Cognitive Development of Very Low Birth Weight Children from Infancy to Pre-school Age

The survival of preterm born infants has increased but the prevalence of long-term morbidities has still remained high. Preterm born children are at an increased risk for various developmental impairments including both severe neurological deficits as well as deficits in cognitive development. According to the literature the developmental outcome perspective differs between countries, centers, and eras. Definitions of preterm infant vary between studies, and the follow-up has been carried out with diverse methods making the comparison less reliable. It is essential to offer parents upto-date information about the outcome of preterm infants born in the same area. A centralized follow-up of children at risk makes it possible to monitor the consequences of changes in the treatment practices of hospitals on developmental outcome. This thesis is part of a larger regional, prospective multidisciplinary follow-up project entitled “Development and Functioning of Very Low Birth Weight Infants from Infancy to School Age” (PIeniPAinoisten RIskilasten käyttäytyminen ja toimintakyky imeväisiästä kouluikään, PIPARI). The thesis consists of four original studies that present data of very low birth weight (VLBW) infants born between 2001 and 2006, who are followed up from the neonatal period until the age of five years. The main outcome measure was cognitive development and secondary outcomes were significant neurological deficits (cerebral palsy, CP, deafness, and blindness). In Study I, the early crying and fussing behavior of preterm infants was studied using parental diaries, and the relation of crying behavior and cognitive and motor development at the age of two years was assessed. In Study II, the developmental outcome (cognitive, CP, deafness, and blindness) at the age of two years was studied in relation to demographic, antenatal, neonatal, and brain imaging data. Development was studied in relationship to a full-term born control group born in the same hospital. In Study III, the stability of cognitive development was studied in VLBW and full-term groups by comparing the outcomes at the ages of two and five years. Finally, in Study IV the precursors of reading skills (phonological processing, rapid automatized naming, and letter knowledge) were assessed for VLBW and full-term children at the age of five years. Pre-reading skills were studied in relation to demographic, antenatal, neonatal, and brain imaging data. The main findings of the thesis were that VLBW infants who fussed or cried more in the infancy were not at greater risk for problems in their cognitive development. However, crying was associated with poorer motor development. The developmental outcome of the present population was better that has been reported earlier and this improvement covered also cognitive development. However, the difference to fullterm born peers was still significant. Major brain pathology and intestinal perforation were independent significant risk factors for adverse outcome, also when several individual risk factors were controlled for. Cognitive development at the age of two years was strongly related with development at the age of five years, stressing the importance of the early assessment, and the possibility for early interventions. Finally, VLBW children had poorer pre-reading skills compared with their full-term born peers, but the IQ was an important mediator even when children with mental retardation were excluded from the analysis. The findings suggest that counseling parents about the developmental perspectives of their preterm infant should be based on data covering the same birth hospital. Neonatal brain imaging data and neonatal morbidity are important predictors for developmental outcome. The findings of the present study stress the importance of both short-term (two years) and long-term (five years) follow-ups for the individual, and for improving the quality of care.

Musikaliska möten man minns : om musikundervisningen i årskurserna sju till nio som en arena för starka musikpplevelser

Earlier research has shown that strong experiences related to music (SEM) can occur in very different contexts and take on many different forms. Experiences like these seem significant and have among other things reportedly had an affect on the individual's continuing relationship towards music, which makes them interesting from a pedagogical point of view. Formal teaching situations, though, are under-represented in studies where people have been asked to describe strong experiences that they have had in connection with music. The purpose of my thesis is to investigate what SEM may mean to pupils and teachers in lower secondary school (grades 7-9), and to inquire more deeply into the potential "space" for such experiences within school music education. On a comprehensive level my ambition is to deepen the understanding for SEM as a possible element in pedagogical situations. Three empirical perspectives are employed: pupil-, teacher- and curriculum perspectives. The pupil perspective involved an analysis of written accounts of 166 fifteen-year-olds, describing own strong experiences. The teacher perspective involved studying 28 music teachers' conceptions of the purpose of teaching music in school as well as their understanding about strong music experiences in school context. Further, the teachers' descriptions of SEM that they have had themselves were analysed. The curriculum perspective is reflected through a study of how music experience was represented in 24 local and 2 national curriculum texts for music. Grounded in a phenomenological-hermeneutical perspective the material have been analyzed both qualitatively and quantitatively. The result points towards the fact that the music education in school has the potential to become an arena for SEM and that this can happen in relation to a multitude of activities and genres and take on many different expressions. Only one pupil referred to a musical encounter in the classroom environment; all other experiences that occurred inside the frame of school activity had taken place in other arenas (the school hall, public concert halls, and so on). However, more than 98 % of the descriptions concerned musical encounters in leisure time contexts. The significance of SEM is further clarified by narrative constructions. SEM as a conception does not occur on the curriculum level; however the analyze revealed a number of interesting "openings" which are illustrated. Even though all teachers displayed a fundamentally positive attitude towards the idea of regarding SEM as a feature of formal musical learning, it became clear that many teachers never had approached this theme from a pedagogical point of view before. Still, they proved to have an evident "familiarity" towards the phenomenon based on their own experiences of receptive and performative musical encounter. The possible space for strong musical experiences within school music education is specified through a detailed illustration of six specific themes derived from the reasoning of the teachers. Furthermore, this is described through a mapping of the potential experiencing zone, constructed from the teachers descriptions of educational aims.

Health Related Quality of Life after Childhood Cancer - A Finnish Nationwide survey

The purpose of this Finnish epidemiological nationwide cross-sectional study was to evaluate the Health Related Quality of Life (HRQL) of young people that have survived childhood cancer at least four years after cancer diagnosis. The study aims were (1) to increase knowledge and understanding about the relationship between childhood cancer and its treatment and HRQL of childhood cancer survivors and (2) to identify survivors who need and could benefit from ongoing long-term follow-up, as well as (3) to identify what kind of aftercare the childhood cancer survivors will possibly need. HRQL and fatigue of currently still young survivors of extracranial childhood malignancies were evaluated with self-reports and parent proxy reports. HRQL was measured with age-appropriate generic instruments: PedsQL™, SF-36, 15D, 16D and 17D. Fatigue for children and adolescents aged below 18 years was measured with the PedsQL™ Multidimensional Fatigue Scale Finnish version. PedsQL™ parent-proxy and the PedsQL™ Multidimensional Fatigue Scale Parentproxy instruments were used to assess the perception of the parents on HRQL and fatigue of their children and adolescents. Postal-survey questionnaires were mailed to 852 childhood cancer survivors aged 11-27 years and their randomly selected gender-, age and living-place matched controls, as well as under 18-year-old children´s parents. A total of 474 survivors, 595 controls, 209 survivor’s parent and 253 control’s parent replied. The mean age of survivors at the time of the study was 18.4 years. The mean length of survival was 12.3 years, and the mean age at diagnosis 5.5 years. The most of the Finnish childhood cancer survivors evaluated that their HRQL as good. Survivors rated their HRQL equal or higher than their controls. The only dimension where the survivors scored poorer than the controls was the 15D mobility dimension. Survivors of childhood cancer did not suffer from significant fatigue. There were subgroups of childhood cancer survivors who had poorer level of HRQL, and suffered from fatigue more than the reference group. The demographic factors that associated with poorer HRQL were female gender, greater weight, living alone, need of remedial education, an additional non-cancer diagnosis, survivors with siblings, and self-reported unhappiness. Disease-related factors that associated with poorer HRQL were higher age at the time of diagnosis, the diagnosis of Wilms tumor, neuroblastoma, or osteosarcoma, and treatment with stem cell transplantation. The factors associated with more fatigue in survivors were male gender, older age at evaluation, the need of remedial education at school, lower overall average grade in the latest school marks report, length of survival more than 10 years, lower HRQL-scores, and a sarcoma diagnosis. However, all the used demographic and disease related factors explained only about one third of the variation in the HRQL scores. In open questions, the survivors were most worried about their physical health, but were also worried about their mental health, cancer inheritance, late-effects, and fertility and relapse issues. It seems that there are subgroups of survivors who need and could benefit from ongoing long-term follow-up. In the future, the survivors of childhood cancer need more information about their physical and mental health, as well as on their cancer inheritance, possible late-effects including fertility issues, and on the risk of relapse.

Digitalisaatio ja kuljettajakoulutusyrittäjyys

Digitalisaation myötä myös liikenteestä tulee yhä älykkäämpää. Valtiovalta purkaa sääntelyä ja sallii digitaalisten menetelmien laajempaa käyttöä. Kuljettajakoulutusta pidetään toimialana kuitenkin hyvin konventionaalisena. Diplomityön tarkoituksena on tutkia, mitä digitalisaatio tarkoittaa kuljettajakoulutusyritysten liiketoimintamalleille. Empiiristä aineistoa saatiin teemahaastatteluin ja aineistoa analysoitiin laadullisin menetelmin. Työssä esitellään alan vahvuudet, heikkoudet, mahdollisuudet ja uhat sekä tulevaisuuden skenaariot. Digitalisaatio aiheuttaa merkittäviä muutoksia kuljettajakoulutusalan yrityksille. Auto ei ole enää entisenlainen statussymboli eikä rahan käytön kohde. Digitaaliajan ihmiset eivät aina kaipaa fyysistä liikkumista, kun vielä kivijalkakaupatkin vähenevät. Ajokorttia ei useinkaan koeta välttämättömäksi aikuistumisriitiksi. Uusi teknologia voi kuitenkin radikaalisti parantaa alan yritysten suorituskykyä: palvelut muuttuvat ajasta ja paikasta riippumattomiksi sekä skaalautuviksi. Kuluttajien kannalta digitalisaatio puolestaan parantaa asiakaslähtöisyyttä. Alan liiketoimintamallien kehittymiseen vaikuttaa neljä taustavoimaa: digitalisaatio, perinteet, sääntely ja yrittäjyys. Liiketoimintamalli sisältää opetukselliset ydintoiminnot, sisäiset prosessit, liiketoiminnan tukitoiminnot ja arvoehdotuksen asiakkaalle. Liiketoiminnan kehittäminen vastaamaan digitalisaation vaatimuksia edellyttää proaktiivista innovaatiostrategiaa. Siihen perustuvien innovaatiomenetelmien avulla yritys voi kehittää liiketoimintamalliaan digitalisaation tarjoamien ja tiedon asymmetriasta kumpuavien mahdollisuuksien hyödyntämiseksi.