Targeting of caries prevention at preschool children, a practice based study

Aim and design: To evaluate an oral health program directed to expecting families and their children. The intervention was carried out in one of the four health care areas of the city of Turku. Another area acted as a control. Subjects and methods: Children (n = 1217), born between January 1, 1998 and June 30, 1999, in the respective health care areas were screened for mutans streptococci bacteria (MS), and their caretakers were interviewed when the child was 18 months old. MScolonization was used as the child’s risk indicator. Intensified health education and the use of xylitol lozenges targeted at the children at risk were the main elements of the program. Controls and the non-MS-colonized children received routine prevention –examination and education at the ages of three and five years. Altogether 794 subjects were followed for 42 months after receiving consent from their caretakers. Associations of oral-health-related factors with MS colonization and caries increment were studied inside the control group. Results: MS colonization associated with the occupation of the caretaker and ethnicity. The program was effective in white-collar families; prevented fraction being 67 %. In blue-collar families no effect was achieved. At the age of five years, caries increment was strongly related to the occupation of the caretaker, MS at 18 months, child’s sugar use, night feeding, use of thirst quencher at the age of 18 months, and father’s reported oral health. Conclusions: Programs targeted at MS-colonized children can reduce caries in whitecollar families. A program mainly based on activity at home seems to favor white-collar families, whereas different kind of support is needed for the blue-collar families.

Koulutetut maahanmuuttajat työmarkkinoilla. Tutkimus korkeakoulututkinnon suorittaneiden maahanmuuttajien työllistymisestä ja työurien alusta Suomessa

Maahanmuuttajien määrä on Suomessa merkittävämmin lisääntynyt vasta 1990- ja 2000-luvuilla. Vuonna 2010 Suomessa asui lähes 170 000 ulkomaan kansalaista. Tavallisimmin Suomeen muutetaan avioliiton, paluumuuton tai pakolaisuuden vuoksi. Pieni, joskin kasvava joukko muuttaa työn tai opiskelun vuoksi. Myös kansalaisuuksien, koulutustaustojen, ammattien jne. kirjo muuttajien joukossa on suuri. Ulkomaan kansalaisten lisääntyessä Suomessa on jouduttu kohtaamaan monenlaisia maahanmuuttoon liittyviä haasteita, joista työllistymiseen liittyvät kysymykset eivät ole vähäisimpiä. Tutkimuksessa tarkastellaan lähtömaassaan korkeakoulututkinnon suorittaneiden maahanmuuttajien työllistymistä ja työuran alkua Suomessa. Tutkimuksen tarkoituksena on selvittää, miten korkeakoulutetut maahanmuuttajat ovat Suomessa työllistyneet, minkälaisia heidän työuriensa alut ovat Suomessa olleet ja miten he ovat onnistuneet uudessa maassa hyödyntämään lähtömaassa hankkimaansa koulutusta. Lisäksi tutkimuksessa tarkastellaan, miten maahanmuuttajien lähtömaan erilaiset elämäntilanteet, olosuhteet ja valinnat ovat vaikuttaneet työuran muotoutumiseen Suomessa. Tutkimuksen aineisto muodostuu kysely- sekä haastatteluaineistosta. Kyselyaineiston (n=99) tarkoituksena on luoda määrällistä kuvaa korkeakoulutettujen maahanmuuttajien työllistymisestä Suomessa. Numerotietojen taakse jää kuitenkin näkymättömiin tieto maahanmuuttajien yksilöllisistä kokemuksista liittyen työllistymiseen ja työuran muotoutumiseen uudessa maassa. Toisena aineistona hyödynnettävän elämäkerrallisen haastatteluaineiston (n=20) kautta on mahdollista tehdä näkyväksi ne tutkittavien yksilölliset työ- ja koulutusuraan liittyvät valinnat, joita maahanmuuttajat ovat tehneet niin lähtömaassa kuin Suomessa sekä ne tilanteet ja olosuhteet, joissa tutkittavat ovat lähtömaassa eläneet ja joiden pohjalta he ovat tulleet Suomeen ja Suomen työmarkkinoille. Aineistoissa mukana olevat maahanmuuttajat olivat pääosin avioliiton, paluumuuton sekä pakolaisuuden vuoksi Suomeen tulleita. Vain muutama oli tullut työn vuoksi. Maahanmuuttajien työmarkkina-asemaa selitetään usein maahanmuuttajien resursseilla, kuten kielitaidolla, koulutuksella, työkokemuksella, sosiaalisten suhteiden ja verkostojen laadulla ja määrällä jne. Myös maahanmuuttajiin kohdistuvilla syrjivillä ja ennakkoluuloisilla asenteilla on keskeinen merkitys työllistymisessä. Koulutuksen ollessa yksi keskeisimmistä työmarkkina-asemaa määräävistä tekijöistä, tulisi koulutettujen maahanmuuttajien sijoittua hankitun tutkinnon oikeuttamiin tehtäviin. Tutkimuksessa kuitenkin havaittiin, että työllistyminen oli maahanmuuttajilla vaikeaa hyvästä koulutuksesta huolimatta. Kyselyaineistoon vastanneista vain muutama (6 %) oli työssä heti Suomeen muuttovuoden lopussa, kolme vuotta Suomessa asuttuaan työssä oli runsas kolmannes (35 %) ja aineistonkeruuhetkellä eli vuonna 2004 työssä oli 38 % vastaajista. Työsuhteet olivat tutkittavilla useimmiten määräaikaisia ja kestoltaan lyhyitä. Lisäksi työurat koostuivat runsaasta työttömyydestä sekä koulutukseen osallistumisesta. Myönteistä kuitenkin oli, että mikäli korkeakoulutetut maahanmuuttajat onnistuivat Suomessa työllistymään, vastasi työ usein joko kokonaan tai ainakin osittain hankittua korkeakoulututkintoa. Korkeakoulutettujen maahanmuuttajien työuran alut Suomessa voidaan tyypitellä kolmeen ryhmään, joista kukin jakaantui vielä kahteen alaryhmään siten, että kaiken kaikkiaan saatiin kuusi erilaista työuran alun tyyppiä: koulutusta vastaava vakaa ja vakiintuva ura, koulutusta osittain vastaava sekaura ja laskeva ura sekä koulutusta vastaamaton sisääntuloura ja työttömän ura . Haastatteluaineiston kautta tarkastellaan korkeakoulutettujen maahanmuuttajien yksilöllisiä elämänuria lähtien liikkeelle korkeakoulutettujen maahanmuuttajien lähtömaassa tekemistä ura- ja ammatinvalinnoista jatkuen Suomeen muuton kautta aina työuran muotoutumiseen Suomessa. Haastatteluja toisistaan erottelevina keskeisinä teemoina olivat toisaalta pärjääminen Suomessa ja suomalaisilla työmarkkinoilla toisaalta elämän muotoutuminen lähtömaassa ja nimenomaan siellä tehdyt ura- ja ammatinvalinnat ja niihin liittyvät kokemukset ja elämäntilanteet. Näiden kriteerien pohjalta aineisto jakaantui kolmeen ryhmään, jotka nimettiin pärjääjiksi, harhailijoiksi ja sinnittelijöiksi. Pärjääjien kertomukset muotoutuivat tietyllä tavalla myönteisen kehän kautta: niin lähtömaassa tehdyt ammatinvalinnat kuin työuran muotoutuminen Suomessa tapahtuivat suhteellisen vaivattomasti. Useimmiten työt Suomessa vastasivat lähtömaassa hankittua koulutusta. Omiin uravalintoihin oltiin myöhemmin myös tyytyväisiä. Harhailijoille oman paikan löytyminen oli puolestaan hankalampaa. Leimallista tälle ryhmälle oli tietynlainen valintojen vaikeus sekä tyytymättömyys omiin aikaisemmin tehtyihin ratkaisuihin. Jotkut harmittelivat nuorena tekemiään uravalintoja niin, että päättivät Suomessa hankkia kokonaan uuden ammatin. Muutto Suomeen merkitsi useimmille ammatillisen aseman laskua. Sinnittelijät kertoivat jo lähtökohdiltaan kahteen muuhun ryhmään nähden hyvin erilaista tarinaa. Tämän ryhmän lähes koko elämä lähtömaassa oli sodan ja levottomuuksien sävyttämää. Tämä näkyi myös ammatinvalinnassa: opiskelupaikka oli saatettu valita esimerkiksi sen perusteella, missä oli milloinkin turvallista opiskella. Myös Suomeen muutto erosi kahdesta aikaisemmasta ryhmästä, sillä lähtö entisestä kotimaasta oli tapahtunut usein hyvinkin yllättäen vailla etukäteissuunnittelua tilanteiden kärjistyttyä nopeasti. Suomessa työelämään pääseminen oli kaikille sinnittelijöille vaikeaa ja haastatteluhetkellä useilla vielä hyvin alkutekijöissä. Hyväkään koulutus ei aina takaa maahanmuuttajille työtä uudessa maassa, sillä hankittua tutkintoa ja osaamista ei ole helppo siirtää maasta toiseen. Pahimmassa tapauksessa vieraassa maassa suoritettu korkeakoulututkinto voi kokonaan mitätöityä uudessa maassa ja korkeakoulututkinnon myötä hankittu osaaminen menettää täysin arvonsa. Kyse on niin yksilön kuin yhteiskunnankin resurssien tuhlaamisesta tilanteessa, jossa maassa pysyvästi asuvat koulutetut maahanmuuttajat työskentelevät tavalla tai toisella koulutustaan vastaamattomissa epävakaissa töissä, työmarkkinoiden laitamilla tai ovat kokonaan työmarkkinoiden ulkopuolella.

Päämääriä, ajelehtimista, tietämättömyyttä, etsintää: Koulutusvalinnat, opinnot ja koulutuksen vaihtaminen yliopisto-opiskelijoiden kokemana 2000 -luvun taitteessa

Tutkimuksessa tarkastellaan yliopisto-opiskelua, opintojen kokemista ja niiden kulkua alkaen koulutusvalinnoista. Lisäksi tutkimuksessa pyritään ymmärtämään ja kuvaamaan yliopisto-opintojen aikaista koulutuksen vaihtamista prosessina. Kyseessä on seurantatutkimus Turun yliopistossa vuonna 1998 aloittaneesta opiskelijakohortista. Tutkittavat opiskelijat valittiin sillä perusteella, että he vastasivat kolmeen opintoja koskevaan kyselyyn ja olivat vähintään kolmen vuoden ajan läsnä olevina opiskelijoina. Opiskelijat (n=440) jaettiin neljään vertailuryhmään: 1) opintoihinsa tyytyväiset, 2) ensimmäisen vuoden jälkeen koulutusta vaihtaneet, 3) toisen vuoden jälkeen koulutusta vaihtaneet ja 4) koulutusta vaihtaa halunneet. Tutkimusaineisto koostuu kolmesta kyselystä, opintorekisteriaineistosta ja koulutusta opintojen aikana vaihtaneiden opiskelijoiden haastatteluista (n=22). Kyselyt tehtiin ensimmäisen, toisen ja kolmannen opintovuoden kevätlukukausilla ja haastattelut vuonna 2002, jolloin opiskelijat opiskelivat Turun yliopistossa neljättä tai viidettä vuotta. Kyselyiden avulla tutkittiin eroavatko koulutusta vaihtaneet opiskelijat muista opiskelijoista rakenteellisilta tekijöiltään tai opintokokemuksissaan. Opintorekisteriaineiston perusteella tutkittiin eroavatko koulutusta vaihtaneet opiskelijat koulutuksessa pysyneistä opiskelijoista opintojen kulussa. Kyselyiden ja haastatteluiden avulla tutkittiin minkälaisia tietoja ja odotuksia opiskelijoilla oli yliopisto-opiskelusta ollut ennen opintojen aloittamista. Haastatteluiden perusteella tutkittiin mitä syitä koulutuksen vaihtamisen taustalla oli ja minkälaisina kertomuksina koulutuksen vaihtamisprosessi näyttäytyi. Koulutusta vaihtaneet opiskelijat erosivat koulutuksessa pysyneistä opiskelijoista aiemman koulutuksen määrän, iän ja perheellisyyden suhteen. Verrattaessa ensimmäisen ja toisen vuoden jälkeen koulutusta vaihtaneita opiskelijoita keskenään havaittiin näillä ryhmillä olevan erilainen perhetausta. Koulutusta valittaessa tärkein tekijä oli kiinnostus alaa kohtaan. Toiseksi voimakkain hakutekijä oli muilla paitsi ensimmäisen vuoden jälkeen koulutusta vaihtaneilla valmiudet haluttuun ammattiin. Vuorostaan ensimmäisen vuoden jälkeen koulutusta vaihtaneilla toiseksi tärkein tekijä hakeutumisessa oli helppo sisäänpääsy opintoihin. Suurin osa opiskelijoista oli päässyt ensisijaisesti haluamaansa koulutukseen. Koulutusta myöhemmin vaihtaneissa ryhmissä ja koulutuksen vaihtoa halunneiden ryhmässä ensisijaisesti haluttuun koulutukseen päässeitä oli alle puolet. Odotukset opiskelusta eivät täysin täyttyneet ensimmäisen puolen vuoden opiskelun aikana. Tutkittujen ryhmien välillä havaittiin eroja kokemuksissa koulutuksen sopivuudesta itselle. Koulutuksen vaihtaminen oli myönteinen kokemus, ja uusi koulutus koettiin aiempaa koulutusta sopivammaksi itselle. Kolmannen vuoden kevätlukukaudella omaa koulutusta kohtaan koettu kiinnostus oli voimakasta muissa ryhmissä paitsi koulutuksen vaihtoa halunneissa. Harvimmin positiivisia tunteita opiskelua kohtaan kokivat vaihtoa halunneet opiskelijat. Koulutuksen vaihtaminen vähensi opintoihin kiinnittymättömyyttä. Koulutuksen vaihtoa halunneiden kokemukset nykyisen koulutuksensa ilmapiiristä olivat negatiivisimpia. Koulutuksen vaihtaminen vaikutti myönteisesti myös opetuksen kokemiseen. Opinnot etenivät kaikissa tutkituissa ryhmissä tasaisesti. Koulutuksen vaihtamisen jälkeisenä vuonna opinnot etenivät vaihtaneissa ryhmissä keskimääräistä enemmän. Haastatteluiden mukaan pääasiallisia syitä koulutuksen vaihtamiselle olivat päätyminen toissijaiseen koulutukseen ja pettyminen aloittamaansa koulutukseen. Narratiivien analyysin avulla tutkimuksessa löydettiin neljä erilaista tarinaa vaihtamisprosessista: 1) toissijaisesta koulutuksesta ensisijaiseen koulutukseen vaihtaminen, 2) ensisijaiseen koulutukseen pettyminen, 3) kiinnostavampaan koulutukseen ajautuminen ja 4) oman alan löytyminen etsinnän kautta. Vaikka koulutuspolitiikassa koulutuksen vaihtaminen nähdään ongelmana, oli se tämän tutkimuksen mukaan opiskelijalle myönteinen kokemus. Tämän tutkimuksen perusteella tulisikin kiinnittää huomiota opiskelijoihin, jotka haluaisivat vaihtaa koulutuksesta toiseen. Heillä opintojen eteneminen osoittautui hitaimmaksi ja opintokokemukset negatiivisimmiksi. Koulutusta vaihtaneiden opiskelijoiden opintojen eteneminen näytti hitaalta verrattuna opintoihinsa tyytyväisiin opiskelijoihin. Koulutuksen vaihtamisen jälkeen opintojen eteneminen kuitenkin nopeutui ja opintotyytyväisyys lisääntyi.

Emancipating and developing learning activity: Systemic intervention and re-instrumentation in higher education.

The central theme of this thesis is the emancipation and further development of learning activity in higher education in the context of the ongoing digital transformation of our societies. It was developed in response to the highly problematic mainstream approach to digital re-instrumentation of teaching and studying practises in contemporary higher education. The mainstream approach is largely based on centralisation, standardisation, commoditisation, and commercialisation, while re-producing the general patterns of control, responsibility, and dependence that are characteristic for activity systems of schooling. Whereas much of educational research and development focuses on the optimisation and fine-tuning of schooling, the overall inquiry that is underlying this thesis has been carried out from an explicitly critical position and within a framework of action science. It thus conceptualises learning activity in higher education not only as an object of inquiry but also as an object to engage with and to intervene into from a perspective of intentional change. The knowledge-constituting interest of this type of inquiry can be tentatively described as a combination of heuristic-instrumental (guidelines for contextualised action and intervention), practical-phronetic (deliberation of value-rational aspects of means and ends), and developmental-emancipatory (deliberation of issues of power, self-determination, and growth) aspects. Its goal is the production of orientation knowledge for educational practise. The thesis provides an analysis, argumentation, and normative claim on why the development of learning activity should be turned into an object of individual|collective inquiry and intentional change in higher education, and why the current state of affairs in higher education actually impedes such a development. It argues for a decisive shift of attention to the intentional emancipation and further development of learning activity as an important cultural instrument for human (self-)production within the digital transformation. The thesis also attempts an in-depth exploration of what type of methodological rationale can actually be applied to an object of inquiry (developing learning activity) that is at the same time conceptualised as an object of intentional change within the ongoing digital transformation. The result of this retrospective reflection is the formulation of “optimally incomplete” guidelines for educational R&D practise that shares the practicalphronetic (value related) and developmental-emancipatory (power related) orientations that had been driving the overall inquiry. In addition, the thesis formulates the instrumental-heuristic knowledge claim that the conceptual instruments that were adapted and validated in the context of a series of intervention studies provide means to effectively intervene into existing practise in higher education to support the necessary development of (increasingly emancipated) networked learning activity. It suggests that digital networked instruments (tools and services) generally should be considered and treated as transient elements within critical systemic intervention research in higher education. It further argues for the predominant use of loosely-coupled, digital networked instruments that allow for individual|collective ownership, control, (co-)production, and re-use in other contexts and for other purposes. Since the range of digital instrumentation options is continuously expanding and currently shows no signs of an imminent slow-down or consolidation, individual and collective exploration and experimentation of this realm needs to be systematically incorporated into higher education practise.

Thinking Outside the Box: Enhancing Science Teaching by Combining (Instead of Contrasting) Laboratory and Simulation Activities

The focus of the present work was on 10- to 12-year-old elementary school students’ conceptual learning outcomes in science in two specific inquiry-learning environments, laboratory and simulation. The main aim was to examine if it would be more beneficial to combine than contrast simulation and laboratory activities in science teaching. It was argued that the status quo where laboratories and simulations are seen as alternative or competing methods in science teaching is hardly an optimal solution to promote students’ learning and understanding in various science domains. It was hypothesized that it would make more sense and be more productive to combine laboratories and simulations. Several explanations and examples were provided to back up the hypothesis. In order to test whether learning with the combination of laboratory and simulation activities can result in better conceptual understanding in science than learning with laboratory or simulation activities alone, two experiments were conducted in the domain of electricity. In these experiments students constructed and studied electrical circuits in three different learning environments: laboratory (real circuits), simulation (virtual circuits), and simulation-laboratory combination (real and virtual circuits were used simultaneously). In order to measure and compare how these environments affected students’ conceptual understanding of circuits, a subject knowledge assessment questionnaire was administered before and after the experimentation. The results of the experiments were presented in four empirical studies. Three of the studies focused on learning outcomes between the conditions and one on learning processes. Study I analyzed learning outcomes from experiment I. The aim of the study was to investigate if it would be more beneficial to combine simulation and laboratory activities than to use them separately in teaching the concepts of simple electricity. Matched-trios were created based on the pre-test results of 66 elementary school students and divided randomly into a laboratory (real circuits), simulation (virtual circuits) and simulation-laboratory combination (real and virtual circuits simultaneously) conditions. In each condition students had 90 minutes to construct and study various circuits. The results showed that studying electrical circuits in the simulation–laboratory combination environment improved students’ conceptual understanding more than studying circuits in simulation and laboratory environments alone. Although there were no statistical differences between simulation and laboratory environments, the learning effect was more pronounced in the simulation condition where the students made clear progress during the intervention, whereas in the laboratory condition students’ conceptual understanding remained at an elementary level after the intervention. Study II analyzed learning outcomes from experiment II. The aim of the study was to investigate if and how learning outcomes in simulation and simulation-laboratory combination environments are mediated by implicit (only procedural guidance) and explicit (more structure and guidance for the discovery process) instruction in the context of simple DC circuits. Matched-quartets were created based on the pre-test results of 50 elementary school students and divided randomly into a simulation implicit (SI), simulation explicit (SE), combination implicit (CI) and combination explicit (CE) conditions. The results showed that when the students were working with the simulation alone, they were able to gain significantly greater amount of subject knowledge when they received metacognitive support (explicit instruction; SE) for the discovery process than when they received only procedural guidance (implicit instruction: SI). However, this additional scaffolding was not enough to reach the level of the students in the combination environment (CI and CE). A surprising finding in Study II was that instructional support had a different effect in the combination environment than in the simulation environment. In the combination environment explicit instruction (CE) did not seem to elicit much additional gain for students’ understanding of electric circuits compared to implicit instruction (CI). Instead, explicit instruction slowed down the inquiry process substantially in the combination environment. Study III analyzed from video data learning processes of those 50 students that participated in experiment II (cf. Study II above). The focus was on three specific learning processes: cognitive conflicts, self-explanations, and analogical encodings. The aim of the study was to find out possible explanations for the success of the combination condition in Experiments I and II. The video data provided clear evidence about the benefits of studying with the real and virtual circuits simultaneously (the combination conditions). Mostly the representations complemented each other, that is, one representation helped students to interpret and understand the outcomes they received from the other representation. However, there were also instances in which analogical encoding took place, that is, situations in which the slightly discrepant results between the representations ‘forced’ students to focus on those features that could be generalised across the two representations. No statistical differences were found in the amount of experienced cognitive conflicts and self-explanations between simulation and combination conditions, though in self-explanations there was a nascent trend in favour of the combination. There was also a clear tendency suggesting that explicit guidance increased the amount of self-explanations. Overall, the amount of cognitive conflicts and self-explanations was very low. The aim of the Study IV was twofold: the main aim was to provide an aggregated overview of the learning outcomes of experiments I and II; the secondary aim was to explore the relationship between the learning environments and students’ prior domain knowledge (low and high) in the experiments. Aggregated results of experiments I & II showed that on average, 91% of the students in the combination environment scored above the average of the laboratory environment, and 76% of them scored also above the average of the simulation environment. Seventy percent of the students in the simulation environment scored above the average of the laboratory environment. The results further showed that overall students seemed to benefit from combining simulations and laboratories regardless of their level of prior knowledge, that is, students with either low or high prior knowledge who studied circuits in the combination environment outperformed their counterparts who studied in the laboratory or simulation environment alone. The effect seemed to be slightly bigger among the students with low prior knowledge. However, more detailed inspection of the results showed that there were considerable differences between the experiments regarding how students with low and high prior knowledge benefitted from the combination: in Experiment I, especially students with low prior knowledge benefitted from the combination as compared to those students that used only the simulation, whereas in Experiment II, only students with high prior knowledge seemed to benefit from the combination relative to the simulation group. Regarding the differences between simulation and laboratory groups, the benefits of using a simulation seemed to be slightly higher among students with high prior knowledge. The results of the four empirical studies support the hypothesis concerning the benefits of using simulation along with laboratory activities to promote students’ conceptual understanding of electricity. It can be concluded that when teaching students about electricity, the students can gain better understanding when they have an opportunity to use the simulation and the real circuits in parallel than if they have only the real circuits or only a computer simulation available, even when the use of the simulation is supported with the explicit instruction. The outcomes of the empirical studies can be considered as the first unambiguous evidence on the (additional) benefits of combining laboratory and simulation activities in science education as compared to learning with laboratories and simulations alone.

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

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

Future trends of Finnish cement based construction

The construction material sector, as a capital intensive industry, is highly vulnerable to rapid fluctuations in the economic cycles. In Finland this was witnessed especially during the late 2000s, as in 2007 and 2008 the demand for several construction materials exceeded their supply and right after this, in 2009 the demand collapsed fast as a result of an international recession. These factors brought about the need to study the future trends of the market place of the commissioning company, Finnsementti Oy. As reliable short term market forecasts for the sector are difficult to compose, the study concentrates primarily in examining and identifying the trends that are likely to affect the Finnish cement industry, and as an extension, the concrete industry in a frame of 10 to 15 years. The study’s scope comprehends also the examination of the domestic construction sector, as it represents the end user industry of both cement and concrete. These motives for the study produce the research problem, which is to conduct a trend analysis for cement based building in the Finnish market area in the 2020s. The theoretical frame for composing a trend analysis in the case of this study is twofold. This is due to the fact that both, the macro and micro environments of the examined industries are studied. The main methods used are the PESTE-model (macro) and Porter’s five forces model (micro). The study applies a qualitative approach and the data is gathered by interviewing a group of experts from the cement, concrete and construction industries. The result of the paper is an overall trend analysis for the Finnish cement based building sector, which is based on ‘sub trend analyses’ concerning four identified sub-sectors of the Finnish construction industry. The results are a combination of findings from these sub-sectors and the analyzed data that deals with the studied sector’s macro and micro environment. The conclusions provide an overall picture of the examined sectors’ potential future as a whole and by defined sub-sectors of the construction industry. The recognition of future trends in different areas of the construction industry can be applied as a means for an industry actor’s decision making and in estimating the types of construction that are likely to grow or decline. Finally, based on the analyzed data and conclusions, the commissioning company is provided with a brief SWOT analysis, that provides additional tools for decision making and planning processes regarding the future.

Perspektivmöten i skola och handledning : lärares tankar om specialpedagogisk handledning

To create a more inclusive school, an increase in multidisciplinary cooperation is needed. One possible form of collaboration could encompass the special education teacher taking on the role of a consultant for other teachers in need of support in working with heterogeneous groups of pupils. Previous research shows that special education teachers see the role as consultant as diffuse and complex. The overarching aim of the present study involves deepening the knowledge on how consultation in a special educational context can be understood and developed based on teachers’ descriptions on this particular form of activity interpreted against various perspectives on consultation. The study is qualitative in nature and rests on a hermeneutic interpretive research tradition in combination with an abductive approach. The theoretical framework consists of two different approaches to consultation: the directive and the non-directive approach. The approaches differ regarding particular emphasis on advice and reflection during the consultation and with respect to who or what should be the focus of the consultation. The two approaches are here studied through various theories such as social learning theory, Bruner's theory of scaffolding, Roger’s humanist psychology, and constructivism. Semi-structured interviews were held with eighteen special education teachers (n=9) and class teachers (n=9) working in the compulsory school. The overall interpretation of the results shows that special education consultation can be understood as three different types of consultation. Consultation as counseling which harmonizes with the directive perspective on consultation is the most prominent type. In the consultation as counseling conversation, the special educational knowledge transfer is central and the focus is placed on the pupil. Although special education knowledge transfer emerges as a unique aspect of special education consultation, there are several inherent challenges in this type of consultation that can be addressed in that teachers also describe two other types of consultation. In the reflective consultation, there is a move away from the pupil focus and toward a focus on the class teacher and the use of reflection. The reflective consultation harmonizes with the non-directive approach to consultation. This type of consultation does not as of yet have a prominent place in the Finland-Swedish school context and at this stage it is not seen as a legitimate type of consultation according to the teachers’ descriptions. Despite this, certain aspects of the reflective conversation could be given more space in the development of consultation within special educational contexts. The co-operative consultation is characterized by the teachers acting as teammates and using professional exchange as a strategy for consultation. Both teachers' knowledge is seen as central, and rather than the special education teacher acting as the expert and moderator, the teachers control the consultation together and jointly move the work along. The co-operative consultation enables the focus to move from the pupil toward the context, which can lead to the development of inclusive practices. The results indicate that this type of consultation holds potential in the development of special educational consultation that takes place between equal colleagues. The co-operative consultation opens up for a third collaborative approach to consultation, where aspects of the directive and non-directive perspective can merge and develop. The thesis concludes with the proposal that special pedagogical consultation can be understood from an integrated perspective. The characteristics of the consultation can vary depending on the type of problem or situation, while co-operative consultation can be seen as the ideal as equal colleagues meet in consultation conversations. In order to develop the co-operative consultation, both teachers are required to have knowledge of consultation as a practice, to be part of a collaborative school climate, and that teachers are provided with enough time to take part in consultations.

Low-fidelity bench models for basic surgical skills training during undergraduate medical education

It is remarkable the reduction in the number of medical students choosing general surgery as a career. In this context, new possibilities in the field of surgical education should be developed to combat this lack of interest. In this study, a program of surgical training based on learning with models of low-fidelity bench is designed as a complementary alternative to the various methodologies in the teaching of basic surgical skills during medical education, and to develop personal interests in career choice.

Internet-based breast cancer patient’s pathway as an empowering patient educational tool

This three-phase study was conducted to examine the effect of the Breast Cancer Patient’s Pathway program (BCPP) on breast cancer patients’ empowering process from the viewpoint of the difference between knowledge expectations and perceptions of received knowledge, knowledge level, quality of life, anxiety and treatment-related side effects during the breast cancer treatment process. The BCPP is an Internet-based patient education tool describing a flow chart of the patient pathway during the breast treatment process, from breast cancer diagnostic tests to the follow-up after treatments. The ultimate goal of this study was to evaluate the effect of the BCPP to the breast cancer patient’s empowerment by using the patient pathway as a patient education tool. In phase I, a systematic literature review was carried out to chart the solutions and outcomes of Internet-based educational programs for breast cancer patients. In phase II, a Delphi study was conducted to evaluate the usability of web pages and adequacy of their content. In phase III, the BCPP program was piloted with 10 patients and patients were randomised to an intervention group (n=50) and control group (n=48). According to the results of this study, the Internet is an effective patient education tool for increasing knowledge, and BCPP can be used as a patient education method supporting other education methods. However, breast cancer patients’ perceptions of received knowledge were not fulfilled; their knowledge expectations exceed the perceived amount of received knowledge. Although control group patients’ knowledge expectations were met better with the knowledge they received in hospital compared to the patients in the intervention group, no statistical differences were found between the groups in terms of quality of life, anxiety and treatment-related side effects. However, anxiety decreased faster in the intervention group when looking at internal differences between the groups at different measurement times. In the intervention group the relationship between the difference between knowledge expectations and perceptions of received knowledge correlated significantly with quality of life and anxiety. Their knowledge level was also significant higher than in the control group. These results support the theory that the empowering process requires patient’s awareness of knowledge expectations and perceptions of received knowledge. There is a need to develop patient education to meet patients’ perceptions of received knowledge, including oral and written education and BCPP, to fulfil patient’s knowledge expectations and facilitate the empowering process. Further research is needed on the process of cognitive empowerment with breast cancer patients. There is a need for new patient education methods to increase breast cancer patients’ awareness of knowing.

Understanding and improving quality of secondary school education : conceptions among teachers in Tanzania

Temat för studien handlar om gymnasielärares uppfattningar om kvalitet och om hur kvalitet kan utvecklas i gymnasieutbildningen in Tanzania. Studien är till sin karaktär kvalitativ och består av utprövade semistrukturerade intervjuer med sammanlagt trettio lärare som arbetar i fyra gymnasieskolor både i urbana och rurala miljöer. Lärarna har varierande arbetserfarenhet och undervisar i olika ämnen. Huvudfokus har gällt identifieringen av variationer i lärares uppfattningar om kvalitet. På basen av två forskningsfrågor avslöjar analysen uppfattningar av hur lärare förstår och önskar utveckla kvaliteten på gymnasieutbildningen. Resultaten visar att lärare förstår kvaliteten på utbildningen i sina skolor som försök att möta skolans och samhällets mål, som individuella prestationer och förmågor som att inneha kompetenser och som att möta utmaningar inom utbildning, Identifierade uppfattningar var baserade på lärarnas personliga kunskap, arbetsmiljön och varierande omständigheter som rådde i deras skolor. Uppfattningar om en förbättring av kvaliteten i gymnasieutbildningen innefattade utveckling av lärares motivation, skolmiljön, arbetet i klassrum, kvaliteten på lärares kunskaper och färdigheter och undervisningsmaterial. Ambitionen bakom studien ar att erbjuda en plattform för strategier för att förbättra kvaliteten på gymnasieutbildningen. Resultaten strävar till att ge en fördjupad insikt i uppfattningar hos en utvald grupp av lärare som arbetar under samma villkor inom gymnasieskolor I Tanzania. Av den här anledningen är den genererade kunskapen därför relevant för att belysa lärares uppfattningar även utanför den studerade gruppen av respondenter.

School-based Drama Program to Enhance Social and Emotional Wellbeing at Elementary School

Julkaisumaa: Hong Kong

Conceptions of mathematics teacher education : thoughts among teacher educators in Tanzania

This study addresses the question of teacher educators’ conceptions of mathematics teacher education (MTE) in teacher colleges in Tanzania, and their thoughts on how to further develop it. The tension between exponents of content as opposed to pedagogy has continued to cause challenging conceptual differences, which also influences what teacher educators conceive as desirable in the development of this domain. This tension is connected to the dissatisfaction of parents and teachers with the failure of school mathematics. From this point of view, the overall aim was to identify and describe teacher educators’ various conceptions of MTE. Inspired by the debate among teacher educators about what the balance should be between subject matter and pedagogical knowledge, it was important to look at the theoretical faces of MTE. The theoretical background involved the review of what is visible in MTE, what is yet to be known and the challenges within the practice. This task revealed meanings, perspectives in MTE, professional development and assessment. To do this, two questions were asked, to which no clear solutions satisfactorily existed. The questions to guide the investigation were, firstly, what are teacher educators’ conceptions of MTE, and secondly, what are teacher educators’ thoughts on the development of MTE? The two questions led to the choice of phenomenography as the methodological approach. Against the guiding questions, 27 mathematics teacher educators were interviewed in relation to the first question, while 32 responded to an open-ended questionnaire regarding question two. The interview statements as well as the questionnaire responses were coded and analysed (classified). The process of classification generated patterns of qualitatively different ways of seeing MTE. The results indicate that MTE is conceived as a process of learning through investigation, fostering inspiration, an approach to learning with an emphasis on problem solving, and a focus on pedagogical knowledge and skills in the process of teaching and learning. In addition, the teaching and learning of mathematics is seen as subject didactics with a focus on subject matter and as an organized integration of subject matter, pedagogical knowledge and some school practice; and also as academic content knowledge in which assessment is inherent. The respondents also saw the need to build learner-educator relationships. Finally, they emphasized taking advantage of teacher educators’ neighbourhood learning groups, networking and collaboration as sustainable knowledge and skills sharing strategies in professional development. Regarding desirable development, teacher educators’ thoughts emphasised enhancing pedagogical knowledge and subject matter, and to be determined by them as opposed to conventional top-down seminars and workshops. This study has revealed various conceptions and thoughts about MTE based on teacher educators´ diverse history of professional development in mathematics. It has been reasonably substantiated that some teacher educators teach school mathematics in the name of MTE, hardly distinguishing between the role and purpose of the two in developing a mathematics teacher. What teacher educators conceive as MTE and what they do regarding the education of teachers of mathematics revealed variations in terms of seeing the phenomenon of interest. Within limits, desirable thoughts shed light on solutions to phobias, and in the same way low self-esteem and stigmatization call for the building of teacher educator-student teacher relationships.

Simulerade skoldilemman : redskap för utveckling av reflektionsförmåga?

Syftet med avhandlingen är att studera lärarstuderandes samtal om simulerad skolverksamhet för att söka förstå möjligheter och begränsningar med simulerade dilemman som medierande redskap för reflektion över lärares arbete. Undersökningen är genomförd under seminarier i svensk och finländsk lärarutbildning. Forskningsprocessen består av tre faser; en konstruktionsfas, en prövningsfas och en undersökningsfas. Under konstruktionsfasen producerades simuleringar på basen av en narrativ analys av semistrukturerade intervjuer med nyutbildade lärare. Simuleringarna testades med lärare och lärarstuderande i prövningsfasen. I undersökningsfasen utarbetades reflektionsfrågor och studiens empiriska data samlades in genom videoobservation. Totalt femton samtal filmades vid fem seminarier och tre olika lärosäten, två i Sverige och ett i Svenskfinland. De studerande som förekommer i datamaterialet befann sig i början, mitten och i slutet av sin lärarutbildning. Analysen bygger på Schöns olika reflektionsbegrepp och ett sociokulturellt perspektiv som bygger på den ryska kulturhistoriska skolan. Resultaten visar att de studerande engagerade sig starkt i samtalen i de flesta fall och att engagemanget var relaterat till deras uppfattningar om simuleringens autenticitet. Simuleringarna och reflektionsfrågorna användes både som sekundära och tertiära artefakter. Bland simuleringarnas modaliteter framstod ljudet som den viktigaste för nyanser av förståelse och engagemang och reflektionsfrågorna fungerade som kommunikativt stöd och strukturell scaffolding. När de studerande använde simuleringen för dekontextualisering i en öppen dialog förekom en tertiär dialog, i vilken förhandling av ny mening ägde rum. Kreativ reflektion – att se dilemmat ur olika perspektiv och reciprok reflektion – öppen utmanande dialog förekom flitigt i vilka en didaktiskanalytisk praktikgemenskap skapades. Slutsatserna är att simulerade skoldilemman kan utgöra en potential för lärarstuderandes utveckling av reflektionsförmåga när de används i mindre samtalsgrupper och den didaktiska inramningen relateras till aktuellt kursinnehåll. Om simuleringens innehåll inte upplevs som autentiskt finns dock risk för att förutfattade meningar om lärares arbete förstärks om de inte utmanas av medstuderande eller lärarutbildare.

Individual dietary counselling during and after pregnancy: Impact on diet and body weight

In Finland, maternity and child health clinics play a key role in promoting health in young families. Currently, obesity causes the greatest challenges to clinics. In obese pregnant women, an increased risk for metabolic diseases exist which can affect both the mother and child. The purpose of this thesis was to explore the role of dietary counselling: in Finnish health clinics; in the regulation of dietary intake; and in affecting the body weight of women. The main aim was to test the effect of dietary counselling and probiotic intervention on dietary intake and maternal body weight during and after pregnancy. In addition to dietary counselling, the effect of other factors, such as eating behaviour on dietary intake and body weight control after pregnancy was assessed. Another aim was also to evaluate dietary counselling practices by nurses (n = 327) in Finnish health clinics assessed by a questionnaire. At the beginning of the pregnancy, women (n = 256) enrolled in a dietary intervention study, were randomised into three groups. One group received dietary counselling with probiotics, one had counselling with placebo and the third group was the control group. The control group consisted of women whom did not receive counselling and took placebo. Probiotics and placebo supplements were used until the end of exclusive breastfeeding or six months after pregnancy. Women were followed from early pregnancy up to four years after pregnancy. Follow-up visits took place three times during pregnancy, at one and six months, and one, two and four years after pregnancy. Dietary counselling, provided by a nutritionist, aimed to influence the quality of dietary fat intake. Dietary counselling is important to provide in clinics, as determined by the nurses, and these nurses expressed a want to improve their own nutritional knowledge through education. The nurses had varying knowledge of current dietary recommendations. Dietary counselling for women during and after pregnancy resulted in beneficial changes in dietary intake up to one year after pregnancy and body weight and waist circumference up to four years after pregnancy. Probiotics had a beneficial effect together with dietary counselling on waist circumference until one year after pregnancy, but not throughout the long term, four years after pregnancy. Other factors, such as eating behaviour, associated with dietary intake and body weight control after pregnancy. Specifically, dietary recommendations are reached amongst women whom had high cognitive restraint in their eating behaviour and did not demonstrate uncontrolled eating. Overweight women more frequently emotionally ate compared to normal weight women and women with central adiposity related more frequently to having an uncontrolled eating behaviour than women with normal waist circumference. In addition, being overweight prior to pregnancy and excessive weight gain during pregnancy associated with increased body weight retention after pregnancy. This study showed that individual dietary counselling is useful in influencing dietary intake which adheres to dietary recommendations and this counselling influences, favourably, body weight after pregnancy. Especially, women with the risk for weight retention, such as women who have emotional and uncontrolled eating behaviours, who were overweight prior to pregnancy or those who had excessive weight gain during pregnancy, may benefit from individual dietary counselling. This study underscores the need to develop dietary counselling practices for pregnant women and their follow-up after pregnancy in Finnish health clinics. These practices include increasing the efficacy of the counselling such as collaboration with families, having knowledgable health professionals and having sufficient resources.