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- Maandi, Peeter, 1975-
(författare)
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Change and Persistence in a Reformed Landscape : A geographical analysis of land reforms and landscape change in Muhu and Rapla municipalities, Estonia, c. 1840 to 2003
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A land reform is usually introduced to create conditions for change, either in agriculture or in the character of landownership. Since the middle of the 19th century, numerous radical land reforms have been implemented in rural Estonia, often at times of political and social upheaval. The aim of this thesis is to examine the influence of land reforms upon the landscape, in two case study areas: the territories of the present-day rural municipalities of Muhu and Rapla.Through cartographical analyses, field observations, and interviews with residents in the case study areas, the thesis focuses upon the geography of change and persistence in property structures and the material landscape, from the mid-19th century to the present. At the local level, the implementation of a land reform is likely to meet the resistance of the material structures of the landscape and the existing organization of land use and land rights. Some spatial structures, created in the past, tend to persist into the post-reform situation. There are several possible reasons behind their persistence: the structures are difficult to change, they maintain a function also in the post-reform situation, or they survive because of neglect.The thesis shows that the recurrent reforms help to explain not only what changes in the landscape and the property structure. The reforms also help to explain why some landscape features persist, at specific locations. The thesis also demonstrates that people made use of the persistence in the landscape during the Soviet period, in order to preserve the memory of the pre-Soviet property structure. Following Estonian re-independence in 1991, the land, which was nationalized in 1940, became re-privatised, partly through restitution. This has shed a new light upon the substance of change and persistence, not least in the landscape.
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| 2. |
- Norlin, Anna-Karin, 1977-
(författare)
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Exploring the Biopsychosocial Model in Irritable Bowel Syndrome : with emphasis on stress, comorbidities and fatigue
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundIrritable bowel syndrome (IBS) is a common, chronic, relapsing, and sometimes disabling, symptombased disorder of gut brain interactions. It has got a female predominance and occurs in all ages, with a slight decrease among elderly. The IBS symptoms can affect everyday work and social life in addition to an increased use of health care resources. Most IBS patients are diagnosed and helped in primary health care (PHC). For many patients, available treatment is insufficient. It is known that both extraintestinal symptoms such as fatigue, as well as comorbidities such as mood disorders, chronic pain syndromes, and insomnia contribute to the illness burden, often to a larger extent than the gastrointestinal symptoms as such.Even though the pathophysiology of IBS is not completely known, it is now conceptualized as a disorder of altered brain-gut interactions, where a biopsychosocial model helps in understanding the symptoms. Exposure to stress is thought to play an important role overall in the pathology of IBS, as well as immune activation at least in a subgroup of patients.This thesis aimed to gain deeper understanding of the biopsychosocial mechanisms of IBS and its associations with stress, comorbidities, and fatigue.Methods Study I and II are based on the Twin cities IBS study population, which included IBS patients and a control group of other patients without gastrointestinal complaints from ten PHC centres in the county of Östergötland. Alongside demographics, psychosocial questionnaires and a GI symptom diary, it included analyses of hair cortisol concentrations (HCC) evaluated in study I, and data on self-rated health as well as diagnoses of comorbidities, and number of health care contacts from a regional registry, evaluated for study II.Study III of this thesis is based on the Brain-Gut study with a population of secondary care IBS patients, and healthy controls (HC). It included self-rated measures of fatigue impact on the daily life and early adverse life events, as well as measures of circulating TNF-α, and analyses of resting-state functional magnetic resonance imaging of brain areas within a mesocorticolimbic circuitry of known relevance for fatigue.Results Study I: Perceived stress was higher in the IBS group while a considerable portion of IBS patients had low levels of HCC. No association between perceived stress and HCC was seen in either group.Study II: IBS patients had lower self-rated health and more PHC utilization than the non-IBS patients. Good self-rated health was independently associated with younger age, higher sense of coherence and less gastrointestinal pain in both groups. In IBS, PHC utilization was associated with comorbidities in general, and sleep disorders in particular.Study III: Fatigue impact on daily life, and TNF- α were higher in IBS patients than in HC. In IBS, further an association was seen between fatigue impact on the one hand, and TNF- α, emotional abuse in childhood, as well as altered mesocorticolimbic connectivity on the other.Conclusion In conclusion this thesis firstly emphasizes that IBS patients in many ways, including health outcomes, consists a vulnerable group of PHC patients. We add evidence for a possible suppression of the stress response system in a substantial portion of IBS patients.Further, comorbid sleep disorders seem to be particularly associated with excess PHC utilization in IBS and could possibly be a target for treatment interventions. Moreover, alongside treating gastrointestinal pain, efforts to improve the individuals’ sense of coherence could be one way to achieve better self-rated health in both IBS and non-IBS patients.Finally, we suggest that fatigue in IBS is associated with immune activation, central alterations and to some extend also previous childhood trauma.
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| 3. |
- Peil, Tiina, 1967-
(författare)
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Islescapes : Estonian small islands and islanders through three centuries
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis applies a modification of the concept of landscape to embody physical settings, social behaviour and affixed meanings. The argument focuses on both how a specific environment was created as well as perceived on four Estonian islands from the late seventeenth century until the present. Islands have clear natural boundaries, and thus they comprise well-defined entities. Physical environment is seen as an important factor in the formation of home and identity. Island life in Estonia was on the background of complicated power relations dominated by foreign ruling classes less restricted, and historically the islanders had better opportunities for gaining a livelihood. They were thus part of a common Baltic Sea world often passed by in native Estonian research, which has concentrated on mainland farming traditions. Living conditions on the islands were drastically changed by Soviet occupation after the Second World War when they came to belong to the strictly regulated border area towards the West. The occupation is seen as a focal point of the thesis lending it a before and after perspective. The local variation was great and therefore island communities and landscapes are critically examined in a long-term perspective focusing on settlement history, the outward signs of belonging to a place (kinship, way of doing things, skills, dialect, humour, traditions) and on landscape biography. It is argued that constant change was accommodated in the mental picture, but an abrupt one caused an idealisation of national cultural values. The mythical elements are examined after first establishing the content of the islescapes of home and of popular islescapes of the 1930s. At present, people are in the process of renewing contacts and revising their islescapes of memory and imagination into possible futures.
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