Vertigo in children

Vertigo in children is more common than previously thought. However, only a small fraction of affected children meet a physician. The reason for this may be the benign course of vertigo in children. Most childhood vertigo is self-limiting, and the provoking factor can often be identified. The differential diagnostic process in children with vertigo is extensive and quite challenging even for otologists and child neurologists, who are the key persons involved in treating vertiginous children. The cause of vertigo can vary from orthostatic hypotension to a brain tumor, and thus, a structured approach is essential in avoiding unnecessary examinations and achieving a diagnosis. Common forms of vertigo in children are otitis media-related dizziness, benign paroxysmal vertigo of childhood, migraine-associated dizziness, and vestibular neuronitis. Orthostatic hypotension, which is not a true vertigo, is the predominant type of dizziness in children. Vertigo is often divided according to origin into peripheral and central types. An otologist is familiar with peripheral causes, while a neurologist treats central causes. Close cooperation between different specialists is essential. Sometimes consultation with a psy-chiatrist or an ophthalmologist can lead to the correct diagnosis. The purpose of this study was to evaluate the prevalence and clinical characteristics of vertigo in children. We prospectively collected general population-based data from three schools and one child wel-fare clinic located close to Helsinki University Central Hospital (HUCH). A simple questionnaire with mostly closed questions was given to 300 consecutive children visiting the welfare clinic. At the schools, entire classes that fit the desired age groups received the questionnaire. Of the 1050 children who received the questionnaire, 938 (473 girls, 465 boys) returned it, the response rate thus being 89% (I). In Study II, we evaluated the 24 vertiginous children (15 girls, 9 boys) with true vertigo and 12 healthy age- and gender-matched controls. A detailed medical history was obtained using a structured approach, and an otoneurologic examination, including audiogram, electronystagmography, and tympanometry, was performed at the HUCH ear, nose, and throat clinic for cooperative subjects. In Study III, we reviewed and evaluated the medical records of 119 children (63 girls, 56 boys) aged 0-17 years who had visited the ear, nose, and throat clinic with a primary complaint of vertigo in 2000-2004. We also wanted information about indications for imaging of the head in vertiginous children. To this end, we reviewed the medical records of 978 children who had undergone imaging of the head for various indications. Of these, 87 children aged 0-16 years were imaged because of vertigo. Subjects of interest were the 23 vertiginous children with an acute deviant finding in magnetic resonance images or com-puterized tomography (IV). Our results indicate that vertigo and other balance problems in children are quite common. Of the HUCH area population, 8% of the children had sometimes experienced vertigo, dizziness, or balance problems. Of these 23% had vertigo sufficiently severe to stop their activity (I). The structured data collection approach eased the evaluation of vertiginous children. More headaches and head traumas were observed in vertiginous children than in healthy controls (II). The most common diagnoses of ear, nose, and throat clinic patients within the five-year period were benign paroxysmal vertigo of child-hood, migraine-associated dizziness, vestibular neuronitis, and otitis media-related vertigo. Valuable diagnostic tools in the diagnostic process were patient history and otoneurologic examinations, includ-ing audiogram, electronystagmography, and tympanometry (III). If the vertiginous child had neurologi-cal deficits, persistent headache, or preceding head trauma, imaging of the head was indicated (IV).

Jouko Turkan Teatterikorkeakoulun kauden yhteiskunnallinen kontekstuaalisuus vuosina 1982 - 1985

The subject of my doctoral thesis is the social contextuality of Finnish theater director, Jouko Turkka's (b. 1942) educational tenure in the Theater Academy of Finland 1982 1985. Jouko Turkka announced in the opening speech of his rectorship in 1982 that Finnish society had undergone a social shift into a new cultural age, and that actors needed new facilities like capacity, flexibility, and ability for renewal in their work. My sociological research reveals that Turkka adapted cultural practices and norms of new capitalism and new liberalism, and built a performance environment for actors' educational work, a real life simulation of a new capitalist workplace. Actors educational praxis became a cultural performance, a media spectacle. Turkka's tenure became the most commented upon and discussed era in Finnish postwar theater history. The sociological method of my thesis is to compare information of sociological research literature about new capitalist work, and Turkka's educational theater work. In regard to the conceptions of legitimation, time, dynamics, knowledge, and social narrative consubstantial changes occurred simultaneously in both contexts of workplace. I adapt systems and chaos theory's concepts and modules when researching how a theatrical performance self-organizes in a complex social space and the space of Information. Ilya Prigogine's chaos theoretic concept, fluctuation, is the central social and aesthetic concept of my thesis. The chaos theoretic conception of the world was reflected in actors' pedagogy and organizational renewals: the state of far from equilibrium was the prerequisite of creativity and progress. I interpret the social and theater's aesthetical fluctuations as the cultural metaphor of new capitalism. I define the wide cultural feedback created by Turkka's tenure of educational praxis, and ideas adapted from the social context into theater education, as an autopoietic communicative process between theater education and society: as a black box, theater converted the virtual conception of the world into a concrete form of an actor's psychophysical praxis. Theater educational praxis performed socially contextual meanings referring to a subject's position in the social change of 1980s Finland. My other theoretic framework lies close to the American performance theory, with its close ties to the social sciences, and to the tradition of rhetoric and communication: theater's rhetorical utility materializes quotidian cultural practices in a theatrical performance, and helps the audience to research social situations and cultural praxis by mirroring them and creating an explanatory frame.