Depression and its assessment among stroke patients and their caregivers

Approximately one-third of stroke patients experience depression. Stroke also has a profound effect on the lives of caregivers of stroke survivors. However, depression in this latter population has received little attention. In this study the objectives were to determine which factors are associated with and can be used to predict depression at different points in time after stroke; to compare different depression assessment methods among stroke patients; and to determine the prevalence, course and associated factors of depression among the caregivers of stroke patients. A total of 100 consecutive hospital-admitted patients no older than 70 years of age were followed for 18 months after having their first ischaemic stroke. Depression was assessed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), Beck Depression Inventory (BDI), Hamilton Rating Scale (HRSD), Visual Analogue Mood Scale (VAMS), Clinical Global Impression (CGI) and caregiver ratings. Neurological assessments and a comprehensive neuropsychological test battery were performed. Depression in caregivers was assessed by BDI. Depressive symptoms had early onsets in most cases. Mild depressive symptoms were often persistent with little change during the 18-month follow-up, although there was an increase in major depression over the same time interval. Stroke severity was associated with depression especially from 6 to 12 months post-stroke. At the acute phase, older patients were at higher risk of depression, and a higher proportion of men were depressed at 18 months post-stroke. Of the various depression assessment methods, none stood clearly apart from the others. The feasibility of each did not differ greatly, but prevalence rates differed widely according to the different criteria. When compared against DSM-III-R criteria, sensitivity and specificity were acceptable for the CGI, BDI, and HRSD. The CGI and BDI had better sensitivity than the more specific HRSD. The VAMS seemed not to be a reliable method for assessing depression among stroke patients. The caregivers often rated patients depression as more severe than did the patients themselves. Moreover, their ratings seemed to be influenced by their own depression. Of the caregivers, 30-33% were depressed. At the acute phase, caregiver depression was associated with the severity of the stroke and the older age of the patient. The best predictor of caregiver depression at later follow-up was caregiver depression at the acute phase. The results suggest that depression should be assessed during the early post-stroke period and that the follow-up of those at risk of poor emotional outcome should be extended beyond the first year post-stroke. Further, the assessment of well-being of the caregivers of stroke patients should be included as a part of a rehabilitation plan for stroke patients.

Language in Acquisition : Early Lexical Development and Associations between Lexicon and Grammar Findings from Full-Term and Very-Low-Birth-Weight Finnish Children

The aim was to analyse the growth and compositional development of the receptive and expressive lexicons between the ages 0,9 and 2;0 in the full-term (FT) and the very-low-birth-weight (VLBW) children who are acquiring Finnish. The associations between the expressive lexicon and grammar at 1;6 and 2;0 in the FT children were also studied. In addition, the language skills of the VLBW children at 2;0 were analysed, as well as the predictive value of early lexicon to the later language performance. Four groups took part in the studies: the longitudinal (N = 35) and cross-sectional (N = 146) samples of the FT children, and the longitudinal (N = 32) and cross-sectional (N = 66) samples of VLBW children. The data was gathered by applying of the structured parental rating method (the Finnish version of the Communicative Development Inventory), through analysis of the children´s spontaneous speech and by administering a a formal test (Reynell Developmental Language Scales). The FT children acquired their receptive lexicons earlier, at a faster rate and with larger individual variation than their expressive lexicons. The acquisition rate of the expressive lexicon increased from slow to faster in most children (91%). Highly parallel developmental paths for lexical semantic categories were detected in the receptive and expressive lexicons of the Finnish children when they were analysed in relation to the growth of the lexicon size, as described in the literature for children acquiring other languages. The emergence of grammar was closely associated with expressive lexical growth. The VLBW children acquired their receptive lexicons at a slower rate and had weaker language skills at 2;0 than the full-term children. The compositional development of both lexicons happened at a slower rate in the VLBW children when compared to the FT controls. However, when the compositional development was analysed in relation to the growth of lexicon size, this development occurred qualitatively in a nearly parallel manner in the VLBW children as in the FT children. Early receptive and expressive lexicon sizes were significantly associated with later language skills in both groups. The effect of the background variables (gender, length of the mother s basic education, birth weight) on the language development in the FT and the VLBW children differed. The results provide new information of early language acquisition by the Finnish FT and VLBW children. The results support the view that the early acquisition of the semantic lexical categories is related to lexicon growth. The current findings also propose that the early grammatical acquisition is closely related to the growth of expressive vocabulary size. The language development of the VLBW children should be followed in clinical work.

Feature integration in human vision

The earliest stages of human cortical visual processing can be conceived as extraction of local stimulus features. However, more complex visual functions, such as object recognition, require integration of multiple features. Recently, neural processes underlying feature integration in the visual system have been under intensive study. A specialized mid-level stage preceding the object recognition stage has been proposed to account for the processing of contours, surfaces and shapes as well as configuration. This thesis consists of four experimental, psychophysical studies on human visual feature integration. In two studies, classification image a recently developed psychophysical reverse correlation method was used. In this method visual noise is added to near-threshold stimuli. By investigating the relationship between random features in the noise and observer s perceptual decision in each trial, it is possible to estimate what features of the stimuli are critical for the task. The method allows visualizing the critical features that are used in a psychophysical task directly as a spatial correlation map, yielding an effective "behavioral receptive field". Visual context is known to modulate the perception of stimulus features. Some of these interactions are quite complex, and it is not known whether they reflect early or late stages of perceptual processing. The first study investigated the mechanisms of collinear facilitation, where nearby collinear Gabor flankers increase the detectability of a central Gabor. The behavioral receptive field of the mechanism mediating the detection of the central Gabor stimulus was measured by the classification image method. The results show that collinear flankers increase the extent of the behavioral receptive field for the central Gabor, in the direction of the flankers. The increased sensitivity at the ends of the receptive field suggests a low-level explanation for the facilitation. The second study investigated how visual features are integrated into percepts of surface brightness. A novel variant of the classification image method with brightness matching task was used. Many theories assume that perceived brightness is based on the analysis of luminance border features. Here, for the first time this assumption was directly tested. The classification images show that the perceived brightness of both an illusory Craik-O Brien-Cornsweet stimulus and a real uniform step stimulus depends solely on the border. Moreover, the spatial tuning of the features remains almost constant when the stimulus size is changed, suggesting that brightness perception is based on the output of a single spatial frequency channel. The third and fourth studies investigated global form integration in random-dot Glass patterns. In these patterns, a global form can be immediately perceived, if even a small proportion of random dots are paired to dipoles according to a geometrical rule. In the third study the discrimination of orientation structure in highly coherent concentric and Cartesian (straight) Glass patterns was measured. The results showed that the global form was more efficiently discriminated in concentric patterns. The fourth study investigated how form detectability depends on the global regularity of the Glass pattern. The local structure was either Cartesian or curved. It was shown that randomizing the local orientation deteriorated the performance only with the curved pattern. The results give support for the idea that curved and Cartesian patterns are processed in at least partially separate neural systems.

Tarkkaavaisuuden vaikutus puheen merkityssisällön käsittelyyn: Aivojen herätevastetutkimus

Semantic processing can be studied with semantic priming. Target words that are preceded by semantically related prime words are recognized faster and more accurately than targets preceded by unrelated prime words. Semantic priming also affects the magnitude of the N400 event-related potential. The response is smaller to a target word when it is preceded by a related than an unrelated prime word. The effect is called the N400 effect. It is not yet clear, however, how attention modulates semantic priming and the N400 effect. This study investigated how the direction of attention affects the semantic processing of speech. The N400 effect was studied in experimental conditions in which the subjects attention was directed 1) away from the speech stimuli, 2) to phonological features of the speech stimuli, and 3) to semantic features of the speech stimuli. The first aim of the study was to investigate whether the N400 effect for spoken words is dependent on attention to the auditory information. The second aim was to study the differences in the N400 effect when attention is directed to the semantic or other features of speech stimuli. The results showed an N400 effect even when attention was directed away from the speech stimuli. The N400 effect was, however, stronger in conditions during which the speech stimuli were attended. The magnitude of the behavioral semantic priming and the N400 effect did not differ between the conditions during which attention was directed to the semantic or phonological features of the words. The findings indicate that the semantic processing of spoken words is not dependent on attention to auditory information. Furthermore, the results suggest that whether or not semantic processing is relevant for the task performance does not affect the semantic processing of attended spoken words.

Self-rating scales in the assessment of current and childhood symptoms of attention deficit hyperactivity disorder in adults

Objective: Attention deficit hyperactivity disorder (ADHD) is a life-long condition, but because of its historical status as a self-remitting disorder of childhood, empirically validated and reliable methods for the assessment of adults are scarce. In this study, the validity and reliability of the Wender Utah Rating Scale (WURS) and the Adult Problem Questionnaire (APQ), which survey childhood and current symptoms of ADHD, respectively, were studied in a Finnish sample. Methods: The self-rating scales were administered to adults with an ADHD diagnosis (n = 38), healthy control participants (n = 41), and adults diagnosed with dyslexia (n = 37). Items of the self-rating scales were subjected to factor analyses, after which the reliability and discriminatory power of the subscales, derived from the factors, were examined. The effects of group and gender on the subscales of both rating scales were studied. Additionally, the effect of age on the subscales of the WURS was investigated. Finally, the diagnostic accuracy of the total scores was studied. Results: On the basis of the factor analyses, a four-factor structure for the WURS and five-factor structure for the APQ had the best fit to the data. All of the subscales of the APQ and three of the WURS achieved sufficient reliability. The ADHD group had the highest scores on all of the subscales of the APQ, whereas two of the subscales of the WURS did not statistically differ between the ADHD and the Dyslexia group. None of the subscales of the WURS or the APQ was associated with the participant's gender. However, one subscale of the WURS describing dysthymia was positively correlated with the participant's age. With the WURS, the probability of a correct positive classification was .59 in the current sample and .21 when the relatively low prevalence of adult ADHD was taken into account. The probabilities of correct positive classifications with the APQ were .71 and .23, respectively. Conclusions: The WURS and the APQ can provide accurate and reliable information of childhood and adult ADHD symptoms, given some important constraints. Classifications made on the basis of the total scores are reliable predictors of ADHD diagnosis only in populations with a high proportion of ADHD and a low proportion of other similar disorders. The subscale scores can provide detailed information of an individual's symptoms if the characteristics and limitations of each domain are taken into account. Improvements are suggested for two subscales of the WURS.

Exploring Problem Decomposition in Conceptual Design

Design embraces several disciplines dedicated to the production of artifacts and services. These disciplines are quite independent and only recently has psychological interest focused on them. Nowadays, the psychological theories of design, also called design cognition literature, describe the design process from the information processing viewpoint. These models co-exist with the normative standards of how designs should be crafted. In many places there are concrete discrepancies between these two in a way that resembles the differences between the actual and ideal decision-making. This study aimed to explore the possible difference related to problem decomposition. Decomposition is a standard component of human problem-solving models and is also included in the normative models of design. The idea of decomposition is to focus on a single aspect of the problem at a time. Despite its significance, the nature of decomposition in conceptual design is poorly understood and has only been preliminary investigated. This study addressed the status of decomposition in conceptual design of products using protocol analysis. Previous empirical investigations have argued that there are implicit and explicit decomposition, but have not provided a theoretical basis for these two. Therefore, the current research began by reviewing the problem solving and design literature and then composing a cognitive model of the solution search of conceptual design. The result is a synthetic view which describes recognition and decomposition as the basic schemata for conceptual design. A psychological experiment was conducted to explore decomposition. In the test, sixteen (N=16) senior students of mechanical engineering created concepts for two alternative tasks. The concurrent think-aloud method and protocol analysis were used to study decomposition. The results showed that despite the emphasis on decomposition in the formal education, only few designers (N=3) used decomposition explicitly and spontaneously in the presented tasks, although the designers in general applied a top-down control strategy. Instead, inferring from the use of structured strategies, the designers always relied on implicit decomposition. These results confirm the initial observations found in the literature, but they also suggest that decomposition should be investigated further. In the future, the benefits and possibilities of explicit decomposition should be considered along with the cognitive mechanisms behind decomposition. After that, the current results could be reinterpreted.

Toimintatutkimus tietokoneavusteisten opetusohjelmien hyödynnettävyydestä ammatillisessa koulutuksessa sähköalalla

Tutkimuksen tavoitteena oli tutkia tietokoneavusteisen opetuksen opetusmenetelmänä ja tietokoneavusteisten opetusohjelmien oppimateriaalina soveltuvuutta erilaisiin sähköalan ammatillisiin opetus- ja oppimistilanteisiin. Tietokoneavusteisilla opetusohjelmilla tarkoitetaan tässä tutkimuksessa erilaisia digitaaliseen muotoon tallennettuja oppimateriaaleja ja tietokoneavusteisella opetuksella näiden digitaalisten oppimateriaalien hyödyntämistä erilaisissa oppimistilanteissa. Opetusteknologian kehittymisen myötä myöskin opettajin valittavissa olevat opetusmenetelmät lisääntyvät ja monipuolistuvat. Vastaavalla tavalla myöskin oppimateriaalit kehittyvät ja mahdollistavat oppijan näkökulmasta entistä yksilöllisemmät opiskelumahdollisuudet. Tutkimuksen viitekehyksen liittyvinä keskeisinä elementteinä olivat tietokoneavusteinen opetus opetusmenetelmänä ja sen valintaan liittyvät tekijät: oppisisällöt ja oppimiselle asetetut tavoitteet, opettajan opetusmenetelmällinen osaaminen, erilaiset oppijat yksilöllisine oppimistavoitteineen sekä käytettävissä olevat erilaiset oppimateriaalit. Tutkimus toteutettiin toimintatutkimuksena ja siihen osallistui tutkijan lisäksi 15 sähköalan opettajaa kahdesta erikokoisesta ammattioppilaitoksesta. Varsinainen toimintatutkimus aloitettiin keväällä 1994 ja se jatkui kevääseen 1996. Lisäksi suoritettiin vertaileva tutkimus, johon osallistui 9 opettajaa kolmesta erillisestä ammattioppilaitoksesta syksyllä 1996 jatkuen kevääseen 1997. Keskeisimmistä tutkimustuloksista mainitsen opettajien heikon tuntemuksen tietokoneavusteisesta opetuksesta ja sen hyödyntämiseen liittyvistä elementeistä. Opettajilta puuttuu taito suunnitella tietokoneavusteisia opetusohjelmia oppimateriaaleina hyödyntäviä opetus- ja oppimistilanteita. Tutkimuksen mukaan opettajilla ei kuitenkaan ole negatiivista ennakkoasennetta opetusmenetelmää kohtaan ja opiskelijat suhtautuvat erittäin myönteisesti erilaisiin tietokoneavusteisiin opetusohjelmiin oppimateriaaleina. Avainsanat: Tietokoneavusteinen opetus, tietokoneavusteinen oppiminen, tietokoneavusteinen oppimateriaali

The effect of interrogative function on intonation in spontaneous and read Finnish

Goals This study aims to map the effect of interrogative function on the intonation of spontaneous and read Finnish. Earlier research shows that the most prominent feature in Finnish question intonation is an appeal to the listener. Question word questions typically start with a high peak which is followed by falling intonation. In yes/no questions, F0 remains on a high level until the word carrying sentence stress and then falls. Final rises are mainly found in intonation clichés such as "Ai mitä?" ("What?") These earlier results are based on read speech and enacted dialogues. In this study, questions and statements found in spontaneous dialogues were compared. These utterances were also compared with read versions of the same utterances. Fundamental frequency values were compared using a mixed model. Contours were also grouped using auditory and visual inspection. Thus it was possible to compare frequencies of contour types according to utterance type and speech style. The position of questions in the F0 distribution of the whole material was also investigated in this study. Method The material consisted of four spontaneous dialogues and their read versions. The speakers were young adults from the Helsinki metropolitan area, four females and four males. The whole material was first divided into broad dialogue function categories arising from the material and F0 curves were calculated for each category. After this, 277 questions and 244 statements were selected for closer inspection. Values reflecting F0 distribution and contour shape were measured from the F0 contours of these utterances. A mixed model was used to analyse the differences. Utterance type, question type, speech style and speaker gender were used as fixed effects. The frequencies of F0 contour types were compared using a Chi square test. Additional material in this study came from eight young female speakers in central Finland. Results and conclusions In the mixed model analysis, significant differences were found both between questions and statements and between spontaneous and read speech. Generally, utterance type affected the variables reflecting contour type while speech style affected the variables reflecting F0 distribution. The effect of question type was not clearly visible. In read speech the contours resembled earlier results more closely. Speakers had different strategies in differentiating between questions and statements. In the whole material, F0 was slightly higher in questions than in statements. The effect of dialectal background could be seen in the contour types. The results show that interrogative function affects intonation in both spontaneous and read Finnish.

Esimiestaitojen tärkeys, hallinta ja kehitystarpeet

This study examines the leadership skills in municipal organisation. The study reflects the manager views on leadership skills required. The purpose of this study was to reflect the most important leadership skills currently and in the future as well as the control of these skills. The study also examines the importance of the change and development needs of the leadership skills. In addition, the effect of background variables on evaluation of leadership skills were also examined. The quantitative research method was used in the study. The material was collected with the structured questionnaire from 324 Kotka city managers. SPSS-program was used to analyse the study material. Factor analysis was used as the main method for analysis. In addition, mean and standard deviations were used to better reflect the study results. Based on the study results, the most important leadership skills currently and in the future are associated with internet skills, work control, problem solving and human resource management skills. Managers expected the importance of leadership skills to grow in the future. Main growth is associated with the software utilisation, language skills, communication skills as well as financial leadership skills. Strongest competence according to managers is associated with the internet skills. Managers also considered to control well the skills related to employee know-how and manager networking. In addition, significant development needs are required in leadership skills. Main improvement areas were discovered in software utilisation, work control, human resource management skills as well as skills requiring problem solving. It should be noted that the main improvement areas appeared in the leadership skills that were evaluated as most important apart from software utilisation. Position, municipal segments and sex were observed to explain most of the deviation in received responses.

Ohjaukselliset käytännöt yliopisto-opintojen alkuvaiheessa : Maatalous-metsätieteellisen tiedekunnan opiskelijoiden merkitykselliset kokemukset ensimmäisen opiskeluvuoden ohjauksesta

In this Master's Thesis I study guidance practises, which facilitate first year students' integration into the university. Besides formal guidance, for example tutoring and peer tutoring, general student advising and introduction courses, I address my research to informal everyday guidance practices. I aim to highlight existing supportive practices, which are meaningful from the university students' perspective. My aim is to study what kind of guidance practises exists in university and how these practises support first year student. The aim of the guidance practises is to facilitate new university student to integrate into the academic community. I study the implementation of this aim as a development of an academic identity, which requires that students have an opportunity for guided participation in academic practises. The research is based on phenomenological-hermeneutic research tradition, and my aim is to produce information of students' everyday experiences and meanings. My informants were students of agriculture and forestry at University of Helsinki. I gathered research material utilizing the critical incident technique in 11 theme interviews, which I carried out with individuals, pairs or small groups. During interviews I asked the students to describe and evaluate their first year guidance experiences, especially those that were extreme positive or negative. Based on my research I specified four meaningful guidance practices: care of students, transparency of the practises of the learning community, presence of guidance in everyday activities of a student and communal reflection to studies. I represent the character and components of the guidance practises, and I also describe the meaning of those practises to university students. Keywords: Guidance practices, guidance, first year studies, academic community, integration, academic identity,critical incidents

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.