Postnatal depressive symptoms amongst women in Central Vietnam: A cross-sectional study investigating prevalence and associations with social, cultural and infant factors

Background This study investigated the prevalence and socio-cultural correlates of postnatal mood disturbance amongst women 18–45 years old in Central Vietnam. Son preference and traditional confinement practices were explored as well as factors such as poverty, parity, family and intimate partner relationships and infant health. Methods A cross-sectional study was conducted in twelve randomly selected Commune Health Centres from urban and rural districts of Thua Thien Hue Province, Vietnam. Mother-infant dyads one to six months postpartum were invited to participate. Questionnaires from 431 mothers (urban n = 216; rural n = 215) assessed demographic and family characteristics, traditional confinement practices, son preference, infant health and social capital. The Edinburgh Postnatal Depression Scale (EPDS) and WHO5 Wellbeing Index indicated depressive symptoms and emotional wellbeing. Data were analysed using general linear models. Results Using an EPDS cut-off of 12/13, 18.1 % (n = 78, 95 % CI 14.6 - 22.1) of women had depressive symptoms (20.4 % urban; 15.8 % rural). Contrary to predictions, infant gender and traditional confinement were unrelated to depressive symptoms. Poverty, food insecurity, being frightened of family members, and intimate partner violence increased both depressive symptoms and lowered wellbeing. The first model accounted for 30.2 % of the variance in EPDS score and found being frightened of one’s husband, husband’s unemployment, breastfeeding difficulties, infant diarrhoea, and cognitive social capital were associated with higher EPDS scores. The second model had accounted for 22 % of the variance in WHO5 score. Living in Hue city, low education, poor maternal competence and a negative family response to the baby lowered maternal wellbeing. Conclusions Traditional confinement practices and son preference were not linked to depressive symptoms among mothers, but were correlates of family relationships and wellbeing. Poverty, food insecurity, violence, infant ill health, and discordant intimate and family relationships were linked with depressive symptoms in Central Vietnam.

A Sketch of the Phonology and Grammar of Rajbanshi

This dissertation is a synchronic description of the phonology and grammar of two dialects of the Rajbanshi language (Eastern Indo-Aryan) as spoken in Jhapa, Nepal. I have primarily confined the analysis to the oral expression, since the emerging literary form is still in its infancy. The grammatical analysis is therefore based, for the most part, on a corpus of oral narrative text which was recorded and transcribed from three informants from north-east Jhapa. An informant, speaking a dialect from south-west Jhapa cross checked this text corpus and provided additional elicited material. I have described the phonology, morphology and syntax of the language, and also one aspect of its discourse structure. For the most part the phonology follows the basic Indo-Aryan pattern. Derivational morphology, compounding, reduplication, echo formation and onomatopoeic constructions are considered, as well as number, noun classes (their assignment and grammatical function), pronouns, and case and postpositions. In verbal morphology I cover causative stems, the copula, primary and secondary agreement, tense, aspect, mood, auxiliary constructions and non-finite forms. The term secondary agreement here refers to genitive agreement, dative-subject agreement and patient (and sometimes patient-agent) agreement. The breaking of default agreement rules has a range of pragmatic inferences. I argue that a distinction, based on formal, semantic and statistical grounds, should be made between conjunct verbs, derivational compound verbs and quasi-aspectual compound verbs. Rajbanshi has an open set of adjectives, and it additionally makes use of a restricted set of nouns which can function as adjectives. Various particles, and the emphatic and conjunctive clitics are also considered. The syntactic structures studied include: non-declarative speech acts, phrase-internal and clause-internal constituent order, negation, subordination, coordination and valence adjustment. I explain how the future, present and past tenses in Rajbanshi oral narratives do not seem to maintain a time reference, but rather to indicate a distinction between background and foreground information. I call this tense neutralisation .

Supply capability of sheep on the Mitchell grass downs of North and Central West Queensland

While, in the past, sheep have been predominantly reared and grazed in western Queensland for wool, interest in the sheep meat industry increased when wool prices became depressed. For north west and central west Queensland producers, opportunities may exist to participate in live sheep and meat export to Asia. The capability of the Mitchell grass downs to provide sufficient numbers of export quality sheep under the variable climatic conditions while sustaining the land resources has been simulated. Sheep numbers were found to be insufficient to maintain a consistent supply for live export. However, raising marking rates and lowering mortalities effectively increased reproductive performance to a level at which a surplus for export could be sustainable. Other practices might be required for the liveweight specifications to be met. 24th Biennial Conference. Adelaide, South Australia.

Exercise improves quality of life in ADT-treated prostate cancer: Systematic review of RCTs

Men receiving androgen deprivation therapy (ADT) for prostate cancer (PCa) are likely to develop metabolic conditions such as diabetes, cardiovascular disease, abdominal obesity and osteoporosis. Other treatment-related side effects adversely influence quality of life (QoL) including vasomotor distress, depression, anxiety, mood swings, poor sleep quality and compromised sexual function. The objective of this study was to systematically review the nature and effects of dietary and exercise interventions on QoL, androgen deprivation symptoms and metabolic risk factors in men with PCa undergoing ADT. An electronic search of CINAHL, CENTRAL, Medline, PsychINFO and reference lists was performed to identify peer-reviewed articles published between January 2004 and December, 2014 in English. Eligible study designs included randomised controlled trials with pre- and post-intervention data. Data extraction and assessment of methodological quality with the Cochrane approach was conducted by two independent reviewers. Seven exercise studies were identified. Exercise significantly improved QoL, but showed no effect on metabolic risk factors (weight, waist circumference, lean or fat mass, blood pressure, lipid profile). Two dietary studies were identified, both of which tested soy supplements. Soy supplementation did not improve any outcomes. No dietary counselling studies were identified. No studies evaluated androgen-deficiency symptoms (libido, erectile function, sleep quality, mood swings, depression, anxiety, bone mineral density). Evidence from RCTs indicates that exercise enhances health- and disease-specific QoL in men with PCa undergoing ADT. Further studies are required to evaluate the effect of exercise and dietary interventions on QoL, androgen deprivation symptoms and metabolic risk factors in this cohort.

Simulation of the supply capability of sheep on the Mitchell grass downs of north west Queensland

Sheep in western Queensland have been predominantly reared for wool. When wool prices became depressed interest in the sheep meat industry, increased. For north west Queensland producers, opportunities may exist to participate in live sheep and meat export to Asia. A simulation model was developed to determine whether this sheep producing area has the capability to provide sufficient numbers of sheep under variable climatic conditions while sustaining the land resources. Maximum capacity for sustainability of resources (as described by stock numbers) was derived from an in-depth study of the agricultural and pastoral potential of Queensland. Decades of sheep production and climatic data spanning differing seasonal conditions were collated for analysis. A ruminant biology model adapted from Grazplan was used to simulate pregnancy rate. Empirical equations predict mortalities, marking rates, and weight characteristics of sheep of various ages from simple climatic measures, stocking rate and reproductive status. The initial age structure of flocks was determined by running the model for several years with historical climatic conditions. Drought management strategies such as selling a proportion of wethers progressively down to two-tooth and oldest ewes were incorporated. Management decisions such as time of joining, age at which ewes were cast-for-age, wether turn-off age and turning-off rate of lambs vary with geographical area and can be specified at run time. The model is run for sequences of climatic conditions generated stochastically from distributions based on historical climatic data correlated in some instances. The model highlights the difficulties of sustaining a consistent supply of sheep under variable climatic conditions.

Musiikki ahdistuksen taitona : Filosofinen tutkimus musiikin eksistentiaalis-ontologisesta merkityksestä

Music as the Art of Anxiety: A Philosophical Approach to the Existential-Ontological Meaning of Music. The present research studies music as an art of anxiety from the points of view of both Martin Heidegger s thought and phenomenological philosophy in general. In the Heideggerian perspective, anxiety is understood as a fundamental mode of being (Grundbefindlichkeit) in human existence. Taken as an existential-ontological concept, anxiety is conceived philosophically and not psychologically. The central research questions are: what is the relationship between music and existential-ontological anxiety? In what way can music be considered as an art of anxiety? In thinking of music as a channel and manifestation of anxiety, what makes it a special case? What are the possible applications of phenomenology and Heideggerian thought in musicology? The main aim of the research is to develop a theory of music as an art of existential-ontological anxiety and to apply this theory to musicologically relevant phenomena. Furthermore, the research will contribute to contemporary musicological debates and research as it aims to outline the phenomenological study of music as a field of its own; the development of a specific methodology is implicit in these aims. The main subject of the study, a theory of music as an art of anxiety, integrates Heideggerian and phenomenological philosophies with critical and cultural theories concerning violence, social sacrifice, and mimetic desire (René Girard), music, noise and society (Jacques Attali), and the affect-based charme of music (Vladimir Jankélévitch). Thus, in addition to the subjective mood (Stimmung) of emptiness and meaninglessness, the philosophical concept of anxiety also refers to a state of disorder and chaos in general; for instance, to noise in the realm of sound and total (social) violence at the level of society. In this study, music is approached as conveying the existentially crucial human compulsion for signifying i.e., organizing chaos. In music, this happens primarily at the immediate level of experience, i.e. in affectivity, and also in relation to all of the aforementioned dimensions (sound, society, consciousness, and so on). Thus, music s existential-ontological meaning in human existence, Dasein, is in its ability to reveal different orders of existence as such. Indeed, this makes music the art of anxiety: more precisely, music can be existentially significant at the level of moods. The study proceeds from outlining the relevance of phenomenology and Heidegger s philosophy in musicology to the philosophical development of a theory of music as the art of anxiety. The theory is developed further through the study of three selected specific musical phenomena: the concept of a musical work, guitar smashing in the performance tradition of rock music, and Erik Bergman s orchestral work Colori ed improvvisazioni. The first example illustrates the level of individual human-subject in music as the art of anxiety, as a means of signifying chaos, while the second example focuses on the collective need to socio-culturally channel violence. The third example, being music-analytical, studies contemporary music s ability to mirror the structures of anxiety at the level of a specific musical text. The selected examples illustrate that, in addition to the philosophical orientation, the research also contributes to music analysis, popular music studies, and the cultural-critical study of music. Key words: music, anxiety, phenomenology, Martin Heidegger, ontology, guitar smashing, Erik Bergman, musical work, affectivity, Stimmung, René Girard

Vilijonkka ikkunassa - Tove Janssonin muumiteosten kuva, sana ja liike

Tove Jansson (1914--2001) was a Finnish illustrator, author, artist, caricaturist and comic artist. She is best known for her Moomin Books, written in Swedish, which she illustrated herself, and published between 1945 and 1977. My study focuses on the interweaving of images and words in Jansson s picturebooks, novels and short stories situated in the fantasy world of Moomin Valley. In particular, it concentrates on Jansson s development of a special kind of aesthetics of movement and stasis, based upon both illustration and text. The conventions of picturebook art and illustration are significant to both Jansson s visual art and her writing, and she was acutely conscious of them. My analysis of Jansson s work begins by discussing her first published picturebooks and less familiar illustrations (before she began her Moomin books) and I then proceed to discuss her three Moomin picturebooks, The Book about Moomin, Mymble and Little My; Who Will Comfort Toffle?, and The Dangerous Journey. The discussion moves from images to words and from words to images: Barthes s (1982) concept of anchoring and, in particular, what he calls relaying , form a point of reading and viewing Moomin texts and illustrations in a complementary relation, in which the message s unity occurs on a higher level: that of the story, the anecdote, the diegesis . The eight illustrated Moomin novels and one collection of short stories are analysed in a similar manner, taking into account the academic discourse about picturebooks which was developed in the last decade of the 20th century and beginning of the 21st century by, among others, scholars such as Nodelman, Rhedin, Doonan, Thiele, Stephens, Lewis, Nikolajeva and Scott. In her Moomin books, Jansson uses a wide variety of narrative and illustrative styles which are complementary to each other. Each book is different and unique in its own way, but a certain development or progression of mood and representation can be seen when assessing the series as a whole. Jansson s early stories are happy and adventurous but her later Moomin novels, beginning from Moominland Midwinter, focus more on the interiority of the characters, placing them in difficult situations which approximate social reality. This orientation is also reflected in the representation of movement and space. The books which were published first include more obviously descriptive passages, exemplifying the tradition of literary pictorialism. Whereas in Jansson s later work, the space develops into something that is alive which can have an enduring effect on the characters personalities and behaviour. This study shows how the idea of an image a dynamic image -- forms a holistic foundation for Jansson s imagination and work. The idea of central perspective, or frame, for instance, provided inspiration for whole stories or in the way that she developed her characters, as in the case of the Fillyjonk, who is a complex female figure, simultaneously frantic and prim. The idea of movement is central to the narrative art of picturebooks and illustrated texts, particularly in relation to the way that action is depicted. Jansson, however, also develops a specific choreography of characters in which poses and postures signify action, feelings and relationships. Here, I use two ideas from modern dance, contraction and release (Graham), to characterise the language of movement which is evident in Jansson s words and images. In Jansson s final Moomin novels and short stories, the idea of space becomes more and more dynamic and closely linked with characterisation. My study also examines a number of Jansson s early sketches for her Moomin novels, in which movement is performed much more dramatically than in those illustrations which appeared in the last novels to be published.

"Ei vittu, mennään röökille" : tutkimus sitaattien tehtävistä ja tekemisestä kaunokirjallis-journalistisissa lehtijutuissa

This research deals with direct speech quotations in magazine articles through two questions: As my major research question, I study the functions of speech quotations based on a data consisting of six literary-journalistic magazine articles. My minor research question builds on the fact that there is no absolute relation between the sound waves of the spoken language and the graphemes of the written one. Hence, I study the general thoughts on how utterances should be arranged in the written form based on a large review of literature and textbooks on journalistic writing as well as interviews I have made with magazine writers and editors, and the Council of Mass Media in Finland. To support my main research questions, I also examine the reference system of the Finnish language, define the aspects of the literary-journalistic article and study vernacular cues in written speech quotations. FUNCTIONS OF QUOTATIONS. I demonstrate the results of my analysis with a six-pointed apparatus. It is a continuum which extends from the structural level of text, all the way through the explicit functions, to the implicit functions of the quotation. The explicit functions deal with the question of what is the content, whereas the implicit ones base mainly on the question how the content is presented. 1. The speech quotation is an distinctive element in the structure of the magazine article. Thereby it creates a rhythm for the text, such as episodes, paragraphs and clauses. 2. All stories are told through a plot, and in magazine articles, the speech quotations are one of the narrative elements that propel the plot forward. 3. The speech quotations create and intensify the location written in the story. This location can be a physical one but also a social one, in which case it describes the atmosphere and mood in the physical environment and of the story characters. 4. The quotations enhance the plausibility of the facts and assumptions presented in the article, and moreover, when a text is placed between quotation marks, the reader can be assured that the text has been reproduced in the authentic verbatim way. 5. Speech quotations tell about the speaker's unique way of using language and the first-hand experiences of the person quoted. 6. The sixth function of speech quotations is probably the most essential one: the quotations characterize the quoted speaker. In other words, in addition to the propositional content of the utterance, the way in which it has been said transmits a lot of the speaker's character (e.g. nature, generation, behaviour, education, attitudes etc.). It is important to notice, that these six functions of my speech quotation apparatus do not exlude one another. It means that every speech quotation basically includes all of the functions discussed above. However, in practice one or more of them have a principal role, while the others play a subsidiary role. HOW TO MAKE QUOTATIONS? It is not suprising that the field of journalism (textbooks, literature and interviews) holds heterogeneous and unestablished thoughts on how the spoken language should be arranged in written quotations, which is my minor research question. However, the most frequent and distinctive aspects can be depicted in a couple of words: serve the reader and respect the target person. Very common advice on how to arrange the quotations is − firstly, to delete such vernacular cues (e.g. repetitions and ”expletives”) that are common in spoken communication, but purposeless in the written language. − secondly, to complete the phonetic word forms of the spoken language into a more reader-friendly form (esim. punanen → punainen, 'red'), and − thirdly, to enhance the independence of clauses from the (authentic) context and to toughen reciprocal links between them. According to the knowledge of the journalistic field, utterances recorded in different points in time of an interview or a data-collecting session can be transferred as consecutive quotations or even merged together. However, if there is any temporal-spatial location written in the story, the dialogue of the story characters should also be situated in an authentic context – chronologically in the right place in the continuum of the events. To summarize, the way in which the utterances should be arranged into written speech quotations is always situationally-specific − and it is strongly based on the author's discretion.

Pain in juvenile idiopathic arthritis : parents and children as agents of disease management

Juvenile idiopathic arthritis (JIA) is a severe childhood disease usually characterized by long-term morbidity, unpredictable course, pain, and limitations in daily activities and social participation. The disease affects not only the child but also the whole family. The family is expected to adhere to an often very laborious regimen over a long period of time. However, the parental role is incoherently conceptualized in the research field. Pain in JIA is of somatic origin, but psychosocial factors, such as mood and self-efficacy, are critical in the perception of pain and in its impact on functioning. This study examined the factors correlating and possibly explaining pain in JIA, with a special emphasis on the mutual relations between parent- and patient-driven variables. In this patient series pain was not associated with the disease activity. The degree of pain was on average fairly low in children with JIA. When the children were clustered according to age, anxiety and depression, four distinguishable cluster groups significantly associated with pain emerged. One of the groups was described by concept vulnerability because of unfavorable variable associations. Parental depressive and anxiety symptoms accompanied by illness management had a predictive power in discriminating groups of children with varying distress levels. The parent’s and child’s perception of a child’s functional capability, distress, and somatic self-efficacy had independent explanatory power predicting the child’s pain. Of special interest in the current study was self-efficacy, which refers to the belief of an individual that he/she has the ability to engage in the behavior required for tackling the disease. In children with JIA, strong self-efficacy was related to lower levels of pain, depressive symptoms and trait anxiety. This suggests strengthening a child’s sense of self-efficacy, when helping the child to cope with his or her disease. Pain experienced by a child with JIA needs to be viewed in a multidimensional bio-psycho-social context that covers biological, environmental and cognitive behavioral mechanisms. The relations between the parent-child variables are complex and affect pain both directly and indirectly. Developing pain-treatment modalities that recognize the family as a system is also warranted.

Spinaalistenoosipotilaiden psyykkinen hyvinvointi ennen leikkaushoitoa ja sen jälkeen

Surgical treatment of lumbar spinal stenosis (LSS) is a treatment option for those patients who remain severely symptomatic after a course of conservative treatment. Majority of the patients treated surgically enjoy good-to-excellent outcomes with respect to pain alleviation and functional recovery. However, between 20% and 40% of the patients who have surgery for LSS do not benefit from it. The knowledge of the psychological factors associated with recovery and treatment outcome is still scarce. The aim of this study was to assess LSS patients selected for surgical treatment. Specifically, the study assessed the prevalence of depression (Beck Depression Inventory, BDI) before surgical treatment and three months after the treatment. Also preoperative life satisfaction (four-item Life Satisfaction scale) of the LSS patients was studied. Furthermore, the patients satisfaction with surgery outcome at the three months postoperative stage was studied. One-fifth (20%) of the LSS-patients were found to have depression preoperatively. The patients assessments of the pain intensity or location were not associated with depression. The factors that did associate with depression were subjective disability of everyday living and poor life satisfaction. In addition to this, low sense of coherence and poor life satisfaction were associated with depression in logistic regression models. Significant associations were seen between preoperative depression and postoperative high disability scores, high symptom severity scores and higher pain intensity ratings. The patients with continuous depression (60% of the patients who had preoperative depression) showed less improvement in symptom severity, disability, pain and walking capacity than the patients who did not experience depression at any stage. In those patients who recovered from depression (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. One-fourth (25%) of the preoperative patients with LSS were found to be dissatisfied with life. The dissatisfied patients were significantly younger and had more self-reported somatic comorbidity. The dissatisfied patients had also elevated subjective disability scores and more extensive pain locations. Also lower coping resources and higher BDI scores were associated with life dissatisfaction. Younger age and somatic comorbidity were associated with life dissatisfaction in regression models. Two-thirds (66%) of the patients were at least clearly satisfied with the surgery outcome at three months postoperative stage. In group comparisons, the lack of physical, functional and emotional well-being was associated with the patients dissatisfaction with the surgery outcome. Younger age, postoperative symptom severity, disability and depression were independently associated with dissatisfaction with the surgery outcome. The results show that depression and psychological well-being are important factors with respect to LSS patients functional ability and recovery both before and three months after surgical treatment. Therefore, the clinical practice recommendations should include an assessment of depression

Cognitive Functioning in Young Adults with Depression, Anxiety Disorders, or Burnout Symptoms : Findings from a Population-based Sample

Background. Evidence of cognitive dysfunction in depressive and anxiety disorders is growing. However, the neuropsychological profile of young adults has received only little systematic investigation, although depressive and anxiety disorders are major public health problems for this age group. Available studies have typically failed to account for psychiatric comorbidity, and samples derived from population-based settings have also seldom been investigated. Burnout-related cognitive functioning has previously been investigated in only few studies, again all using clinical samples and wide age groups. Aims. Based on the information gained by conducting a comprehensive review, studies on cognitive impairment in depressive and anxiety disorders among young adults are rare. The present study examined cognitive functioning in young adults with a history of unipolar depressive or anxiety disorders in comparison to healthy peers, and associations of current burnout symptoms with cognitive functioning, in a population-based setting. The aim was also to determine whether cognitive deficits vary as a function of different disorder characteristics, such as severity, psychiatric comorbidity, age at onset, or the treatments received. Methods. Verbal and visual short-term memory, verbal long-term memory and learning, attention, psychomotor processing speed, verbal intelligence, and executive functioning were measured in a population-based sample of 21-35 year olds. Performance was compared firstly between participants with pure non-psychotic depression (n=68) and healthy peers (n=70), secondly between pure (n=69) and comorbid depression (n=57), and thirdly between participants with anxiety disorders (n=76) and healthy peers (n=71). The diagnostic procedure was based on the SCID interview. Fourthly, the associations of current burnout symptoms, measured with the Maslach Burnout Inventory General Survey, and neuropsychological test performance were investigated among working young adults (n=225). Results. Young adults with depressive or anxiety disorders, with or without psychiatric comorbidity, were not found to have major cognitive impairments when compared to healthy peers. Only mildly compromised verbal learning was found among depressed participants. Pure and comorbid depression groups did not differ in cognitive functioning, either. Among depressed participants, those who had received treatment showed more impaired verbal memory and executive functioning, and earlier onset corresponded with more impaired executive functioning. In anxiety disorders, psychotropic medication and low psychosocial functioning were associated with deficits in executive functioning, psychomotor processing speed, and visual short-term memory. Current burnout symptoms were associated with better performance in verbal working memory and verbal intelligence. However, lower examiner-rated social and occupational functioning was associated with problems in verbal attention, memory, and learning. Conclusions. Depression, anxiety disorders, or burnout symptoms may not be associated with major cognitive deficits among young adults derived from the general population. Even psychiatric comorbidity may not aggravate cognitive functioning in depressive or anxiety disorders among these young adults. However, treatment-seeking in depression was found to be associated with cognitive deficits, suggesting that these deficits relate to increased distress. Additionally, early-onset depression, found to be associated with executive dysfunction, may represent a more severe form of the disorder. In anxiety disorders, those with low symptom-related psychosocial functioning may have cognitive impairment. An association with self-reported burnout symptoms and cognitive deficits was not detected, but individuals with low social and occupational functioning may have impaired cognition.

Methodological and Empirical Advances in the Quantitative Analysis of Spontaneous Responses in Psychophysiological Time Series

The aim of the present study was to advance the methodology and use of time series analysis to quantify dynamic structures in psychophysiological processes and thereby to produce information on spontaneously coupled physiological responses and their behavioral and experiential correlates. Series of analyses using both simulated and empirical cardiac (IBI), electrodermal (EDA), and facial electromyographic (EMG) data indicated that, despite potential autocorrelated structures, smoothing increased the reliability of detecting response coupling from an interindividual distribution of intraindividual measures and that especially the measures of covariance produced accurate information on the extent of coupled responses. This methodology was applied to analyze spontaneously coupled IBI, EDA, and facial EMG responses and vagal activity in their relation to emotional experience and personality characteristics in a group of middle-aged men (n = 37) during the administration of the Rorschach testing protocol. The results revealed new characteristics in the relationship between phasic end-organ synchronization and vagal activity, on the one hand, and individual differences in emotional adjustment to novel situations on the other. Specifically, it appeared that the vagal system is intimately related to emotional and social responsivity. It was also found that the lack of spontaneously synchronized responses is related to decreased energetic arousal (e.g., depression, mood). These findings indicate that the present process analysis approach has many advantages for use in both experimental and applied research, and that it is a useful new paradigm in psychophysiological research. Keywords: Autonomic Nervous System; Emotion; Facial Electromyography; Individual Differences; Spontaneous Responses; Time Series Analysis; Vagal System

The acceptability, usability and short-term outcomes of Get Real: A web-based program for psychotic-like experiences (PLEs)

Background Psychotic-like experiences (PLEs) are subclinical delusional ideas and perceptual disturbances that have been associated with a range of adverse mental health outcomes. This study reports a qualitative and quantitative analysis of the acceptability, usability and short term outcomes of Get Real, a web program for PLEs in young people. Methods Participants were twelve respondents to an online survey, who reported at least one PLE in the previous 3 months, and were currently distressed. Ratings of the program were collected after participants trialled it for a month. Individual semi-structured interviews then elicited qualitative feedback, which was analyzed using Consensual Qualitative Research (CQR) methodology. PLEs and distress were reassessed at 3 months post-baseline. Results User ratings supported the program's acceptability, usability and perceived utility. Significant reductions in the number, frequency and severity of PLE-related distress were found at 3 months follow-up. The CQR analysis identified four qualitative domains: initial and current understandings of PLEs, responses to the program, and context of its use. Initial understanding involved emotional reactions, avoidance or minimization, limited coping skills and non-psychotic attributions. After using the program, participants saw PLEs as normal and common, had greater self-awareness and understanding of stress, and reported increased capacity to cope and accept experiences. Positive responses to the program focused on its normalization of PLEs, usefulness of its strategies, self-monitoring of mood, and information putting PLEs into perspective. Some respondents wanted more specific and individualized information, thought the program would be more useful for other audiences, or doubted its effectiveness. The program was mostly used in low-stress situations. Conclusions The current study provided initial support for the acceptability, utility and positive short-term outcomes of Get Real. The program now requires efficacy testing in randomized controlled trials.

Mielialan havainnoinnin, tunnistamisen ja säätelyn yhteydet työuupumuksen ryhmähoidon tuloksellisuuteen.

Työuupumus on kolmitahoinen stressioireyhtymä, jolle on tyypillistä uupumusasteinen väsymys, kyynistyneisyys ja ammatillisen itsetunnon heikkeneminen. Balanssi-hanke perustettiin tutkimaan ja kehittämään ryhmähoitomuotoa vakavaan työuupumukseen. Projektin tavoitteena on selvittää kahden eri ryhmähoitomuodon vaikuttavuutta ja sellaisia yksilöön liittyviä tekijöitä, joilla saattaa olla vaikutusta ryhmähoidon tuloksellisuuteen. Tässä tutkimuksessa selvitettiin mielialan havainnoinnin, tunnistamisen ja säätelyn (Trait Meta-Mood) yhteyksiä työuupumuksen laskuun ryhmähoitojen aikana ja kuuden kuukauden pituisella seurantajaksolla. Emootioilla on useiden eri teorioiden mukaan yksilön sopeutumista edistävä signaalitehtävä. Mieliala kertoo yksilön sisäisestä tilasta, ja sitä voidaan kuvata miellyttävänä, epämiellyttävänä, kiihtyneenä tai rauhallisena. Mielialaa voi tarkastella mielialakokemuksen tai mielialan säätelyn tasolla. Mielialan säätelyn tasolla tarkoitetaan ajatuksia mielialasta. Tällä reflektiivisellä tasolla mielialaa havainnoidaan, tunnistetaan ja säädellään. Oletettiin, että jos mieliala tunnistetaan hyvin ja mielialaa säädellään tehokkaasti, työuupumus vähenee eli työuupumuksen ryhmähoito on tuloksellista. Lisäksi tutkittiin missä vaiheessa mahdolliset yhteydet ilmenevät ja eroavatko yhteydet psykoanalyyttisessä ja toiminnallisessa hoitoryhmässä. Tutkimusaineisto kerättiin 1999-2000. Koehenkilöt (n=99) olivat 31-59-vuotiaita valtion laitosten ja valtion yritysten työuupumuksesta kärsiviä työntekijöitä, miehiä oli 24 ja naisia 75. Lisäksi kerättiin ei-uupuneiden kontrolliryhmä (n = 26, ikä 37 - 58 vuotta), jota hyödynnettiin tässä tutkimuksessa vain uupuneiden ja ei-uupuneiden vertailuihin ennen hoidon alkua. Molempina vuosina uupuneet henkilöt satunnaistettiin toiminnallisiin ja psykoanalyyttisiin hoitoryhmiin. Työuupumus mitattiin 9 kuukautta kestäneen hoidon alussa, lopussa ja puoli vuotta hoidon päättymisen jälkeen. Mielialan havainnointi, tunnistaminen ja säätely mitattiin hoidon alussa, lopussa ja puoli vuotta hoidon päättymisen jälkeen. Tulokset osoittivat, että mielialan tunnistamisen korkea taso ja mielialan säätelyn korkea taso olivat yhteydessä työuupumuksen voimakkaampaan laskuun koko tutkimusjakson ajan. Yhteydet olivat erilaiset eri ryhmähoidoissa hoidon aikana ja seurantajaksolla. Hoidon aikana psykoanalyyttisessä hoitoryhmässä mielialan havainnoinnin lisääntyminen ja mielialan säätelyn tehokkuus olivat yhteydessä työuupumuksen voimakkaampaan laskuun. Toiminnallisessa hoitoryhmässä sen sijaan mielialan tunnistamisen taito oli yhteydessä työuupumuksen voimakkaampaan laskuun hoidon aikana. Seurantajaksolla molemmissa hoitoryhmissä mielialan tunnistamisen taito oli yhteydessä työuupumuksen voimakkaampaan laskuun. Kontrolliryhmässä ei todettu mielialan havainnoinnin, tunnistamisen ja säätelyn taitojen ja työuupumuksen vähenemisen välistä yhteyttä. Tutkimuksen tulokset antavat uutta tietoa sellaisista yksilöllisistä tekijöistä, joilla on työuupumuksen ryhmähoitoprosessia moderoiva rooli. Mielialan hyvin tunnistaminen ja mielialan tehokas säätely saattavat olla sellaisia ryhmäterapiassa opittuja yksilöllisiä voimavaroja, joita työuupumuksesta toipumisessa tarvitaan hoidon päättymisen jälkeen. Koska mielialan hyvin tunnistamisen, mielialan tehokkaan säätelyn ja työuupumuksen ryhmähoidon tuloksellisuuden väliset yhteydet todettiin molemmissa ryhmähoitomenetelmissä, voi olettaa, että molemmat ryhmähoitomenetelmät ovat vakavaa työuupumusta vähentäviä hoitomenetelmiä. Ryhmähoidon aikana opitut mielialan tunnistamisen ja säätelyn taidot auttavat ylläpitämään terapian aikana alkanutta hyvinvoinnin kasvua. Avainsanat: työuupumus, toiminnallinen ryhmäterapia, psykoanalyyttinen ryhmäterapia, mielialan havainnointi, mielialan tunnistaminen, mielialan säätely, työuupumuksen ryhmähoidon tuloksellisuus

Nuorten henkilökohtaisten tavoitteiden profiilit ja subjektiivinen hyvinvointi

Personal goals offer an important aspect of personality and motivation. Personal goals are conscious and subjectively motivated objectives by which a person directs his or her life over time. Personal goals are related to adolescents' subjective well-being. The aim of the present research was to find out, what kinds of groups of adolescents can be formed by the content of personal goals and how these groups differ in goal appraisals, meaningful life events and subjective well-being. The second aim of the study was to detect gender differences and differences between vocational and high school students in goal appraisals, meaningful life events and subjective well-being. Adolescents in upper secondary education (N=1144) were grouped together by the content of their personal goals using a person oriented approach and a cluster analysis. Clusters found in the analysis were named by the centre goal as (1) a property group, (2) a vocation group, (3) a future education and personal relationships group and (4) a selffocused group. Adolescents in the property group put a little effort into their career goal, they were not exhausted in school work and their subjective well-being was average. Adolescents in the vocation group felt progress in their career goal and put effort into it. They had goals related to life-style. They did not feel exhausted and their subjective well-being was average. The future education and personal relationships group put effort into their career goal and considered progressing in it. Personal relationships were important in their lives. They were exhausted in their school work but they did not feel cynicism. Their own health was one of their goals and they felt satisfaction in their life. Adolescents in the self-focused group did not put effort into their career goal nor considered progressing in it. They were exhausted and especially cynical in their school work. They suffered from almost clinically significant depression. They had low life-satisfaction and low self-esteem. The following gender and educational differences were found. Compared with boys, girls felt their career goal was more important and stressful, and girls also put more effort into it. Girls were more exhausted, depressed and they had lower selfesteem than boys. High school students felt more stress with their career goal than vocational school students. High school students were more exhausted, but still they felt more satisfaction with their lives. In practice, to cover adolescents' personal goals is a possibility to find distressed individuals who might be in need for extra support.