Political communication literature has documented various forms of framing election campaigns although that on Ghana are few. These included issues, horse race, coverage tone and presidential candidates’ media visibility leading to an incumbency advantage. These are normally attributed to news values that reflect political power such as relevance and politicians’ elite status. Hence, this study is intended to explore explanation for the trend of campaign coverage in Ghana, a developing democracy, using four Ghanaian newspapers in 2008 and 2012. Through content analysis and in-depth interviews, the thesis grounded in gatekeeping and framing theories, has demonstrated that: (1) the state-owned newspapers did not give an incumbency advantage (2), the coverage was issues-based (3), election stories were more positive in tone (4), there was media bias and (5) politicians paid money (‘soli’) to journalists for coverage. These empirical findings show that during the campaigns, gatekeeping and framing practices were driven more likely by the ‘soli’ norm rather than the norm of objective and impartial journalism. Thus the study offers a new explanation why there was no incumbency advantage, why the press bias, why coverage was largely positive in tone and why issues-based framing. However, horse race appears to have the potential to dominate Ghana’s elections coverage. The conclusions of this study, one argues, were as a result of interplay between candidates’ desire not only to dominate the newspapers but also to be projected positively and journalists’ desire to make money from politicians. Simply put: stories of elections published by the newspapers were defined by ‘soli’ journalism which promoted ‘protocol’ journalism. This means most election stories that reached electorates were from speeches of candidates. Therefore, the stories lacked critical interpretation of campaign events raising issues of capacity of the press in Ghana to function effectively as public sphere contributing to participatory democracy.

What is the relationship between ethnic heterogeneity and the ability of the poor to organize and influence democratic governments to improve their welfare? Political scientists and economists have argued that democracies are superior to non-democracies for improving poverty outcomes because they are advantaged with institutional mechanisms such as universal suffrage and majority rule. Yet, there are numerous cases where democracy has done little to help the poor. Through a series of essays, I examine the effects of ethnic heterogeneity of the poor on the effect of democracy and oil revenue on poverty. I argue that ethnic heterogeneity reduces the likelihood that poor citizens will organize and pressure political elites to provide public goods and services that improve their general welfare. As a result, democracy and oil revenue are less likely to improve poverty outcomes when the poor are ethnically heterogeneous compared to being homogeneous. The first chapter presents a cross-national study to help us understand the general effects of ethnic heterogeneity of the poor on the effects of democracy on poverty. The results are not statistically significant. It is not clear if the lack of significance is due to notable endogeneity issues or that the hypothesis is wrong. For that reason, the second chapter takes advantage of an institutional natural experiment in Indonesia to produce more reliable results. The results show that ethnic heterogeneity of the poor significantly affects the effect of elections on the majority of the dependent variables. In the third chapter, I test the effects of ethnic heterogeneity of the poor on the effect of oil revenue among Brazilian municipalities. The revenues local democratic governments depend upon increased significantly due to the sharp increase of offshore oil royalties and world oil prices from early 1990s to the early 2010s. This allows me to measure the effects of ethnic heterogeneity of the poor on the effect of oil revenue on poverty at the municipal level. Results suggest that ethnic heterogeneity of the poor does not significantly affect the effect of local oil revenue on poverty outcomes in Brazil.

Part of a new cohort of diplomatic actors, sub-state governments represent a particularly complex challenge for our understanding of international relations. These actors are both territorially constituted and governmental; they look and sound very similar to states. Crucially, however, they are not states at all. When paradiplomatic relations are conducted on the part of sub-state governments with a strong regional identity, in particular ‘stateless nations’, there can sometimes be challenge – implicit or explicit – to the authority of the state to speak for, or represent, its people. This thesis takes three such stateless nations: Wales, Scotland and Bavaria, and analyses their paradiplomatic activities. The unique political context in each of these case studies is used as a frame within which to understand and interpret both the motivations and implications of such activities. Using a conceptual toolkit less familiar to traditional paradiplomatic analysis, including sovereignty games, performativity and mimicry, the study explores the ways in which sub-state governments acquire international agency, and the extent to which this agency is contested by other actors. Despite the range in political ambitions in each of the stateless nations considered, the paradiplomatic activities they conducted were often remarkably similar. What differed, however, was the way that these activities were interpreted, depending on the political context and the tenor of inter-governmental relations within the state. The paradox of paradiplomacy is that in many ways it remains unremarkable in its day-to-day practices. Yet, at other times, sub-state governments use their international relationships to make important claims about their status and position within their state, the currency of exchanges becoming that rarefied concept: sovereignty. Using a marginal site of international relations such as paradiplomacy, this thesis explores the heterogeneity of the field and the variety of relationships that exist and persist within it.

One of the most comprehensive collective rights regimes has been developed in the area of indigenous peoples and respective land and resource rights in particular. International legal instruments (ILO C169 and UNDRIPS) and Inter-American jurisprudence (e.g. the Saramaka and Sarayaku cases) significantly safeguard such rights. The latter materialise in the form of prior consultation mechanisms regarding natural resource extraction and ultimately exemplify indigenous peoples’ self-determination. However, practice shows that such collective mechanisms are established without truly taking indigenous peoples’ representative institutions according to their customs and traditions into account. This can be attributed to the fact that the interplay and local dynamics between indigenous communities, leaders and representative organisations are too complex to be reduced to collective wholes. In order to disentangle such dynamics, power relations between the players, issues of legitimacy, representativity and accountability of participatory mechanisms, and the inclusion of subgroups and individuals in collective decision-making are examined. By combining international legal standards and ethnographic research, a legal anthropological perspective informs this piece of research. Firstly, insights are gained by understanding individual or ‘subgroup’ rights in relation to collective claims in international and regional legal standards. Secondly, this relationship is observed by means of two case studies in the Bolivian Lowlands that shall shed light upon the implementation of such standards in the extractive sector. Thereby, specific subgroups are chosen to illustrate participatory exclusion and inequalities, including women (I), different age groups (II), monolingual people and persons with lower education levels (III) and local leaders (IV). Empirical insights draw on a prior consultation process with Guaraní people in the hydrocarbon sector and collective decision-making mechanisms in the case of Chiquitano people in the mining sector. Based on such empirical observations, a catalogue of guiding principles will be proposed in order to refine the existing UNDRIPS framework.

Made available in DSpace on 2016-08-17T13:54:05Z (GMT). No. of bitstreams: 1 Elisangela Santos Amorim.pdf: 2170978 bytes, checksum: ea4c5760b6a43c7114a551fce2702a5c (MD5) Previous issue date: 2007-08-20 / The inquiry approaches the question of countrywomen and your education in settlement of the Agrarian Reformation in the Tocantina region - MA. We carry through study on the trajectory of countrywomen in search of recognition of the category of agricultural worker woman, focusing the fights of the movements in favor of the education of the field in Brazil, in Maranhão and the Tocantina region, emphasizing the protagonists women of this process. Study of qualitative character, developed with the objective to study as the gender relations they intervened with the educational trajectories of adult and young countrywomen. It brings theoretical contributions of Scott, Moscovici, Jodelet, Sá, Silva, Louro, Nobre, in the perspectives of gender and social representation. Interviews in the period of 2005/2007 had been carried through, using the methodological approach of the verbal history, through halfstructuralized interviews. The stories had been submitted to the technique of thematic analysis of content, having the categories gender and social representation for the interpretations. It tells to the importance of the National Program of Education in the Agrarian Reformation - PRONERA in the Tocantina region and its contribution for the rise of the schooling of that parcel of the population. It approaches the relations lived deeply for the countrywomen, from the relations of gender and your social representations of countrywomen and learned woman. It focuses aspects of the trajectories of life of these women, where are explicit and many times implicit the difficulties in the search for schooling. At last the study stands out the influence of the relations of gender in the elaboration of the social representations in its specific conditions. / A investigação aborda a questão de mulheres camponesas e sua educação em assentamentos da Reforma Agrária na região Tocantina MA. Realizamos estudo sobre a trajetória das mulheres camponesas em busca de reconhecimento da categoria de mulher trabalhadora rural, enfocando as lutas dos movimentos em prol da educação do campo no Brasil, no Maranhão e na região Tocantina, enfatizando as protagonistas deste processo. Estudo de caráter qualitativo, desenvolvido com o objetivo de estudar como as relações de gênero interferem nas trajetórias educacionais das mulheres camponesas jovens e adultas. Traz contribuições teóricas de Scott, Moscovici, Jodelet, Sá, Silva, Louro, Nobre, nas perspectivas de gênero e de representação social. Foram realizadas entrevistas no período de 2005/2007, fazendo uso do enfoque metodológico da historia oral, através de entrevistas semi-estruturadas. Os relatos foram submetidos à técnica de análise de conteúdo temático, utilizando-se as categorias gênero e representação social para as interpretações. Relata a importância do Programa Nacional de Educação na Reforma Agrária - PRONERA na região Tocantina e sua contribuição para a elevação da escolaridade daquela parcela da população. Aborda as relações vivenciadas pelas mulheres camponesas, a partir das relações de gênero e de suas representações sociais de mulher camponesa e escolarizada. Enfoca aspectos das trajetórias de vida dessas mulheres, onde estão explicitadas e muitas vezes implícitas as dificuldades na busca por escolarização. Enfim o estudo ressalta a influência das relações de gênero na elaboração das representações sociais dadas as suas condições específicas.

Abstract Recent studies in adults have shown that musculoskeletal (MS) pains are often experienced at several body sites. The number of pain sites has been shown to be proportional to poor health outcomes, such as functional ability and health-related quality of life (HRQoL). This study investigated the occurrence and persistence of MS pain in multiple locations, determinants of multiple-site pain, and the impact of multiple-site pain on HRQoL and health care use among adolescents aged 16 to 19. The data were based on three inquiries that were administered to the adolescents of the Northern Finland Birth Cohort 1986. MS pain was common and often occurred at multiple sites. Moreover, the majority of adolescents with multiple-site pain at 16 reported multiple-site pain also at 18. Multiple-site MS pains were strongly associated with psychosocial complaints, but also with high physical activity level, long sitting time, short sleeping time, smoking, and overweight. Emotional problems, behavioral problems, and high sitting time among males, and emotional problems, high physical activity level, short sleeping time, and smoking among females were predictive factors for the persistence of multiple-site pain. The likelihood of reduced HRQoL increased according to the number of MS pain sites. A trend toward an increase in health care use with the number of pain sites was also observed. Reporting pain in multiple sites in adolescence may have both peripheral (tissue origin) and central (pain experience) causes. As multiple-site pain in adolescence may predict subsequent MS morbidity, the adolescents who are at highest risk and also at the highest need of health promotion should be identified in further studies. / Tiivistelmä Aikuisväestössä tehtyjen tutkimusten perusteella tuki- ja liikuntaelimistön kivut esiintyvät tavallisesti usealla kehon alueella samanaikaisesti. Monikipuisuudella näyttää olevan epäedullisia vaikutuksia useisiin terveyteen liittyviin ilmiöihin kuten toiminta- ja työkykyyn sekä elämänlaatuun. Tässä tutkimuksessa tarkasteltiin monipaikkaisen tuki- ja liikuntaelinkivun esiintyvyyttä, pysyvyyttä ja riskitekijöitä sekä sen vaikutusta terveyteen liittyvään elämänlaatuun ja terveyspalvelujen käyttöön 16–19 –vuotiailla nuorilla. Tutkimuksen aineisto perustui kolmeen kyselyyn, jotka lähetettiin Pohjois-Suomen syntymäkohortti 1986:n nuorille. Tuki- ja liikuntaelinkipu oli yleistä ja esiintyi tavallisimmin usealla kehon alueella. Suurin osa nuorista, jotka raportoivat monen paikan kipua 16-vuotiaana, raportoivat sitä myös 18-vuotiaana. Monen kehon alueen tuki- ja liikuntaelinkipu yhdistyi voimakkaasti psykososiaalisiin tekijöihin, mutta myös korkeaan liikunta-aktiivisuuteen, runsaaseen istumiseen, vähäiseen uneen, tupakointiin ja ylipainoon. Käyttäytymisen- ja tunne-elämän häiriöt sekä runsas istuminen pojilla, ja tunne-elämän häiriöt, korkea liikunnallinen aktiivisuus, vähäinen uni sekä tupakointi tytöillä ennustivat monen kehon alueen kivun pysyvyyttä. Todennäköisyys heikentyneeseen terveyteen liittyvään elämänlaatuun lisääntyi suhteessa kipualueiden määrään. Myös terveyspalvelujen käytön ja kipualueiden lukumäärän välillä havaittiin yhteys. Monen paikan tuki- ja liikuntaelinkipua selittänevät sekä kudostasoiset että keskushermostolliset syyt. Koska laaja-alainen kipuoireilu nuoruudessa voi ennustaa myöhempiä tuki- ja liikuntaelinongelmia, riskiryhmiä ja samalla eniten terveyden edistämistä tarvitsevia nuoria tulisi pyrkiä jatkossa tarkemmin tunnistamaan.

Abstract It has been proposed that in addition to oral glucose tolerance test, detected by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), glycosylated hemoglobin (HbA1c 5.7–6.4%) can be used for screening individuals at high risk of developing type 2 diabetes and CVD. The aim of the present study was to assess whether the use of ADA 2010 prediabetes definition, especially the use of HbA1c 5.7–6.4% may detect different individuals with prediabetes as compared to the use of IFG or IGT, and whether the traditional CVD-risk factors differed between these definitions. Furthermore, the aim was to study if the inflammatory mediators associated with cardiovascular disease are increased in prediabetes and to assess the power of HbA1c 5.7–6.4%, 2-h glucose, and fasting glucose predicting type 2 diabetes and CVD. The present study consisted of the Oulu 35 population. This prospective population-based study was conducted in 1990–2008 to assess the prevalence of type 2 diabetes and glucose abnormalities. All inhabitants of the City of Oulu, Finland, born in 1935 and living in Oulu on 1st October 1990 (n=1,008), were invited to participate 1990–1992 (831 enrolled). At the baseline of the present study 1996–1998, 815 were invited and 593 (73%) of them enrolled. Prediabetes was classified as IFG (fasting blood glucose, FBG 5.6–6.0 mmol/L), IGT (2-hour BG ≥7.8 and <11.1 mmol/L) and/or HbA1c 5.7–6.4%. Inflammation was measured with IL-1Ra, IL-8 and RANTES. Prevalence of isolated prediabetes in this population was common with limited overlap between the three different definitions. Differences in CVD risk factors were observed between the three hyperglycemia groups. Isolated HbA1c was associated with overweight and more adverse lipid profile. Low-grade inflammation (measured by IL-1Ra, IL-8 and RANTES) was associated with prediabetes with levels comparable to those with diabetes. The association was independent of visceral adiposity. Finally, HbA1c and 2-h glucose, but not fasting glucose, predicted CVD in 10 years follow-up in women, but not in men. In conclusion, this study demonstrates that HbA1c 5.7–6.4% detects partly different individuals with prediabetes as compared to IFG and IGT. Using only fasting glucose and HbA1c for screening, many subjects at high risk for diabetes and CVD would be missed. However, HbA1c 5.7-6.4% diagnose individuals with high traditional cardiovascular risk factors. Prediabetes is associated with inflammation measured with IL-1Ra, IL-8 and RANTES. Finally, 2-h glucose value is important in screening subjects in high risk for diabetes and CVD. / Tiivistelmä Vuonna 2010 Amerikan diabetesyhdistys (ADA) esitti sokerihemoglobiinin HbA1c 5.7-6.4 % -arvoa diabeteksen esiasteeksi kohonneen paastosokerin (IFG) ja heikentyneen sokerinsiedon (IGT) lisäksi. Tämän tutkimuksen tarkoituksena oli selvittää, miten ADA 2010 -määritelmä diabeteksen esiasteista löytää riskihenkilöitä ja mitkä ovat perinteiset sydän- ja verisuonisairauksien riskitekijät eri ryhmillä (IFG, IGT ja HbA1c 5.7–6.4%). Tulehdusmarkkereita ja näiden eroja määritettiin verrattuna diabeetikoihin ja terveisiin henkilöihin. Lisäksi selvitettiin, kuinka nämä eri diabeteksen esiasteet ennustavat sydän- ja verisuonisairauksien syntyä. Tutkimusaineistona oli Oulu 35 aineisto, jota on tutkittu v. 1990–2008 tyypin 2 diabeteksen ja sokerihäiriöiden esiintyvyyden selvittämiseksi. Ensimmäinen seurantatutkimus tässä ikäkohortissa, joka on nykyisen tutkimuksen alkuvaihe, tehtiin 1996–1998. Osallistujia oli tällöin 593. Seuraava seurantatutkimus tehtiin 2007–2008. Diabeteksen esiasteeksi määritettiin IFG (kohonnut paastoverensokeri, FBG 5.6–6.0 mmol/L), IGT (2-tunnin verensokeri BG ≥7.8 ja <11.1 mmol/L) ja HbA1c 5.7–6.4%. Diabeteksen esiasteiden esiintyvyys tässä aineistossa oli huomattava ja määritelmät löysivät vain vähän samoja ihmisiä. Perinteisissä sydän- ja verisuonisairauksien riskitekijöissä oli selkeitä eroja: henkilöt, joilla oli HbA1c 5.7–6.4%, olivat selkeästi enemmän ylipainoisia ja vyötärölihavia, sekä heillä oli huonommat rasva-arvot (HDL ja triglyseridit). HbA1c ja IGT ennustivat sydän- ja verisuonitautien ilmaantumista naisilla, mutta eivät miehillä. Kaikki nämä määritelmät ennustivat diabeteksen syntyä, mutta ei-diabeetikoilla vain 2 tunnin sokeri ennusti sydän- ja verisuonitautia. Sen sijaan matala-asteinen tulehdusreaktio mitattuna IL-1Ra, IL-8 and RANTES- tulehdusmarkkereilla liittyi jo diabeteksen esiasteeseen (ADA 2010) yhtä paljon kuin diabeetikoilla, eikä tämä selittynyt vyötärölihavuudella. Tutkimus osoitti, että diabeteksen eri esiasteet diagnosoivat eri ihmisiä. Jos 2- tunnin sokerirasitusta ei käytettäisi, jäisi runsaasti todellisessa sydän- ja verisuonisairauksien riskissä olevia henkilöitä löytymättä. Toisaalta sokerihemoglobiini HbA1c 5.7–6.4% löytää eri ihmisiä, joilla perinteiset riskitekijät sydän- verisuonisairauksille ovat yleisemmät, joten senkin käyttö voi diabeteksen seulonnassa olla parempi kuin paastosokerin, joka löysi selkeästi huonommin riskihenkilöitä. Sokerirasituskoe on edelleen tärkeä riskihenkilöiden seulonnassa.

Abstract Best available technology (BAT) should be used for peat extraction runoff purification. One currently used BAT technique is treatment wetland construction on pristine peatland, but under Finnish national strategies, new peat extraction areas should only be established on previously drained peatland and it can be challenging to find natural, intact peatland for treatment wetlands near these areas. This thesis evaluated the function and purification efficiency of treatment wetlands constructed on drained peatland and examined factors that could indicate their purification efficiency. The year-round removal efficiency of treatment wetlands established in drained or pristine peatland areas in a cold climate was also studied. A first study examined the water flow processes in treatment wetlands constructed on drained peatland. In more than 50% of the 20 wetlands studied, the active flow depth was under 20 cm and water distribution was unequal. A second study determined the purification efficiency of treatment wetlands constructed on drained peatland and examined factors indicating removal efficiency. The removal efficiency of suspended solids and inorganic nitrogen was good, but in some wetlands leaching of phosphorus and iron was observed, e.g. due to changes in peat properties, first after drainage and then after rewetting, altering e.g., oxygen conditions in the peat layer. The surface peat content of elements such as phosphorus, iron, aluminum, magnesium, manganese, and calcium can be used as a proxy to assess leaching of phosphorus. A third study examined the year-round purification efficiency of treatment wetlands based on peat extraction load monitoring program values. Seasonal variation in the purification efficiency of constructed wetlands was observed for total nitrogen, ammonium-nitrogen, and chemical oxygen demand (CODMn). Based on these results, it is possible to evaluate the suitability of different drained peatland areas for water purification purposes. Treatment wetlands were shown to generally purify runoff water during winter mainly as well as in other seasons, except for nitrogen and CODMn, but there may be variations between wetlands. / Tiivistelmä Turvetuotannon valumavesien käsittelyssä tulee käyttää parasta saatavilla olevaa käyttökelpoista tekniikkaa, esimerkiksi luonnontilaisille suoalueille rakennettuja pintavalutuskenttiä. Valtakunnallisilla alueidenkäyttöstrategioilla turvetuotantoa ohjataan yhä enemmän jo aiemmin ojitetuille suoalueille. Näiden läheisyydestä ei välttämättä löydy sopivaa ojittamatonta suoaluetta pintavalutuskentän perustamista varten. Tämän tutkimuksen tavoitteena oli selvittää miten ojitetuille suoalueille rakennetut pintavalutuskentät (kosteikot) toimivat ja puhdistavat valumavesiä sekä mitkä tekijät voivat kuvata niiden toimivuutta. Työssä selvitettiin myös ojittamattomille ja ojitetuille suoalueille rakennettujen pintavalutuskenttien ympärivuotista toimivuutta. Työn ensimmäisessä osassa tutkittiin veden virtausta ojitetulle suoalueille rakennetuilla pintavalutuskentillä. Yli puolella tutkituista pintavalutuskentistä oli havaittavissa, että veden virtauskerros turpeessa oli matala (alle 20 cm) ja vesi jakautui pintavalutuskentälle epätasaisesti. Työn toisessa osassa selvitettiin ojitetuille suoalueille rakennettujen pintavalutuskenttien puhdistustehokkuutta ja sitä indikoivia tekijöitä. Ojitetut pintavalutuskentät puhdistivat hyvin kiintoainetta ja epäorgaanista typpeä, mutta joillakin kohteilla oli havaittavissa fosforin ja raudan huuhtoutumista, mikä johtunee osaltaan kuivatuksen aiheuttamista muutoksista turpeessa ja happiolosuhteiden muutoksista uudelleen vesittämisen jälkeen. Erityisesti fosforin huuhtoumista voitiin alustavasti arvioida pintaturpeen fosfori-, rauta-, alumiini-, magnesium-, mangaani- ja kalsiumpitoisuuksien perusteella. Työn kolmannessa osassa määritettiin olemassa olevan vedenlaatuaineiston avulla pintavalutuskenttien ympärivuotista puhdistustehokkuutta. Selvää vuodenaikaisvaihtelua ei havaittu kokonaistyppeä, ammoniumtyppeä ja kemiallisen hapenkulutuksen (CODMn)-arvoa lukuun ottamatta. Työn tuloksia voidaan käyttää, kun arvioidaan etukäteen ojitettujen suoalueiden soveltuvuutta vedenpuhdistukseen. Kosteikot vaikuttivat pääasiassa typpeä ja CODMn-arvoa lukuun ottamatta olevan yhtä tehokkaita valumavesien puhdistajia myös talvella kuin muina vuodenaikoina, tosin kohteiden välillä oli vaihtelua.

Abstract The purpose of this study was to describe and explain the lifestyle of residents of Lapland who have a risk of cardiovascular diseases. Moreover, the effectiveness of counseling intervention on current lifestyle and adherence to lifestyle change were studied. Participants’ self-assessed and self-reported lifestyles and how these reflect objective measurements were also investigated. The data were collected in three phases in 2007–2009: baseline (n = 53) and follow-ups at 6 months (n = 32) and 12 months (n = 34). Lifestyle intervention was carried out using Skype videocall except for one group. The data was formed of blood test results (fP-Kol, fP-Kol-HDL, fP-Kol-LDL, fP-Gluk), anthropometric (height, weight, BMI, waist circumference) and blood pressure measurements, diabetes risk test, lifestyle questionnaire, adherence to lifestyle change questionnaire and food and exercise diaries. At baseline, serum cholesterol and LDL cholesterol were raised. Participants were at least overweight; they did not exercise enough nor receive enough vegetables or fiber. The self-assessed lifestyle was contradictory to the measurement results. Factors affecting adherence to lifestyle change were the urge to take care of oneself and the responsibility for one’s health. At the 6-month follow-up, improvement in cardiovascular health was detected: the cholesterol level and diabetes risk had decreased. Waist circumference and the number of obese (BMI > 30) decreased. In addition, health-improving changes in lifestyle were detected. The usage of vegetables and berries increased and the usage of salt decreased. However, participants did not exercise enough. At the 12-month follow-up, worsening in dietary habits was detected. However, blood pressure declined and men’s waist circumference remained the same when compared to the previous follow-up. Between baseline and 6-month follow-up some improvements in cardiovascular health could be detected but they did not remain until the 12-month follow-up. Participants assessed their lifestyle to be better than what the objective measurements indicated. Factors affecting adherence to lifestyle change were self-efficacy, adherence to the given advice and guidance and concern over the current lifestyle. Participants benefited from the counseling intervention because small changes were detected towards healthier lifestyle. Lifestyles changed into healthier direction. The results of this study can be utilized when developing counseling intervention further. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja selittää sydän- ja verisuonisairauksien riskiryhmään kuuluvien lappilaisten elintapoja ja ohjausintervention vaikuttavuutta elintapoihin ja elintapamuutokseen sitoutumiseen. Lisäksi kuvattiin tutkittavien itsearvioimia ja raportoimia elintapoja sekä verrattiin niitä objektiivisiin mittaustuloksiin. Ohjausinterventio toteutettiin videopuhelinvälitteisesti Skypellä yhtä ryhmää lukuun ottamatta. Tutkimukseen osallistui 53 työikäistä lappilaista. Tutkimusaineisto kerättiin kolmessa vaiheessa vuosina 2007–2009: nollamittaus (n = 53) sekä seurantamittaukset kuuden (n = 32) ja 12 (n = 34) kuukauden kuluttua. Tutkimusaineisto muodostui verikoetuloksista (fP-Kol, fP-Kol-HDL, fP-Kol-LDL, fP-Gluk), antropometristen mittausten tuloksista (pituus, paino, BMI ja vyötärönympärysmitta), verenpaineesta, diabeteksen riskitestistä, elintapa- ja sitoutumiskyselystä sekä ruoka- ja liikuntapäiväkirjoista. Nollamittauksessa seerumin kolesteroli ja LDL-kolesteroli olivat koholla. Tutkittavat olivat vähintään ylipainoisia, ja liikunta sekä kasvisten ja kuidun saanti oli vähäistä. Oma arvio elintavoista oli ristiriidassa mittaustulosten kanssa. Nollamittauksessa elintapamuutokseen sitouttavia tekijöitä olivat halu huolehtia itsestä ja vastuu omasta terveydestä. Kuuden kuukauden seurantamittauksessa verisuoniterveys oli parantunut kolesterolin ja diabetesriskin osalta. Vyötärönympärysmitta ja lihavien määrä (BMI > 30) väheni. Myös elintavoissa havaittiin muutoksia valtimoterveyttä edistävään suuntaan. Kasvisten ja marjojen käyttö lisääntyi sekä suolan käyttö väheni. Liikuntaa ei kuitenkaan ollut riittävästi. Kahdentoista kuukauden seurantamittauksessa todettiin ”repsahdusta” ruokailutottumuksissa. Edelliseen mittaukseen nähden verenpaine laski ja miesten vyötärönympärysmitta pysyi samana. Nolla- ja kuuden kuukauden mittauksen välillä tapahtui valtimoterveyttä edistäviä muutoksia, joista kaikki eivät ilmentyneet 12 kuukauden seurantamittauksessa. Osallistujat arvioivat elintapojaan paremmaksi kuin mittaustulokset osoittivat. Elintapamuutokseen sitoutumiseen vaikuttavia tekijöitä ovat pystyvyys, sitoutuminen neuvoihin ja ohjeisiin sekä huoli nykyisistä elintavoista. Osallistujat hyötyivät ohjausinterventiosta, sillä elintavoissa tapahtui pieniä muutoksia terveelliseen suuntaan. Tuloksia voidaan hyödyntää kehitettäessä ohjausinterventioita.

Abstract About 11% of infants are born preterm (before 37 weeks of gestation) worldwide. Adults born preterm with very low birth weight show enhancement of cardiometabolic risk factors such as elevated blood pressure and impaired glucose regulation compared with their peers born at term. Not all the cardiometabolic risk factors related to preterm birth are known, or whether they apply to those born less preterm, although about 80% of premature infants are born late preterm. The association between preterm birth and cardiometabolic risk factors in adolescence and adulthood was investigated in three cohort studies: The Helsinki Study of Very Low Birth Weight Adults, the Northern Finland Birth Cohort 1986, and the ESTER study. Preterm birth over its whole range has a long-term impact on a child’s health in later life: adults born preterm with very low birth weight had lower resting energy expenditure, but higher resting energy expenditure per unit lean body mass than their peers born at term. Adolescent girls born before 34 weeks of gestation had higher blood pressure and boys have elevated levels of LDL cholesterol and apolipoprotein B. Adults born preterm were more likely to be obese and to have hypertension or metabolic syndrome than their peers born at term. In addition to conventional biomarkers of cardiometabolic disorders, they had alterations in other cardiometabolic biomarkers, such as uric acid and liver transaminases. Adolescents and adults born preterm are at greater risk of developing cardiometabolic disorders than their peers born at term. Most of the cardiometabolic risk factors related to preterm birth are modifiable. Favorable early life circumstances of premature infants, such as optimal nutrition and reduction of stress in neonatal intensive care units, might reduce the risk of later cardiometabolic disorders. In addition, children and adults born preterm might particularly benefit from primary prevention such as screening for additional risk factors and promotion of healthy lifestyles. / Tiivistelmä Noin joka yhdeksäs lapsi maailmassa syntyy ennenaikaisesti, ennen 37. raskausviikkoa. Keskosena syntyneillä aikuisilla on todettu enemmän joitakin sydän- ja verisuonisairauksien riskitekijöitä kuin heidän täysaikaisena syntyneillä ikätovereillaan. Näistä eniten on tutkittu etenkin kohonneen verenpaineen ja heikentyneen sokerin siedon esiintyvyyttä, mutta kaikkia myöhempien sairauksien riskitekijöitä ei tunneta. Suurin osa aiemmista keskostutkimuksista on tehty hyvin tai erittäin ennenaikaisesti syntyneillä, vaikka yli 80% keskosista syntyy lievästi ennenaikaisena. Ei ole juurikaan tutkimuksia siitä, ovatko sydän- ja verisuonitautien riskitekijät lisääntyneet myös tässä suuressa lievemmin ennenaikaisesti syntyneiden joukossa. Eriasteisen ennenaikaisen syntymän vaikutuksia nuoruus- ja aikuisiän sydän- ja verisuonitautien riskitekijöihin tutkittiin kolmessa kohorttitutkimuksessa: Helsingin Pikku-K -tutkimuksessa, Pohjois-Suomen syntymäkohortti 1986 -tutkimuksessa sekä ESTER-tutkimuksessa. Ennenaikaisella syntymällä sinänsä on pitkäaikaiset vaikutuksen syntyneen lapsen terveyteen myös nuoruudessa ja aikuisuudessa: Hyvin pienipainoisena ennenaikaisesti syntyneillä on korkeampi lepoenergian kulutus rasvatonta painoyksikköä kohden kuin täysiaikaisena syntyneillä ikätovereilla. Hyvin ennenaikaisena (ennen 34. raskausviikkoa) syntyneillä tytöillä on 16-vuotiaina korkeampi verenpaine, ja pojilla suuremmat LDL-kolesterolin ja apolipoproteiini B:n pitoisuudet. Keskosena syntyneet puolestaan täyttivät aikuisina todennäköisemmin lihavuuden, verenpainetaudin ja metabolisen oireyhtymän kriteerit. Perinteisten sydän- ja verisuonitautien riskitekijöiden lisäksi heillä oli muutoksia myös monissa muissa sydän- ja verisuonitautien merkkiaineissa, kuten uraatin ja maksa-arvojen pitoisuuksissa. Ennenaikaisesti syntyneillä nuorilla ja aikuisilla on suurentunut riski sairastua sydän- ja verisuonitauteihin myöhemmällä iällä. Näitä riskejä on mahdollista ennaltaehkäistä, minkä vuoksi ennenaikaisesti syntyneet nuoret ja aikuiset voivat hyötyä terveellisistä elämäntavoista erityisen paljon.