Intercultural Competence of Masters of Science in Business Administration and in Technology

Tutkielman tavoitteena on selvittää minkälaista kulttuurienvälistä kompetenssia Lappeenrannan teknillisestä yliopistosta vastavalmistuneilla kauppatieteenmaistereilla sekä diplomi-insinööreillä tulisi olla työnantajien näkökulmasta. Tutkimuksen tarkoituksena on myös tarkastella, että voidaanko kaikkia Lappeenrannan teknillisestä yliopistosta valmistuvia kutsua Kansainvälisiksi Huippuosaajiksi sekä kuinka Lappeenrannan teknillinen yliopisto voisi parantaa vastavalmistuvien kulttuurienvälistä kompetenssia. Teoreettinen osa tarkastelee kulttuurienvälisen kommunikaation tärkeimpiä elementtejä, kulttuurienvälistä kompetenssia ja vastavalmistuneiden kauppatieteenmaistereiden sekä diplomi-insinöörien tarvitsemaa ammatillista osaamista. Empiria koostuu kymmenen työnantajien teemahaastattelun tuloksista. Lopuksi johtopäätöksissä empirian tuloksia verrataan teorian löydöksiin. Tulokset osoittavat että kulttuurienvälinen kompetenssi koostuu kolmesta dimensiosta: henkilökohtaisista ominaisuuksista, tiedosta ja kommunikointikyvystä. Henkilökohtaisiin ominaisuuksiin sisältyvät empaattisuus, epävarmuuden sietokyky sekä avoin ja utelias asenne. Tieto - ulottuvuus koostuu yleisestä ja erityisestä kulttuuritiedosta, kielitaidosta sekä ammatillisesta osaamisesta. Kommunikointikykyyn puolestaan sisältyvät hyvät vuorovaikutustaidot. Työnantajat olettavat nykyään vastavalmistuneilla olevan ammatillisen osaamisen ja kielitaidon lisäksi, kulttuuritietoutta sekä kansainvälistä kokemusta. Lappeenrannan teknillinen yliopisto voisi parantaa vastavalmistuneiden kulttuurienvälistä kompetenssia tarjoamalla kulttuurienvälisen kommunikaation opetusta.

The cultural dimension in focus : promoting awareness of diversity and respect for difference in a Finland-Swedish EFL classroom

This study addresses the role of EFL education, its potential and shortcomings, and the challenges the future of EFL education will bring. It is argued that new societal demands and the limited time we have at our disposal in the classroom make it necessary to rethink goals and content and move away from the transmissionof limited sets of facts and information to helping students develop awareness and competences that can be applied in many different situations, also in a perspective of lifelong learning. The overall aim of the current study is to problematize and increase understanding of the implementation of cultural aspects in the language classroom by addressing the interrelated what, why and how of the cultural dimension within EFL education. This has been conducted by means of theoretical explorations into the area, alongside an attempt at promoting intercultural competence (IC) in a more systematic and insightful manner within my own educational praxis. The focus of the intercultural work in the classroom was on the promotion of awareness of difference and diversity, as well as respect for such difference through the ability to decenter from cultural norms and behavior that previously have been taken for granted. These are two elements that have been suggested as fundamental for other work with IC in the classroom and for the realization of important aspects of the underlying values of basic education. In the context of this study, IC comprises several interconnected components supportingeach other in a variety of ways, with the further aim being interaction with and respect for difference in general, not only concerning e.g. representatives ofcertain English-speaking communities. The methodology was informed by action research, with myself in the role of the teacher-researcher or the reflective practitioner. For the purpose of the project I was authorized to take on the EFL education for the three years of upper comprehensive school of one random class of students originally assigned to one of the language teachers of the selected Finland-Swedish school. Thus, the class of 17 students was not specifically chosen for the project, and the aims and contents chosen for the development project were placed within the framework of the ordinary curriculum. By exploring the students¿ insights concerning different English-speaking cultural groups, mainly through a set of questionnaires, it was possible to outline the work with the cultural dimension in the classroom for the following three years. Work progress was evaluated at specific stages, and the final project evaluations were conducted through individual student interviews in grade 9. The interviews were focused on possible development of students¿ insights concerning different aspects of the cultural dimension. In particular this concerned awareness of difference and diversity, including modification of stereotypes, as well as the ability to decenterin order to be better able to respect such difference. I also explored students¿ awareness and views of the activities and approaches used in class, as well asaffordances both inside and outside the EFL classroom in relation to these intended insights. A further focus area was the perceived relevance to students of different aspects of the cultural dimension. The frameworks and approaches adopted for the work in the classroom all have in common that they are based on a constructivist framework, where knowledge is constructed and reconstructed through interaction with one¿s social and cultural environment, including interaction with others. Reflective processes precede or are simultaneous with the learning of basic factual knowledge. This entails a view of learning as a progression from simple to more complex models rather than as a progression from facts to understanding and analysis. Here, the development of intercultural competence is seen asa cyclical process, or along a spiral curriculum, from simple to more complex levels through a combination of cognitive, affective and behavioral elements within a framework of experiential learning. This project has shown one possible wayforward concerning the development of intercultural competence within EFL education through a more systematic and comprehensive approach regarding linguistic and cultural aspects. The evaluation of the educational process explored in the study suggests the possibilities for work with the promotion of awareness of difference and diversity concerning some specific context that, based on students¿ prior knowledge and preconceptions, would benefit from further work. In this case, the specific context primarily concerned different aspects of both cultural and linguistic conditions in the UK. It is also suggested that many students developed the ability to decenter, described in the study as integral to being able to respect otherness. What still remains to be explored are more individualized approaches considering students¿ different levels of departure. Further work alsoneeds to be put into how to apply insights gained in these specific situations to more general contexts. It is also necessary to explore the use of the suggested approaches in a wider range of different contexts.

In pursuit of an intercultural dimension in EFL-teaching : exploring cognitions among Finland-Swedish comprehensive school teachers

This thesis is about the educational purpose of foreign language teaching (FLT) in an increasingly internationalised world.The past 20-30 years have witnessed a fundamental rethinking of the aims of FLT, entailing a shift in emphasis from linguistic competence over communicative competence to intercultural competence. The growing emphasis on cultural issues, called for by research and international curricular documents, places new demandson language teachers. The overall aim of this study is to deepen the knowledge about the attitudes of teachers at the upper level of the Finland-Swedish comprehensive school towards the treatment of culture in English foreign language (EFL) teaching. The questions in focus are: 1) How do teachers interpret the concept"culture" in EFL-teaching?, 2) How do they specify the cultural objectives of their teaching? and 3) What do they do to attain these objectives? The thesis strives to reveal whether or not language teaching today can be describedas intercultural, in the sense that culture is taught with the aim of promotingintercultural understanding, tolerance and empathy. This abductive and largely exploratory study is placed within a constructivist and sociocultural framework,and is inspired by both phenomenography and hermeneutics. It takes its starting-point in language didactics, and can also be regarded as a contribution to teacher cognition research. The empirical data consists of verbatim transcribed interviews with 13 Finland-Swedish teachers of English at grades 7-9. The findings are presented according to three orientations and reviewed with reference to the 2004 Finnish National Framework Curriculum. Within the cognitive orientation, "culture" is perceived as factual knowledge, and the teaching of cultureis defined in terms of the transmission of knowledge, especially about Britain and the USA (Pedagogy of Information). Within the action-related orientation, "culture" is seen as skills of a social and socio-linguistic nature, andthe teaching aims at preparing the students for contacts with people from the target language areas (Pedagogy of Preparation). Within the affective orientation, which takes a more holistic approach, "culture" is seen as a bi-directional perspective. Students are encouraged to look at their own familiar culture from another perspective, and learn to empathise with and show respect for otherness in general, not just concerning representatives of English-speaking countries (Pedagogy of Encounter). Very few of the interviewed teachers represent the third approach, which is the one that can be characterised as truly intercultural. The study indicates that many teachers feel unsure about how to teach culture in an appropriate and up-to-date manner. This is attributed to, among other things, lack of teacher insights as well as lack of time and adequate material. The thesis ends with a set of recommendations as to how EFL could be developed ina more intercultural direction.

Exploration of the social dimension of corporate responsibility in a welfare state

This study focuses on corporate social responsibility (or CSR)as the latest dimension to emerge in the corporate responsibility and sustainability agenda, which in the recent past has rapidly risen to the top of the list of concerns for civil societies worldwide. Despite the continuing debates and discussions about the scope, benefits, and impacts of CSR to business and community in various sectors, levels, and types of society, many companies have moved forward to confront the opportunities and challenges of CSR. Thus, this study is about those proactive companies with a focus on the importance of CSR and its management inside and outside the company. It is an exploration and learning from the experience of Finnish companies, as well as other actors interested or involved in shaping the course of CSR, locally and globally. It also looks closely at how national culture affects the views, thinking, and management of CSR in a welfare state. This dissertation primarily draws on the analyses of information collected from a series of qualitative interviews and the existing literature in the area. This is complemented by an analysis of written and published documents on CSR from various sources. The results of the study give insightful information and detailed descriptions of a roadmap useful in learning and understanding CSR in Finnish companies. Despite the varying conceptual connotations, essential roadmap indicators point to the importance of framing CSR within the corporate responsibility concept, Finnish development and the welfare state system, globalization, stakeholders, and the pursuit of sustainable development as the main drivers of CSR, the remarkable progress of CSR in companies, and identification of key management areas and practices relevant to CSR. Similarly,the study reveals the importance of culture as essential in understanding and learning CSR. Finnish culture has a positive influence on the views, thinking, and management practices of CSR issues. Such a positive influence of culture, therefore, makes it easy for business people to discuss and understand CSR, because those CSR issues are already considered common and taken-for-granted by Finns and are implicit in the welfare state provisions. The experience of Finnish companies in implementing CSR policies in the supply chain is a concrete proactive step in advancing the message of CSR, that is, to bring companies and suppliers together to work on improving and strengthening relationships towards socially responsible practices worldwide. Such a forward step to deal with CSR issues in the supply chain reflects the companies' commitments and belief that CSR can be managed with the suppliers and gain positive benefits. Despite the problems and complexities, particularly in the global supply chain, managing CSR for Finnish companies presents new opportunities and challenges that are expected to intensify in the near future. The focus on CSR policy implementation inthe supply chain points to the importance of companies taking initiatives and forging cooperation with suppliers with the aim of addressing and improving CSR questions in the supply chains. The proactive stance of Finnish companies toward CSR is complemented by the active supporting role of important societalactors such as the government and NGOs. These actors carry out various promotional efforts and campaigns, thus bringing CSR into the mainstream of Finnish companies and strengthening the synergistic learning about CSR within the Finnish business and civil circles. The efforts of the government and NGOs to promote CSR are indicative of the importance of multipartite involvement and the emergence of better civil regulations. Likewise, their drive to learn from each other, exchange experiences, and contribute in CSR debates facilitated the evolution of CSRnetworks in the country. The results of this study add to the mounting evidence that CSR, in general, has created a new dimension in managing corporate sustainability. This study provides compelling empirical evidence and some direct quotations about CSR in the Finnish context. This information can be used to learn and gain new useful insights, approaches, and concepts for managing CSR.

Choice of Business Process Modeling Methodology - Case Northern Dimension Research Centre (NORDI) in Lappeenranta University of Technology

The main outcome of the master thesis is innovative solution, which can support a choice of business process modeling methodology. Potential users of this tool are people with background in business process modeling and possibilities to collect required information about organization’s business processes. Master thesis states the importance of business process modeling in implementation of strategic goals of organization. It is made by revealing the place of the concept in Business Process Management (BPM) and its particular case Business Process Reengineering (BPR). In order to support the theoretical outcomes of the thesis a case study of Northern Dimension Research Centre (NORDI) in Lappeenranta University of Technology was conducted. On its example several solutions are shown: how to apply business process modeling methodologies in practice; in which way business process models can be useful for BPM and BPR initiatives; how to apply proposed innovative solution for a choice of business process modeling methodology.

Verbal learning in mild cognitive impairment and alzheimer's disease : behavioural and neural approaches

The main focus of the present thesis was at verbal episodic memory processes that are particularly vulnerable to preclinical and clinical Alzheimer’s disease (AD). Here these processes were studied by a word learning paradigm, cutting across the domains of memory and language learning studies. Moreover, the differentiation between normal aging, mild cognitive impairment (MCI) and AD was studied by the cognitive screening test CERAD. In study I, the aim was to examine how patients with amnestic MCI differ from healthy controls in the different CERAD subtests. Also, the sensitivity and specificity of the CERAD screening test to MCI and AD was examined, as previous studies on the sensitivity and specificity of the CERAD have not included MCI patients. The results indicated that MCI is characterized by an encoding deficit, as shown by the overall worse performance on the CERAD Wordlist learning test compared with controls. As a screening test, CERAD was not very sensitive to MCI. In study II, verbal learning and forgetting in amnestic MCI, AD and healthy elderly controls was investigated with an experimental word learning paradigm, where names of 40 unfamiliar objects (mainly archaic tools) were trained with or without semantic support. The object names were trained during a 4-day long period and a follow-up was conducted one week, 4 weeks and 8 weeks after the training period. Manipulation of semantic support was included in the paradigm because it was hypothesized that semantic support might have some beneficial effects in the present learning task especially for the MCI group, as semantic memory is quite well preserved in MCI in contrast to episodic memory. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, indicating that the MCI patients’ preserved semantic memory abilities compensated for their impaired episodic memory. The MCI group performed equally well as the controls in the tasks tapping incidental learning and recognition memory, whereas the AD group showed impairment. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that acquisition is compromised in both MCI and AD, whereas long13 term retention is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI. In studies III and IV, the neural correlates of naming newly learned objects were examined in healthy elderly subjects and in amnestic MCI patients by means of positron emission tomography (PET) right after the training period. The naming of newly learned objects by healthy elderly subjects recruited a left-lateralized network, including frontotemporal regions and the cerebellum, which was more extensive than the one related to the naming of familiar objects (study III). Semantic support showed no effects on the PET results for the healthy subjects. The observed activation increases may reflect lexicalsemantic and lexical-phonological retrieval, as well as more general associative memory mechanisms. In study IV, compared to the controls, the MCI patients showed increased anterior cingulate activation when naming newly learned objects that had been learned without semantic support. This suggests a recruitment of additional executive and attentional resources in the MCI group.

Cognitive Functions After Traumatic Brain Injury. A 30-year Follow-up Study

Many cognitive deficits after TBI (traumatic brain injury) are well known, such as memory and concentration problems, as well as reduced information-processing speed. What happens to patients and cognitive functioning after immediate recovery is poorly known. Cognitive functioning is flexible and may be influenced by genetic, psychological and environmental factors decades after TBI. The general aim of this thesis was to describe the long-term cognitive course after TBI, to find variables that may contribute to it, and how the cognitive functions after TBI are associated with specific medical factors and reduced survival. The original study group consisted of 192 patients with TBI who were originally assessed with the Mild Deterioration Battery (MDB) on average two years after the injury, during the years 1966 – 1972. During a 30-year follow-up, we studied the risks for reduced survival, and the mortality of the patients was compared with the general population using the Standardized Mortality Ratio (SMR). Sixty-one patients were re-assessed during 1998-2000. These patients were evaluated with the MDB, computerized testing, and with various other neuropsychological methods for attention and executive functions. Apolipoprotein-E (ApoE) genotyping and magnetic resonance imaging (MRI) based on volumetric analysis of the hippocampus and lateral ventricles were performed. Depressive symptoms were evaluated with the short form of the Beck depression inventory. The cognitive performance at follow-up was compared with a control group that was similar to the study group in regard to age and education. The cognitive outcome of the patients with TBI varied after three decades. The majority of the patients showed a decline in their cognitive level, the rest either improved or stayed at the same level. Male gender and higher age at injury were significant risk factors for the decline. Whereas most cognitive domains declined during the follow-up, semantic memory behaved in the opposite way, showing recovery after TBI. In the follow-up assessment, the memory decline and impairments in the set-shifting domain of executive functions were associated with MRI-volumetric measures, whereas reduction in information-processing speed was not associated with the MRI measures. The presence of local contusions was only weakly associated with cognitive functions. Only few cognitive methods for attention were capable of discriminating TBI patients with and without depressive symptoms. On the other hand, most complex attentional tests were sensitive enough to discriminate TBI patients (non-depressive) from controls. This means that complex attention functions, mediated by the frontal lobes, are relatively independent of depressive symptoms post-TBI. The presence of ApoE4 was associated with different kinds of memory processes including verbal and visual episodic memory, semantic memory and verbal working memory, depending on the length of time since TBI. Many other cognitive processes were not affected by the presence of ApoE4. Age at injury and poor vocational outcome were independent risk factors for reduced survival in the multivariate analysis. Late mortality was higher among younger subjects (age < 40 years at death) compared with the general population which should be borne in mind when assessing the need for rehabilitation services and long-term follow-up after TBI.

Mild Cognitive Impairment and Early Detection of Alzheimer`s Disease. A Positron Emission Tomography Study

Alzheimer`s disease (AD) is characterised neuropathologically by the presence of extracellular amyloid plaques, intraneuronal neurofibrillary tangles, and cerebral neuronal loss. The pathological changes in AD are believed to start even decades before clinical symptoms are detectable. AD gradually affects episodic memory, cognition, behaviour and the ability to perform everyday activities. Mild cognitive impairment (MCI) represents a transitional state between normal aging and dementia disorders, especially AD. The predictive accuracy of the current and commonly used MCI criteria devide this disorder into amnestic (aMCI) and non-amnestic (naMCI) MCI. It seems that many individuals with aMCI tend to convert to AD. However many MCI individuals will remain stable and some may even recover. At present, the principal drugs for the treatment of AD provide only symptomatic and palliative benefits. Safe and effective mechanism-based therapies are needed for this devastating neurodegenerative disease of later life. In conjunction with the development of new therapeutic drugs, tools for early detection of AD would be important. In future one of the challenges will be to detect at an early stage these MCI individuals who will convert to AD. Methods which can predict which MCI subjects will convert to AD will be much more important if the new drug candidates prove to have disease-arresting or even disease–slowing effects. These types of drugs are likely to have the best efficacy if administered in the early or even in the presymptomatic phase of the disease when the synaptic and neuronal loss has not become too widespread. There is no clinical method to determine with certainly which MCI individuals will progress to AD. However there are several methods which have been suggested as predictors of conversion to AD, e.g. increased [11C] PIB uptake, hippocampal atrophy in MRI, low CSF A beta 42 level, high CSF tau-protein level, apolipoprotein E (APOE) ε4 allele and impairment in episodic memory and executive functions. In the present study subjects with MCI appear to have significantly higher [¹¹C] PIB uptake vs healthy elderly in several brain areas including frontal cortex, the posterior cingulate, the parietal and lateral temporal cortices, putamen and caudate. Also results from this PET study indicate that over time, MCI subjects who display increased [¹¹C] PIB uptake appear to be significantly more likely to convert to AD than MCI subjects with negative [¹¹C] PIB retention. Also hippocampal atrophy seems to increase in MCI individuals clearly during the conversion to AD. In this study [¹¹C] PIB uptake increases early and changes relatively little during the AD process whereas there is progressive hippocampal atrophy during the disease. In addition to increased [¹¹C] PIB retention and hippocampal atrophy, the status of APOE ε4 allele might contribute to the conversion from MCI to AD.

PET and MR imaging in Parkinson’s disease patients with cognitive impairment. A study of dopaminergic dysfunction, amyloid deposition, cortical hypometabolism and brain atrophy

Parkinson’s disease (PD) is the second most common neurodegenerative disorder. It is characterized by a severe loss of substantia nigra dopaminergic neurons leading to dopamine depletion in the striatum. PD affects movement, producing motor symptoms such as rigidity, tremor and bradykinesia. Non-motor symptoms include autonomic dysfunction, neurobehavioral problems and cognitive impairment, which may lead to dementia. The pathophysiological basis of cognitive impairment and dementia in PD is unclear. The aim of this thesis was to study the pathophysiological basis of cognitive impairment and dementia in PD. We evaluated the relation between frontostriatal dopaminergic dysfunction and the cognitive symptoms in PD patients with [18F]Fdopa PET. We also combined [C]PIB and [¹⁸F]FDG PET and magnetic resonance imaging in PD patients with and without dementia. In addition, we analysed subregional striatal [¹⁸F]Fdopa PET data to find out whether a simple ratio approach would reliably separate PD patients from healthy controls. The impaired dopaminergic function of the frontostriatal regions was related to the impairment in cognitive functions, such as memory and cognitive processing in PD patients. PD patients with dementia showed an impaired glucose metabolism but not amyloid deposition in the cortical brain regions, and the hypometabolism was associated with the degree of cognitive impairment. PD patients had atrophy, both in the prefrontal cortex and in the hippocampus, and the hippocampal atrophy was related to impaired memory. A single 15-min scan 75 min after a tracer injection seemed to be sufficient for separating patients with PD from healthy controls in a clinical research environment. In conclusion, the occurrence of cognitive impairment and dementia in PD seems to be multifactorial and relates to changes, such as reduced dopaminergic activity, hypometabolism, brain atrophy and rarely to amyloid accumulation.

Genetically Determined Hypometabolism in Alzheimer’s Disease and Midlife Risk Factors for Cognitive Impairment

The role of genetic factors in the pathogenesis of Alzheimer’s disease (AD) is not completely understood. In order to improve this understanding, the cerebral glucose metabolism of seven monozygotic and nine dizygotic twin pairs discordant for AD was compared to that of 13 unrelated controls using positron emission tomography (PET). Traditional region of interest analysis revealed no differences between the non-demented dizygotic co-twins and controls. In contrast, in voxel-level and automated region of interest analyses, the non-demented monozygotic co-twins displayed a lower metabolic rate in temporal and parietal cortices as well as in subcortical grey matter structures when compared to controls. Again, no reductions were seen in the non-demented dizygotic co-twins. The reductions seen in the non-demented monozygotic co-twins may indicate a higher genetically mediated risk of AD or genetically mediated hypometabolism possibly rendering them more vulnerable to AD pathogenesis. With no disease modifying treatment available for AD, prevention of dementia is of the utmost importance. A total of 2 165 at least 65 years old twins of the Finnish Twin Cohort with questionnaire data from 1981 participated in a validated telephone interview assessing cognitive function between 1999 and 2007. Those subjects reporting heavy alcohol drinking in 1981 had an elevated cognitive impairment risk over 20 years later compared to light drinkers. In addition, binge drinking was associated with an increased risk even when total alcohol consumption was controlled for, suggesting that binge drinking is an independent risk factor for cognitive impairment. When compared to light drinkers, also non-drinkers had an increased risk of cognitive impairment. Midlife hypertension, obesity and low leisure time physical activity but not hypercholesterolemia were significant risk factors for cognitive impairment. The accumulation of risk factors increased cognitive impairment risk in an additive manner. A previously postulated dementia risk score based on midlife demographic and cardiovascular factors was validated. The risk score was found to well predict cognitive impairment risk, and cognitive impairment risk increased significantly as the score became higher. However, the risk score is not accurate enough for use in the clinic without further testing.

Asiakastyytyväisyyden muodostuminen: Kognitiivinen, affektiivinen ja kognitiivis-affektiivinen näkemysvertailu

Tässä Pro gradu –tutkielmassa tavoiteltiin kokonaiskuvaa teemapuistoalan asiakastyytyväisyyden muodostumisesta kognitiivisesta, affektiivisesta ja kognitiivis-affektiivisesta näkökulmasta. Lisäksi tarkasteltiin kunkin näkökulman teoriapohjaa; miten asiakas muodostaa arvionsa tyytyväisyydestään sekä tyytyväisyyteen vaikuttavia tekijöitä kussakin näkökulmassa. Tutkimus toteutettiin kvalitatiivisena tutkimuksena, ryhmähaastatteluna. Tutkimustulosten perusteella todettiin asiakastyytyväisyyden muodostuvan kognitioiden ja affektien yhteisvaikutuksesta, tulosten tukien kognitiivis-affektiivista näkökulmaa. Lisäksi tuloksissa saatiin viitteitä sosiaalisesta näkökulmasta asiakastyytyväisyyden muodostumisessa, affektiivisesta diskonfirmaatiosta sekä asiakastyytyväisyyden dynaamisesta luonteesta. Myös asiakastyytyväisyyden ja –tyytymättömyyden prosessien havaittiin eroavan ainakin jossain määrin. Uudet, viitekehyksen ulkopuoliset havainnot tukivat uusimman kirjallisuuden käsitystä asiakastyytyväisyydestä monitasoisena ja –ulotteisena käsitteenä.

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.