Substance misuse problems during pregnancy with special emphasis on buprenorphine

Maternal drug abuse during pregnancy endangers the future health and wellbeing of the infant and growing child. On the other hand, via maternal abstinence, these problems would never occur; so the problems would be totally preventable. Buprenorphine is widely used in opioid maintenance treatment as a substitute medication. In Finland, during 2000 s buprenorphine misuse has steadily increased. In 2009 almost one third of clientele of substance treatment units were in treatment because of buprenorphine dependence. At Helsinki Women s Clinic the first child with prenatal buprenorphine exposure was born in 2001. During 1992-2001 in the three capital area maternity hospitals (Women s clinic, Maternity hospital, Jorvi hospital) 524 women were followed at special antenatal clinics due to substance abuse problems. Three control women were drawn from birth register to each case woman and matched for parity and same place and date of the index birth. According to register data mortality rate was 38-fold higher among cases than controls within 6-15 years after index birth. Especially, the risk for violent or accidental death was increased. The women with substance misuse problems had also elevated risk for viral hepatitis and psychiatric morbidity. They were more often reimbursed for psychopharmaceuticals. Disability pensions and rehabilitation allowances were more often granted to cases than controls. In total 626 children were born from these pregnancies. According to register data 38% of these children were placed in out-of-home care as part of child protection services by the age of two years, and half of them by the age of 12 years, the median follow-up time was 5.8 years. The risk for out-of-home care was associated with factors identifiable during the pre- and perinatal period. In 2002-2005 67 pregnant women with buprenorphine dependence were followed up at the Helsinki University Hospital, Department of Obstetrics and Gynecology. Their pregnancies were uneventful. The prematurity rate was similar and there were no more major anomalies compared to the national statistics. The neonates were lighter compared to the national statistics. They were also born in good condition, with no perinatal hypoxia as defined by standard clinical parameters or certain biochemical markers in the cord blood: erythropoietin, S100 and cardiac troponin-t. Almost 80% of newborns developed neonatal abstinence syndrome (NAS) and two third of them needed morphine medication for it. Maternal smoking over ten cigarettes per day aggravated and benzodiazepine use attenuated NAS. An infant s highest urinary norbuprenorphine concentration during their first 3 days of life correlated with the duration of morphine treatment. The average length of infant s hospital stay was 25 days.

The Tourism-Development Nexus in Namibia : A Study on National Tourism Policy and Local Tourism Enterprises' Policy Knowledge

The tourism development nexus in southern Africa involves highly topical issues related to tourism planning, power relations, community participation, and natural resources. Namibia offers a particularly interesting context for the study of these issues due to its colonial legacy, vast tourism potential, recently adopted tourism policy and community-based approaches to tourism and natural resource management. This study is an interdisciplinary endeavour to analyse the role of tourism in Namibia s post-apartheid transformation process by focusing on Namibian tourism policy and local tourism enterprises' policy knowledge. Major attention is paid to how the tourism policy's national development objectives are understood and conceptualised by the representatives of different tourism enterprises and the ways in which they relate to the practical needs of the enterprises. Through such local policy knowledge the study explores various opportunities, challenges and constraints related to the promotion of tourism as a development strategy. The study utilises a political economy approach to tourism and development through three current and interrelated discourses which are relevant in the Namibian context. These are tourism, power and inequality, tourism and sustainable development, and tourism and poverty reduction. The qualitative research material was gathered in Namibia in 2006-2007 and 2008. This material consists of 34 semi-structured interviews in 16 tourism enterprises, including private trophy hunting farms and private lodges, small tour operators and community-based tourism enterprises. In addition, the research material consists of observations in the enterprises, and 37 informal and 23 expert interviews. The findings indicate that in the light of local tourism enterprises the tourism policy objectives appear more complex and ambiguous. Furthermore, they involve multiple meanings and interpretations which reflect the socio-economic stratification of the informants and Namibian society, together with the professional stratification of the tourism enterprises and restrictions on the capacity of tourism to address the development objectives. In the light of such findings it is obvious that aspects of power and inequality affect the tourism development nexus in Namibia. The study concludes that, as in the case of other southern African countries, in order to promote sustainable development and reduce poverty, Namibia should not only target tourism growth but pay attention to who benefits from that growth and how. From a political economy point of view, it is important that prevailing structural challenges are addressed equally in the planning of tourism, development and natural resource management. Such approach would help the Namibian majority to enjoy the benefits of increasing tourism in the country.

Whose ETSIP? National and local ownership of Namibia's education and training sector improvement programme

Tämä työ tarkastelee kansallista ja paikallista omistajuutta Namibian opetussektorin kehittämisohjelmassa. Opetussektorin kehittämisohjelma ETSIP on 15-vuotinen sektoriohjelma vuosille 2005-2015 ja sen tavoitteena on edesauttaa Namibian kehittymistä tietoyhteiskunnaksi. Tutkimuksen tarkoituksena on selvittää miten kansallinen ja paikallinen omistajuus on toteutunut ETSIP prosessin aikana. Erityisesti pyritään selvittämään paikallistason opetussektorin virkamiesten näkemyksiä ETSIP prosessista, heidän roolistaan siinä ja siitä millaisia vaikuttamisen ja hallinnan mahdollisuuksia heillä on ollut prosessin aikana. Tutkimuksen lähtökohta on laadullinen ja lähestymistapa konstruktionistinen: tutkimus tarkastelee todellisuutta ihmisten kokemusten, näkemysten ja toiminnan kautta. Tutkimusaineisto koostuu haastatteluista, epävirallisista keskusteluista, lehtiartikkeleista ja ETSIP dokumenteista. Tutkimus osoittaa että kansallinen omistajuus on epämääräinen käsite sillä kansallisia toimijoita ja näkemyksiä on useita. Tutkimus vahvistaa Castel-Brancon huomion siitä, että omistajuutta on tarkasteltava kontekstissaan: muuttuvana ja kilpailtuna. ETSIPin rinnalle ollaan valmistelemassa uutta strategista ohjelmaa opetusministeriölle mikä saattaa muuttaa omistajuutta ETSIPiin. ETSIP dokumenttien omistajuusretoriikka myötäilee kansainvälisiä sitoumuksia avun vaikuttavuuden parantamiseksi mutta niistä puuttuu syvällisempi analyysi siitä, miten kansallinen ja paikallinen omistajuus toteutuisi käytännössä. Avunantajien näkemys omistajuudesta on suppea: omistajuus nähdään lähinnä sitoutumisena ennalta määrättyyn politiikkaohjelmaan. Haastatteluaineistosta nousee esiin Whitfieldin ja Frazerin jaottelu suppeista ja laajoista omistajuuskäsityksistä. Sitoutumista ETSIP ohjelmaan pidetään tärkeänä mutta riittämättömänä määritteenä omistajuudelle. Paikallisella tasolla sitoutuminen ETSIP ohjelman periaatteisiin ja tavoitteisiin on toteutunut melko hyvin mutta jos omistajuutta tarkastellaan laajemmin vaikutusvallan ja hallinnan käsitteiden kautta voidaan todeta että omistajuus on ollut heikkoa. Paikallisella tasolla ei ole ollut juurikaan vaikutusvaltaa ETSIP ohjelman sisältöön eikä mahdollisuutta hallita ohjelman toteutusta ja päättää siitä mitä hankkeita ohjelman kautta rahoitetaan. Tujanin demokraattisen omistajuuden käsite kuvaa tarvetta muuttaa ja laajentaa omistajuusajattelua huomioiden paikallisen tason paremmin. Tämä tutkimus viittaa siihen että omistajuuden toteutuminen paikallisella tasolla edellyttäisi institutionaalisen kulttuurin muutosta ja institutionaalisen legitimiteetin vahvistamista. Omistajuuden mahdollistamiseksi paikallisella tasolla tarvittaisiin poliittista johtajuutta, luottamusta, vastuullisuuden kulttuurin kehittämistä, tehokkaampaa tiedonjakoa, laajaa osallistumista, vuoropuhelua ja yhteistyötä. Ennen kaikkea tarvittaisiin paikallisen tason vaikutusvaltaa päätöksenteossa ja kontrollia resurssien käytöstä. Tälle muutokselle on selvä tarve ja tilaus.

Towards Explaining the Tasks and Roles of the Boards of Directors

While previous research has helped to improve our understanding of corporate governance and boards of directors, less is known about the factors that affect boards’ tasks and roles and directors’ motivation and engagement. This requires knowledge of how board decisions are being made and the internal and external factors that affect the decision-making process. Large inferential leaps have been made from board demographics to firm performance with equivocal results. This thesis concentrates on how the institutional, behavioral and social identification factors impact the enactment of board roles and tasks. Data used in this thesis were collected in 2009 through a mailed survey to Finnish large and middle-sized corporations. The findings suggest that firstly, the national context of an organization is reflected in board roles and shapes how and for what reasons the board roles are carried out; secondly, the directors’ human and external social capital invariably impacts their engagement in board tasks and that conflicts among directors moderate those relationships; finally, directors’ identification with the organization, its shareholders and its customers affect the directors’ involvement in board tasks. By addressing the impact of organisational context, board-internal behaviour and social identification of board members on board roles and tasks, this thesis firstly complements the shareholder supremacy view as the only reason for the board’s involvement with specific tasks; secondly questions the existence of the board as separate from its institutional context; and thirdly questions the view that a board is a ‘black box’, subject to a selection of input demographic variables and producing quantifiable results. The thesis demonstrates that boards are complex organisational bodies, which involve much interaction among board members. Director behaviour and its influence on board decision making is an important determinant of board tasks and boards are likely subjected to inter-group tensions and are susceptible to the influence of internal and external social forces.

Lunch eating patterns during working hours and their social and work-related determinants : Study of Finnish employees

Work has a central role in the lives of big share of adult Finns and meals they eat during the workday comprise an important factor in their nutrition, health, and well-being. On workdays, lunch is mainly eaten at worksite canteens or, especially among women, as a packed meal in the workplace s break room. No national-level data is available on the nutritional quality of the meals served by canteens, although the Finnish Institute of Occupational Health laid out the first nutrition recommendations for worksite canteens in 1971. The aim of this study was to examine the contribution of various socio-demographic, socioeconomic, and work-related factors to the lunch eating patterns of Finnish employees during the working day and how lunch eating patterns influence dietary intake. Four different population-based cross-sectional datasets were used in this thesis. Three of the datasets were collected by the National Institute for Health and Welfare (Health Behaviour and Health among the Finnish Adult Population survey from 1979 to 2001, n=24746, and 2005 to 2007, n=5585, the National Findiet 2002 Study, n=261), and one of them by the Finnish Institute of Occupational Health (Work and Health in Finland survey from 1997, 2000, and 2003, n=6369). The Health Behaviour and Health among the Finnish Adult Population survey and the Work and Health in Finland survey are nationally representative studies that are conducted repeatedly. Survey information was collected by self-administered questionnaires, dietary recalls, and telephone interviews. The frequency of worksite canteen use has been quite stable for over two decades in Finland. A small decreasing trend can be seen in all socioeconomic groups. During the whole period studied, those with more years of education ate at worksite canteens more often than the others. The size of the workplace was the most important work-related determinant associated with the use of a worksite canteen. At small workplaces, other work-related determinants, like occupation, physical strain at work, and job control, were also associated with canteen use, whereas at bigger workplaces the associations were almost nonexistent. The major social determinants of worksite canteen availability were the education and occupational status of employees and the only work-related determinant was the size of the workplace. A worksite canteen was more commonly available to employees at larger workplaces and to those with the higher education and the higher occupational status. Even when the canteen was equally available to all employees, its use was nevertheless determined by occupational class and the place of residence, especially among female employees. Those with higher occupational status and those living in the Helsinki capital area ate in canteens more frequently than the others. Employees who ate at a worksite canteen consumed more vegetables and vegetable and fish dishes at lunch than did those who ate packed lunches. Also, the daily consumption of vegetables and the proportion of the daily users of vegetables were higher among those male employees who ate at a canteen. In conclusion, life possibilities, i.e. the availability of a canteen, education, occupational status, and work-related factors, played an important role in the choice of where to eat lunch among Finnish employees. The most basic prerequisite for eating in a canteen was availability, but there were also a number of underlying social determinants. Occupational status and the place of residence were the major structural factors behind individuals choices in their lunch eating patterns. To ensure the nutrition, health, and well-being of employees, employers should provide them with the option to have good quality meals during working hours. The availability of worksite canteens should be especially supported in lower socioeconomic groups. In addition, employees should be encouraged to have lunch at a worksite canteen when one is available by removing structural barriers to its use.

Estimating national contributions of greenhouse gas emissions :The CSE-WRI controversy

Analysts have identified four related questions that need to be asked and answered before agreements to respond to global warming will be possible.1 Which countries bear responsibility for causing the problem? What quantities and mix of greenhouse gases should each country be allowed to emit? Which countries have the resources to do something about the problem? Where are the best opportunities for undertaking projects to respond to the problem? Failure to distinguish among these four questions, or willingness to accept superficial answers, promotes unnecessary controversy.

Nature of chemistry in the national frame curricula for upper secondary education in Finland, Norway and Sweden

The aim of this study was to discover how current chemistry syllabi in the frame curricula for up- per secondary education in three Nordic countries (Finland, Norway, and Sweden) take into account topics related to the nature of chemistry. By qualitative content analysis, the statements related to the nature of chemistry were divided into categories. Conclusions and implications for improving the frame curricula under study were made by comparing results with research into the nature of science. Chemistry syllabi from the Nordic frame curricula analyzed take into account the aims related to the nature of chemistry in a very similar manner. The ideas that should be made more explicit in all of the analyzed curricula are: i) the limits of the chemical models and theories, ii) the relationship between chemistry and other natural sciences, iii) the importance of creativity in chemical research, iv) the concepts of evidence in science texts, v) the social nature of chemical research, and vi) chemistry as a technological practice.

The Asian elephants Elephas maximus of Cat Tien National Park, Vietnam: status and conservation of a vanishing population

This study updates the status and conservation of the Endangered Asian elephant Elephas maximus in Cat Tien National Park, Vietnam. Line transect indirect surveys, block surveys for elephant signs, village surveys of elephant-human conflict incidents, guard-post surveys for records of sightings, and surveys of elephant food plants were undertaken during the dry and wet seasons of 2001. A minimum of 11 elephants and a maximum of 15-17 elephants was estimated for c. 500 km2 of the Park and its vicinity. The elephants are largely confined to the southern boundary of the Park and make extensive use of the adjoining La Nga State Forest Enterprises. During the dry season the elephants depend on at least 26 species of wild and cultivated plants, chiefly the fruits of cashew. Most of the villages surveyed reported some elephant-human conflict. Two adult male elephants seem to cover a large area to raid crops, whereas the family groups restrict themselves to a few villages; overall, the conflict is not serious. Since 2001 there have been no reports of any deaths or births of elephants in the Park. We make recommendations for habitat protection and management, increasing the viability of the small population, reducing elephant-human conflicts, and improving the chances of survival of the declining elephants of this Park. The Government has now approved an Action Plan for Urgent Conservation Areas in Vietnam that calls for the establishment of three elephant conservation areas in the country, including Cat Tien National Park.

Environment Education for Ecosystem Conservation

Conservation of natural resources through sustainable ecosystem management and development is the key to our secured future. The management of ecosystem involves inventorying and monitoring, and applying integrated technologies, methodologies and interdisciplinary approaches for its conservation. Hence, now it is even more critical than ever before for the humans to be environmentally literate. To realise this vision, both ecological and environmental education must become a fundamental part of the education system at all levels of education. Currently, it is even more critical than ever before for the humankind as a whole to have a clear understanding of environmental concerns and to follow sustainable development practices. The degradation of our environment is linked to continuing problems of pollution, loss of forest, solid waste disposal, and issues related to economic productivity and national as well as ecological security. Environmental management has gained momentum in the recent years with the initiatives focussing on managing environmental hazards and preventing possible disasters. Environmental issues make better sense, when one can understand them in the context of one’s own cognitive sphere. Environmental education focusing on real-world contexts and issues often begins close to home, encouraging learners to understand and forge connections with their immediate surroundings. The awareness, knowledge, and skills needed for these local connections and understandings provide a base for moving out into larger systems, broader issues, and a more sophisticated comprehension of causes, connections, and consequences. Environmental Education Programme at CES in collaboration with Karnataka Environment Research Foundation (KERF) referred as ‘Know your Ecosystem’ focuses on the importance of investigating the ecosystems within the context of human influences, incorporating an examination of ecology, economics, culture, political structure, and social equity as well as natural processes and systems. The ultimate goal of environment education is to develop an environmentally literate public. It needs to address the connection between our conception and practice of education and our relationship as human cultures to life-sustaining ecological systems. For each environmental issue there are many perspectives and much uncertainty. Environmental education cultivates the ability to recognise uncertainty, envision alternative scenarios, and adapt to changing conditions and information. These knowledge, skills, and mindset translate into a citizenry who is better equipped to address its common problems and take advantage of opportunities, whether environmental concerns are involved or not.