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.

Relationship between Daily Habits, Oral Microbiota and Caries with Special Reference to Xylitol

Caries is a plaque-associated multifactorial chronic disease. Oral hygiene habits, sugar, and oral micobiota interactions are important for caries to occur. Xylitol has been shown to reduce caries mainly due to its effects on mutans streptococci (MS). The purpose of this study was to evaluate the relationship of daily oral health habits and bacterial level on the caries occurrence and to study the effect of xylitol on the composition of oral microflora. A total of 192, 10-12 years old, male school children had been screened for salivary MS. Healthy subjects with high MS counts participated in two parallel double-blinded, randomised, controlled trials. In the first 5-week trial, subjects were assigned into xylitol (n=35) and sorbitol gum (n=38) groups. At baseline, children were examined using International Caries Detection and Assessment System (ICDAS) criteria and interviewed for oral health habits. In the second 4-week trial, subjects were assigned into xylitol (n=25) and saccharine mouthrinse (n=25) groups. In the end of both interventions, saliva samples were collected. The samples were analysed for changes in MS counts and changes in the composition of the oral microbiota assessed by the Human Oral Microbe Identification Microarray (HOMIM). Relationships between daily habits, bacterial levels and caries were evaluated. Daily use of sweets and soft drinks were the habits significantly associated with caries severity measured by ICDAS Caries Index (CI), while toothbrushing was the only habit associated with the low caries severity. Abiotrophia defectiva and Actinomyces meyeri/ A. odontolyticus were significantly higher in caries-affected children while Shuttleworthia satelles was significantly higher in caries-free children. Xylitol showed significant reduction in salivary levels of MS in both trials. No significant effects on other members of the microbiota were found when evaluated by HOMIM. In conclusion, other members of oral microbiota than MS may be associated with caries occurrence or absence. The use of xylitol had significant effect on MS with no effects on the other members of the salivary microbiota.

In search of good relationships to music : understanding aspiration and challenge in developing music school teacher practices

This study focuses on teacher practices in publicly funded music schools in Finland. As views on the aims of music education change and broaden, music schools across Europe share the challenge of developing their activities in response. In public and scholarly debate, there have been calls for increased diversity of contents and concepts of teaching. In Finland, the official national curriculum for state-funded music schools builds on the ideal that teaching and learning should create conditions which promote ‘a good relationship to music’. The meaning of this concept has been deliberately left open in order to leave room for dialogue, flexibility, and teacher autonomy. Since what is meant by ‘good’ is not defined in advance, the notion of ‘improving’ practices is also open to discussion. The purpose of the study is to examine these issues from teachers’ point of view by asking what music school teachers aim to accomplish as they develop their practices. Methodologically, the study introduces a suggestion for building empirical research on Alperson’s ‘robust’ praxial approach to music education, a philosophical theory which is strongly committed to practitioner perspectives and musical diversity. A systematic method for analysing music education practices, interpretive practice analysis, is elaborated with support from interpretive research methods originally used in policy analysis. In addition, the research design shows how reflecting conversations (a collaborative approach well-known in Nordic social work) can be fruitfully applied in interpretive research and combined with teacher inquiry. Data have been generated in a collaborative project involving five experienced music school teachers and the researcher. The empirical material includes transcripts from group conversations, data from teacher inquiry conducted within the project, and transcripts from follow-up interviews. The teachers’ aspirations can be understood as strivings to reinforce the connection between musical practices and various forms of human flourishing such that music and flourishing can sustain each other. Examples from their practices show how the word ‘good’ receives its meaning in context. Central among the teachers’ concerns is their hope that students develop a free and sustainable interest in music, often described as inspiration. I propose that ‘good relationships to music’ and ‘inspiration’ can be understood as philosophical mediators which support the transition from an indeterminate ‘interest in music’ towards specific ways in which music can become a (co-)constitutive part of living well in each person’s particular circumstances. Different musical practices emphasise different aspects of what is considered important in music and in human life. Music school teachers consciously balance between a variety of such values. They also make efforts to resist pressure which might threaten the goods they think are most important. Such goods include joy, participation, perseverance, solid musical skills related to specific practices, and a strong sense of vitality. The insights from this study suggest that when teachers are able to create inspiration, they seem to do so by performing complex work which combines musical and educational aims and makes general positive contributions to their students’ lives. Ensuring that teaching and learning in music schools remain as constructive and meaningful as possible for both students and teachers is a demanding task. The study indicates that collaborative, reflective and interdisciplinary work may be helpful as support for development processes on both individual and collective levels of music school teacher practices.

A longitudinal study on the lexical sophistication and sentence length in Finnish upper secondary school students’ English compositions.

The aim of the present study was to find out the level of lexical sophistication and the mean length of sentences used in compositions written by Finnish upper secondary school students of English. In addition, the present study investigated the possible relationship between the two abovementioned variables. The study at hand was longitudinal: as data, a set of 50 compositions were collected in 2014 from the same writers both in the first and the final year of upper secondary school, 25 in the first year and 25 in the final year. In the analysis, an internet-based program called VocabProfile was utilized in order to find out the lexical sophistication of the investigated students. To find out the mean length of sentence and the relationship between these two, I used Microsoft Excel. Findings of the present study include a minor decrease in the use of less frequent vocabulary and a slight increase in the use of the two most frequently appearing thousand words of English: both of these changes were 1.99 percentage points. As for the mean length of sentence, it grew by 1.28 words during upper secondary school. As for the relationship between the two variables, no clear correlations could be found. It became, however, relatively clear that the topic of the composition might have an effect on the results. Thus more research is needed to fully see the effect of lexical sophistication and mean length of sentence on one another. In addition, future research would benefit greatly if all investigated students wrote on the same topic.