteckning med förslag till utvecklingen av området för djurskydd.

Thermal performance and concentration of gases in facilities for pigs in semiarid region from State of Paraiba - Brazil

The study was conducted in a facility for pigs during the nursery and finishing in the town of 'Montadas', in the semiarid of the state of Paraiba, Brazil, in the rainy and dry season, aiming to evaluate the concentration of oxygen, methane, carbon monoxide and ammonia, and the bioclimatic indexes: ambient temperature (AT), relative humidity (RH) and the index of black globe temperature and humidity (IBGTH). These indexes differed significantly (P>0.05) between the periods and times. The AT in the rainy season was in the thermal comfort zone(TCZ) in most of the times in the nursery; for the finishing phase, thermal discomfort occurred; during the dry season, there was thermal comfort in the nursery phase; in the finishing phase the thermal discomfort occurred at all times. In the rainy season, the IBGTH was in TCZ; in the dry season, it was above the TCZ. The RH in the rainy period was in the TCZ; in the dry season, in most of the times, below the range of the TCZ. The concentration of gases showed no differences (P > 0.05) between periods and between the times, and the carbon monoxide, hydrogen sulfide and methane were below 1.0 ppm, and the ammonia showed a mean of 5.2 ppm. None of the analyzed gases exceeded the limits established by Brazilian and international standards for animals and workers.

Oil Transportation in the Gulf of Finland in 2020 and 2030

This study is part of the Minimizing risks of maritime oil transport by holistic safety strategies (MIMIC) project. The purpose of this study is to provide a current state analysis of oil transportation volumes in the Baltic Sea and to create scenarios for oil transportation in the Gulf of Finland for the years 2020 and 2030. Future scenarios and information about oil transportation will be utilized in the modelling of oil transportation risks, which will be carried out as part of the MIMIC project. Approximately 290 million tons of oil and oil products were transported in the Baltic Sea in 2009, of which 55% (160 million tons) via the Gulf of Finland. Oil transportation volumes in the Gulf of Finland have increased from 40 million to almost 160 million tonnes over the last ten years. In Russia and Estonia, oil transportation mainly consists of export transports of the Russian oil industry. In Finnish ports in the Gulf of Finland, the majority of oil traffic is concentrated to the port of Sköldvik, while the remainder mainly consists of different oil products for domestic use. Transit transports to/from Russia make up small volumes of oil transportation. The largest oil ports in the Gulf of Finland are Primorsk, Tallinn, St. Petersburg and Sköldvik. The basis for the scenarios for the years 2020 and 2030 is formed by national energy strategies, the EU`s climate and energy strategies as well other energy and transportation forecasts for the years 2020 and 2030. Three alternative scenarios were produced for both 2020 and 2030. The oil volumes are based on the expert estimates of nine specialists. The specialists gave three volumes for each scenario: the expected oil transport volumes, and the minimum and maximum volumes. Variations in the volumes between the scenarios are not large, but each scenario tends to have rather a large difference between the figures for minimum and maximum volumes. This variation between the minimum and maximum volumes ranges around 30 to 40 million tonnes depending on the scenario. On the basis of this study, no a dramatic increase in oil transportation volumes in the Gulf of Finland is to be expected. Most of the scenarios only forecasted a moderate growth in maritime oil transportation compared to the current levels. The effects of the European energy policy favouring renewable energy sources can be seen in the 2030 scenarios, in which the transported oil volumes are smaller than in the 2020 scenarios. In the Slow development 2020 scenario, oil transport volumes for 2020 are expected to be 170.6 Mt (million tonnes), in the Average development 2020 187.1 Mt and in the Strong development 2020 201.5 Mt. The corresponding oil volumes for the 2030 scenarios were 165 Mt for the Stagnating development 2030 scenario, 177.5 Mt for the Towards a greener society 2030 scenario and 169.5 Mt in the Decarbonising society 2030 scenario.

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

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

Professional sports and gambling regulation in Finland - Examining the institutional factors of gambling affecting professional sport clubs in Finland

This study examines how to institutional environment of gambling is currently in motion both in Europe and Finland. Furthermore, it examines the criticism by Finnish professional sport clubs directed towards the national gambling monopolies, especially Veikkaus Oy. This criticism addresses the acclaimed issue of low or non-existing sponsorship funds coming to the clubs despite the clubs’ duties to promote Veikkaus Oy in their stadiums etc. In essence the main research objective was to examine the interaction and institutional environments of both Finnish professional sport clubs and gambling regulation. This was done through three sub-objectives: 1) to analyze professional sport as business and its institutional environment 2) to analyze the institutions of gambling in their current state and their potential future 3) to evaluate the potential impact of an institutional change in gambling legislation to the professional sport clubs The findings from Finland were then compared to those of Denmark where an institutional change had occurred in gambling regulation. Empirical data was collected through multiple interviews. Interviewees represented sport clubs (7), sport association (1), sport league (1), Finnish monopoly representatives (2), commercial gambling providers (1), Danish monopoly system representatives (1), Danish sport club (1). In addition a vast amount of secondary data (e.g. Green and white books by EU, court decisions, a variety of studies etc.). Theoretically this study combines the aspects of institutional theory with the theory of professional sports as business. This proved to be a rather new approach and no published literature was found to have done specifically this. The findings of this study are twofold, on the European level it is clear that the momentum if towards a more liberated gambling market while Finland is at the moment trying to go the opposite direction and uphold its monopoly. From the sport club’s level the findings suggest that currently sport clubs do not directly benefit from the funds originated from Veikkaus Oy as these funds are more or less used on the association/league levels. However, the clubs themselves are also lacking in self-criticism as they are lacking in clear sponsorship packages/programs which Veikkaus Oy might be interested in participating. If liberation of the gambling market would occur it is highly possible that that the largest clubs in football and ice-hockey would be the main beneficiaries while smaller clubs and sports could possibly be worse off than currently. These interpretations were well supported by the findings from Denmark.

Key factors in transforming university internationalization into commercial activity in Finland. Case of University of Turku

Globalization, developments in ICT, emergence of knowledge society and other changes have reformed the environment for international higher education during the past few decades. Consequently, higher education sector has moved towards more marketing-oriented system, and universities have started to undertake commercial activities as part of their internationalization. This development has emerged to Finland as well, which forms the basis for this study. The purpose is to examine commercialization in Finnish university landscape and to investigate the ways Finnish university could capitalize its international activities and educational knowledge for export. The research question of the study is: What are the key factors in transforming university internationalization into commercial activity in the Finnish university landscape? The main problem is further divided into three sub-questions: 1) How can a university internationalize; 2) what are the motivational factors behind university internationalization and commercialization; and 3) how can higher education be developed into export services and products? The research was conducted as a qualitative case study of University of Turku. Methods used for gathering and examining data were interviewing and document analysis. Primary data was collected through four individual semi-structured interviews, which were conducted face-to-face. Secondary data that included reports, articles and electronic materials such as university web pages, was used to complement the primary data. The results were analyzed by theming the data into three broader categories of internationalization activities; drivers and motivations and; education export activities. After the data was organized in themes, analysis continued by comparing different parts of data and finding patterns that would explain the phenomenon in Finnish universities. According to the empirical data, University of Turku is currently on the growth state of internationalization with strategies such as internationalization of curriculum, establishment of international research groups, mobility of students and academics, international networking and support services. Commercialization phenomenon is still rather new to the case university, but it has already developed educational products and services for export. The study concludes that university internationalization cannot be directly transformed into commercial activities in the Finnish context, but the universities need to be active in actually creating educational products. The key factors found in this study include: 1) the Finnish government policies behind the current hype of export education; 2) the potential and knowledge capacity of universities for exports; 3) need for additional profits; 4) further internationalization through commercial activities; 5) recognizing and exploiting the specific areas of strength and 6) establishing of cooperative partnerships for better products.

The role of emotional state, sexual arousal, and alcohol intoxication as situational factors associated with adults’ online sexual contact with children and adolescents

In the present study we explored whether and how the situational factors; emotional states, sexual arousal, and alcohol intoxication influenced the propensity in adults to engage in online sexual contact with children (13 or younger) and adolescents (14 – 17 year olds). The results were compared to a group of adults that had engaged in online sexual contact with adults only (18 or older). We also looked at the variation over time within these situational factors during the online sexual contact with a child, an adolescent, or an adult. The present study was an online self-report survey to the adult populations in Finland, Sweden, and Germany, with a final sample (N = 776) of women and men who were active on the Internet. The participants were asked to report whether, how, and with whom they had engaged in online sexual contact. The results showed that more men than women reported online sexual contact with persons of all age groups, and that the situational factors; emotional states and sexual arousal influenced the propensity in both women and men to engage in online sexual contact with children and adolescents. However, the effects of alcohol intoxication were small and significant only for men. These results indicate that higher levels of emotional state and sexual arousal might increase the propensity to go against social norms and contact children and adolescents online for sexual purposes, but it can also imply that that those who look for online sexual contact online with children and adolescents, are more emotionally and/or sexually aroused than the group that only seek adult company or that these are post-hoc explanations for such sexual activities.

Long-term nutrient load management and lake restoration: Case of Säkylän Pyhäjärvi (SW Finland)

Eutrophication caused by anthropogenic nutrient pollution has become one of the most severe threats to water bodies. Nutrients enter water bodies from atmospheric precipitation, industrial and domestic wastewaters and surface runoff from agricultural and forest areas. As point pollution has been significantly reduced in developed countries in recent decades, agricultural non-point sources have been increasingly identified as the largest source of nutrient loading in water bodies. In this study, Lake Säkylän Pyhäjärvi and its catchment are studied as an example of a long-term, voluntary-based, co-operative model of lake and catchment management. Lake Pyhäjärvi is located in the centre of an intensive agricultural area in southwestern Finland. More than 20 professional fishermen operate in the lake area, and the lake is used as a drinking water source and for various recreational activities. Lake Pyhäjärvi is a good example of a large and shallow lake that suffers from eutrophication and is subject to measures to improve this undesired state under changing conditions. Climate change is one of the most important challenges faced by Lake Pyhäjärvi and other water bodies. The results show that climatic variation affects the amounts of runoff and nutrient loading and their timing during the year. The findings from the study area concerning warm winters and their influences on nutrient loading are in accordance with the IPCC scenarios of future climate change. In addition to nutrient reduction measures, the restoration of food chains (biomanipulation) is a key method in water quality management. The food-web structure in Lake Pyhäjärvi has, however, become disturbed due to mild winters, short ice cover and low fish catch. Ice cover that enables winter seining is extremely important to the water quality and ecosystem of Lake Pyhäjärvi, as the vendace stock is one of the key factors affecting the food web and the state of the lake. New methods for the reduction of nutrient loading and the treatment of runoff waters from agriculture, such as sand filters, were tested in field conditions. The results confirm that the filter technique is an applicable method for nutrient reduction, but further development is needed. The ability of sand filters to absorb nutrients can be improved with nutrient binding compounds, such as lime. Long-term hydrological, chemical and biological research and monitoring data on Lake Pyhäjärvi and its catchment provide a basis for water protection measures and improve our understanding of the complicated physical, chemical and biological interactions between the terrestrial and aquatic realms. In addition to measurements carried out in field conditions, Lake Pyhäjärvi and its catchment were studied using various modelling methods. In the calibration and validation of models, long-term and wide-ranging time series data proved to be valuable. Collaboration between researchers, modellers and local water managers further improves the reliability and usefulness of models. Lake Pyhäjärvi and its catchment can also be regarded as a good research laboratory from the point of view of the Baltic Sea. The main problem in both of them is eutrophication caused by excess nutrients, and nutrient loading has to be reduced – especially from agriculture. Mitigation measures are also similar in both cases.

Professionalization of controllers in Finland

Professions are a special category of occupations that possesses exclusive rights over its domain of expertise. Professions apply expert knowledge in their work by using professional discretion and judgment to solve their clients’ problems. With control over their expert knowledge base, professions are able to control the supply of practitioners in their field and regulate the practice in their market. Professionalization is the process during which occupations attempt to gain the status of a profession. The benefits of becoming a profession are extensive – professional autonomy, social and financial rewards, prestige, status, and an exclusive community are only a few of the privileges that established professions possess. Many aspiring occupations have tried and failed to gain the status of a profession and one of these groups is the occupation of controllers in Finland. The objective of this study to uncover, why controllers have not professionalized, which properties of the occupation correspond with the elements generally regarded to pertain to professions, and which aspects of the occupational group may hinder the professionalization project. The professionalization project of controllers is analyzed using a multi-actor model of professionalization, in which practitioners, clients, the state, training institutions, and employing organizations are considered to affect the project. The properties of the occupation of controllers are compared to features generally associated with professions. The research methodology for this thesis is qualitative, and the study is conducted as an exploratory research. The data is primarily gathered using semi-structured interviews, which were conducted between March and May 2013 lasting from 40 minutes to an hour. In total, four controllers were interviewed, who worked for different companies operating in different industries, and whose experience of working as a controller varied between a few years to nearly 15 years. The data in this study indicates that although controllers possess qualities that distinguish professions from other occupational groups, the professionalization of controllers may not be plausible. Controllers enjoy considerable autonomy in organizations, and they possess a strong orientation towards serving their clients. The more profound problem with the occupation is its non-exclusive, indistinct knowledge base that does not rely solely on a single knowledge base. Controllers’ expertise is relatively organization-specific and built on several different fields of knowledge and not just management accounting, which could be considered as their primary knowledge base. In addition, controllers have not organized themselves, which is a quintessential, but by no means a sufficient prerequisite for professionalization.

State of logistics and transport in the Baltic Sea region in 2025

The world’s pace of change is accelerating and new innovations, inventions and technologies come about every day. Change is unavoidable. It is difficult to keep up and even more difficult to prepare for the future. Even though it is not possible to know exactly what will happen in the future, by studying futures people can better anticipate what might lie ahead. By making decisions and realizing the consequences of their choices today, people and governments are able to actively decide how they will act in the future. Both opportunities and pitfalls lie ahead, which encourages actors to make more farsighted decisions. The Baltic Sea region is an interesting area for futures studies. It comprises 11 nations and more than 100 million inhabitants and entails countries with advanced, high-income economies, like Finland, Germany and Denmark, and developing economies, like Russia, Latvia and Lithuania. The western, eastern, northern and southern parts of the region are separated by the Baltic Sea, which at the same time represents a barrier and a facility for trade and travel between the countries belonging to the region The purpose of this study was to uncover the most probable future of transport and logistics in the Baltic Sea region in 2025 by using the Delphi method. Altogether 109 responses were collected in two separate instances from experts in all the Baltic Sea region countries, 56 of whom were defined as academic respondents and 53 of whom business respondents. Only minor differences in the opinions of academic and business experts were discovered, and the larger differences lie between eastern and western response groups. The Baltic Sea region is a very heterogeneous region and the division is clearest between East and West, which differ in political, economic, social, technological and environmental aspects. The probable future of the Baltic Sea region presented in this study is coherent with previous studies on the same subject. The future of the Baltic Sea region in terms of logistics and transport looks quite bright according to the experts who participated in the study. Trade volumes will grow and the importance of logistics and transport to the competitiveness of the region will increase. Respondents from eastern countries seemed to be more optimistic about the future in general. Most differences between opinions could be explained by the gap in technological and infrastructural development between the East and West. As eastern countries are less-developed in some parts of their economies, it is easier for them to improve the technical condition of infrastructure by merely catching up with the western countries.