The Child Occupational Self Assessment (COSA, version 2.1) : lasten toimintamahdollisuuksien itsearviointi COSA:n esittely ja suomentamisprosessi

Tämän opinnäytetyön tarkoituksena on aloittaa lapsille ja nuorille suunnatun The Child Occupational Self Assessment (COSA, version 2.1) itsearviointimenetelmän suomenkielisen version käännöstyö. COSA on asiakaslähtöinen itsearviointi, jolla kartoitetaan lasten ja nuorten kokemusta toiminnallisesta pätevyydestään ja jokapäiväisten toimintojen tärkeydestä heille. COSA pohjaa Inhimillisen toiminnan malliin ja sen toteutus seuraa asiakaslähtöistä teoriaa. COSA:n avulla voidaan asettaa toimintaterapialle tavoitteet ja tarkastella niiden toteutumista. Työssämme suomennamme arviointimenetelmän nimen muotoon; Lasten toimintamahdollisuuksien itsearviointi COSA. Arviointimenetelmän käännöstyö tehdään Helsingin ammattikorkeakoulu Stadian toimintaterapian koulutusohjelmalle. Opinnäytetyössä esittelemme ensin arviointia ja tavoitteiden asettamista lasten toimintaterapiassa sekä itsearvioinnin käyttämistä arviointimenetelmänä. Esittelemme COSA itsearviointimenetelmän sekä sen taustalla vaikuttavat Inhimillisen toiminnan mallin sisällön ja asiakaslähtöisyyden. Kartoitamme myös The Child Occupational Self Assessment (COSA, version 2.1 )itsearviointimenetelmän kehittymistä, sitä edeltäneitä arviointimenetelmiä ja COSA:sta aiemmin tehtyjä tutkimuksia. Opinnäytetyössä suomennamme COSA:n arviointilomakkeen. Arviointilomakkeessa on 25 lasten ja nuorten toiminnallista pätevyyttä ja jokapäiväisten toimintojen tärkeyttä kartoittava väittämää. Suomentamisprosessissa selvitämme COSA:n arviointilomakkeen väittämien suomennosten ymmärrettävyyden onnistumista kahdeksan käyttökokeiluun ja haastatteluun osallistuvan lapsen avulla. Saimme arviointilomakkeen suomentamisprosessiin apua neljältä lasten kanssa työskentelevältä toimintaterapeutilta sekä koulutusohjelmamme koulutuspäälliköltä. Käyttökokeiluiden sekä toimintaterapeuttien palautteiden avulla viimeistelimme suomennetun arviointilomakkeen väittämät. Opinnäytetyön lopuksi pohdimme arviointilomakkeen suomentamisprosessin vaiheita sekä mahdollisia jatkotutkimusehdotuksia. Luovutimme Lasten toimintamahdollisuuksien itsearviointi COSA:n arviointilomakkeen koulutusohjelmamme käyttöön ja mahdollisten jatkotutkimusten kohteeksi.

Expertise and decision making among clinicians in investigations of alleged child sexual abuse

The purpose of the present thesis was to explore different aspects of decision making and expertise in investigations of child sexual abuse (CSA) and subsequently shed some light on the reasons for shortcomings in the investigation processes. Clinicians’ subjective attitudes as well as scientifically based knowledge concerning CSA, CSA investigation and interviewing were explored. Furthermore the clinicians’ own view on their expertise and what enhances this expertise was investigated. Also, the effects of scientific knowledge, experience and attitudes on the decision making in a case of CSA were explored. Finally, the effects of different kinds of feedback as well as experience on the ability to evaluate CSA in the light of children’s behavior and base rates were investigated. Both explorative and experimental methods were used. The purpose of Study I was to investigate whether clinicians investigating child sexual abuse (CSA) rely more on scientific knowledge or on clinical experience when evaluating their own expertise. Another goal was to check what kind of beliefs the clinicians held. The connections between these different factors were investigated. A questionnaire covering items concerning demographic data, experience, knowledge about CSA, selfevaluated expertise and beliefs about CSA was given to social workers, child psychiatrists and psychologists working with children. The results showed that the clinicians relied more on their clinical experience than on scientific knowledge when evaluating their expertise as investigators of CSA. Furthermore, social workers possessed stronger attitudes in favor of children than the other groups, while child psychiatrists had more negative attitudes towards the criminal justice system. Male participants held less strong beliefs than female participants. The findings indicate that the education of CSA investigators should focus more on theoretical knowledge and decision making processes as well as the role of beliefs In Study II school and family counseling psychologists completed a Child Sexual Abuse Attitude and Belief Scale. Four CSA related attitude and belief subscales were identified: 1. The Disclosure subscale reflecting favoring a disclosure at any cost, 2. The Pro-Child subscale reflecting unconditional belief in children's reports, 3. The Intuition subscale reflecting favoring an intuitive approach to CSA investigations, and 4. The Anti Criminal Justice System subscale reflecting negative attitudes towards the legal system. Beliefs that were erroneous according to empirical research were analyzed separately. The results suggest that some psychologists hold extreme attitudes and many erroneous beliefs related to CSA. Some misconceptions are common. Female participants tended to hold stronger attitudes than male participants. The more training in interviewing children the participants have, the more erroneous beliefs and stronger attitudes they hold. Experience did not affect attitudes and beliefs. In Study III mental health professionals’ sensitivity to suggestive interviewing in CSA cases was explored. Furthermore, the effects of attitudes and beliefs related to CSA and experience with CSA investigations on the sensitivity to suggestive influences in the interview were investigated. Also, the effect of base rate estimates of CSA on decisions was examined. A questionnaire covering items concerning demographic data, different aspects of clinical experience, self-evaluated expertise, beliefs and knowledge about CSA and a set of ambiguous material based on real trial documents concerning an alleged CSA case was given to child mental health professionals. The experiment was based on a 2 x 2 x 2 x 2 (leading questions: yes vs no) x (stereotype induction: yes vs no) x (emotional tone: pressure to respond vs no pressure to respond) x (threats and rewards: yes vs no) between-subjects factorial design, in which the suggestiveness of the methods with which the responses of the child were obtained were varied. There was an additional condition in which the material did not contain any interview transcripts. The results showed that clinicians are sensitive only to the presence of leading questions but not to the presence of other suggestive techniques. Furthermore, the clinicians were not sensitive to the possibility that suggestive techniques could have been used when no interview transcripts had been included in the trial material. Experience had an effect on the sensitivity of the clinicians only regarding leading questions. Strong beliefs related to CSA lessened the sensitivity to leading questions. Those showing strong beliefs on the belief scales used in this study were even more prone to prosecute than other participants when other suggestive influences than leading questions were present. Controversy exists regarding effects of experience and feedback on clinical decision making. In Study IV the impact of the number of handled cases and of feedback on the decisions in cases of alleged CSA was investigated. One-hundred vignettes describing cases of suspected CSA were given to students with no experience with investigating CSA. The vignettes were based on statistical data about symptoms and prevalence of CSA. According to the theoretical likelihood of CSA the children described were categorized as abused or not abused. The participants were asked to decide whether abuse had occurred. They were divided into 4 groups: one received feedback on whether their decision was right or wrong, one received information about cognitive processes involved in decision making, one received both, and one did not receive feedback at all. The results showed that participants who received feedback on their performance made more correct positive decisions and participants who got information about decision making processes made more correct negative decisions. Feedback and information combined decreased the number of correct positive decisions but increased the number of correct negative decisions. The number of read cases had in itself a positive effect on correct positive decision.

Dental Health in Primary Teeth after Prevention of Mother-Child Transmission of Mutans Streptococci. A Historical Cohort Study on Restorative Visits and Maternal Prevention Costs

Mutansstreptokokkitartunnan ehkäisemisen pitkäaikaisvaikutukset maitohampaiden terveyteen. Kohorttitutkimus korjaavan hoidon määrästä ja kariesehkäisyn kustannuksista. Tutkimuksen tarkoituksena oli selvittää varhaisen mutansstreptokokki (MS)-kolonisaation ehkäisyn pitkäaikaisvaikutuksia korkean kariesriskin omaavien lasten maitohampaistossa sekä tarkastella MS-tartunnan estämisen kustannuksia. Tiedot lasten hampaiden terveydestä ja hammashoitotoimenpiteistä syntymästä 10-vuotiaaksi sekä äiteihin kohdistuneen kariesehkäisyn kustannuksista kerättiin Ylivieskan terveyskeskuksen asiakirjoista. Tutkimuksessa oli mukana yhteensä 507 lasta, heistä 148 oli osallistunut aikaisempaan Ylivieskan äiti-lapsitutkimukseen, jossa verrattiin äitien käyttämän ksylitolipurukumin ja äidille tehtyjen fluori- tai klooriheksidiinilakkausten vaikutusta pikkulasten hampaiden terveyteen. Maitohammaskariesta esiintyi 10-vuotiaaksi asti merkitsevästi vähemmän lapsilla, jotka eivät olleet saaneet MS-tartuntaa alle 2-vuotiaana, heidän maitohampaansa säilyivät 3,4 vuotta kauemmin täysin ehjinä (p<0.001) ja he tarvitsivat vähemmän maitohampaiden korjaavaa hoitoa (p=0.005) kuin lapset, joiden hampaisto oli kolonisoitunut MS-bakteerilla jo 2-vuotiaana. Koska ksylitoliryhmän lasten MS-kolonisaatio oli vähäisintä, heidän maitohampaissaan oli vähemmän kariesta ja korjaavan hoidon tarvetta kuin kahden muun korkeariskisen ryhmän lapsilla. Äitien käyttämän ksylitolipurukumin kustannukset olivat yhteensä 116 euroa ja lapsen maitohampaiden säilyminen täysin ehjinä vuoden pidempään maksoi 37 euroa. Kun MS-tartunta oli saatu estettyä, korkean kariesriskin omaavien lasten hampaiden terveys oli samalla tasolla kuin keskimäärin koko ikäkohortilla. Lapsen maitohampaat säilyvät terveinä pidempään ja korjaavan hoidon tarve vähenee, kun MS-kolonisaatio alle 2-vuotiaana saadaan estettyä. Lapsen MS-kolonisaatio vähenee merkitsevästi, kun äiti käyttää ksylitolipurukumia lapsen ollessa 0-2 vuoden ikäinen, siten pikkulapsen äidin säännöllinen ksylitolipurukumin käyttö saattaa olla julkisen tereydenhuollon kannalta tarkoituksenmukainenterveyttä edistävä menetelmä.

Eettinen kasvu ja dialogisuus draaman näyttämöllä : valokiilassa päiväkodin draamaprosessi

This research is a phenomenological-hermeneutic case-study based on the methods of action research in which narrative methods are used to examine a process drama carried out in a day-care centre, focusing on its dialogicality and possibilities of offering children and adults ethical problems to examine and solve. A process drama built around a story was carried out in a Finnish day-care centre in 1999 with the aim of bringing ethical education to the level of conscious consideration and action. The research consists of two case-studies. The first focuses on Risto, one of the children who participated in the process, his actions in group situations, his commitment to the rules set by the leaders, his attitude towards the group and its members as well as the common agreements concerning the group, and his solutions to fictive dilemmas in relation to Lawrence Kohlberg’s and Carol Gilligan’s concepts of justice and care. On this basis conclusions are made on how drama can be applied to dealing with ethical dilemmas with children aged four to seven. The second case-study searches for ethical themes and signs of dialogicality in the story that was created together by the children and leaders, and in the action that took place in the drama sessions. The subjects of this study consist of two groups participating in the process drama, both consisting of seven children aged four to seven. Narratives were written on each child based on his/her participation in four drama sessions selected to be used in this study. The narratives include the writer’s interpretations of the dialogicality of the drama and the ethical themes observed and recognised in the videos and in the transcriptions of the video recordings. The description and interpretation of the dialogicality and the ethical themes observed in the drama sessions is based on the researcher’s dialogue with the writings of Georg Henrik von Wright, Martin Buber and Mihail Bahtin, as well as Nicholas C. Burbules’ definitions of the basic conditions for dialogical teaching. As a result of the study, drama activity proved to be a means by which dialogically abstract ethical questions and conflicts could be dealt with even with young children and which revealed the zone of proximal development of both children and adults. Drama became a stage for ethical growth and dialogicality, and the common play of children and adults could be seen as an indicator of deep dialogicality. On the basis of this study, it can be said that drama is a very suitable way of establishing a shape and form of ethical education in which it is possible to make planned, target-oriented progress and which can be consciously observed by following the development of both the child and the educator.

Att lära för livet hemma och i skolan : elevers uppfattningar av kost och hälsa, konsumtion och privatekonomi samt hushåll och miljö

The home is an important societal arena for upbringing and learning. A child can experience a feeling of participation in the household he or she belongs to very early in life. In this manner, the home environment constitutes an essential foundation for instruction in the subject of Home Economics. At school, Home Economics pupils should fulfill the intentions that school curriculum has for the subject, that is to say develop the knowledge, skills, and values that allow pupils to be able to take responsibility for their health, finances, comfort, and safety in their close environment. The purpose of this study is twofold. Firstly, the study aims to examine what knowledge and attitudes children and teenagers have acquired from their home environment, close environment, as well as school. Secondly, the study aims to evaluate the effects of instruction in Home Economics, at the 7th grade level, as regards diet and health, consumption and private finances, as well as household and the environment. The study’s methodological foundation focuses on pupils’ understanding of the surrounding world. A phenomenographical approach to the research phenomenon basis itself on the supposition that knowledge is fixed in human beings’ consciousness and experiences. Furthermore, the study stresses individual variations in conjunction with the experienced phenomenon. The empirical portion of the study is based on semistructured interviews of 30 pupils divided into two reference groups. The pupils were interviewed before instruction in the subject of Home Economics started and upon completing instruction. The interview data was analyzed and interpreted in accordance with the “multistage model”. The study results show that upbringing in the home environment is determinative as pertains to understanding of the socio-cultural household environment. Mealtime traditions, for example, are deeply ingrained but nonetheless influenced by lifestyle changes. The study shows that a didactic challenge exists to draw attention to the consequences of poor mealtime habits and stress for everyone raising or educating children and teenagers. Despite good knowledge of what a healthy diet is, the majority of pupils choose fast-food and junk-food when they eat out to save time and money. Studies of pupils’ preparedness for consumption show that a purposeful upbringing in the home in combination with relevant instruction in Home Economics, results in knowledgeable consumers. This study also shows that upbringing in the home environment and instruction in Home Economics requires an intense and conscious focus on the consequences of a household not run in accordance with nature, where the household lifestyle is nonsustainable. Pupils’ understanding is often based on the disregarding of the survival perspective for a comfort perspective. Parents and Home Economics teachers should be able to bring up and teach children and teenagers in a manner that allows children and teenagers to take responsibility for their health, private finances, as well as comfort and safety in the close environment. The method is conscious nurturing and instruction.

Political participation beyond the vote : how the institutional context shapes patterns of political participation in 18 Western European democracies

Politiskt deltagande är en definierande del av varje demokratiskt politiskt system, även mellan valen. Men det har skett en betydande utveckling i vilka aktiviteter som uppfattas som politiskt deltagande. Det är inte enbart aktiviteter i politiska partier som är i fokus, men också olika protestaktiviteter, delaktighet i nya sociala rörelser och livsstilspolitik i form av politisk konsumtion. Politiskt deltagande mellan valen kan leda till en potentiell legitimitetskonflikt. Den potentiella konflikten mellan ansvarsutkrävande och medborgarnas aktiva medverkan har varit känd sedan länge. Representativa demokratier har genom olika institutionella mekanismer försökt konstruera ett fungerande politiskt system som förenar möjligheten för politiskt deltagande med en tydlig ansvarsstruktur. I detta sammanhang har den institutionella öppenheten haft en central position eftersom denna antas påverka hur lätt det är för medborgarna att påverka de formella beslutfattarna. Avhandlingen undersöker därmed konsekvenserna av institutionell öppenhet för olika former av politiskt deltagande. Resultaten tyder på att demokratiska staters institutionella uppbyggnad har väsentliga konsekvenser för det politiska deltagandet. Men samspelet mellan systemet och deltagandet verkar vara mera invecklat än de dominerande teorierna om politiska institutioner och deltagande ger vid handen. Institutionell öppenhet har inte den förväntade effekt beroende på om den politiska handlingen sker inom eller utanför det formella systemet, och den institutionella effekten är mera uttalad för föreningsaktivism och politisk konsumtion, vilket är de aktiviteter som ligger längst bort från det formella politiska systemet. Resultaten utmanar därmed centrala teoretiska antaganden inom forskningen om politiskt deltagande. I ljuset av de resultat som presenteras i avhandlingen framstår det som särskilt angeläget att omvärdera effekten av institutionell öppenhet.

Health-related quality of life in school children: validation of instrument, child self assessment, parent-proxy assessment and school nursing documentation of health check-ups

The aims of this study were to validate an international Health-Related Quality of Life (HRQL) instrument, to describe child self and parent-proxy assessed HRQL at child age 10 to 12 and to compare child self assessments with parent-proxy assessments and school nursing documentation. The study is part of the Schools on the Move –research project. In phase one, a cross-cultural translation and validation process was performed to develop a Finnish version of Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). The process included a two-way translation, cognitive interviews (children n=7, parents n=5) and a survey (children n=1097, parents n=999). In phase two, baseline and follow-up surveys (children n=986, parents n=710) were conducted to describe and compare the child self and parent-proxy assessed HRQL in school children between the ages 10 and 12. Phase three included two separate data, school nurse documented patient records (children n=270) and a survey (children n=986). The relation between child self assessed HRQL and school nursing documentation was evaluated. Validity and reliability of the Finnish version of PedsQL™ 4.0 was good (Child Self Report α=0.91, Parent-Proxy Report α=0.88). Children reported lower HRQL scores at the emotional (mean 76/80) than the physical (mean 85/89) health domains and significantly lower scores at the age of 10 than 12 (dMean=4, p=<0.001). Agreement between child self and parent-proxy assessment was fragile (r=0,4, p=<0.001) but increased as the child grew from age 10 to 12 years. At health check-ups, school nurses documented frequently children’s physical health, such as growth (97%) and posture (98/99%) but seldom emotional issues, such as mood (2/7%). The PedsQLTM 4.0 is a valid instrument to assess HRQL in Finnish school children although future research is recommended. Children’s emotional wellbeing needs future attention. HRQL scores increase during ages between childhood and adolescence. Concordance between child self and parent-proxy assessed HRQL is low. School nursing documentation, related to child health check-ups, is not in line with child self assessed HRQL and emotional issues need more attention.

Value co-creation through virtual community participation

Consumers create a great deal of content in the Internet. As they do not get a monetary compensation for doing so, it seems apparent that other types of reward are derived from giving up one's time and other resources. The purpose of this study is to describe value creation and user participation in a virtual community. It can be broken down into three research questions. 1. What is the value creation logic of a virtual community? 2. What value is perceived by virtual community users? 3. What is the association between value perceived by virtual community users and their participation in a community? The study employs the discussion on value co-creation as well as perspectives on the notion of value for consumers to create a theoretical framework for value creation. To understand value creation in the context of virtual communities and to create a theoretical framework for user participation, existing literature and research on virtual communities is discussed. The empirical part of the study employs quantitative methodology to analyze data collected by sending a survey questionnaire to the users of a Finnish wellbeing-based virtual community. The results indicate that virtual community users perceive self-development, enjoyment, reputation-building and community commitment value when using the service and that value perceptions are associated with community participation. Moreover, it was found that different types of value are associated with different forms of participation. Based on the findings, it is suggested that the four types of value make up a considerable share of value for virtual community users. Moreover, as the results indicate that different value types are associated with different forms of participation, it suggested that virtual community organizers consider what forms of participation they want to promote and design their virtual communities to support creation of the different types of value accordingly.