Early Childhood Caries and a Community Trial of its Prevention in Tehran, Iran

Varhaislapsuuden karies ja sen ehkäisy kehittyvän terveydenhuollon maassa Varhaislapsuuden karies on merkittävä kansanterveysongelma varsinkin lapsirikkaissa maissa ja väestöissä. Karieksen hoitaminen vie paljon voimavaroja ja aiheuttaa mittavia taloudellisia seuraamuksia. Karies voi ilmaantua lapselle jo vauvaikäisenä, pian ensimmäisten maitohampaiden puhjettua suuhun. Alle 3-vuotiaiden karieksesta on kuitenkin niukasti tilastotietoja. Maailman terveysjärjestökin suosittaa tietojen keräämistä vasta 3-vuotiaiden ikäryhmästä. Heistä kariesta sairastaa Suomessa 16 %, Yhdysvalloissa 25 %, Englannissa 30 %, Iranissa 46 % ja Saudi-Arabiassa 61 %. Tämä väitöstutkimus selvitti karieksen esiintymistä ja sen vaaratekijöitä 1─3-vuotiailla Teheranissa. Lisäksi tutkimus arvioi perusterveydenhuoltoon sisällytetyn karieksen ehkäisyn tuloksellisuutta. Tutkimuskohteiksi arvottiin Teheranista 18 neuvolaa. Jokaisessa oltiin 4 päivää, jolloin kaikkia rokotuksiin tulleita 1─3-vuotiaita äiteineen pyydettiin osallistumaan tutkimukseen. Kahta lukuun ottamatta kaikki äidit suostuivat, ja aineistoon tuli kaikkiaan 504 lasta äiteineen. Kaikki 1-vuotiaat, 242 lasta äiteineen, valittiin karieksen ehkäisykokeiluun. Sitä varten neuvolat jaettiin kolmeen ryhmään, joista kaksi (A ja B) oli koeryhmiä ja yksi (C) oli vertailuryhmä. Tutkimus alkoi äidin haastattelulla. Siinä selvitettiin perheen koulutus- ja tulotaso sekä lapsen ruokinnasta imetyksen kesto, yösyötöt ja päiväaikaan nautitut makeat. Vielä kysyttiin lapsen ja äidin suuhygieniatavoista ja äidin kokemuksista lapsen suun puhdistamisessa. Sitten hammaslääkäri tutki lapsen suun ja kirjasi karieksen ja hammasplakin esiintymät. Suun tutkimuksen jälkeen äiti ja lapsi siirtyivät rokotushuoneeseen. Koeryhmissä (A ja B) äidit saivat terveydenhoitajalta suunterveyttä koskevan esitteen ja kehotuksen lukea se huolellisesti. Lisäksi ryhmässä A terveydenhoitaja kertoi suun ja hampaiden terveydenhoidosta saman esitteen avulla, ja neuvolan henkilökunta muistutti suunhoidon tärkeydestä puhelimitse kahdesti seuraavan puolen vuoden kuluessa. Vertailuryhmässä äideille ei annettu suunhoidon ohjeita. Kaikissa ryhmissä äitejä muistutettiin seuraavan rokotuskerran ajankohdasta, muttei mainittu tulevaa toista hammastarkastusta. Varhaislapsuuden kariesta sairasti ikäryhmästä riippuen 3─26 % tutkituista 1─3-vuotiaista, ja 65─76 %:lla oli hammasplakkia. Äideistä 68 % harjasi hampaansa päivittäin ja 39 % puhdisti lapsensa suun päivittäin. Mitä useammin äiti harjasi omat hampaansa, sitä paremmin hän huolehti lapsen suun puhtaudesta. Rintaruokinta oli yleistä eikä lisännyt kariesvaaraa. Yöllä pullomaitoa saavilla karies oli 5 kertaa yleisempää kuin muilla. Neuvolassa saatu ohjeistus ehkäisi selvästi karieksen syntyä puolen vuoden kokeessa.

Onko varhaisen tuen päiväkoti mahdollinen? : Tutkimus varhaiskasvatuksen yhteisöllisestä kehittämisestä

Is the early childhood day care facility possible? The research considering communal development of the early education. In Finland mothers and fathers look after 400 000 pre-school children. Half of these attend day care facilities, in which 50 000 staff are employed. The aim of this research is to develop co-operation practices within the day care centre. This research refines and expands my own interest in and knowledge of day care management and content development. The basis of the research draws upon ethnographic material covering the period 1999–2005. The day care centre chosen as a central informant was the first suburban centre founded in 1963, and it provided a rich local and welfare state research perspective. It became clear that the day care facility’s co-operation practices formed the basis of bringing up children and at the same time produced a new multi-operational and multi-layered community for child participation. Adult day care centre workers bringing up the children as a professional work and solutions defining the conditions for the work are expressed in a child’s upbringing. This obviously has an impact in where as the development of communities. From the human and community scientific point of view, the group of youngest children will take up a future position as key players in communities as essential actors and reformers. The research was carried out as multiphase and multiscientific practical research and iterative data formation. The results verified that the co-operation between parents and day care staff produces important benefits for all the stakeholders. However, the day care staff has difficulties in implementing the benefits. During the research process, it became clear that conceptually day care staff saw the practices as ”very important, but not easily realised in practice”. As a result this demanded further research to address this issue and to extend this to the carefacility’s co-operation practises and their communal and social conditions. The research looks at the carefacility’s co-operation with key stakeholders. At the same time it undertakes an analytical and historical examination of carefacilitys’s with an experimental focus as two day care centres chosen as experimental objects. The results of the research showed that the benefits gained by children were determined by the day care centre’s socio-political structure and the parent’s resources. The research framework categorised early childhood education as generational and gender based structures. As part of the research, the strains endemic to these formations have been examined. The system for bringing up children was created as part of a so called welfare state project by implemented by the Day Care Act in year 1973. The law secured the subjective right for every pre-school child to have access to day care facilities. The law also introduced a labour and sosiopolitical phase and the refinement of the day care facility’s education-care concept. The latest phase that started during the early 1990´s was called the market-based social services strategy. As a result of this phase, state support was limited and the screening function of the law was relaxed. This new strategy resulted in a divisive and bureaucratic social welfare system, that individualised and segregated children and their parents, leaving some families outside the communal and welfare state benefit net. The modern day care centre is a hybrid of different aims. Children spend longer and more irregular time in day care. The families are multicultural and that requires more training for the staff. The work in day care has been enhanced, for example he level of education for the staff has been lowered and productivity has been improved. However, administrative work and different kinds of support and net work functions together with the continuous change have taken over from the work done face to face with children. Staff experiences more pressure as the management and the work load has increased. Consequently the long-term planning and daily implementation of the nuclear task of the day care facility is difficult to control. This will have an effect on both motivation and manageability of the work. Overall quality of the early childhood upbringing has been weakened. The possibilities for the near future were tested in the two day care centres chosen as an experi-ment objects. The analysis of these experiments showed that generative interaction work will benefit everyone: children, parents and employees. The main results of the research are new concepts of an early support day care centre, which can be empirically and theoretically possi-ble for development the near future. Key words: Day care facility’s co-operation practises, early childhood education as generational structure, child’s multi-operational and multi-layered community, multi-subjective operator, generative interaction work, communal composition.

Lapsi, lapsuus ja perhe varhaiskasvatusasiakirjoissa 1967-1999

The aim of this study is to describe and interpret discourses in Finnish national early childhood education and care (ECEC) documents concerning the child, childhood and family, including preschool education of six-year-old children. The study begins with preparation phase of the Act on Children s Day Care (1967) and concludes with the definition of ECEC policy (1999). The research data consists of committee memoranda and national ECEC curriculum guidelines. The total number of documents studied was 20, comprising some 1700 pages. The research data was examined with qualitative text analysis and employed a discursive approach. A semiotic square (Greimas rectangle) served as a tool for clarifying the discourses and constructions reflected in the research data. The theoretical framework of the study consists of the theories of childhood and family studies. The main concepts from childhood studies used in this study were childhood as a cultural construct and child-centred pedagogy in ECEC. The theoretical approaches from family studies used were the formation of modern and late-modern parenthood and family, as well as the concept of familism. Two main discursive lines were constructed from the ECEC documents. The notion of universalistic childhood suggests that early education and care aim to create the same good childhood for all children, regardless of their family background or living area. The second discursive line followed in the documents is the familistic discourse. This discourse contains emphasis on the priority of parental care. The construct of the competent child was found in the research data as early as in the mid-1970s. On the other hand, the construct of the weak family is distinguishable throughout almost the entire research period. This raises the question of whether Finnish ECEC system has been developed for the competent and self-sufficient child of a weak family which needs constant support and guidance of welfare experts. According to the study, it appears that within the Finnish ECEC system the relatively heavy emphasis on social work rather than on early education has been legitimised by the construct of the weak family. This study also shows that a more thorough analysis should be given to what we mean when we say that the main task of ECEC system is to support families in the upbringing of their children. The study was completed during the period when historical decisions concerning the administration in Finland were in the making (i.e. the potential transfer of ECEC services from the Ministry of Social Affairs and Health to the Ministry of Education). Also, over the past decade, a major reformation of the Act on Children s Daycare has been on the agenda, but no concrete measures have been implemented. Based on the findings of this study, we can ask for what kind of child and family we are preparing the ECEc reforms of the new millennium. Key words: ECEC policy Finland, childhood, family, familism, discourse analysis, semiotic square

"Olen enemmän alkanut pohtimaan ja sanomaan ääneen mitä ajattelen" : ammatillinen kehittyminen ja yhteisöllinen palaute päiväkodin työtiimeissä

I have more often thought over what I am thinking and also I have often told it to others - professional development and collegial feedback on kindergarten teams. The need for professional feedback surfaces year after year in enquiries made among staff members in the field of early childhood education. Because the pressure to be effective adds to the workload of the heads of kindergartens, there are few opportunities to give staff concrete feedback on a daily basis. Because peers are able to observe each other close at hand, their reciprocal feedback can compensate for that of the kindergarten head. In this study the practical training process of collegial feedback is studied and also the opportunities for feedback as a means of supporting professional development in the context of kindergarten. The development project involving the entire kindergarten community (N=21) was implemented in 2003-2004 through three developing cycles. The Johar´s Window , produced by Luft and Jung with the Model of Situational Leadership by Hersey and Blanchard, acted as a theoretical frame of reference. It has been used in this study both for its qualitative and its quantitative methods. The data were carried out through questions, interviews, diaries, written descriptions and monthly evaluations. The qualitative and quantitative methods were also used in analysing the data. The results showed that during the training process, the staff as a giver of feedback moved from the professional basic level to the professional maturity level. Their awareness of both their own and their peers´ know-how expanded from the initial state to the final state. It became evident that team size is the essential key element in the practise of giving feedback to team members. The team atmosphere and the commitment of the team members are in significant factors in the training of giving and receiving feedback. As a result of analyses, delivering feedback was grouped into three categories: developmental feedback, descriptive feedback and either supportive or destructive feedback. Receiving feedback was likewise groupped into three categories: aspiring to develop, unaccommodating and accepting. The ability to control feelings improved along with the skills of giving feedback; it was possible to analyse development through the professional development model represented in the theory of the study. The results showed that professional know-how of other kinds also developed during the process. Giving feedback among fellow workers enables team members to receive feedback everyday. Training to give feedback means examining a field of professional know-how and also formulating shared rules. The results of this study give support to previous studies that have emphasised practical training in natural circumstances. Keywords: feedback, professional development, learning at work

Kumppanuus on tiiviimpää kuin yhteistyö : Maahanmuuttajataustaisten vanhempien näkemyksiä kasvatuskumppanuudesta

The main idea of this study was to find out how immigrants understand and define successful co-operation and professional partnership in early childhood education. Another target of this research was to think over how the parents see professional partnership from their viewpoint, and how willing / ready the they are in engaging in the professional partnership with the day care personnel. The theoretical part of this research is based on theories of immigration and theories of it s different forms, theories of cultural varieties and theory of modernizing co-operation through using professional partnership. Also guidelines and policies for day care and early childhood education play a part in the theory section. Theory part is written to support research problems. The research method used in this study is peer interview. The interviewed are both immigrants and customers of day care services. The data collected is comprised of materials from peer interviews and personal background information. The interviewed were of Somalia and Russian ethnic groups. Interview were carried out in each group in the participants own mother tongue. These peer interviews showed that parents were interested and willing to discuss professional partnership. From this research one can conclude that the term professional partnership is seen as a complex term, and as a term difficult to understand. From the results it is seen that quite often the principles of professional partnership are not carried out in practise. According to the material gathered, the parents feel that lack of common language and prejudice against immigrants effectively prevents the professional partnership from being formed. The cultural differences can become challenging in a professional partnership. Based on this research, one can conclude that when different cultures meet, there has to be mutual will to understand and to be understood in order to make sure that the children s development, both educational and physical, is supported in a best possible way.

Water in Action : Encounters among 2- to 3-Year-Old Children, Adults, and Water in Day Care

In line with cultural psychology and developmental theory, a single case approach is applied to construct knowledge on how children s interaction emerge interlinked to historical, social, cultural, and material context. The study focuses on the negotiation of constraints and meaning construction among 2-to 3-year-old children, a preschool teacher, and the researcher in settings with water. Water as an element offers a special case of cultural canalization: adults selectively monitor and guide children s access to it. The work follows the socio-cultural tradition in psychology, particularly the co-constructivist theory of human development and the Network of Meanings perspective developed at the University of São Paulo. Valsiner s concepts of Zone of Free Movement and Zone of Promoted Action are applied together with studies where interactions are seen as spaces of construction where negotiation of constraints for actions, emotions, and conceptions occur. The corpus was derived at a Finnish municipal day care centre. During a seven months period, children s actions were video recorded in small groups twice a month. The teacher and the researcher were present. Four sessions with two children were chosen for qualitative microanalysis; the analysis also addressed the transformations during the months covered by the study. Moreover, the data derivation was analyzed reflectively. The narrowed down arenas for actions were continuously negotiated among the participants both nonverbally and verbally. The adults expectations and intentions were materialized in the arrangements of the setting canalizing the possibilities for actions. Children s co-regulated actions emerged in relation to the adults presence, re-structuring attempts, and the constraints of the setting. Children co-constructed novel movements and meanings in relation to the initiatives and objects offered. Gestures, postures, and verbalizations emerged from the initially random movements and became constructed to have specific meanings and functions; meaning construction became abbreviated. The participants attempted to make sense of the ambiguous (explicit and implicit) intentions and fuzzy boundaries of promoted and possible actions: individualized yet overlapping features were continuously negotiated by all the participants. Throughout the months, children s actions increasingly corresponded adults (re-defined) conceptions of water researchers as an emerging group culture. Water became an instrument and a context for co-regulations. The study contributes to discussions on children as participants in cultural canalization and emphasizes the need for analysis in early childhood education practices on the implicit and explicit constraint structures for actions.

Lapsen osallisuuden mahdollistaminen päiväkodin toimintakulttuurissa : Tilastollinen tutkimus osallisuuden tasomallista

Children s participation has been a subject in the international research since past ten years. This research has explored participation from the standpoint of the UN s Convention of the Rights of the Child and focused mainly on schoolchildren or on the working youth s chances in developing countries to have impact on their own lives (eg. Sinclair, 2004 and Thomas, 2002). In Finland there has been less research about the children s rights while the main focus has been on the customers of the child welfare system. This study examines children s participation in Helsinki metropolitan area via the views and the practices of the personnel of early childhood education. The adopted viewpoint is Shier s level model of participation (2001), in which the children s participation process is building in phases, is observed via the everyday actions of the kindergarten personnel. Attention has been paid on the special characteristics of the Finnish early childhood education. This study was part of VKK-Metro s research project. The inquiry in May 2010 was directed to all working teams in the kindergartens of the Helsinki metropolitan area. Of these 56.59 % (1116 teams) answered. The quantitative data analyzed by principal component analysis gave four principal components, from which three were named after Shier s participation model. The fourth component included variables about rules and power. The level model of participation fit well to assess early childhood education in the Helsinki metropolitan area. The professionalism of the personnel became emphasized in the area of everyday interactions between the personnel and the children. Important aspects of the children s participation are to become heard, to get support in the play and in interaction and to be able to share both power and responsibility with personnel of the early childhood education.

Opetussuunnitelmat puntarissa : Varhaiskasvatussuunnitelman perusteet 2005 ja Esiopetuksen opetussuunnitelman perusteet 2000 kasvatusnäkemyksen ja -ideologian näkökulmasta

The present study compares educational views and ideologies, especially concerning children, childhood and learning, found within two documents guiding early childhood education in Finland, Varhaiskasvatussuunnitelman perusteet 2005 and Esiopetuksen opetussuunnitelman perusteet 2000. These documents are also available in English, titled The National Curriculum Guidelines on Early Childhood Education and Care in Finland 2000 and The Core Curriculum for Pre-school Education in Finland 2005. The method used in the study was a slightly applied Bereday´s comparative method. Both documents talk of the child as weak but also as active and able to learn and develop. The child was also social, emotional and individual in both documents. In Varhaiskasvatussuunnitelman perusteet 2005 parents and social networks were emphasised more than in Esiopetuksen opetussuunnitelman perusteet 2000. Views regarding learning were mainly constructive. The aim of Esiopetuksen opetussuunnitelman perusteet 2000 seemed to be in preparing children to adulthood, whereas in Varhaiskasvatussuunnitelman perusteet 2005 the childhood had an intrinsic value. Applying Davies division, both documents were found to represent mainly romantic ideology, but conservative ideology could also be recognised, especially when the views about children and childhood were under examination. Revisionistic ideology was more apparent in Esiopetuksen opetussuunnitelman perusteet 2000 than in Varhaiskasvatussuunnitelman perusteet 2005, while democratic ideology was more dominant in the latter. Although there was a strong cohesion between these two guiding documents regarding educational views and educational ideologies, there were some traces to be found in Esiopetuksen opetussuunnitelman perusteet 2000 that pointed towards primary school tradition.

Lasten toiminnan dokumentointi varhaiskasvatuksessa

Early childhood education carries multiple experiences, activities, challenges, disappointments, achievements and encounters. Small children have difficulties to remember, piece together and pass on those experiences and feelings to their teachers or parents. The aim of this study was to examine the contex and organization of early childhood education where documentation raises and develops. Furthermore it was examined what the documentation of small children means in practice and how the teachers understood it. In this study the mixed methods have been used to expose different perspectives about the subject. Also the material was collected using several methods and is a part of two other studies. The quantitative study was made with material which included 892 randomly chosen children and their teachers from 313 daycare units in the metropolitan area of Finland. The material is a part of a Children´s agentive perception uncovered study (2010), which was carried out by the University of Helsinki. The qualitative study was made by using the material of a VKK-Metro development project, which was carried out also in the metropolitan area (2009). The analysis and the conclusions were made by using Reunamo´s theoretical model of agentive perception and Bronfenbrenner´s ecological systems theory. The angle is childcentered, constructivistic and sosioconstructivistic education. In this study a remarkable confrontation was found between the visions and the practices of the early childhood educators. The documentation was not a powerful educational tool for them and the pedagogy was not built up in a sosioconstructive way. After all it was noticeable that when the teachers got more recources and pedagogical support to the documentation of the children, they found more child-centered angel in their practices as early educators. It seemed that the teachers usally work under quite a pressure and should get more resouces to become able to develop the pedagogy. This study is useful for those who are interested in the child-centered way of working and the documentation as a pedagogical tool. It is also a good basis for further studies and for the attempts to regenerate early childhood education.

Kurkistus lapsen arkeen vuorohoidossa

Nonstandard hour child care is a subject rarely studied. From an adult's perspective it is commonly associated with a concern for child's wellbeing. The aim of this study was to view nonstandard hour child care and its everyday routines from children´s perspective. Three research questions were set. The first question dealt with structuring of physical environment and time in a kindergarten providing nonstandard hour child care. The second and third questions handled children s agency and social interaction with adults and peers. The research design was qualitative, and the study was carried out as a case study. Research material was mainly obtained through observation, but interviews, photography and written documents were used as well. The material was analysed by means of content analysis. The study suggests that the physical environment and schedule of a kindergarten providing nonstandard hour child care are similar to those of kindergartens in general. The kindergarten's daily routine enabled children s active agency especially during free play sessions for which there was plenty of time. During free play children were able to interact with both adults and peers. Children s individual day care schedules challenged interaction between children. These special features should be considered in developing and planning nonstandard hour child care. In other word, children's agency and opportunities to social interaction should be kept in mind in organising the environment of early childhood education in kindergartens providing nonstandard hour child care.

Jos olisin viisas niin siivoisin : Lasten luovat prosessit päiväkodissa

It has been found usually to talk in the early childhood education in connection with the creativity about arts and skills and about play. In this treatise, the creativity is approached besides play but also from the point of view of the creativity of the everyday. The starting point for the study is the view according to which the creativity is complex interaction between a creative person and an environment. The theoretical body of the study is the Componential theory of creativity of Amabile (1996). The process which is open and product which is new and suitable or acceptable were defined creative. In the opinion of many researchers, the creativity is a phenomenon that has determined in a certain time and place so the creativity is examined from the point of view of the social constructionism. As creative processes in the day nursery it has been defined pretend play, child´s involvement and children´s agentive perception which is based on the Children´s agentive perception theory of Reunamo (2007). The purpose of the study is to clarify how the child's personal factors and the social environment affect the creative processes of children in the day nursery. This Master's thesis is based on the Children' s agentive perception uncovered study led by Jyrki Reunamo (2010) which was carried out in the spring of 2010 in Keski-Uusimaa and in Hämeenlinna and Taiwan. From the study, a name has also been used "on the sources of Orientation", a research project and development project. The study includes the children's evaluation sector, the observation sector, the children's interview sector and the evaluation sector of the pedagogic environment. 891 Children 1-7 year-old by age participated in the study. All the sectors which belong to the study of Reunamo were utilized in this treatise and the Finnish day nurseries or preschool groups which had participated in the study were marked off as the target group. The main component analysis, sum variables, the correlation coefficients, Mann-Whitney s U-test and Kruskall-Wallas test were used for the statistical examination of the quantitative material. In this treatise it was noticed, both the personal properties of the child and a social environment, that they affected all the examined creative processes which also had a significant connection with each other statistically. The definition of creativity was filled best by the participative answers. However, the number of the participative answers was only 8% in the questions concerning adults. That raised the question whether an attempt should be made to have effect so that the children's better participation also in the interaction with the adults would be possible in the educational culture of the day nursery. In the further study, the conscious building of the social environment which supports the creativity from a social constructionism point of view could indeed be an interesting task. The treatise is suitable for an examination of the interaction between the child's person and a social environment especially from the point of view of the creativity.

Fyysinen varhaiskasvatusympäristö päiväkotien varhaiskasvatussuunnitelmissa

The National Curriculum Guidelines on Early Childhood Education and Care (ECEC) in Finland says that ECEC is developed holistically through observing children´s and the educator community´s activities and the ECEC environment. The background of this research was that assesment should be based on commonly agreed principles, which are recorded e.g. to unit-specific ECEC curriculum. The objective of this research was to investigate how unit-specific ECEC curriculums have descriped the physical indoor environment in day-care centres. According to the National Curriculum Guidelines on ECEC, there are four ways of acting that are peculiar to children: playing, physical activities, exploration and artistic experiences and self-expression. The descriptions of physical environment in unit-spesific curriculums were observed through above mentioned four ways of acting. In addition to that, the descriptions of four ways of acting were compared to each other, in order to find out, which are the main differencies and similarities in relation to physical ECEC environment. Research material was build on unit-specific ECEC curriculums from 18 day-care centres of Helsinki. Target of the research were the descriptions of physical indoor environment in curriculums.The method used in the research was theory-guided content analysis. The analyses were mainly qualitative. The descriptions of psysical environment varied widely both quantitatively and by substance. All curriculums contained mentions of playing and artistic experiences and self-expression, but mentions of physical activities and exploration were noticiably fewer. All four ways of acting were mentioned in research material in relation to premises and instruments. Also, principles related to the use of premises and instruments and other more common priciples were mentioned in relation to all ways of acting. Instead of that, children were not mentioned even once as an upholders or innovators of physical activities environment and children were mentioned only once regarding to exploration environment. All ways of acting included scenarios of e.g. that environment must provide possibilities of particular way of acting, and both materials and instruments must be available for children. Anyhow, research material did not include any principle or scenario that relates to physical environment that would have occurred in every unit-specific curriculum.