Fatigued driving : prevalence, risk factors and groups, and the law

Fatigue and sleepiness are major causes of road traffic accidents. However, precise data is often lacking because a validated and reliable device for detecting the level of sleepiness (cf. the breathalyzer for alcohol levels) does not exist, nor does criteria for the unambiguous detection of fatigue/sleepiness as a contributing factor in accident causation. Therefore, identification of risk factors and groups might not always be easy. Furthermore, it is extremely difficult to incorporate fatigue in operationalized terms into either traffic or criminal law. The main aims of this thesis were to estimate the prevalence of fatigue problems while driving among the Finnish driving population, to explore how VALT multidisciplinary investigation teams, Finnish police, and courts recognize (and prosecute) fatigue in traffic, to identify risk factors and groups, and finally to explore the application of the Finnish Road Traffic Act (RTA), which explicitly forbids driving while tired in Article 63. Several different sources of data were used: a computerized database and the original folders of multidisciplinary teams investigating fatal accidents (VALT), the driver records database (AKE), prosecutor and court decisions, a survey of young male military conscripts, and a survey of a representative sample of the Finnish active driving population. The results show that 8-15% of fatal accidents during 1991-2001 were fatigue related, that every fifth Finnish driver has fallen asleep while driving at some point during his/her driving career, and that the Finnish police and courts punish on average one driver per day on the basis of fatigued driving (based on the data from the years 2004-2005). The main finding regarding risk factors and risk groups is that during the summer months, especially in the afternoon, the risk of falling asleep while driving is increased. Furthermore, the results indicate that those with a higher risk of falling asleep while driving are men in general, but especially young male drivers including military conscripts and the elderly during the afternoon hours and the summer in particular; professional drivers breaking the rules about duty and rest hours; and drivers with a tendency to fall asleep easily. A time-of-day pattern of sleep-related incidents was repeatedly found. It was found that VALT teams can be considered relatively reliable when assessing the role of fatigue and sleepiness in accident causation; thus, similar experts might be valuable in the court process as expert witnesses when fatigue or sleepiness are suspected to have a role in an accident’s origins. However, the application of Article 63 of the RTA that forbids, among other things, fatigued driving will continue to be an issue that deserves further attention. This should be done in the context of a needed attitude change towards driving while in a state of extreme tiredness (e.g., after being awake for more than 24 hours), which produces performance deterioration comparable to illegal intoxication (BAC around 0.1%). Regarding the well-known interactive effect of increased sleepiness and even small alcohol levels, the relatively high proportion (up to 14.5%) of Finnish drivers owning and using a breathalyzer raises some concern. This concern exists because these drivers are obviously more focused on not breaking the “magic” line of 0.05% BAC than being concerned about driving impairment, which might be much worse than they realize because of the interactive effects of increased sleepiness and even low alcohol consumption. In conclusion, there is no doubt that fatigue and sleepiness problems while driving are common among the Finnish driving population. While we wait for the invention of reliable devices for fatigue/sleepiness detection, we should invest more effort in raising public awareness about the dangerousness of fatigued driving and educate drivers about how to recognize and deal with fatigue and sleepiness when they ultimately occur.

Psychological consequences of cancer from the salutogenic and dyadic perspective

Previous empirical research has shown that positive, i.e. salutogenic, psychological resources and social support, have health-promoting effects in stressful life situations. In the present study the associations between sense of coherence (SOC), dispositional optimism, partner support, psychological distress, and quality of life among cancer patients and their partners were examined. The data was collected from Helsinki University Central Hospital in 1997 2000 by self-report questionnaires approximately 2, 8, and 14 months post diagnosis. Participants in studies I-IV were 155, 123, 153, and 147 cancer patients and their partners, respectively. The sample of the present study consisted of physically relatively well-functioning patients, whose overall psychological wellbeing was generally good as compared to the healthy population. Partners in this study, however, reacted more strongly to their partners illness and treatment. The partners displayed e.g. higher levels of anxiety and depression than the patients. The results of this study indicated that cancer patients and their partners with strong SOC and who are optimistic report fewer symptoms of distress. Moreover, patients who display an optimistic attitude to life, who receive support from their partner, and who control how they express anger have a better quality of life. The findings also confirmed that the role of the partner is significant in coping with cancer. The symptoms of depression and anxiety in patients and partners were associated, and the partner s optimism seemed to protect also the patient from elevated levels of anxiety. The role of the partner was also highlighted in the couples anger-expression styles. The patients and partners tendency to inhibit anger was associated with decreased partner support and worse patient quality of life. Finally, in the present study we found substantial gender differences. For the patients, partner support was more significant for the women than for the men. Furthermore, for the female patients, the husband s tendency to openly express anger (anger-out) had a negative impact on their psychological quality of life, whereas the wives high anger-out seemed to predict good psychological quality of life in the men. Also, in this study the female partners reported higher levels of anxiety and depression as compared to the male partners. The results of the present study extend the previous literature on positive psychological resources and psychological wellbeing among cancer couples. Furthermore, these findings support the theory on SOC and optimism as health-promoting factors. However, the construct of SOC seems to include other important elements besides optimism. The findings of this study are applicable in designing new rehabilitation programmes for cancer patients and their partners.

Nuorten kokema yksinäisyys ja sen yhteys tulevaisuusorientaatioon

The aim of this study was to examine 1) how much and how adolescents experience loneliness, 2) how they orientate to the future, 3) are loneliness experiences and future attitudes associated with self-esteem and 4) are loneliness experiences associated with future orientation. The data (n=172) was collected in September 2003 and it consisted of 9th grade students living in countryside and city. The research was quantitative questionnaire study and it was statistically analysed. So far the problem of loneliness has not been noticed enough. People experience loneliness when there is discrepancy between actual and desired levels of interpersonal contact. In adolescence loneliness is quite common because young people go through the crises of human relationships and identity. In adolescence the meaning of friends and fellows increases and the relationship with parents changes. Future orientation becomes meaningful in adolescence because young people have to make realistic choices concerning their future life. In this study almost every adolescent had someone to be with and talk to. However 19% of adolescents experienced loneliness. Lonely adolescents experienced lack of friendships and fellowships. Lonely adolescents also felt that they left outside of others and that they were alone. Boys experienced more often lack of friendships and fellowships than girls. Girls experienced that they left more often outside and that they were more often alone than boys. Adolescents living in city experienced a little more loneliness experiences than adolescents living in countryside. Lonely adolescents had also difficulties to make social relationships and they experienced loneliness also related with parents. Lonely adolescents had also weak self-esteem. Adolescents orientated to the future mainly positively. The most important future target was health and the least important target was the universal peace and problems solving of the world. Adolescents believed that they affect to their future mainly by themselves and they planed their future about 5-10 years ahead. For adolescents it was important to have education and work to the future. In the future it was also important to have a lifelong companion and own family. For most of the young people it was also important to keep up social relationships and realize him/herself. Adolescents thought high standard of living and money also quite important things in the future. Girls preferred different future targets more important than boys. For the boys only money and high standard of living were more important than for girls. 18% of adolescents had pessimistic attitude to the future. For pessimistic adolescents many future targets were less important than for the adolescents having affirmative or optimistic attitude for the future. Adolescents who had pessimistic attitude to the future had also weak self-esteem. For the lonely adolescents it was not so important 1) to keep up social relationships and realize themselves in the future. Lonely adolescents did not prefer 2) lifelong companion and own family as important as other young people. Also 3) others acceptance and appreciation were not so important for lonely adolescents. 4) Travelling was also more insignificant for lonely than for others. Lonely adolescents future attitudes were quite pessimistic. Parent related loneliness explained future targets insignificance and pessimistic attitude for the future the most. The experience of loneliness seems to be associated with future orientation in many cases. That s why it is important to pay attention to adolescents loneliness experiences. Loneliness is real and serious problem which threats health. Thus we need to examine further loneliness in adolescence and as a result of that it is possible to develop and use interventions to help lonely adolescents to orientate positively to their future.

"Kyllähän täällä tehdään kaikenlaista laidasta laitaan..." : Nuorten työpajatoiminta ja oppiminen työpajoilla työharjoittelijoiden kokemana

Workshops can be seen as a one kind of occupational model in the field of the social employing. The objective of social employing is to support the employment of those persons who are in a weak labour market position and to maintain their ability to function. The objectives of the workshops, which are offering work experience and learning of life management, maintain the same goal as social employment. Workshop services in Finland are relatively little scientifically studied in spite of their fairly long history. The workshop as a concept is still quite sparsely defined and also an unknown occupational model to the large part of people. The starting point for this study was to clarify what the workshops are like, what the services are like and how learning can be seen from the point of view of the workshop services. The objective of this study was to analyse how the apprentices experience the workshop services as well as learning in the workshops and thus describe how the workshops are shaped at the youth workshops. According to earlier studies the apprentices have experienced the workshops as useful periods in their lives and also they believe that other people in society appreciate the experience that apprentices have been received from the workshops. This study can be described as a qualitative study. Its methodological foundation is in phenomenology and especially in existential phenomenology. The research material consisted of seven individual interviews and two group interviews. In the group interviews five apprentices were those who had also participated in the individual interviews and one apprentice who did not participate. The interviewees' ages were between 17-22 years. The interviews were carried out as semi-structured interviews. The method which was utilised in the analysis of the research material is developed by Juha Perttula (2000). This analyse method is based on existential phenomenology. The apprentices considered that significant experiences in the workshop services were the entry to the workshop, the form of activity of the workshop, workshop community, the achieving of life management and work experience, the understanding of the significance of the education and the planning of the future. Regarding to learning the attitude, on-the-job learning, the importance of the mentors, the new information and new skills achieved were significant experiences at the workshop for the apprentices. The apprentices' experiences reflect well the achievement of the objectives which are set for the workshop services. Results of this study are also compatible to the results of earlier studies of apprentices' positive experience of the workshop services. The results can be utilised in developing the workshop services to offer more versatile experiences than before and to improve learning conditions on the workshops. The arranging of the on-the-job learning and the significance of the actions of mentors should also be noticed.

Pellon pientareelta akateemisiin sfääreihin : Opettajuuden rakentuminen ja muuttuminen sotienjälkeisessä Suomessa opettajien omaelämäkertojen valossa

From the field to the academic sphere how teachers professional identities and roles have changed in post-war Finland This study explores teacher autobiographies. The span of the writings extends mainly from the Second World War to the new millennium. The autobiographers are mostly elementary and secondary school teachers in Finland, although there are a few who have worked in vocational schools, polytechnic institutes or one of the various adult education centres. The researcher is aware of the diversity among those educational institutions and their teachers, but wanted to concentrate on similarities rather than differences. The autobiographers have been explored with four different research questions in view. The first was to identify professional and personal elements and themes mentioned by teachers in writing about themselves. The second was to identify the factors that have affected those elements and themes. The third was to examine the kinds of literary forms teachers used in their autobiographies. The fourth was the most crucial and an endeavour to connect the previous questions: how teachers professional identities and roles have changed during the period studied. In the first five chapters the teachers voices come through clearly. Two of these chapters are organized in chronological order. The first is about childhood, youth and the time spent in school, the second deals with the years studying in university or teachers college and finally being recruited to the teachers. In these chapters the rural background of many teachers stands out, an issue that also emerged symbolically or de facto in the autobiographies. The chronological scheme changes to a thematic order, in which social matters (students, parents, colleagues) and teachers working circumstances are dealt with. Four selected autobiographies are examined closely. In these autobiographies five different types of teacher narratives can be identified. To begin with, teachers stressed their vocation, which is quite a normal work orientation for those working in the educational field. Others emphasised how they were looking for professional development; a few wrote about personal advancement as well. There are also narratives by teachers who simply drifted into the profession of teaching, while a few teachers felt unwelcome in their own schools. As for the changes that teachers have witnessed, there are also some themes that are widely shared. Most pointed out how the teacher has become more foster parent than educator, as real parents have withdrawn from their responsibilities of raising children. This theme was frequently broached, although attitude towards it and ways of handling the phenomenon differed substantially. Teachers also stressed how their profession has lost the aura and prestige it once had. At the same time teachers are being expected to collaborate more with their colleagues, which is not in line with the centuries-old tradition of working alone. Teachers seem to be in a state of flux, buffeted by elements of stability and change interacting simultaneously. Many teachers are demanding a re-examination of their working reality. Teachers long and intimate relationship with society and the state may be at a crossroads. Key words: teachers professional identity and role, autobiographical study, post-war Finland

Kotitaloustaidon ulottuvuuksia : Analyysi kotitaloustaidosta eksistentialistis-hermeneuttisen fenomenologian valossa

DOMESTIC SKILLS AS THE ART OF EVERYDAY LIFE. An inquiry about domestic skills as a way of being-in-the-world in the light of existentialist-hermeneutics phenomenology. This study focuses on analyzing domestic skills in a phenomenological manner. The description phenomenological emerges from the interpretation process, which originates from the ontological question of domestic skills. The ontological question of how domestic skills are directs one s phenomenological gaze to the experiencing of domestic skills, rather than merely viewing their action or technical aspects. Along with the ontological question, the axiological question of what the meaning of domestic skills is drives the analysis. This study is both theoretical and philosophical. Phenomenology is the guiding philosophy, theory and methodology of the inquiry. Existentialist-hermeneutics is the emphasis which most appropriately describes the phenomenological attitude adopted within the analysis. Martin Heidegger s philosophy of being and Maurice Merleau-Ponty s philosophy of the lived body essentially form the theoretical base for the inquiry. The analysis reveals domestic skills within a core of Care and the Other. Care and the Other are anchored both in Heidegger s analysis of Dasein and in Merleau-Ponty s analysis of the reversible being-in-the-world. The social nature of being and the action-oriented intentionality of the lived body are embodied in Care and the Other. This ontological base of domestic skills enables us to see the extensions that inhabit in it. These extensions are redoing, emotional experiencing, adapting and emancipating. The analysis connects ability and action, which is why domestic skills and household activity must be seen as a united whole. This united whole is not the matter of the two components of the phenomenon, but is rather the matter of domestic skills as a way of being-in-the-world. Domestic skills are a channel for the phenomenon Home Economics to manifest in our lives. This is the gaze that presents domestic skills as to be like the poetry of everyday life. The main result of the study is the elucidation of the ontology of domestic skills and the naming of its extensions. This growth of philosophical understanding makes it possible to strengthen the science of home economics.

Dialogisuus ja kohtaaminen : Tutkimus kristillisten koulujen toimintakulttuurista kasvatussuhteen näkökulmasta

The main focus of this research was to describe the educational purpose of Christian schools within their operation culture. The Christian schools founded in Finland can be seen as part of a greater movement in Europe. In this research the dialogue and encounter in the educational scheme of Finnish Christian schools were examined by asking three research questions: 1. What is the nature of the dialogue in education in Finnish Christian schools? 2. How do the teachers describe themselves as educators? 3. What are the special characteristics in the operation culture of a Christian school? The educational relationship was regarded as fundamental and in the background reflected the absolute value of each student. Communication skills were viewed as essential in the building of relationships, which also included emotion communication skills as a broader view. The teachers expressed their comprehension of the meaning of the dialogue in the building of a relationship with practical examples. Students learned to understand one another's experiences by discussion and listening to one another. The values that created a connection were mutual appreciation, honesty, taking the other one into account, and the ability for empathy. Caring was regarded as a relationship between people, as well as a genuine mutual encounter, in which all parties would listen to one another and be heard by others. The respondents thought that individual attention and time were the keys to reaching well-being and an encounter. Students' commitment to the community was supported by mutual agreements, identifying with the common world, and encounters. The appearance of Christian love agape was named as the basis for an educational relationship. The answers emphasised shared everyday life at school. According to the teachers, the willingness for personal growth enabled encounters, although growth as such was often regarded as difficult. Cognitive emphasising and emotional experiencing from a dynamic perspective, were the means by which students' ethical understanding was comprehended. The teachers named three key factors to create a confidential relationship: a respectful attitude, courage, and genuineness. Within the school operational environment, a sense of community was emphasised, in which each student was taken into account individually. The active role of parents was an essential part of the school culture. The administration of the schools appeared committed. The additional pressure in school work came from efforts to ensure the official status of the school, as well as the large amount of administrative work involved in a private school. According to the research data, there was no evidence to support any elitism that is often associated with private schools.

Yhteinen käsityö peruskoulun 7. luokalla : Opettajien kokemuksia yhteisen käsityön opetuksesta ja organisoinnista

Finnish education politics presume that basic education should be equal to all students. While organising craft education equality can be understood as similarity or as possibility to choose. The possibility to be able to choose whether textile or technical craft despite of one´s gender has been the aim of laws and curriculums already over 30 years. In practice it´s almost impossible to students to ignore feminine and masculine roles that go deep into our culture. Choosing craft has been divided by gender, which is the reason why possibility to choose has not been good enough to educationalists of equality. The latest guidelines for the National core curriculum for bacis education were issued in 2004. According to curriculum craft education consists parts of both technical and textile craft. All students should take part in both sectors of crafts. Furthermore, one can be given a possibility to consentrate his studies in whether textile or technical craft. The curriculum does not set the rules how the education should be organised, which means that it can be organised in many ways depending on city, school or teacher. Teachers and other specialists have contradictory feelings towards shared craft education, because traditional way to see craft in Finland is to separate textile craft from technical craft. Both crafts have some common features that are introduced in curriculum. Besides there is many equal things in craft theories that bind textile and technical craft to each other. The main purpose of this research was to find out, how shared craft education has been organised at the 7.th grade in Finnish comprehensive school, and which things affect in the settlements. Second goal was to describe and compare teachers´ experiences in teaching shared craft education. Third aim of this study was how shared craft has changed craft education. I collected the research material in May 2006 by interviewing both textile and technical craft teachers who teach shared craft. The material consists of fourteen theme interviews. In the analysis of the material I used theoretic bounded document analysis. According to the research there are three different ways to organise shared craft education: 50 50-arrangement, exchanging period and project week. In the schools that carried out 50 50-arrangement teaching was realised mainly in heterogenous groups. Principals had usual a lot of authorization on how to arrange craft education, which means that their views on equality, laws and curriculum affected in the settlemets more than teachers´ opinions. Teachers´ attitudes to shared craft were mainly positive. The changing of craft education can be divided in two parts: the aims and the containings of the curriculum have changed, as well as the meaning of the craft as core subject. Teachers have been forced to decrease the containings of both textile and technical crafts. Despite of eliminations both crafts still have comprehensive containings. Teachers decided what to teach by these argumets: Students should learn some basic things or produce a certain product. Usually teachers had also a lot of experience and special intrests in crafts. According to this research there is four significant meanings for shared craft education: 1) developing readiness for doing things, 2) developing skills of thinking, 3) delight of doing things and 4) teaching attitude.

Luonnoksia käsityön ruumiillisuudesta. : Käsityö Maurice Merleau-Pontyn ruumiinfenomenologian valossa.

Purpose This study focused on craft from a standpoint of phenomenological philosophy and craft was interpreted through Maurice Merleau-Ponty’s phenomenology of the body. The main focus was the physical phase of the craft process, wherein a product is made from material. The aim was to interpret corporality in craft. There is no former research focusing on lived body in craft science. Physical, bodily making is inalienable in craft, but it is not articulated. Recent discussion has focused on craft as ”whole”, which emphasizes designing part in the process, and craft becomes conceptualized with the theories of art and design. The axiomatic yet silenced basis of craft, corporality, deserves to become examined as well. That is why this study answers the questions: how craft manifests in the light of phenomenology of the body and what is corporality in craft? Methods In this study I cultivated a phenomenological attitude and turned my exploring eye on craft ”in itself”. In addition I restrained myself from mere making and placed myself looking at the occurrence of craft to describe it verbally. I read up Maurice Merleau-Ponty’s phenomenology of the body on his principal work (2002) and former interpretations of it. Interpreting and understanding textual data were based on Gadamer’s hermeneutics, and the four-pronged composition of the study followed Koski’s (1995) version of the Gadamerian process of textual interpretation. Conclusions In the construction of bodily phenomenology craft was to be contemplated as a mutual relationship between the maker and the world materializing in bodily making. At the moment of making a human being becomes one with his craft, and the connection between the maker, material and the equipment appears as communication. Operational dimension was distinctive in the intentionality of craft, which operates in many ways, also in craft products. The synesthesia and synergy of craft were emphasized and craft as bodily practice came to life through them. The moment of making appeared as situation generating time and space, where throwing oneself into making may give the maker an experience of upraise beyond the dualism of mind and body. The conception of the implicit nature of craft knowledge was strengthened. In the light of interpretation it was possible to conceptualize craft as a performance and making ”in itself” as a work of art. In that case craft appeared as bodily expression, which as an experience approaches art without being it after all. The concept of aesthetic was settled into making as well. Bodily and phenomenological viewpoint on craft gave material to critically contemplate the concept of “whole craft” (kokonainen käsityö) and provided different kind of understanding of craft as making.

Käsityökohtaamisia muinaisuuden kanssa : Neulalla neulominen eli kinnasneulatekniikka ...muutakin kuin neulakinnas?

The aim of this study was to find out how the technique of knotless netting is perceived by the craftsperson of the twenty first century. In this study the craftspeople are represented by the researcher herself, seven craftspeople and teachers (3) teaching knotless netting as well as their students (21). The main interests of this study are the mental pictures and relationship to knotless netting that craftspeople have in the twenty first century. Points of focus are also the specific characteristics of knotless netting, as well as experimenting with new and different materials. The aim of these experiments has been to find new and unusual uses for knotless netting. Preserving knotless netting as a craft and technique are also questions dealt with in this study. The methodology of this study is a qualitative and phenomenographic study of several cases. The data collected are interviews of the teachers, observations in two knotless netting courses, questionnaires answered by the students in these courses and experimental samples made by the author and evaluated by other craftspeople. These samples were made during the years 2005-2008. The interviews, questionnaires and evaluations were conducted under winter and spring 2008. The reference literature is comprised from publications in several different fields. In this study ethnography is the most dominant field of reference due to the fact that knotless netting is so strongly linked to history and antiquity. In the past the technique of knotless netting has been passed down from generation to generation in whatever form the teacher has known. There are many different ways of stitching and binding in knotless netting. This technique is closely connected to traditional knotless netting mittens even today. Nowadays knotless knitting is taught in craft schools, evening classes and in other recreational courses. The concrete understanding of knotless netting by means of two-dimensional instructions is challenging. Craftspeople often require somebody to actually demonstrate the correct way to make the stitches and hold the work before they can proceed with the technique. The way knotless netting is perceived by craftspeople is linked to their backgrounds and preconstructed mental images concerning the technique. An etnographer approaches knotless netting in a different way from a crafts-scientist or a person in an evening class wishing to master the technique. The attitude of the teacher is passed on to students and also affects the way the student perceives knotless netting and its possibilities as a technique. A craftsperson has mixed feelings toward knotted netting. On the other hand the surfaces produced by this rare technique are intriguing but the costs due to the slow manufacturing process are seen as an encumbrance.

Tekstiilikulttuurisen lukutaidon edistäminen museoissa

Purpose: The study focuses on the question, how to advance textile cultural interpretation skills in museum. The theme was actual, because there have been many workshops in different kind of museums, which have raised textile into important role of their museum pedagogy. The knowing of nature of textile materials was highlighted in former studies as the most crucial thing in craft. That is reason for choosing textile to study. The theoretical approach of study was particularized to the meanings which have been given to craft during recent ten years. Furthermore the composition of textile culture and transmitting textile cultural heritage were examined throug the theory. The finnish museum as a place for learning, as well as the contens of museum pedagogy, were analyzed. The fundamental approach to study was cultural research and art education. Methods: The methodological approach was theory-based theme interview. Before interviewing informants the charting was made by using literature, interviews and observation, to find out the most important themes within subject. Specialists were interviewed personally and results were sent to them by e-mail for further comments. There were 8 informants and they were chosen with intentional sampling from different kind of museums, from teacher education and among craft teachers. Research material was analyzed with content analysis by using deductive reasoning. Conclusions: The study revealed that there are three strategies in advancing textile cultural interpretation. The most remarkable strategies are 1) making acquaintance of materials and working with them, 2) getting exiting events with posibilities to use one s whole body and 3) getting textile cultural knowledge by using for example discovery - style learning. In practice those strategies were mixed, which also was considered advisable. Another conclusion the study revealed, is the desirable, acceptable attitude not only to the craft with creative, free beginning but also to the craft made like its model in museum. Learning from model can be felt as a very moving experience, like a journey in time. The side result of the study was the importance of collaboration of museums and schools in advancing textile cultural interpretation skills as well as significance of using internet in collaboration and relations.

Reformin implementaatio - Michael Fullanin teoriaan perustuva muutosteoreettisten tekijöiden sisällönanalyyttinen tarkastelu Kelpo-kehittämistoiminnan kunnallisten koordinaattoreiden puheessa

The educational reform, launched in Finland in 2008, concerns the implementation of the Special Education Strategy (Opetusministeriö 2007) under an improvement initiative called Kelpo. One of the main proposed alterations of the Strategy relates to the support system of comprehensive school pupils. The existed two-level model (general and special support) is to be altered by the new three-level model (general, intensified and special support). There are 233 municipalities involved nationwide in the Kelpo initiative, each of which has a municipal coordinator as a national delegate. The Centre for Educational Assessment [the Centre] at the University of Helsinki, led by Professor Jarkko Hautamäki, carries out the developmental assessment of the initiative’s developmental process. As a part of that assessment the Centre interviewed 151 municipal coordinators in November 2008. This thesis considers the Kelpo initiative from Michael Fullan’s change theory’s aspect. The aim is to identify the change theoretical factors in the speech of the municipal coordinators interviewed by the Centre, and to constitute a view of what the crucial factors in the reform implementation process are. The appearance of the change theoretical factors, in the coordinators’ speech, and the meaning of these appearances are being considered from the change process point of view. The Centre collected the data by interviewing the municipal coordinators (n=151) in small groups of 4-11 people. The interview method was based on Vesala and Rantanen’s (2007) qualitative attitude survey method which was adapted and evolved for the Centre’s developmental assessment by Hilasvuori. The method of the analysis was a qualitative theory-based content analysis, processed using the Atlas.ti software. The theoretical frame of reference was grounded on Fullan’s change theory and the analysis was based on three change theoretical categories: implementation, cooperation and perspectives in the change process. The analysis of the interview data revealed spoken expressions in the coordinators’ speech which were either positively or negatively related to the theoretical categories. On the grounds of these change theoretical relations the existence of the change process was observed. The crucial factors of reform implementation were found, and the conclusion is that the encounter of the new reform-based and already existing strategies in school produces interface challenges. These challenges are particularly confronted in the context of the implementation of the new three-level support model. The interface challenges are classified as follows: conceptual, method-based, action-based and belief-based challenges. Keywords: reform, implementation, change process, Michael Fullan, Kelpo, intensified support, special support

Uskonnonopetuksen tunnustuksellisuus koulun kiistakysymyksenä : Evankelinen herätysliike oppivelvollisuuskoulun kristillisyyden asialla 1912-1926

In the early years of independence the Finnish school system went through a major change. Both the Compulsory school attendance act (1921) and the Religious freedom act (1923) were legislated almost simultaneously. Although the legislators were deciding on the whole content of the citizenship education given in the compulsory school, their attention was mainly concentrated on the issue of the religious education. The former study concerning the subject shows that this issue was strongly influenced by the political power struggle between the conservative and the socialist parties. One of the underlying factors was also the Church s decreased authority concerning the elementary school. The aim of this research was to study the Finnish evangelical movement s attitude and opinions on the issue of religious education and on its status and nature. Their opinions on the issue were especially investigated from the point of view of their own evangelical lower elementary school teachers seminar, which was deeply connected with the matter of confessionalism. The source material of this research of educational history consist of documents of the school administration and the Lutheran Evangelical Association as well as of vast collection of educational, Church s and evangelical movement s journals. According to the results of this study, the evangelical movement plead very strongly for denominational religious education. However, the confessionalism they were pursuing differed from the common understanding of the concept at that time. This became evident both because of their demands for increased education on the Christian doctrine and because of their sharp criticism against loosely confessional, generally Christian religious education. The evangelical movement s strict opinion was combined with their effort to emphasize the Lutherian doctrine in the Evangelical Lutheran Church in Finland. The founding of the Evangelical seminar for lower elementary school teachers in Karkku was a significant indication of the evangelical movement s dedication to strive towards school s Christianity. The objective of the evangelical seminar was to change the school by means of training evangelical minded teachers. The seminar was only a part of much larger plans of evangelical education and home missionary work. However, maintaining the seminar proved to be impossible, especially as the National Board of Education was absolutely against it, claiming that it would endanger the unity of the compulsory school. The National Board of Education indicated that the objectivity of citizenship education would be forfeit, if every marginal ideological movement could educate their own teachers.

Oral Health among Iranian Preadolescents : A School-Based Health Education Intervention

The present study assessed oral health and its determinants among Iranian preadolescents, and evaluated a school-based health education programme aimed to promote their oral health. The target population of this study comprised a random sample of the third-grade school children (n = 459) of all public primary schools in 19 areas of Tehran city. The data came from a clinical examination of the children and two self-administered questionnaires: one for children, and one for mothers. The clinical dental examination was performed for recording children's oral health. The mothers' questionnaires covered background factors, oral self-care (OSC) behaviours and oral health-related knowledge and attitude statements. After baseline data collection, a community trial was designed as a 3-month school-based intervention study. For the intervention trial, the third-grade classes as the clusters were randomly assigned to the intervention and control groups. Three kinds of intervention were implemented, one in class, one via the parents, and one as a combination of these. One group served as controls with no intervention. The outcome measures of the study were changes in plaque and bleeding scores recorded. The results showed that mean dmft was 3.75 (SD = 2.8) for the primary teeth and mean DMFT was 0.4 (SD = 0.9) for the permanent teeth. All children had plaque on at least one index tooth and bleeding on probing in at least one index tooth occurred in 81%. About one-third (34%) of the children reported favourable OSC and less than half (46%) of the children reported brushing their teeth at least twice daily. Girls reported favourable OSC (OR = 2.0), had decay-free teeth (OR = 1.8) and treated permanent teeth (OR = 3.3) more than did boys. Mother's oral health-related aspects, i.e., mother's favourable OSC, high knowledge levels of and positive attitudes towards oral health, and active supervision of the child's tooth brushing had a positive effect on all aspects of children's oral health status and behaviours (ORs from 1.3 to 1.9). After the intervention, the results showed a strong intervention effect on healthy gingiva in both groups where parents were involved: the parental-aid group (OR = 7.7, 95% CI 2.2-27.7) and combined group (OR = 6.6, 95% CI 2.0-22.1). To improve children's oral health, community school-based oral health educational programmes should be established to include all primary schools. These programmes should benefit from the common risk factor approach and a multi-sectored approach to employ for communication between the community, the school, and the family. Oral health interventions should empower the parents' ability to improve their own oral health behaviour and then to transfer that healthy behaviour to their children.

Konsumerismi, potilaiden ja kuluttajien aktiivinen toiminta sekä erityisesti lääkäreiden kokemukset ja näkemykset potilaista kuluttajina

Consumerism emphasises the patient s position and freedom of choice. Consumerism is being promoted by a range of phenomena occurring in society and health care. Different actors hold different views on the patient as a consumer and on his or her participation. Consumer demand is created outside the patient physician relationship and the commercialisation of services generates new expectations with respect to physician s work. More and more patients may be interested in adopting a more equal position in the care relationship, and trying to negotiate with the physician or to even dictate how he or she should be cared for. In Finland, very little research has been conducted on patients and consumers organising themselves at national system level, patients as choosers, and physicians attitudes to various consumerist phenomena or the choice made by the patient. In the empirical data for this study, the term consumer-patient refers to active consumers and patients making choices related to their clinical care prior to a physician s diagnosis. Consumer-patients are also represented by consumer and patient organisations and movements. The main research question is: How do physicians regard the care choice made by the patient? This question is addressed from a perspective encompassing patients and consumers organised activities and individuals active behaviour in health care as well as physicians experiences and their views on patients as consumers making choices related to their care. The first part (Study I), examines the patient organisation field, information sources used including the websites of such organisations, files from Finland s Slot Machine Association, RAY, a survey conducted by a Finnish television news department and interviews of patient organisations. Based on observation and a physician survey, Study II examines physicians attitudes to the idea that patients could obtain information through consumer movements about physicians care practices before seeking medical care. Studies III−IV use a physician survey to examine physicians attitudes to direct-to-consumer-advertising of prescription drugs (DTCA) and their experiences and views of patient requests related to treatments and examinations. Study V uses comparative surveys to examine the attitudes of health care professionals and the population to the introduction of new technologies in health care, using genetic screenings and tests as an example. The number of patient organisations increased, with a particular escalation as of the 1990s. The characteristics and operating methods of the organisations varied greatly. Physicians organisations adopted a negative or neutral attitude towards the consumer movements idea of distributing information on care practices, whereas individual physicians attitudes were slightly more positive. Physicians regarded direct-to-consumer-advertising of prescription drugs as negative, but took a more permissive attitude towards indirect advertising. More than every third physician considered drug advertisements in general to be harmful or useless in the distribution of drug information to patients or consumers. More than half of physicians conducting patient work reported that they (very) often encountered patients who stated upon arrival for a consultation that they wanted specific treatments or examinations, and that the number of such situations had increased. Such situations were viewed as positive with regard to the care relationship by every fifth physician and as negative by two fifths. Physicians justified a reserved attitude to the patients consumer role by referring to their medical expertise and position as care decision-makers, the patient physician relationship and the public health care system. Reasons for a positive attitude included the patient s participation and co-operation, the patient physician relationship and the patient s knowledge. Professionals were more reserved than lay people about the introduction and extension of genetic technologies in health care. A significant minority of the physicians did not take a clear pro or con attitude to the patients consumer role or to the use of new technologies in health care. The physicians age, gender, place of work and specialisation influenced their attitudes to the patient s consumer role, and private physicians viewed it in a more positive light than those working in public health care. Active consumer-patients challenge the society to hold a discussion of the patient s choice, participation in care decision-making and participation in health care policy in general. Their transformation into customers and consumers implies not only a new division of individuals roles and powers, but also contributes to changing relationships between system level roles: between citizens and the state and between public and private health care. This phenomenon raises various issues related to health care policy. In conclusion, topics are presented for discussion, practical measures and further research. Keywords: health care, consumerism, distribution of technologies, commercialisation, physicians, patients, consumers, patient s choice, patient s role.