Kivaa ja hyödyllistä, mutta jo se riittää : Yläasteen kielikylpyoppilaiden käsityksiä ruotsinkielisestä kielikylpyopetuksesta Helsingissä

The aim of this study was to find out how immersion students experience immersion education, how they feel about the implementation of immersion education methods and what role immersion plays in immersion students’ lives outside the school context. In addition, the influence of sex, grade level, school and type of immersion education on students’ perceptions was studied. The population included all students at the lower secondary level in Helsinki who participated in Swedish immersion education during 2002–2003. The sample consisted of 128 students who represented two different forms of immersion: 47% of the students had previously participated in early total immersion while 53 % of the students had taken part in early partial immersion. The data were gathered through a questionnaire and interviews. All 128 students answered the questionnaire, and 10 students were chosen to focus interviews through purposive sampling. In addition, students’ parents were invited to fill in a questionnaire where students’ background information was requested. The data were collected during the spring of 2003. Principal Component Analysis and one-way variance analysis were used as statistical analysis methods. Also frequencies, average, correlations and cross tabs were studied. In the PCA a right-angled varimax-rotation was performed separately to every thematic entity that arose from the theoretical background. Sum variables were formed from the Principal Components by summing up all the items that received over .400 charges for the specific Principal Component. Significance testing of the mean was performed with F and t-tests. Results indicate that immersion students in lower secondary school experience immersion quite diversely as a whole. Students are satisfied with the fact that they are in the immersion class but not with the amount of teaching in Swedish. Students feel it is very important and useful to learn Swedish bearing in mind their future studies and working life. The students estimate their language skills to be very high. Yet they prefer using Finnish during classes. The fact that teachers use Swedish does not considerably affect how well the students learn the factual content in various subjects, especially if the student knows Swedish well. Theoretical subjects seemed to cause most problems. Swedish played only a very small part in students’ lives outside the school context and it was used merely when travelling abroad and in different kinds of guiding situations. Unless the students were talked to in Swedish, they kept on speaking Finnish. When asked about students’ experiences no statistically significant differences between sexes were found in this study. On the contrary, in some cases their grade level but especially their school and form of immersion had clear statistically significant differences on students’ perceptions.

Functional and work disability and treatment received by patients with major depressive disorder

This study is one part of a collaborative depression research project, the Vantaa Depression Study (VDS), involving the Department of Mental and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry of the Peijas Medical Care District (PMCD), Vantaa, Finland. The VDS includes two parts, a record-based study consisting of 803 patients, and a prospective, naturalistic cohort study of 269 patients. Both studies include secondary-level care psychiatric out- and inpatients with a new episode of major depressive disorder (MDD). Data for the record-based part of the study came from a computerised patient database incorporating all outpatient visits as well as treatment periods at the inpatient unit. We included all patients aged 20 to 59 years old who had been assigned a clinical diagnosis of depressive episode or recurrent depressive disorder according to the International Classification of Diseases, 10th edition (ICD-10) criteria and who had at least one outpatient visit or day as an inpatient in the PMCD during the study period January 1, 1996, to December 31, 1996. All those with an earlier diagnosis of schizophrenia, other non-affective psychosis, or bipolar disorder were excluded. Patients treated in the somatic departments of Peijas Hospital and those who had consulted but not received treatment from the psychiatric consultation services were excluded. The study sample comprised 290 male and 513 female patients. All their psychiatric records were reviewed and each patient completed a structured form with 57 items. The treatment provided was reviewed up to the end of the depression episode or to the end of 1997. Most (84%) of the patients received antidepressants, including a minority (11%) on treatment with clearly subtherapeutic low doses. During the treatment period the depressed patients investigated averaged only a few visits to psychiatrists (median two visits), but more to other health professionals (median seven). One-fifth of both genders were inpatients, with a mean of nearly two inpatient treatment periods during the overall treatment period investigated. The median length of a hospital stay was 2 weeks. Use of antidepressants was quite conservative: The first antidepressant had been switched to another compound in only about one-fifth (22%) of patients, and only two patients had received up to five antidepressant trials. Only 7% of those prescribed any antidepressant received two antidepressants simultaneously. None of the patients was prescribed any other augmentation medication. Refusing antidepressant treatment was the most common explanation for receiving no antidepressants. During the treatment period, 19% of those not already receiving a disability pension were granted one due to psychiatric illness. These patients were nearly nine years older than those not pensioned. They were also more severely ill, made significantly more visits to professionals and received significantly more concomitant medications (hypnotics, anxiolytics, and neuroleptics) than did those receiving no pension. In the prospective part of the VDS, 806 adult patients were screened (aged 20-59 years) in the PMCD for a possible new episode of DSM-IV MDD. Of these, 542 patients were interviewed face-to-face with the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Version 2.0. Exclusion criteria were the same as in the record-based part of the VDS. Of these, 542 269 patients fulfiled the criteria of DSM-IV MDE. This study investigated factors associated with patients' functional disability, social adjustment, and work disability (being on sick-leave or being granted a disability pension). In the beginning of the treatment the most important single factor associated with overall social and functional disability was found to be severity of depression, but older age and personality disorders also significantly contributed. Total duration and severity of depression, phobic disorders, alcoholism, and personality disorders all independently contributed to poor social adjustment. Of those who were employed, almost half (43%) were on sick-leave. Besides severity and number of episodes of depression, female gender and age over 50 years strongly and independently predicted being on sick-leave. Factors influencing social and occupational disability and social adjustment among patients with MDD were studied prospectively during an 18-month follow-up period. Patients' functional disability and social adjustment were alleviated during the follow-up concurrently with recovery from depression. The current level of functioning and social adjustment of a patient with depression was predicted by severity of depression, recurrence before baseline and during follow-up, lack of full remission, and time spent depressed. Comorbid psychiatric disorders, personality traits (neuroticism), and perceived social support also had a significant influence. During the 18-month follow-up period, of the 269, 13 (5%) patients switched to bipolar disorder, and 58 (20%) dropped out. Of the 198, 186 (94%) patients were at baseline not pensioned, and they were investigated. Of them, 21 were granted a disability pension during the follow-up. Those who received a pension were significantly older, more seldom had vocational education, and were more often on sick-leave than those not pensioned, but did not differ with regard to any other sociodemographic or clinical factors. Patients with MDD received mostly adequate antidepressant treatment, but problems existed in treatment intensity and monitoring. It is challenging to find those at greatest risk for disability and to provide them adequate and efficacious treatment. This includes great challenges to the whole society to provide sufficient resources.

Depression, Anxiety, Psychiatric Comorbidity and Dimensions of Temperament and Personality

This study is part of the Mood Disorders Project conducted by the Department of Mental Health and Alcohol Research, National Public Health Institute, and consists of a general population survey sample and a major depressive disorder (MDD) patient cohort from Vantaa Depression Study (VDS). The general population survey study was conducted in 2003 in the cities of Espoo and Vantaa. The VDS is a collaborative depression research project between the Department of Mental Health and Alcohol Research of the National Public Health Institute and the Department of Psychiatry of the Peijas Medical Care District (PMCD) beginning in 1997. It is a prospective, naturalistic cohort study of 269 secondary-level care psychiatric out- and inpatients with a new episode of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) MDD. In the general population survey study, a total of 900 participants (300 from Espoo, 600 from Vantaa) aged 20 70 years were randomly drawn from the Population Register Centre in Finland. A self-report booklet, including the Eysenck Personality Inventory (EPI), the Temperament and Character Inventory Revised (TCI-R), the Beck Depression Inventory and the Beck Anxiety Inventory was mailed to all subjects. Altogether 441 participants responded (94 returned only the shortened version without TCI-R) and gave their informed consent. VDS involved screening all patients aged 20-60 years (n=806) in the PMCD for a possible new episode of DSM-IV MDD. 542 consenting patients were interviewed with a semi-structured interview (the WHO Schedules for Clinical Assessment in Neuropsychiatry, version 2.0). 269 patients with a current DSM-IV MDD were included in the study and further interviewed with semi-structured interviews to assess all other axis I and II psychiatric diagnoses. Exclusion criteria were DSM-IV bipolar I and II, schizoaffective disorder, schizophrenia or another psychosis, organic and substance-induced mood disorders. In the present study are included those 193 (139 females, 54 males) individuals who could be followed up at both 6 and 18 months, and their depression had remained unipolar. Personality was investigated with the EPI. Personality dimensions associated not only to the symptoms of depression, but also to the symptoms of anxiety among general population and in depressive patients, as well as to comorbid disorders in MDD patients, supporting the dimensional view of depression and anxiety. Among the general population High Harm Avoidance and low Self-Directedness associated moderately, whereas low extraversion and high neuroticism strongly with the depressive and anxiety symptoms. The personality dimensions, especially high Harm Avoidance, low Self-Directedness and high neuroticism were also somewhat predictive of self-reported use of health care services for psychiatric reasons, and lifetime mental disorder. Moreover, high Harm Avoidance associated with a family history of mental disorder. In depressive patients, neuroticism scores were found to decline markedly and extraversion scores to increase somewhat with recovery. The predictive value of the changes in symptoms of depression and anxiety in explaining follow-up neuroticism was about 1/3 of that of baseline neuroticism. In contrast to neuroticism, the scores of extraversion showed no dependence on the symptoms of anxiety, and the change in the symptoms of depression explained only 1/20 of the follow-up extraversion compared with baseline extraversion. No evidence was found of the scar effect during a one-year follow-up period. Finally, even after controlling for symptoms of both depression and anxiety, depressive patients had a somewhat higher level of neuroticism (odds ratio 1.11, p=0.001) and a slightly lower level of extraversion (odds ratio 0.92, p=0.003) than subjects in the general population. Among MDD patients, a positive dose-exposure relationship appeared to exist between neuroticism and prevalence and number of comorbid axis I and II disorders. A negative relationship existed between level of extraversion and prevalence of comorbid social phobia and cluster C personality disorders. Personality dimensions are associated with the symptoms of depression and anxiety. Futhermore these findings support the hypothesis that high neuroticism and somewhat low extraversion might be vulnerability factors for MDD, and that high neuroticism and low extraversion predispose to comorbid axis I and II disorders among patients with MDD.

Long-term Outcome of DSM-IV Major Depressive Disorder in Psychiatric Care

Much of what we know regarding the long-term course and outcome of major depressive disorder (MDD) is based on studies of mostly inpatient tertiary level cohorts and samples predating the era of the current antidepressants and the use of maintenance therapies. In addition, there is a lack of studies investigating the comprehensive significance of comorbid axis I and II disorders on the outcome of MDD. The present study forms a part of the Vantaa Depression Study (VDS), a regionally representative prospective and naturalistic cohort study of 269 secondary-level care psychiatric out- and inpatients (aged 20-59) with a new episode of DSM-IV MDD, and followed-up up to five years (n=182) with a life-chart and semistructured interviews. The aim was to investigate the long-term outcome of MDD and risk factors for poor recovery, recurrences, suicidal attempts and diagnostic switch to bipolar disorder, and the association of a family history of different psychiatric disorders on the outcome. The effects of comorbid disorders together with various other predictors from different domains on the outcome were comprehensively investigated. According to this study, the long-term outcome of MDD appears to be more variable when its outcome is investigated among modern, community-treated, secondary-care outpatients compared to previous mostly inpatient studies. MDD was also highly recurrent in these settings, but the recurrent episodes seemed shorter, and the outcome was unlikely to be uniformly chronic. Higher severity of MDD predicted significantly the number of recurrences and longer time spent ill. In addition, longer episode duration, comorbid dysthymic disorder, cluster C personality disorders and social phobia predicted a worse outcome. The incidence rate of suicide attempts varied robustly de¬pending on the level of depression, being 21-fold during major depressive episodes (MDEs), and 4-fold during partial remission compared to periods of full remission. Although a history of previous attempts and poor social support also indicated risk, time spent depressed was the central factor determining overall long-term risk. Switch to bipolar disorder occurred mainly to type II, earlier to type I, and more gradually over time to type II. Higher severity of MDD, comorbid social phobia, obsessive compulsive disorder, and cluster B personality disorder features predicted the diagnostic switch. The majority of patients were also likely to have positive family histories not exclusively of mood, but also of other mental disorders. Having a positive family history of severe mental disorders was likely to be clinically associated with a significantly more adverse outcome.

Recognition, comorbidity, and outcome of DSM-IV bipolar I and II disorders in psychiatric care

This study is part of an ongoing collaborative bipolar research project, the Jorvi Bipolar Study (JoBS). The JoBS is run by the Department of Mental Health and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital (HUCH), Espoo, Finland. It is a prospective, naturalistic cohort study of secondary level care psychiatric in- and outpatients with a new episode of bipolar disorder (BD). The second report also included 269 major depressive disorder (MDD) patients from the Vantaa Depression Study (VDS). The VDS was carried out in collaboration with the Department of Psychiatry of the Peijas Medical Care District. Using the Mood Disorder Questionnaire (MDQ), all in- and outpatients at the Department of Psychiatry at Jorvi Hospital who currently had a possible new phase of DSM-IV BD were sought. Altogether, 1630 psychiatric patients were screened, and 490 were interviewed using a semistructured interview (SCID-I/P). The patients included in the cohort (n=191) had at intake a current phase of BD. The patients were evaluated at intake and at 6- and 18-month interviews. Based on this study, BD is poorly recognized even in psychiatric settings. Of the BD patients with acute worsening of illness, 39% had never been correctly diagnosed. The classic presentations of BD with hospitalizations, manic episodes, and psychotic symptoms lead clinicians to correct diagnosis of BD I in psychiatric care. Time of follow-up elapsed in psychiatric care, but none of the clinical features, seemed to explain correct diagnosis of BD II, suggesting reliance on cross- sectional presentation of illness. Even though BD II was clearly less often correctly diagnosed than BD I, few other differences between the two types of BD were detected. BD I and II patients appeared to differ little in terms of clinical picture or comorbidity, and the prevalence of psychiatric comorbidity was strongly related to the current illness phase in both types. At the same time, the difference in outcome was clear. BD II patients spent about 40% more time depressed than BD I patients. Patterns of psychiatric comorbidity of BD and MDD differed somewhat qualitatively. Overall, MDD patients were likely to have more anxiety disorders and cluster A personality disorders, and bipolar patients to have more cluster B personality disorders. The adverse consequences of missing or delayed diagnosis are potentially serious. Thus, these findings strongly support the value of screening for BD in psychiatric settings, especially among the major depressive patients. Nevertheless, the diagnosis must be based on a clinical interview and follow-up of mood. Comorbidity, present in 59% of bipolar patients in a current phase, needs concomitant evaluation, follow-up, and treatment. To improve outcome in BD, treatment of bipolar depression is a major challenge for clinicians.

Suicidal behaviour in bipolar disorder

The Jorvi Bipolar Study (JoBS) is a collaborative ongoing bipolar research project between the Department of Mental Health and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital (HUCH), Espoo, Finland. The JoBS is a prospective, naturalistic cohort study of secondary level care psychiatric out-and inpatients with a new episode of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) bipolar disorder (BD). Altogether, 1630 patients (aged 18-59) years were screened using the Mood Disorder Questionnaire (MDQ) for a possible new episode of DSM-IV BD. 490 patients were interviewed with semi-structured interview [the Structured Clinical Interview for DSM-IV Disorders, research version with Psychotic Screen (SCID-I/P)]. 191 patients with new episode of DSM-IV BD were included in the bipolar cohort study. Psychiatric comorbidity was evaluated using semi-structured interviews. At 6- and 18-month follow-up, the interviews were repeated and life-chart methodology was used to integrate all available information about nature and duration of all different phases. Suicidal behaviour was examined both at intake and follow-up by psychometric scale [Scale for Suicidal Ideation (SSI)], interviewer s questions and medical and psychiatric records. The aim of this thesis was to evaluate prevalence of suicidal behaviour and incidence of suicide attempts, and examine the wide range of risk factors for attempted suicide both, at intake and follow-up, in representative secondary-level sample of psychiatric in- and outpatients with BD. In this study suicidal behaviour was common among psychiatric patients with BD. During the episode when patients were included into cohort study (index episode), 20% of the patients had attempted suicide and 61% had suicidal ideation. Severity of depressive episode and hopelessness were independent risk factors for suicidal ideation, whereas hopelessness, comorbid personality disorder and previous suicide attempt predicted suicide attempts during the index episode. There were no differences in prevalence of suicidal behaviour between bipolar I and II disorder; the risk factors were overlapping but not identical. During the index episode, suicide attempts took place during depressive, mixed and depressive mixed phases. Furthermore, there were marked differences regarding level of suicidal ideation during different phases, with the highest levels during the mixed phases of the illness. Hopelessness was independently associated with suicidal behaviour during the depressive phase. A subjective rating of severity of depression (Beck Depression Inventory) and younger age predicted suicide attempts during mixed phases. During the 18-month follow-up 20% of patients attempted suicide. Previous suicide attempts, hopelessness, depressive phase at index episode and younger age at intake were independent risk factors for suicide attempts during follow-up. Taken altogether, 55% patients attempted suicide before index episode, during index episode or during follow-up. The incidence of suicide attempts was 37-fold during combined mixed and depressive mixed states and 18-fold during major depressive phase as compared with other phases. Prior suicide attempt and time spent in combined mixed phases - mixed and depressive mixed - and depressive phases independently predicted the suicide attempt during follow-up. More than half of the patients have attempted suicide during their lifetime, a finding which highlights the public health importance of suicidal behaviour in bipolar disorder. Clinically, it is crucial to recognize BD and manage the mixed and depressive phases of bipolar patients fast and effectively, as time spent in depressive and mixed phases involves a remarkably high risk of suicide attempts.

Depressive Disorders in Primary Health Care

The Vantaa Primary Care Depression Study (PC-VDS) is a naturalistic and prospective cohort study concerning primary care patients with depressive disorders. It forms a collaborative research project between the Department of Mental and Alcohol Research of the National Public Health Institute, and the Primary Health Care Organization of the City of Vantaa. The aim is to obtain a comprehensive view on clinically significant depression in primary care, and to compare depressive patients in primary care and in secondary level psychiatric care in terms of clinical characteristics. Consecutive patients (N=1111) in three primary care health centres were screened for depression with the PRIME-MD, and positive cases interviewed by telephone. Cases with current depressive symptoms were diagnosed face-to-face with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P). A cohort of 137 patients with unipolar depressive disorders, comprising all patients with at least two depressive symptoms and clinically significant distress or disability, was recruited. The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), medical records, rating scales, interview and a retrospective life-chart were used to obtain comprehensive cross-sectional and retrospective longitudinal information. For investigation of suicidal behaviour the Scale for Suicidal Ideation (SSI), patient records and the interview were used. The methodology was designed to be comparable to The Vantaa Depression Study (VDS) conducted in secondary level psychiatric care. Comparison of major depressive disorder (MDD) patients aged 20-59 from primary care in PC-VDS (N=79) was conducted with new psychiatric outpatients (N =223) and inpatients (N =46) in VDS. The PC-VDS cohort was prospectively followed up at 3, 6 and 18 months. Altogether 123 patients (90%) completed the follow-up. Duration of the index episode and the timing of relapses or recurrences were examined using a life-chart. The retrospective investigation revealed current MDD in most (66%), and lifetime MDD in nearly all (90%) cases of clinically significant depressive syndromes. Two thirds of the “subsyndromal” cases had a history of major depressive episode (MDE), although they were currently either in partial remission or a potential prodromal phase. Recurrences and chronicity were common. The picture of depression was complicated by Axis I co-morbidity in 59%, Axis II in 52% and chronic Axis III disorders in 47%; only 12% had no co-morbidity. Within their lifetimes, one third (37%) had seriously considered suicide, and one sixth (17%) had attempted it. Suicidal behaviour clustered in patients with moderate to severe MDD, co-morbidity with personality disorders, and a history of treatment in psychiatric care. The majority had received treatment for depression, but suicidal ideation had mostly remained unrecognised. The comparison of patients with MDD in primary care to those in psychiatric care revealed that the majority of suicidal or psychotic patients were receiving psychiatric treatment, and the patients with the most severe symptoms and functional limitations were hospitalized. In other clinical aspects, patients with MDD in primary care were surprisingly similar to psychiatric outpatients. Mental health contacts earlier in the current MDE were common among primary care patients. The 18-month prospective investigation with a life-chart methodology verified the chronic and recurrent nature of depression in primary care. Only one-quarter of patients with MDD achieved and maintained full remission during the follow-up, while another quarter failed to remit at all. The remaining patients suffered either from residual symptoms or recurrences. While severity of depression was the strongest predictor of recovery, presence of co-morbid substance use disorders, chronic medical illness and cluster C personality disorders all contributed to an adverse outcome. In clinical decision making, beside severity of depression and co-morbidity, history of previous MDD should not be ignored by primary care doctors while depression there is usually severe enough to indicate at least follow-up, and concerning those with residual symptoms, evaluation of their current treatment. Moreover, recognition of suicidal behaviour among depressed patients should also be improved. In order to improve outcome of depression in primary care, the often chronic and recurrent nature of depression should be taken into account in organizing the care. According to literature management programs of a chronic disease, with enhancement of the role of case managers and greater integration of primary and specialist care, have been successful. Optimum ways of allocating resources between treatment providers as well as within health centres should be found.

Suicidal ideation and attempts among psychiatric patients with major depressive disorder

This study is part of an ongoing collaborative research and development project, the Vantaa Depression Study (VDS), between the National Public Health Institute, Helsinki and the Department of Psychiatry of Helsinki University Hospital (HUCH), Peijas hospital, Vantaa. The VDS is a prospective, naturalistic cohort study of 269 secondary-level care psychiatric out- and inpatients with a new episode of DSM-IV major depressive disorder (MDD). 269 patients (Nmales=72, Nfemales=197) with a current DSM-IV MDD were interviewed with semistructured interviews to assess all other psychiatric diagnoses. At 6- and 18-month follow-up the interviews were repeated. Suicidal behaviour was investigated both at intake and follow-up by using a psychometric scale (Scale for Suicidal Ideation) and interviewer's questions as well as the patient's psychiatric records. Patients, who reported suicidal ideation while entering the study were followed up weekly, and their level of suicidal ideation, hopelessness, anxiety and depression was measured. In this study suicidal ideation was common among psychiatric patients with MDD. Almost 60% of the depressed patients reported suicidal ideation and 15% of patients attempted suicide at the baseline. Patients with suicidal ideation or attempts had a clearly higher level of overall psychopathology than non-suicidal patients. During the 18-month follow-up period 8% of patients attempted suicide. The risk of an attempt was markedly higher (RR=7.54) during an episode of major depression compared with a period of remission. Suicide attempt during the follow-up period was predicted by lack of partner, a history of previous suicide attempts and time spent in depression. Suicidal ideation resolved for most of the suicidal patients during the first 2 to 3 months. The duration of suicidal ideation was longer for patients with an initially higher level of psychopathology. Declines both in depression and hopelessness independently predicted the subsequent decline in suicidal ideation. They both could have a causal role in reversing the suicidal process. Thus effective treatment of depression is a credible measure in suicide prevention. Patients with suicidal behaviour often received more antidepressants and had more frequent appointments with mental health professionals than non-suicidal patients. Suicidal patients had also more favourable attitudes towards antidepressant treatment and comparable adherence to treatment than those not suicidal. This study does not support the conception that patient attitudes or adherence to treatments would be a factor differentiating suicidal patients from non-suicidal. Instead, problems with adherence or attitudes seem to be generic to all psychiatric care.

Kokonaisvaltainen fysiikanopetus peruskoulussa fysiikan valinnaiskurssilla

Holistic physics education in upper secondary level based on the optional course of physics Keywords: physics education, education, holistic, curriculum, world view, values A physics teacher s task is to put into practice all goals of the curriculum. Holistic physics education means in this research teaching, in which the school s common educational goals and the goals particular to the physics curriculum are taken into account. These involve knowledge, skills and personal value and attitude goals. Research task was to clarify how the educational goals involving student s values and attitudes can be carried out through the subject content of physics. How does the physics teacher communicate the modern world view through the content of the physics class? The goal of this research was to improve teaching, to find new points of view and to widen the perspective on how physics is taught. The teacher, who acted also as a researcher, planned and delivered an optional course where she could study the possibilities of holistic physics education. In 2001-2002 ten girls and two boys of the grade 9th class participated in that elective course. According to principles of action research the teacher-researcher reflected also on her own teaching action. Research method was content analysis that involved both analyzing student feedback, and relevant features of the teacher s knowledge, which are needed for planning and giving the physics lessons. In this research that means taking into account the subject matter knowledge, curriculum, didactic and the pedagogical content knowledge of the teacher. The didactic includes the knowledge of the learning process, students motivation, specific features of the physics didactics and the research of physics education. Among other things, the researcher constructed the contents of the curriculum and abstracted sentences as keywords, from which she drew a concept map. The concept maps, for instance, the map of educational goals and the mapping of the physics essence, were tools for studying contents which are included in the holistic physics education. Moreover, conclusions were reached concerning the contents of physics domains by which these can be achieved. According to this research, the contents employing the holistic physics education is as follows: perception, the essence of science, the development of science, new research topics and interactions in physics. The starting point of teaching should be connected with the student s life experiences and the approach to teaching should be broadly relevant to those experiences. The teacher-researcher observed and analyzed the effects of the experimental physics course, through the lens of a holistic physics education. The students reported that the goals of holistic physics education were achieved in the course. The discourses of the students indicated that in the experimental course they could express their opinions and feelings and make proposals and evaluations. The students had experiences about chances to affect the content of the course, and they considered the philosophical physics course interesting, it awakened questions, increased their self-esteem and helped them to become more aware of their world views. The students analytic skills developed in the interactive learning environment. The physics teacher needs broad knowledge for planning his or her teaching, which is evaluated in this research from contents maps made for the tools of the teaching. In the holistic physics education the teacher needs an open and curious mind and skills for interaction in teaching. This research indicates the importance of teaching physics in developing attitudes and values beside substance of the physics in class environment. The different points of view concerning human beings life make it possible to construct the modern world view of the students and to develop analytic skills and the self-esteem and thus help them in learning. Overall and wide points of view also help to transfer knowledge to practice. Since such contents is not employed by teaching the physics included in the standard curriculum, supplement relevant teaching material that includes such topics are needed.

Routine Measurement of Health-Related Quality of Life in Assessing Cost-Effectiveness in Secondary Health Care

Aims: The aims of this study were 1) to identify and describe health economic studies that have used quality-adjusted life years (QALYs) based on actual measurements of patients' health-related quality of life (HRQoL); 2) to test the feasibility of routine collection of health-related quality of life (HRQoL) data as an indicator of effectiveness of secondary health care; and 3) to establish and compare the cost-utility of three large-volume surgical procedures in a real-world setting in the Helsinki University Central Hospital, a large referral hospital providing secondary and tertiary health-care services for a population of approximately 1.4 million. Patients and methods: So as to identify studies that have used QALYs as an outcome measure, a systematic search of the literature was performed using the Medline, Embase, CINAHL, SCI and Cochrane Library electronic databases. Initial screening of the identified articles involved two reviewers independently reading the abstracts; the full-text articles were also evaluated independently by two reviewers, with a third reviewer used in cases where the two reviewers could not agree a consensus on which articles should be included. The feasibility of routinely evaluating the cost-effectiveness of secondary health care was tested by setting up a system for collecting HRQoL data on approximately 4 900 patients' HRQoL before and after operative treatments performed in the hospital. The HRQoL data used as an indicator of treatment effectiveness was combined with diagnostic and financial indicators routinely collected in the hospital. To compare the cost-effectiveness of three surgical interventions, 712 patients admitted for routine operative treatment completed the 15D HRQoL questionnaire before and also 3-12 months after the operation. QALYs were calculated using the obtained utility data and expected remaining life years of the patients. Direct hospital costs were obtained from the clinical patient administration database of the hospital and a cost-utility analysis was performed from the perspective of the provider of secondary health care services. Main results: The systematic review (Study I) showed that although QALYs gained are considered an important measure of the effectiveness of health care, the number of studies in which QALYs are based on actual measurements of patients' HRQoL is still fairly limited. Of the reviewed full-text articles, only 70 reported QALYs based on actual before after measurements using a valid HRQoL instrument. Collection of simple cost-effectiveness data in secondary health care is feasible and could easily be expanded and performed on a routine basis (Study II). It allows meaningful comparisons between various treatments and provides a means for allocating limited health care resources. The cost per QALY gained was 2 770 for cervical operations and 1 740 for lumbar operations. In cases where surgery was delayed the cost per QALY was doubled (Study III). The cost per QALY ranges between subgroups in cataract surgery (Study IV). The cost per QALY gained was 5 130 for patients having both eyes operated on and 8 210 for patients with only one eye operated on during the 6-month follow-up. In patients whose first eye had been operated on previous to the study period, the mean HRQoL deteriorated after surgery, thus precluding the establishment of the cost per QALY. In arthroplasty patients (Study V) the mean cost per QALY gained in a one-year period was 6 710 for primary hip replacement, 52 270 for revision hip replacement, and 14 000 for primary knee replacement. Conclusions: Although the importance of cost-utility analyses has during recent years been stressed, there are only a limited number of studies in which the evaluation is based on patients own assessment of the treatment effectiveness. Most of the cost-effectiveness and cost-utility analyses are based on modeling that employs expert opinion regarding the outcome of treatment, not on patient-derived assessments. Routine collection of effectiveness information from patients entering treatment in secondary health care turned out to be easy enough and did not, for instance, require additional personnel on the wards in which the study was executed. The mean patient response rate was more than 70 %, suggesting that patients were happy to participate and appreciated the fact that the hospital showed an interest in their well-being even after the actual treatment episode had ended. Spinal surgery leads to a statistically significant and clinically important improvement in HRQoL. The cost per QALY gained was reasonable, at less than half of that observed for instance for hip replacement surgery. However, prolonged waiting for an operation approximately doubled the cost per QALY gained from the surgical intervention. The mean utility gain following routine cataract surgery in a real world setting was relatively small and confined mostly to patients who had had both eyes operated on. The cost of cataract surgery per QALY gained was higher than previously reported and was associated with considerable degree of uncertainty. Hip and knee replacement both improve HRQoL. The cost per QALY gained from knee replacement is two-fold compared to hip replacement. Cost-utility results from the three studied specialties showed that there is great variation in the cost-utility of surgical interventions performed in a real-world setting even when only common, widely accepted interventions are considered. However, the cost per QALY of all the studied interventions, except for revision hip arthroplasty, was well below 50 000, this figure being sometimes cited in the literature as a threshold level for the cost-effectiveness of an intervention. Based on the present study it may be concluded that routine evaluation of the cost-utility of secondary health care is feasible and produces information essential for a rational and balanced allocation of scarce health care resources.

Why Don't Students Talk? Causes of Foreign Language Communication Apprehension in English Classes: A Comparison of High Apprehensive and Low Apprehensive Upper Secondary Students.

OBJECTIVES. Oral foreign language skills are an integral part of one's social, academic and professional competence. This can be problematic for those suffering from foreign language communication apprehension (CA), or a fear of speaking a foreign language. CA manifests itself, for example, through feelings of anxiety and tension, physical arousal and avoidance of foreign language communication situations. According to scholars, foreign language CA may impede the language learning process significantly and have detrimental effects on one's language learning, academic achievement and career prospects. Drawing on upper secondary students' subjective experiences of communication situations in English as a foreign language, this study seeks, first, to describe, analyze and interpret why upper secondary students experience English language communication apprehension in English as a foreign language (EFL) classes. Second, this study seeks to analyse what the most anxiety-arousing oral production tasks in EFL classes are, and which features of different oral production tasks arouse English language communication apprehension and why. The ultimate objectives of the present study are to raise teachers' awareness of foreign language CA and its features, manifestations and impacts in foreign language classes as well as to suggest possible ways to minimize the anxiety-arousing features in foreign language classes. METHODS. The data was collected in two phases by means of six-part Likert-type questionnaires and theme interviews, and analysed using both quantitative and qualitative methods. The questionnaire data was collected in spring 2008. The respondents were 122 first-year upper secondary students, 68 % of whom were girls and 31 % of whom were boys. The data was analysed by statistical methods using SPSS software. The theme interviews were conducted in spring 2009. The interviewees were 11 second-year upper secondary students aged 17 to 19, who were chosen by purposeful selection on the basis of their English language CA level measured in the questionnaires. Six interviewees were classified as high apprehensives and five as low apprehensives according to their score in the foreign language CA scale in the questionnaires. The interview data was coded and thematized using the technique of content analysis. The analysis and interpretation of the data drew on a comparison of the self-reports of the highly apprehensive and low apprehensive upper secondary students. RESULTS. The causes of English language CA in EFL classes as reported by the students were both internal and external in nature. The most notable causes were a low self-assessed English proficiency, a concern over errors, a concern over evaluation, and a concern over the impression made on others. Other causes related to a high English language CA were a lack of authentic oral practise in EFL classes, discouraging teachers and negative experiences of learning English, unrealistic internal demands for oral English performance, high external demands and expectations for oral English performance, the conversation partner's higher English proficiency, and the audience's large size and unfamiliarity. The most anxiety-arousing oral production tasks in EFL classes were presentations or speeches with or without notes in front of the class, acting in front of the class, pair debates with the class as audience, expressing thoughts and ideas to the class, presentations or speeches without notes while seated, group debates with the class as audience, and answering to the teacher's questions involuntarily. The main features affecting the anxiety-arousing potential of an oral production task were a high degree of attention, a large audience, a high degree of evaluation, little time for preparation, little linguistic support, and a long duration.

Modality as portrayed in upper secondary school textbooks : A corpus-based approach

Tämän pro gradu -lopputyön aiheena on englannin kielen modaalisten apuverbien ns. ydinjoukko: will, would, can, could, shall, should, may, might ja must. Semantiikan kannalta nämä apuverbit ovat erityisen kompleksisia: niiden tulkinnassa on usein huomattavaa monivivahteisuutta, vaikka perinteiset kieliopit antavat ymmärtää niillä olevan kaksi tai kolme toisistaan selkeästi erillään olevaa merkitystä. Ne asettavatkin vieraan kielen oppimisympäristössä erityisiä haasteita. Viimeaikainen kehitys korpuslingvistiikan metodeissa on tuottanut entistä tarkempia kuvauksia siitä, miten modaalisia apuverbejä nykyenglannissa käytetään ja mihin suuntaan niiden kehitys on lyhyenkin ajan sisällä kulkenut. Tämän tutkielman tavoitteena on ollut verrata näiden uusien tutkimusten tuloksia siihen todellisuuteen, jonka englannin kielen lukiotasoinen oppimateriaali Suomessa opiskelijalle tarjoaa. Lähdin siitä, että opetussuunnitelman vaatima autenttisuus ja kommunikaativisuus kieltenopetuksessa tulisi näkyä tasapuolisena modaalisten apuverbien kohteluna. Alkuperäinen hypoteesini kuitenkin oli, että siinä miten modaalisuus ilmenee autenttisessa ympäristössä ja siinä miten se esitetään oppikirjoissa, on poikkeavuuksia. Lähestymistapani tähän tutkielmaan oli korpuslähtöinen. Valitsin kahdesta lukion kirjasarjasta ne kirjat, joissa modaaliset apuverbit mainittiin eksplisiittisesti. Skannasin jokaisen neljästä eri kirjasta löytyvän (kokonaisen) tekstin ja rakensin näistä aineksista pienen korpuksen. Tästä korpuksesta hain korpusanalyyseihin tarkoitetulla ohjelmalla kaikki lauseet, joissa esiintyi modaalisia apuverbejä. Tämän jälkeen analysoin jokaisen modaalisen apuverbin semanttisesti lauseyhteydessään. Tämän analyysin tuloksena pystyin rakentamaan taulukoita ja vertailemaan tuloksia uusimpien tutkimusten tuloksiin. Tämän tutkielman perusteella poikkeavuuksia on olemassa. Yleisesti ottaen modaalisten apuverbien keskinäinen frekvenssi oli oikean suuntainen: mitään apuverbiä ei ollut käytetty merkittävästi enemmän tai vähemmän kuin mitä viimeaikaisen tutkimuksen valossa olisi suotavaa. Sen sijaan apuverbien semanttisessa jakaumassa oli paikoin suuriakin eroja siinä, mitkä merkitykset oppikirjoissa painottuivat ja mitkä taas nykyenglannissa vaikuttaisivat olevan frekvensseiltään suurempia. Erityisesti can ja must erottuivat joukosta siinä, että oppikirjojen tarjoama kuva niiden käytöstä on päinvastainen kuin mitä voisi odottaa: can-verbin käyttö painottui selvästi tarkoittamaan ’kykyä’ eikä ’mahdollisuutta’, joka nykytutkimuksen valossa on sen pääasiallinen käyttötapa. Toisaalta must tarkoitti aineistossa ylikorostuneesti ’pakkoa’, kun se useimmiten nykyään tarkoittaa yhtä usein ’johtopäätöstä’ kuin ’pakkoa’. Lisäksi ’lupaa’ pyydettiin aineistossa merkillisen harvoin. Tulosten perusteella esitän, että oppikirjojen tekijät yleisellä tasolla luopuisivat kielioppikirjojen luutuneista käsityksistä ja uskaltaisivat altistaa opiskelijat koko modaalisten apuverbien merkityskirjolle.

The SCOTS corpus and TEFL: Discovering and Using Strategies of Spoken English in Finnish Upper Secondary Schools

Suomen koulutuspolitiikasta vastaavat viranomaiset ovat reagoineet kansainvälisten kommunikaatiotarpeiden asettamiin haasteisiin ja muuttaneet yhden lukion A-tasoisen vieraan kielen kurssin sisällön vastaamaan suullisen viestinnän tarpeita. Tutkimuksessa selvitetään, miten englannin puhestrategioita voi opettaa suomalaisille lukiolaisille ja mitä metodeja on käytettävissä puhestrategioiden oppimisen arvioimiseksi. Vastaan asettamiini kysymyksiin aikaisemman tutkimuskirjallisuuden ja englannin kielen lukio-opetuksesta keräämäni aineiston avulla. Keskeisiä elementtejä tutkielmassa ovat erityisesti pragmaattinen kompetenssi ja kolme yleisen tason puhestrategiaa (keskustelun aloittaminen, oman puheenvuoron säilyttäminen sekä keskustelun ylläpitäminen). Aineistossa on mukana 65 ensimmäisen vuosiluokan lukiolaista (luokka A ja B) Helsingistä ja Espoosta. Opetusmateriaalina on käytetty SCOTS korpusta; tarkemmin määriteltynä puhetiedosto nimeltä Conversation 20: Four secondary school girls in the North East. Tiedostossa esille tulleet, kolmeen puhestrategiaan liittyvät fraasit, sanat ja rakenteet havainnollistettiin opiskelijoille mm. AntConc - konkordanssiohjelman avulla. Opiskelijat tekivät myös kirjallisia ja suullisia harjoituksia, jotka liittyivät puhestrategioihin. Neljälle vapaaehtoiselle opiskelijalle suunnattu toinen suullinen tehtävätyyppi vapaamuotoisine keskusteluineen äänitettiin, transkriboitiin ja tuloksia arvioitiin mm. eurooppalaisen viitekehyksen avulla. Lisäksi B - luokka vastasi kyselylomakkeeseen, jossa kysyttiin heidän mielipiteitään esim. hyödyllisimmästä testioppitunnista sekä heidän osallistumishalukkuudestaan uudelle pitkän englannin kahdeksannelle syventävälle kurssille. Tutkimustulokset ovat kannustavia ja osoittavat, että puhestrategioita on mahdollista opettaa jo lukiotasolla. Vaikka tutkimuksessa käytetty lähestymistapa oli opiskelijoille osittain uusi, valtaosa heistä myönsi oppineensa uutta englannin kielen keskustelurakenteista. Lisäksi vapaaehtoisten opiskelijoiden äänitetyt ja transkriboidut keskustelut tarjoavat hyvän lähtökohdan mahdolliselle jatkotutkimukselle.

The Influence of Constantinople on Middle Byzantine Architecture (843-1204) : A typological and morphological approach at the provincial level.

The influence of the architecture of the Byzantine capital spread to the Mediterranean provinces with travelling masters and architects. In this study the architecture of the Constantinopolitan School has been detected on the basis of the typology of churches, completed by certain morphological aspects when necessary. The impact of the Constantinopolitan workshops appears to have been more important than previously realized. This research revealed that the Constantinopolitan composite domed inscribed-cross type or cross-in-square spread everywhere to the Balkans and it was assumed soon by the local schools of architecture. In addition, two novel variants were invented on the basis of this model: the semi-composite type and the so-called Athonite type. In the latter variant lateral conches, choroi, were added for liturgical reasons. Instead, the origin of the domed ambulatory church was partly provincial. One result of this study is that the origin of the Middle Byzantine domed octagonal types was traced to Constantinople. This is attested on the basis of the archaeological evidence. Also some other architectural elements that have not been preserved in the destroyed capital have survived at the provincial level: the domed hexagonal type, the multi-domed superstructure, the pseudo-octagon and the narthex known as the lite. The Constantinopolitan architecture during the period in question was based on the Early Christian and Late Antique forms, practices and innovations and this also emerges at the provincial level.

How to design educational settings to promote collaborative inquiry: Pedagogical infrastructures for technology-enhanced progressive inquiry

Strategies of scientific, question-driven inquiry are stated to be important cultural practices that should be educated in schools and universities. The present study focuses on investigating multiple efforts to implement a model of Progressive Inquiry and related Web-based tools in primary, secondary and university level education, to develop guidelines for educators in promoting students collaborative inquiry practices with technology. The research consists of four studies. In Study I, the aims were to investigate how a human tutor contributed to the university students collaborative inquiry process through virtual forums, and how the influence of the tutoring activities is demonstrated in the students inquiry discourse. Study II examined an effort to implement technology-enhanced progressive inquiry as a distance working project in a middle school context. Study III examined multiple teachers' methods of organizing progressive inquiry projects in primary and secondary classrooms through a generic analysis framework. In Study IV, a design-based research effort consisting of four consecutive university courses, applying progressive inquiry pedagogy, was retrospectively re-analyzed in order to develop the generic design framework. The results indicate that appropriate teacher support for students collaborative inquiry efforts appears to include interplay between spontaneity and structure. Careful consideration should be given to content mastery, critical working strategies or essential knowledge practices that the inquiry approach is intended to promote. In particular, those elements in students activities should be structured and directed, which are central to the aim of Progressive Inquiry, but which the students do not recognize or demonstrate spontaneously, and which are usually not taken into account in existing pedagogical methods or educational conventions. Such elements are, e.g., productive co-construction activities; sustained engagement in improving produced ideas and explanations; critical reflection of the adopted inquiry practices, and sophisticated use of modern technology for knowledge work. Concerning the scaling-up of inquiry pedagogy, it was concluded that one individual teacher can also apply the principles of Progressive Inquiry in his or her own teaching in many innovative ways, even under various institutional constraints. The developed Pedagogical Infrastructure Framework enabled recognizing and examining some central features and their interplay in the designs of examined inquiry units. The framework may help to recognize and critically evaluate the invisible learning-cultural conventions in various educational settings and can mediate discussions about how to overcome or change them.