Terveyteen liittyvä elämänlaatu laitoskuntoutuksen vaikuttavuuden arvioinnissa : RAND-36-mittarin soveltuvuus työikäisten laitoskuntoutuksen ongelmaprofiilin määrittämiseen ja kuntoutuksen vaikutusten arvioimiseen

The aim of the present research was to examine the validity of the RAND-36 measure of health-related quality of life among the working age rehabilitation clients. The research included two cross-sectional studies and one follow-up study. The subjects of the first study (n = 794) participated in the first period of the five following types of rehabilitation: occupationally oriented medical rehabilitation, musculoskeletal rehabilitation, medical rehabilitation for job burnout, rehabilitation for supporting the work ability and capacity of disabled subjects (vocational rehabilitation) and individualized rehabilitation between October 2000 and October 2001. The subjects of the second study (n = 990) participated in the same rehabilitation during their first rehabilitation period between May 2007 and May 2008. The first subjects participated in a follow-up period no later than May 2003 with the exception of the individual rehabilitation clients (n = 588). Based on the ICF classification, the RAND-36 provides a diverse measure of the health-related quality of life and of the capacity for subjective, perceived physical and psycho-social functioning. The construct properties of the RAND-36 measure proved to be very consistent on the basis of both the cluster and confirmatory factor analyses. At the group level, the RAND-36 measure was shown to be illustrative and sensitive in differentiating the clients’ rehabilitation needs. The results of cluster analyses with the two cross-sectional data indicated a consistent five-cluster solution of rehabilitation groups on the basis of the eight subscales of health-related quality of life. Each of these clusters represented a clear difference in their need for rehabilitation. The RAND-36 measure proved to be sensitive to change. The changes observed in the pre- and post-conditions in relation to all the subscales of quality of life were statistically significant. Depending on the rehabilitation type, different changes in the subscales of the measure were observed, and these changes corresponded to the different emphasis and goals of the specific type of rehabilitation intervention. Similarly, changes in the subscales of the measure were observed in relation to the RAND groups formed by cluster analysis, which were logical and corresponded to the problem profiles of these groups. The confirmatory factor analysis indicated a two-factor solution: an index of the capacity for physical functioning (self-rated general health, bodily pain, physical functioning, physical role functioning) and an index of the capacity for psycho-social functioning (psychological well-being, social functioning, psychological role functioning and energy). These two indices describing functional capacity proved also to be sensitive to change. This two-factor solution seems to be usable for group level analyses when assessing the effects of rehabilitation. The moderately strong correlation between the RAND-36 and work ability index suggests that they partly measure the same phenomenon: perceived health-related quality of life, subjective capacity for activity and perceived work ability have strong links. As expected, the capacity for physical functioning had a stronger correlation with work ability index than with the capacity for psycho-social functioning. According to the present research, the RAND-36 measure can be considered as a screening method for rehabilitation orientation in relation to rehabilitation needs and as a follow-up measure for the health-related quality of life among the working age clients. The RAND-36 measure is also shown to be a useful instrument in estimating the benefits of rehabilitation as well as in effectiveness research.

Vaikuttavuusyhteiskunta : Sosiaalisten olojen arvostelusta vaikutusten todentamiseen

Evaluation practices have pervaded the Finnish society and welfare state. At the same time the term effectiveness has become a powerful organising concept in welfare state activities. The aim of the study is to analyse how the outcome-oriented society came into being through historical processes, to answer the question of how social policy and welfare state practices were brought under the governance of the concept of effectiveness . Discussions about social imagination, Michel Foucault s conceptions of the history of the present and of governmentality, genealogy and archaeology, along with Ian Hacking s notions of dynamic nominalism and styles of reasoning, are used as the conceptual and methodological starting points for the study. In addition, Luc Boltanski s and Laurent Thévenot s ideas of orders of worth , regimes of evaluation in everyday life, are employed. Usually, evaluation is conceptualised as an autonomous epistemic culture and practice (evaluation as epistemic practice), but evaluation is here understood as knowledge-creation processes elementary to different epistemic practices (evaluation in epistemic practices). The emergence of epistemic cultures and styles of reasoning about the effectiveness or impacts of welfare state activities are analysed through Finnish social policy and social work research. The study uses case studies which represent debates and empirical research dealing with the effectiveness and quality of social services and social work. While uncertainty and doubts over the effects and consequences of welfare policies have always been present in discourses about social policy, the theme has not been acknowledged much in social policy research. To resolve these uncertainties, eight styles of reasoning about such effects have emerged over time. These are the statistical, goal-based, needs-based, experimental, interaction-based, performance measurement, auditing and evidence-based styles of reasoning. Social policy research has contributed in various ways to the creation of these epistemic practices. The transformation of the welfare state, starting at the end of 1980s, increased market-orientation and trimmed public welfare responsibilities, and led to the adoption of the New Public Management (NPM) style of leadership. Due to these developments the concept of effectiveness made a breakthrough, and new accountabilities with their knowledge tools for performance measurement and auditing and evidence-based styles of reasoning became more dominant in the ruling of the welfare state. Social sciences and evaluation have developed a heteronomous relation with each other, although there still remain divergent tendencies between them. Key words: evaluation, effectiveness, social policy, welfare state, public services, sociology of knowledge

Aluekehittämisverkostojen arviointi : Verkostotoimijanäkökulma MAL- ja hyvinvointiverkostoihin aluekehittämisen välineinä

The Finnish regional development system has gone through structural reforms from state centered governed system to multi-actor governance, based on negotiation and cooperation. One of the reforms has been the regional cohesion and competitiveness program (COCO) established in 2010. The aim of the program is to increase competitiveness through all the regions and balance the regional development by supporting networking. The main focus of the program is to improve the methods and tools for regional development. In the program there are seven thematic networks founded around topics seen important national wide. This thesis explores regional development networks and their evaluation COCO:s two thematic networks, Wellbeing and Land use, housing and transportation as examples. The aim of the thesis is to explore the network actors understanding of thematic networks as tools for regional development. In particular, the study focuses on how the actors see the possible network level outcomes and wider effects of the networking activity. In addition, the central themes of the study are the prerequisite for successful network processes and improvement of the network process effectiveness by evaluation. The research material in this study consist the interviews of the network coordinators and national and regional actors participating in the network activities. The interviews were conducted in spring 2011. Based on the research results, the networks act on national regional and network level and across them. The cooperation is based on official and unofficial relations. The structure of the networks seemed to be self-organizing and controlled at the same time. The structural elements were found to set the framework for the network process and evaluation. According to the results, the networks enabled the more effective operation of the national development system, support of the regions and political lobbying. For the regions the networks offered support for areal development, new resources and possibility to influence national discourse. As conclusion, the role of the network was to disseminate information, create possibilities for collaboration and execute projects and studies and to effect on national policy making. These factors determined the effectiveness of the networks. However, because different regions were satisfied with different network level outcomes, the utilization of the networks in the regions should be evaluated by their own objectives. Resources, motivation, competence and perceptions of the effects were found to affect the successful implementation of the network process and cooperation in networks. Some network level obstacles could be overcome with coordination, but the challenge was the ability and motivation of the areas to utilize the networks as resources and see them as part of the comprehensive development agenda. Thus, the development should focus on how to increase awareness on how to improve regional cooperation processes and how multiple regional actors could enhance their working by utilizing the networks.

Verkko-opetuksen arvot ja arviointi helsinkiläisten luokanopettajien näkökulmasta

Tutkimuksen päätarkoitus oli hahmottaa verkko-opetuksen arvoja ja arviointia luokanopettajan näkökulmasta. Teoreettisena viitekehyksenä oli mediakasvatus ja didaktiikan käsitys opetus opiskelu oppimisprosessista. Didaktisena perustana käytettiin Kansasen ym. (2000) opettajan pedagogista ajattelua, Lahdeksen (1997) didaktiikan kehämallia sekä Uljensin (1997) opetus opiskelu oppimisprosessia. Lähtökohtana oli luokanopettajan arvioinnin kautta pohtia opetuksen, opiskelun ja oppimisen sekä tieto- ja viestintätekniikan yhtymistä koulukontekstissa. Tutkimuksen pääongelmat olivat: 1) Minkälainen oli luokanopettajan käsitys verkko-opetuksen toteuttamisesta? 2) Miten luokanopettaja arvioi verkko-opetusta? Myös ensimmäistä pääongelmaa lähestyttiin arvojen ja arvioinnin näkökulmasta. Menetelmänä käytettiin teemahaastattelua. Teemahaastattelun teemoja jäsennettiin Gallinin (2001) sosiokulttuurisen verkko-opetuksen arviointimallin sekä Tellan ja Mononen-Aaltosen (2001) mediakasvatuksen monitasomallin avulla. Aineistonkeruussa kahdeksan helsinkiläistä luokanopettajaa vastasivat lyhyeen kyselyyn, jonka jälkeen heitä haastateltiin välittömästi. Laadullisen aineiston analyysissä teemoiteltiin aineisto, ja tämän rinnalla rakennettiin aineistolähtöistä analyysiä. Näiden vuorovaikutuksesta syntyivät tutkimuksen johtopäätökset. Keskeisinä tuloksina tutkimuksessa nähtiin luokanopettajan verkko-opetukseen liittyvien arvojen kaksi eri näkökulmaa: (A) opetus opiskelu oppimismenetelmien ja -tulosten arvonäkökulma sekä (B) ns. kasvatuksellinen ja koulukulttuurin arvonäkökulma. Arvonäkökulmien pohjalta hahmotettiin johtopäätöksissä erilaisia tasoja luokanopettajan opetuksen, opiskelun ja oppimisen arvioinnista, kun tieto- ja viestintätekniikka on mukana prosessissa. Kaksi tasoa tarkennettiin verkko-opetuksen arvioinnin fokuksiksi, jotka olivat (1) teknologinen ja (2) tavoitteinen fokus. Teknologisessa arvioinnin fokuksessa (1) arviointia hallitsee huoli oppilaasta ihmisenä. Arviointi liittyy joko siihen, että oppilaan on opittava perustaidot tieto- ja viestintätekniikassa ja ymmärrettävä Internetin mahdollisuudet, tai siihen, että opettaja pyrkii suojelemaan lapsia Internetin uhkilta ja liialliselta altistumiselta esimerkiksi digitaalisille peleille. Verkko-opetuksen tavoitteinen arvioinnin fokus (2) nojaa siihen, minkälaisia tavoitteita luokanopettaja yleisesti asettaa opetukselleen, vaikka tieto- ja viestintätekniikka ei liittyisikään prosessiin. Fokuksen taustalla on myös mediakasvatuksen näkökulma tieto- ja viestintätekniikan opetuskäyttöön, jolloin keskeistä on, että opetuksen suunnittelu ja arviointi ei lähde teknologiasta käsin vaan didaktiikasta ja peda-gogisista arvoista. Verkko-opetuksen arvioinnin fokusten voidaan nähdä täydentävän toisiaan. Fokusten varioinnissa voidaan puhua luokanopettajan kohdalla todellisesta mediataidosta, joka ulottuu yli ammatillisen pätevyyden aina opettajan henkilökohtaiseen kehittymisen kaareen. Avainsanat: Verkko-opetus, arvot, arviointi, opetus-opiskelu-oppimisprosessi, opettajan pedagoginen ajattelu, tieto- ja viestintätekniikan opetuskäyttö Keywords: Network-Based Education (NBE), values, evaluation, teaching-studying-learning process, teacher's pedagogical thinking, educational use of information and communication technologies (ICT)

Occupational determinants of pancreatic cancer

Objective and background. Tobacco smoking, pancreatitis and diabetes mellitus are the only known causes of pancreatic cancer, leaving ample room for yet unidentified determinants. This is an empirical study on a Finnish data on occupational exposures and pancreatic cancer risk, and a non-Bayesian and a hierarchical Bayesian meta-analysis of data on occupational factors and pancreatic cancer. Methods. The case-control study analyzed 595 incident cases of pancreatic cancer and 1,622 controls of stomach, colon, and rectum cancer, diagnosed 1984-1987 and known to be dead by 1990 in Finland. The next-of-kin responded to a mail questionnaire on job and medical histories and lifestyles. Meta-analysis of occupational risk factors of pancreatic cancer started off with 1,903 identified studies. The analyses were based on different subsets of that database. Five epidemiologists examined the reports and extracted the pertinent data using a standardized extraction form that covered 20 study descriptors and the relevant relative risk estimates. Random effects meta-analyses were applied for 23 chemical agents. In addition, hierarchical Bayesian models for meta-analysis were applied to the occupational data of 27 job titles using job exposure matrix as a link matrix and estimating the relative risks of pancreatic cancer associated with nine occupational agents. Results. In the case-control study, logistic regressions revealed excess risks of pancreatic cancer associated with occupational exposures to ionizing radiation, nonchlorinated solvents, and pesticides. Chlorinated hydrocarbon solvents and related compounds, used mainly in metal degreasing and dry cleaning, are emerging as likely risk factors of pancreatic cancer in the non-Bayesian and the hierarchical Bayesian meta-analysis. Consistent excess risk was found for insecticides, and a high excess for nickel and nickel compounds in the random effects meta-analysis but not in the hierarchical Bayesian meta-analysis. Conclusions. In this study occupational exposure to chlorinated hydrocarbon solvents and related compounds and insecticides increase risk of pancreatic cancer. Hierarchical Bayesian meta-analysis is applicable when studies addressing the agent(s) under study are lacking or very few, but several studies address job titles with potential exposure to these agents. A job-exposure matrix or a formal expert assessment system is necessary in this situation.

Kymijoen vaelluskalojen nousureittien avaamisen kustannusten ja hyötyjen arviointi

The objective of this thesis is to evaluate different means of increasing natural reproduction of migratory fish, especially salmon, in the river Kymijoki. The original stocks of migratory fish in Kymijoki were lost by the 1950s because of hydropower plants and worsened quality of water in the river. Nowadays the salmon stocks is based on hatchery-reared fish, even though there is significant potential of natural smolt production in the river. The main problem in the natural reproduction is that the migratory fish cannot ascend to the reproduction areas above the Korkeakoski and Koivukoski hydropower plants. In this thesis alternative projects which aim to open these ascencion routes and their costs and benefits are evaluated. The method used in the evaluation is social cost-benefit analysis. The alternative projects evaluated in this thesis consist of projects that aim to change the flow patterns between the eastern branches of Kymijoki and projects that involve building a fish ladder. Also different combinations of these projects are considered. The objective of this thesis is to find the project that is the most profitable to execute; this evaluation can be done in comparing the net present values of the projects. In addition to this, a sensitivity analysis will be made on the parameter values that are most uncertain. We compare the net present values of the projects with the net present values of hatchery-reared smolt releases, so we can evaluate, if the projects or the smolt releases are more socially profitable in the long term. The results of this thesis indicate that especially the projects that involve building a fish ladder next to the Korkeakoski hydropower plant are the most socially profitable. If this fish ladder would be built, the natural reproduction of salmon in the Kymijoki river could become so extensive, that hatchery-reared smolt releases could even be stopped. The results of the sensivity analysis indicate that the net present values of the projects depend especially on the initial smolt survival rate of wild salmon and the functioning of the potential fish ladder in Korkeakoski. Also the changes of other parameter values influence the results of the cost-benefit analysis, but not as significantly. When the net present values of the projects and the smolt releases are compared, the results depend on which period of time is selected to count the average catches of reared salmon. If the average of the last 5 years catches is used in counting the net benefits of smolt releases, all the alternative projects are more profitable than the releases. When the average of the last 10 years is used, only building of the fish ladder in Korkeakoski and all the project combinations are more profitable than the smolt releases.

Liikuntaharrastusten luonnonvarojen kulutuksen arviointi MIPS-menetelmällä

Tutkielmassa tarkastellaan liikuntaharrastusten luonnonvarojen kulutusta MIPS (material input per service unit, suom. materiaalipanos palvelusuoritetta kohden) -menetelmällä. MIPS-menetelmä perustuu ekotehokkuusajatteluun ja sen tavoitteena on suhteuttaa tuotteen tai palvelun elinkaaren aikainen luonnonvarojen kulutus siitä saatavaan palveluun. Tässä tutkimuksessa tarkastellaan liikuntaharrastusten materiaalivirtoja erilaisissa liikuntapaikoissa yhden henkilön harrastetuntia kohden. Tarkasteltavia liikuntapaikkoja ovat kevyen liikenteen väylä, kuntorata, liikuntasali ja -halli, jäähalli, uimahalli, kuntokeskus sekä lämmitetty ja lämmittämätön tekonurmikenttä. Tutkielman laskelmat perustuvat pääosin tapaustutkimuksiin suomalaisista liikuntapaikoista. Laskelmissa on huomioitu liikuntapaikalle matkustaminen, liikuntapaikan rakentaminen sekä sen ylläpito ja käyttö. Tarkasteltujen liikuntaharrastusten abioottisten luonnonvarojen kulutus vaihteli 1,7 28 kg:n välillä yhden henkilön harrastetuntia kohden. Abioottisten luonnonvarojen kulutukseen vaikutti eniten liikuntapaikalle matkustaminen. Tarkastelluista liikuntaharrastuksista eniten abioottisia luonnonvaroja ja ilmaa kulutti uimahallissa uiminen. Kuntoradoilla ja kevyen liikenteen väylillä harrastettavien ulkoilulajien MIPS-luvut olivat alhaisimmat. Liikuntaharrastukset erosivat toisistaan eniten veden kulutuksessa, jonka MIPS-luvut vaihtelivat 40 ja 1400 kg:n välillä. Korkein veden MIPS-luku oli jäähallissa tapahtuvalla liikunnalla. Ilman kulutus liikuntaharrastuksissa oli 0,1 6,2 kg harrastetuntia kohden. Tulosten perusteella liikuntaharrastusten luonnonvarojen kulutusta voitaisiin tehokkaimmin vähentää kulkemalla liikuntapaikalle henkilöauton sijaan julkisilla kulkuneuvoilla ja hyödyntämällä lähiympäristön tarjoamia liikuntapaikkoja. Myös liikuntapaikkojen kävijämäärien maksimoiminen on tärkeää harrastetunnille kohdistuvien materiaalivirtojen pienentämiseksi. Tutkielma on toteutettu osana FIN-MIPS Kotitalous tutkimushanketta.

Tietokoneavusteinen arviointi kurssilla Diskreetin matematiikan perusteet

Matematiikan opetuksen kehittämiseen korkeakoulutasolla on monia tapoja. Tavoitteena on parantaa opiskelijoiden opiskelukokemuksia, jotta he oppisivat paremmin. Oppimisen arvioinnin on todettu vaikuttavan oppimiseen merkittävästi. Arviointi tapahtuu yleensä sen perusteella, kuinka hyvin opiskelija menestyy kokeissa. Näihin kokeisiin liittyy kuitenkin useita ongelmia; ne koostuvat usein muutamasta tehtävästä, eivätkä siten kata koko koealuetta. Lisäksi perinteinen koetilanne on kaukana siitä ympäristöstä, jossa opittuja taitoja on tarkoitus käyttää. Tässä työssä tutkittiin Aalto-yliopiston Teknillisen korkeakoulun kurssin Diskreetin matematiikan perusteet (DMP) arviointikäytännön uudistamista. Kurssi toteutettiin sulautuvan oppimisen mallin mukaisesti osin verkossa. Arvioinnissa painotettiin jatkuvaa harjoitustehtävien tekemistä ja suurin osa näistä tehtävistä toteutetiin tietokoneavusteisina verkkotehtävinä. Käytössä oli automaattisen tarkistamisen mahdollistava STACK-järjestelmä. Työ jakaantui kahteen osaan: arvioinnissa käytettävien STACK-tehtävien laatimiseen ja empiiriseen osuuteen, jossa tutkittiin kurssin onnistumista. Tutkimuksessa keskityttiin toisaalta siihen, miten käytetty arviointimenetelmä toimi ja toisaalta siihen, millaiseksi opiskelijat menetelmän kokivat. Kurssia varten toteutettiin yhteensä 67 STACK-tehtävää, joista 46 oli käytössä kurssilla. Lisäksi kurssilla oli 26 perinteistä kirjallista tehtävää. Käytetyn arviointimenetelmän toimivuutta tutkittiin vertaamalla kurssin tuloksia vuosien 2008 ja 2009 DMP-kurssien tuloksiin. Vertailun perusteella huomattiin, että opiskelijat olivat vuonna 2010 ratkaisseet selvästi enemmän harjoitustehtäviä kuin edellisinä vuosina. Myös arvosanan 0 prosentuaalinen osuus suhteessa kaikkiin annettuihin arvosanoihin pieneni. Opiskelijoiden kokemuksien tutkimista varten laadittiin kurssikokemuskysely. Kyselyssä esitettiin väittämiä liittyen STACK-tehtävien laatuun, tavoitteiden ja vaatimusten selkeyteen, arvioinnin asianmukaisuuteen, työmäärän asianmukaisuuteen, opiskelijoiden sitoutuneisuuteen, käytännön järjestelyihin ja sulautuvaan oppimiseen liittyen. Tulokset olivat erittäin positiivisia. Kaikenkaikkiaan kokeilukurssi sujui hyvin; arvointimenetelmä toimi ja opiskelijat olivat tyytyväisiä. Vertailun ja kyselyn perusteella tärkeimmiksi kehityksen kohteiksi nousivat STACK-tehtävien automaattinen palaute, perinteisten tehtävien pisteyttäminen ja jako perinteisten tehtävien ja STACK-tehtävien välillä.

Mitä hyötyä tehohoidosta? : Tehohoitoa sisältäneiden hoitojaksojen vaikuttavuuden arviointi

Intensive care is to be provided to patients benefiting from it, in an ethical, efficient, effective and cost-effective manner. This implies a long-term qualitative and quantitative analysis of intensive care procedures and related resources. The study population consists of 2709 patients treated in the general intensive care unit (ICU) of Helsinki University Hospital. Study sectors investigate intensive care patients mortality, quality of life (QOL), Quality-Adjusted Life-Years (QALY units) and factors related to severity of illness, length of stay (LOS), patient s age, evaluation period as well as experiences and memories connected with the ICU episode. In addition, the study examines the qualities of two QOL measures, the RAND 36 Item Health Survey 1.0 (RAND-36) and the 5 Item EuroQol-5D (EQ-5D) and assesses the correlation of the test results. Patients treated in 1995 responded to the RAND-36 questionnaire in 1996. All patients, treated from 1995-2000, received a QOL questionnaires in 2001, when 1 7 years had lapsed from the intensive treatment. Response rate was 79.5 %. Main Results 1) Of the patients who died within the first year (n = 1047) 66 % died during the intensive care period or within the following month. The non-survivors were more aged than the surviving patients, had generally a higher than average APACHE II and SOFA score depicting the severity of illness, their ICU LOS was longer and hospital stay shorter than of the surviving patients (p < 0.001). Mortality of patients receiving conservative treatment was higher than of those receiving surgical treatment. Patients replying to the QOL survey in 2001 (n = 1099) had recovered well: 97 % of those lived at home. More than half considered their QOL as good or extremely good, 40 % as satisfactory and 7 % as bad. All QOL indexes of those of working-age were considerably lower (p < 0.001) than comparable figures of the age- and gender-adjusted Finnish population. The 5-year monitoring period made evident that mental recovery was slower than physical recovery. 2) The results of RAND-36 and EQ-5D correlated well (p < 0.01). The RAND-36 profile measure distinguished more clearly between the different categories of QOL and their levels. EQ-5D measured well the patient groups general QOL and the sum index was used to calculate QALY units. 3) QALY units were calculated by multiplying the time the patient survived after ICU stay or expected life-years by the EQ-5D sum index. Aging automatically lowers the number of QALY units. Patients under the age of 65 receiving conservative treatment benefited from treatment to a greater extent measured in QALY units than their peers receiving surgical treatment, but in the age group 65 and over patients with surgical treatment received higher QALY ratings than recipients of conservative treatment. 4) The intensive care experience and QOL ratings were connected. The QOL indices were statistically highest for those recipients with memories of intensive care as a positive experience, albeit their illness requiring intensive care treatment was less serious than average. No statistically significant differences were found in the QOL indices of those with negative memories, no memories or those who did not express the quality of their experiences.

Psykoterapian vaikutusten arvioiminen : Keskustelunanalyttinen tutkimus arviointihaastattelun käytänteistä

In the field of psychiatry semi-structured interview is one of the central tools in assessing the psychiatric state of a patient. In semi-structured interview the interviewer participates in the interaction both by the prepared interview questions and by his or her own, unstructured turns. It has been stated that in the context of psychiatric assessment interviewers' unstructured turns help to get focused information but simultaneously may weaken the reliability of the data. This study examines the practices by which semi-structured psychiatric interviews are conducted. The method for the study is conversation analysis, which is both a theory of interaction and a methodology for its empirical, detailed analysis. Using data from 80 video-recorded psychiatric interviews with 16 patients and five interviewers it describes in detail both the structured and unstructured interviewing practices. In the analysis also psychotherapeutic concepts are used to describe phenomena that are characteristic for therapeutic discourse. The data was received from the Helsinki Psychotherapy Study (HPS). HPS is a randomized clinical trial comparing the effectiveness of four forms of psychotherapy in the treatment of depressive and anxiety disorders. A total of 326 patients were randomly assigned to one of three treatment groups: solution-focused therapy, short-term psychodynamic psychotherapy, and long-term psychodynamic psychotherapy. The patients assigned to the long-term psychodynamic psychotherapy group and 41 patients self-selected for psychoanalysis were included in a quasi-experimental design. The primary outcome measures were depressive and anxiety symptoms, while secondary measures included work ability, need for treatment, personality functions, social functioning, and life style. Cost-effectiveness was determined. The data were collected from interviews, questionnaires, psychological tests, and public health registers. The follow-up interviews were conducted five times during a 5-year follow-up. The study shows that interviewers pose elaborated questions that are formulated in a friendly and sensitive way and that make relevant patients' long and story-like responses. When receiving patients' answers interviewers use a wide variety of different interviewing practices by which they direct patients' talk or offer an understanding of the meaning of patients' response. The results of the study are two-fold. Firstly, the study shows that understanding the meaning of mental experiences requires interaction between interviewer and patient. It is stated that therefore semi-structured interview is both relevant and necessary method for collecting data in psychotherapy outcome study. Secondly, the study suggests that conversation analysis, enriched with psychotherapeutic concepts, offers methodological possibilities for psychotherapy process research, especially for process-outcome paradigm.

Männyn neulaskadon arviointi laserkeilauksella

Leaf and needle biomasses are key factors in forest health. Insects that feed on needles cause growth losses and tree mortality. Insect outbreaks in Finnish forests have increased rapidly during the last decade and due to climate change the damages are expected to become more serious. There is a need for cost-efficient methods for inventorying these outbreaks. Remote sensing is a promising means for estimating forests and damages. The purpose of this study is to investigate the usability of airborne laser scanning in estimating Scots pine defoliation caused by the common pine sawfly (Diprion pini L.). The study area is situated in Ilomantsi district, eastern Finland. Study materials included high-pulse airborne laser scannings from July and October 2008. Reference data consisted of 90 circular field plots measured in May-June 2009. Defoliation percentage on these field plots was estimated visually. The study was made on plot-level and methods used were linear regression, unsupervised classification, Maximum likelihood method, and stepwise linear regression. Field plots were divided in defoliation classes in two different ways: When divided in two classes the defoliation percentages used were 0–20 % and 20–100 % and when divided in four classes 0–10 %, 10–20 %, 20–30 % and 30–100 %. The results varied depending on method and laser scanning. In the first laser scanning the best results were obtained with stepwise linear regression. The kappa value was 0,47 when using two classes and 0,37 when divided in four classes. In the second laser scanning the best results were obtained with Maximum likelihood. The kappa values were 0,42 and 0,37, correspondingly. The feature that explained defoliation best was vegetation index (pulses reflected from height > 2m / all pulses). There was no significant difference in the results between the two laser scannings so the seasonal change in defoliation could not be detected in this study.

Internet- karttapalveluiden arviointi ja kehitys strategisessa maankäytön suunnittelussa, tapaustutkimuksena Esikaupunkien renessanssi -hanke

Participation is located in a living and complex environment. Traditional means of participation are only partially able to meet the new environmental requirements. In need are forms of participation which take into account the new opportunities of the environment and residents expertise. Internet map applications are an important channel of participation which potential is in many respects as unexplored and unutilized. They are commonly in inventory the perspectives, bringing out the concerns of the area, and only little for discussing about solutions. Interpretation is usually made by designer. This study focuses on evaluation and development of Internet map applications in strategic land use planning. Subject matter is dealt from designer and the inhabitants point of view. City Planning Department of Helsinki s Esikau-punkien Renessanssi -project and the associated SoftGIS survey acts as the case study. In the beginning of the study I tried to recognize the new environment in which the Internet map applications are placed. The research question is, what kind of challenges and opportunities the e-participation confronts in information society, and what kind of requirements the environmental creates for development of an application. In chapter three I evaluate how successfully these requirements are met in Esikau-punkien Renessanssi -project. I m trying to examine how the application would look like if the environment and the characteristics of the project are met better. The approach is experimental and I try to find new ways to take advantage of Internet maps. I try not to be too limited to current projects and studies. For example, I try to examine how social media and Web 2.0 opportunities can be utilized, and how the learning and shaping nature of planning may be reached in Internet map environment. In chapter four I have developed a new concept for the Esikaupunkien Renessanssi map application, and made images to visualize its operation in practice. I collect all the data in the research and gather it into a new service. The aim is to create a better application for Esikaupunkien Renessanssi -project, which takes into account the living and complex environment of participation and responds to threats and opportunities arising from it. The presented outcome is in many respects different from the current query. In the new service the role of residents is to interact and learn. The traditional standing of the Internet maps and the position of resident as one-sided information donor are questioned. In the concept, the residents innovate and make interpretations too. Influences are taken from a number of modern applications and for example services that make use of social media. The user experience is intended to be interactive, fast and easy. The idea is that the service keeps you up to date with planning matters, not the other way around. Service guides inhabitants, striving to achieve a deeper knowledge of the project's objectives as well as the dynamics and realities that different individuals experience.

Vieraan aksentin arviointi ja mittaaminen suomessa

In the field of second language (L2) acquisition, the term `foreign accent´ is often used to refer to speech characteristics that differ from the pronunciation of native speakers. Foreign accent may affect the intelligibility and perceived comprehensibility of speech and it is also sometimes associated with negative attitudes. The degree of L2 learners foreign accent and the speech characteristics that account for it have previously been studied through speech perception experiments and acoustic measurements. Perception experiments have shown that native listeners are easily able to identify foreign accent in speech. However to date, no studies have been done on the assessment of foreign accent in the speech of non-native speakers of Finnish. The aim of this study is to examine how native speakers of Finnish rate the degree of foreign accentedness in the speech of Russian L2 learners of Finnish. Furthermore, phonetic analysis is used to study the characteristics of speech that affect the perceived strength of foreign accent. Altogether 96 native speakers of Finnish listened to excerpts of read-aloud and spontaneous Finnish speech from ten Russian and six Finnish female speakers. The Russian speakers were intermediate and advanced learners of Finnish and had all immigrated to Finland as adults. Among the listeners, was a group of teachers of Finnish as an L2, and it was presumed that these teachers had been exposed to foreign accent in Finnish and were used to hearing it. The temporal aspects and segmental properties of speech were phonetically analysed in the speech of the Russian speakers in order to measure their effect on the perceived degree of accent. Although wide differences were observed in the use of the rating scale among the listeners, they were still quite unanimous on which speakers had the strongest foreign accent and which had the mildest. The listeners background factors had little effect on their ratings, and the ratings of the teachers of Finnish as an L2 did not differ from those of the other listeners. However, a clear difference was noted in the ratings of the two types of stimuli used in the perception experiment: the read-aloud speech was rated as more strongly accented than the spontaneous speech. It is important to note that the assessment of foreign accent is affected by many factors and their complex interactions in the experimental setting. Futher the study found that, both the temporal aspects of speech, often associated with fluency, and the number of single deviant phonetic segments contributed to the perceived degree of accentedness in the speech of the native Russian speakers.