Individual dietary counselling during and after pregnancy: Impact on diet and body weight

In Finland, maternity and child health clinics play a key role in promoting health in young families. Currently, obesity causes the greatest challenges to clinics. In obese pregnant women, an increased risk for metabolic diseases exist which can affect both the mother and child. The purpose of this thesis was to explore the role of dietary counselling: in Finnish health clinics; in the regulation of dietary intake; and in affecting the body weight of women. The main aim was to test the effect of dietary counselling and probiotic intervention on dietary intake and maternal body weight during and after pregnancy. In addition to dietary counselling, the effect of other factors, such as eating behaviour on dietary intake and body weight control after pregnancy was assessed. Another aim was also to evaluate dietary counselling practices by nurses (n = 327) in Finnish health clinics assessed by a questionnaire. At the beginning of the pregnancy, women (n = 256) enrolled in a dietary intervention study, were randomised into three groups. One group received dietary counselling with probiotics, one had counselling with placebo and the third group was the control group. The control group consisted of women whom did not receive counselling and took placebo. Probiotics and placebo supplements were used until the end of exclusive breastfeeding or six months after pregnancy. Women were followed from early pregnancy up to four years after pregnancy. Follow-up visits took place three times during pregnancy, at one and six months, and one, two and four years after pregnancy. Dietary counselling, provided by a nutritionist, aimed to influence the quality of dietary fat intake. Dietary counselling is important to provide in clinics, as determined by the nurses, and these nurses expressed a want to improve their own nutritional knowledge through education. The nurses had varying knowledge of current dietary recommendations. Dietary counselling for women during and after pregnancy resulted in beneficial changes in dietary intake up to one year after pregnancy and body weight and waist circumference up to four years after pregnancy. Probiotics had a beneficial effect together with dietary counselling on waist circumference until one year after pregnancy, but not throughout the long term, four years after pregnancy. Other factors, such as eating behaviour, associated with dietary intake and body weight control after pregnancy. Specifically, dietary recommendations are reached amongst women whom had high cognitive restraint in their eating behaviour and did not demonstrate uncontrolled eating. Overweight women more frequently emotionally ate compared to normal weight women and women with central adiposity related more frequently to having an uncontrolled eating behaviour than women with normal waist circumference. In addition, being overweight prior to pregnancy and excessive weight gain during pregnancy associated with increased body weight retention after pregnancy. This study showed that individual dietary counselling is useful in influencing dietary intake which adheres to dietary recommendations and this counselling influences, favourably, body weight after pregnancy. Especially, women with the risk for weight retention, such as women who have emotional and uncontrolled eating behaviours, who were overweight prior to pregnancy or those who had excessive weight gain during pregnancy, may benefit from individual dietary counselling. This study underscores the need to develop dietary counselling practices for pregnant women and their follow-up after pregnancy in Finnish health clinics. These practices include increasing the efficacy of the counselling such as collaboration with families, having knowledgable health professionals and having sufficient resources.Siirretty Doriast

Investigating genetic determinants of ankylosing spondylitis

Ankylosing spondylitis (AS) is a common form of inflammatory arthritis, occurring in approximately 0.1% of the British and Finnish populations. The genetic contribution to the disease susceptibility accounts for >90% of the population variance, and the disease severity is also predominantly genetically determined. HLA-B27 has been strongly associated with the disease world-wide, but although it is almost essential for the inheritance of AS, the attributable risk of HLA-B27 has been estimated to be 16-50%, leaving a large component of the genetic variance to be discovered. The influence of a positional and biological candidate gene, transforming growth factor β1 (TGFB1), was investigated in a Finnish and British population. A weak association between the rare TGFB1 1627 T allele and susceptibility to, and age of symptom onset of, AS was noted. However the lack of association of TGFB1 promoter polymorphisms, which are in LD with the TGFB1 1627 alleles, with AS in families with positive non-parametric linkage scores at the locus indicates that these polymorphisms do not explain the observed linkage of disease susceptibility to chromosome 19. A novel high throughput HLA-DRB1 genotyping method based on multiplex primer extension reactions was developed. This method allows rapid and cost-effective screening of a large number of samples. The effect of HLA genes and haplotypes in susceptibility to, and severity of, AS was investigated in the Finnish population. An overrepresentation of HLA-B27 homozygotes was noted in cases with AS compared with the expected number of HLAB27 homozygotes under Hardy-Weinberg equilibrium. Significant associations between both HLA-B27 and HLA-DRB1*08 and a younger age of symptom onset was noted suggesting that genes within the MHC are involved in determining the age of symptom onset. A haplotype-based case-control study noted no association between HLA-DRB1-B27 haplotypes and AS susceptibility, but this study was underpowered. The effect of CYP2D6*4 poor metaboliser allele was investigated in the Finnish AS families. No association was noted, but due to lack of power this study could not exclude a true positive association with the disease. In summary, a novel HLA-DRB1 genotyping technique was developed to enable the assessment of the contribution of HLA-DRB1 genes in a large number of AS samples. HLA-B27 homozygosity was increased in cases with AS compared with the expected number of HLA-B27 homozygotes. HLA-B27 and HLA-DRB1*08 alleles were significantly associated with a younger age of symptom onset in AS. TGFB1 gene polymorphisms do not appear to have a major impact in AS

Various forms of value-based selling capability:Commentary on “Value-Based Selling: An Organizational Capability Perspective”

Non peer reviewe

Vieraannuttaminen : sosiaalityöntekijöiden näkemys vieraannuttamisen ehkäisemisestä

Tutkielmani motiivina on vieraannuttamisen esille nostaminen sekä sen ammatillinen ehkäiseminen sosiaalityössä. Vieraannuttaminen tässä tutkielmassa tarkoittaa, että toinen vanhempi käytöksellään vieraannuttaa lasta avioerotilanteissa toisesta vanhemmasta, siten että lapsen ja vanhemman vuorovaikutussuhde vaikeutuu vieraannuttamisen johdosta. Suomessa vieraannuttamisen kanssa työskentelee monia ammattikuntia ja pelkästään sosiaalityössä eri toimenkuvissa lukuisia sosiaalityöntekijöitä. Tutkielmassani tarkastelen vieraannuttamisilmiötä siihen puuttumisen ja sen ehkäisemisen näkökulmasta sosiaalityön käytännöissä. Tarkoituksenani on selvittää, millaisia haasteita sosiaalityöntekijät kohtaavat vieraannuttamisen kanssa työskennellessään ja miten he puuttuvat haasteelliseen aiheeseen omassa työssänsä. Selvitän myös millaista tukea he toivovat saavansa ja miltä tahoilta vieraannuttamistapauksissa. Tutkielmani aineisto koostuu yhteensä 31 lastensuojelun ja perheneuvolan sosiaalityöntekijän sekä lastenvalvojien vastauksista. Aineisto on kerätty puolistrukturoidun kyselylomakkeen avulla SurveyMonkey-sovellutuksella. Kysely toteutettiin kevään 2017 aikana. Tutkimusmenetelmäni on kvalitatiivinen ja aineisto on analysoitu teorialähtöisen sisällönanalyysin keinoin. Kiintymyssuhdeteoria toimii tutkielmani teoreettisena viitekehyksenä, jonka kautta tarkastelen vieraannuttamisilmiön vaikutusta perheen kiintymyssuhteisiin vanhempien avioerotilanteissa. Lapsi rakentaa kiintymyssuhdetta heti syntymästään asti äitiin ja isään. Vanhempien erotilanteissa kiintymyssuhde saattaa muuttua tai jopa katketa kokonaan ja joskus näissä tilanteissa voi olla kyseessä vieraannuttaminen. Tutkimustuloksista on huomattavissa, kuinka vaikeasta asiasta vieraannuttamisessa on kyse. Vieraannuttamisen koetaan olevan haasteellinen aihe tunnistaa. Keskeisenä tuloksena näkyivät koulutuksen puute tai riittämättömyys vieraannuttamiseen puuttumisen ja ennaltaehkäisyn toteuttamiseksi. Tämän lisäksi sosiaalityöntekijöillä ei ollut työnsä tukena selkeitä toimintatapoja. Käytetyimpänä toimintatapana heillä oli keskustelu, jossa pyrittiin tuomaan vanhemmille esille lapsen etua ja oikeuksia. Haasteista suurimpina näyttäytyivät vanhempien yhteistyökyvyttömyys vieraannuttamistilanteissa, vieraannuttamisen tunnistaminen sekä siihen puuttumisen vaikeus. Tärkeänä kehittämisasiana esille nousivat vastaajien enemmistöllä toimintamallien kehittäminen sekä vanhempien eron aikaisen työskentelyn varhainen ja vahva tuki. Myös yhteistyökumppaneiden ja moniammatillisuuden rakentaminen vieraannuttamistyöskentelyssä koettiin tärkeänä

Marketing performance assessment systems and the business context

Purpose ‐ This study provides empirical evidence for the contextuality of marketing performance assessment (MPA) systems. It aims to introduce a taxonomical classification of MPA profiles based on the relative emphasis placed on different dimensions of marketing performance in different companies and business contexts. Design/methodology/approach ‐ The data used in this study (n=1,157) were collected using a web-based questionnaire, targeted to top managers in Finnish companies. Two multivariate data analysis techniques were used to address the research questions. First, dimensions of marketing performance underlying the current MPA systems were identified through factor analysis. Second, a taxonomy of different profiles of marketing performance measurement was created by clustering respondents based on the relative emphasis placed on the dimensions and characterizing them vis-á-vis contextual factors. Findings ‐ The study identifies nine broad dimensions of marketing performance that underlie the MPA systems in use and five MPA profiles typical of companies of varying sizes in varying industries, market life cycle stages, and competitive positions associated with varying levels of market orientation and business performance. The findings support the previously conceptual notion of contextuality in MPA and provide empirical evidence for the factors that affect MPA systems in practice. Originality/value ‐ The paper presents the first field study of current MPA systems focusing on combinations of metrics in use. The findings of the study provide empirical support for the contextuality of MPA and form a classification of existing contextual systems suitable for benchmarking purposes. Limited evidence for performance differences between MPA profiles is also provided

Effective forms of market orientation across the business cycle:a longitudinal analysis of business-to-business firms

Macroeconomic developments, such as the business cycle, have a remarkable influence on firms and their performance. In business-to-business (B-to-B) markets characterized by a strong emphasis on long-term customer relationships, market orientation (MO) provides a particularly important safeguard for firms against fluctuating market forces. Using panel data from an economic upturn and downturn, we examine the effectiveness of different forms of MO (i.e., customer orientation, competitor orientation, interfunctional coordination, and their combinations) on firm performance in B-to-B firms. Our findings suggest that the impact of MO increases especially during a downturn, with interfunctional coordination clearly boosting firm performance and, conversely, competitor orientation becoming even detrimental. The findings further indicate that both the role of MO and its most effective forms vary across industry sectors, MO having a particularly strong impact on performance among B-to-B service firms. The findings of our study provide guidelines for executives to better manage performance across the business cycle and tailor their investments in MO more effectively, according to the firm's specific industry sector

Impact of paediatric onset primary sclerosing cholangitis on clinical course and outcome of inflammatory bowel disease : a case-control population-based study in Finland

Introduction and aim: The aim of this study was to investigate the outcome of a paediatric onset of inflammatory bowel disease (IBD) in a cohort of subjects with primary sclerosing cholangitis (PSC) and in a matched-age population-based control group without PSC. Methods: We identified 28 IBD-PSC cases (median age at IBD diagnosis 12.5 years, 25-75th: 10-16 years) and selected three IBD controls for each case matched for age and year of IBD diagnosis. All data regarding the gastrointestinal tract and liver were collected at diagnosis and at last follow-up (median 15 years). Results: At diagnosis the prevalence of pancolitis was similar between the groups (78% and 79%, respectively p = -.30), but histologic inflammation was milder in IBD-PSC (61% vs 30%, p = .06). At last follow-up (median age 29 years) pancolitis was less frequent (6% and 33%, respectively p = .04) and the remission higher (76% and 47%, respectively p = .08) in IBD-PSC patients than in IBD patients. Panproctolectomy (32% in IBD-PSC and 34% in IBD, p = 1.0) and the rate of pouchitis (62% and 70%, respectively p = .8) were similar. Conclusions: The outcome of paediatric onset IBD in patients with PSC in adulthood seems to be comparable to those with IBD only.Peer reviewe

Varhaiskasvatuksen erityisopettajien ajatuksia yhteisopettajuudesta inklusiivisessa varhaiskasvatuksessa

Tiivistelmä. Yhteisopettajuus on inklusiivisen opetuksen pedagoginen työmuoto. Sillä tarkoitetaan vähintään kahden kasvatusalan ammattilaisen yhdessä suunnittelemaa, toteuttamaa ja arvioimaa opetusta. Yhteisopettajuudella voidaan vahvistaa lapselle annettavaa tukea inklusiivisessa varhaiskasvatuksessa. Yhteisopettajuus perustuu yhteistyön tekemiseen. Tutkimuksen tavoitteena oli selvittää varhaiskasvatuksen erityisopettajien ajatuksia yhteisopettajuuden toteuttamisesta inklusiivisessa varhaiskasvatuksessa, sen hyödyistä sekä toteuttamisen esteistä. Lisäksi tutkimuksen tavoitteena oli tarkastella ihanteellisen yhteisopettajuuden edellytyksiä. Tutkimuksen lähestymistapa oli laadullinen. Tutkimusaineisto kerättiin puolistrukturoituna teemahaastatteluna, joka toteutettiin yksilö- ja ryhmähaastatteluina joulukuussa 2022. Haastatteluihin osallistui kahdeksan varhaiskasvatuksen erityisopettajaa, jotka työskentelivät kolmessa eri kehittämishankkeessa. Näiden hankkeiden tavoitteena oli edistää tasa-arvoa, kehittää varhaiskasvatuksen laatua sekä vahvistaa lapsen tukea inklusiivisessa varhaiskasvatuksessa. Aineiston analyysissa hyödynnettiin sekä aineistolähtöistä että teoriaohjaavaa sisällönanalyysia. Tutkimuksen tulosten mukaan yhteisopettajuutta toteutettiin yhteistyössä. Suunnittelu, arviointi ja koko päivän huomioiminen nähtiin tärkeänä toteuttamisessa. Yhteisopettajuuden hyötynä lapselle nähtiin tuen mahdollistuminen. Aikuiselle hyötyjä olivat ammatillisen tuen jakaminen ja työhyvinvoinnin vahvistuminen. Yhteisopettajuuden esteinä nähtiin varautuneisuus, näkökulmaerot ja riittämättömät resurssit. Onnistuneen yhteisopettajuuden edellytyksiksi kuvattiin vapaaehtoisuus, myönteinen asennoituminen, toimiva vuorovaikutus sekä suunnittelun ja arvioinnin mahdollistuminen. Ihanteellinen yhteisopettajuus koostui lapsen hyvinvoinnin tukemisesta, myönteisestä asennoitumisesta, toimivasta yhteistyöstä ja riittävistä resursseista ja koulutuksesta sekä esihenkilön tuesta. Tutkimuksessa yhteisopettajuus näyttäytyi varhaiskasvatuksen erityisopettajien kuvailujen perusteella laajana kokonaisuutena, jossa yhteisopettajuuden toteuttamisessa on mukana opettajien lisäksi myös varhaiskasvatuksen tiimi. Yhteisopettajuuden ajateltiin ulottuvan opetushetkien lisäksi koko arkeen. Yhteistyön merkitys korostui yhteisopettajuuden toteuttamisessa. Yhteistyön avulla voitiin jakaa vastuuta työmäärän, roolitusten sekä arjen suhteen. Lisäksi yhteistyö ilmeni pedagogisen ja ammatillisen asiantuntijuuden yhdistämisenä. Yhteisopettajuuden lähtökohtana sekä päämääränä näyttäytyi lapsen hyvinvoinnin tukeminen yhdessä.Early childhood special education teachers’ thoughts about co-teaching in inclusive early childhood education. Abstract. Co-teaching is a pedagogical work form of inclusive teaching. It means that teaching is planned, implemented, and evaluated by at least two professionals in the field of education. Co-teaching can strengthen the support given to the child in inclusive early childhood education. Co-teaching is based on collaboration. The purpose of this study was to find out the thoughts of early childhood special education teachers about the implementation of co-teaching in inclusive early childhood education, its benefits and the obstacles to implementation. Furthermore, the goal of the study was to examine the conditions for ideal co-teaching. The research approach was qualitative. The research material was collected as a semi-structured thematic interview, which was carried out as individual and group interviews in December 2022. Eight early childhood special education teachers who worked in three different development projects participated in the interviews. The goals of these projects were to promote equality, develop the quality of early childhood education and strengthen child’s support in inclusive early childhood education. In the analysis of the data, both material-oriented and theory-driven content analysis were used. According to the results of the study, co-teaching was implemented in collaboration. Planning, evaluation, and consideration of the whole day were seen as important in the implementation. The benefit of co-teaching was seen as the possibility of support for the child. The benefits for the adult were the distribution of professional support and the strengthening of well-being at work. Barriers to co-teaching were seen as inflexibility, differences in viewpoints and insufficient resources. The prerequisites for successful co-teaching were described as voluntariness, a positive attitude, effective interaction and the possibility of planning and evaluation. Ideal coteaching consisted of supporting the child’s well-being, a positive attitude, functional collaboration and sufficient resources and education, as well as support from the leader. In this study, co-teaching appeared as a broad entity, where not only the teachers but also the early childhood education team is involved in the implementation of co-teaching. Co-teaching extended beyond teaching moments to the whole day. The importance of cooperation was emphasized in co-teaching. Collaboration made it possible to share responsibility in terms of workload, roles and in everyday situations. Collaboration made it possible to share responsibility at work. In addition, the collaboration was a combining of pedagogical and professional expertise. Supporting the child’s well-being together appeared to be the starting point and goal of coteaching