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Juha Nyman
Academic Dissertation
To be presented with the permission of the Medical Faculty of the University of Helsinki,
for public examination in Auditorium XII, Unioninkatu 34, University of Helsinki,
on April 26th 2002, at 12.00 noon
Helsinki 2002
Supervised by
Professor Pertti Kekki
Department of General Practice and Primary Health Care
University of Helsinki
Mannerheimintie 172, 00014 Helsinki
Ph.D Marja Sihvonen
Department of General Practice and Primary Health Care
University of Helsinki
Mannerheimintie 172, 00014 Helsinki
Docent Antti Uutela
Department of Epidemiology and Health promotion
National Public Health Institute
Mannerheimintie 166, 00300 Helsinki
Reviewed by
Professor Heimo Viinamäki
Department of Psychiatry
University of Kuopio
Emeritus Professor Georg Walsh
University of Helsinki
Docent Timo Niemi
University of Helsinki
Opponent
Docent Seppo Koskinen
Department of Health and Functional Capacity
National Public Health Institute
Mannerheimintie 166, 00300 Helsinki
ISBN 951-740-261-9
ISSN 0359-3584
ISBN 951-740-264-3 (pdf)
ISSN 1458-6290
http://ethesis.helsinki.fi
Distributor: National Public Health Institute
KTL A4/2002
7R3LUMR0LUYD0HHULDQG1RRUD
,
Acknowledgments
This study was carried out at the Department of General Practice and Primary Health Care at the
University of Helsinki, and at the Department of Epidemiology and Health Promotion at the
National Public Health Institute with funds from Juho Vainio Foundation. I gratefully acknowledge
the Department of General Practice and Primary Health Care at the University of Helsinki for
providing me the opportunity to do academic research. I am very grateful to Professor Pertti Kekki,
for his extremely helpful comments, suggestions, and contribution to this work. Professor Kekki has
provided a supportive atmosphere and demonstrated the scientific process at its best. Marja
Sihvonen, Ph.D., my supervisor, deserves my appreciation for her encouragement and help at
different stages in the preparation of the research.
The Health Education Research Unit at the National Public Health Institute provided me a
productive environment in which to pursue this analysis as a full-time researcher in autumn 2001. I
thank Docent Antti Uutela, the Head of the Health Education Research Unit, for organizing
excellent facilities for the research. I¶d especially like to express my appreciation for guidance
Docent Antti Uutela gave me on specific details and problems. He has always been very supportive
of my work.
I should like to express my thanks to Docent Timo Niemi, Emeritus Professor Georg Walsh, and
Professor Heimo Viinamäki for their supervision. Their comments clarified several aspects of this
research and helped me to edit the text. I thank them warmly.
The task of writing this study in a foreign language was an especially tedious effort for me. I was
lucky to have Ewen McDonald, Doctor of Pharmacy, revise the English text. I am deeply indebted
to him for his help. This appreciation is also extended to Pilvikki Absetz, Mikko Laaksonen, and
Jorma Torppa at the National Public Health Institute for their valuable comments, help, and advice.
Many thanks go to Paul Knekt for his constructive comments on the logistic regression
methodology. I am obliged to thank Ms Marketta Taimi and Mr Jukka Lindeman for their practical
suggestions. I also wish to express my sincere thanks to my colleagues in the Helsinki Polytechnic
Institute for all their encouragement. Three months leave of absence granted by Helsinki
Polytechnic Institute was very helpful in preparing the manuscript.
Above all I wish to express my greatest debt to my wife Pirjo for her support and patience during
the times of work. To my daughters Mirva, Meeri, and Noora, I am deeply grateful for their being
with me during this three-year process.
Helsinki, February 2002 Juha Nyman
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