Oireista puhuminen lääkärin vastaanotolla : Keskustelunanalyyttinen tutkimus lääkärin kysymyksistä

Talking about symptoms during medical consultation. A conversation analytical study of doctors questions This linguistically oriented conversation analytic study investigates doctors questions and patients answers during medical consultation. The focus is on 1) the syntactic constructions of the doctors questions concerning the patients symptoms, 2) the function of different types of syntactic constructions, and 3) the sequential placement of the questions. The data used in the study consist of 57 videotaped doctor patient encounters in Finnish primary health care. The study shows that the traditional division between open and closed questions is vague and needs to be examined further. Open wh-questions and closed yes/no questions form heterogeneous classes: some of the closed questions can be treated as open and vice versa. Wh-questions which occur during the physical examination are often constructed to elicit short answers. These questions can consist of one word (e.g. milloin when ) which does not move to a new topic but supports the unfinished activity of palpation. During the verbal examination, wh-questions are formulated to elicit long descriptions as answers. For example, by asking mites + X ( what about + X), the doctor can open up a new topic and simultaneously give the patient the opportunity to discuss the topic from his/her perspective. Almost half of the yes/no questions project longer than just a minimal answer (e.g. a short confirmation or rejection). In these questions, the doctors use verbal elements which show that more than just a minimal answer is required. They can, for example, add an indefinite element (joku some or mitään any ) to a yes/no question, add a conjunctive vai ( or ) to the end of the question and thus open a space for various types of answers, or add a suggested answer to the question. In addition, the results show that declarative questions not only check understanding, but display the doctor s diagnosing process, check whether the doctor can move on to the next topic or action, and display implicitly the doctor s idea of what is connected and what is relevant. One aim of the study is to describe how different syntactic structures work together. A typical question chain consists of two or three questions. The first question is an open wh-question that elicits a new topic and creates different types of presuppositions. Contingent questions are constructed as yes/no questions that seek an affirmative answer or as declarative sentences that seek confirmation. Contingent questions can function as repair initiators and thus support achieving mutual understanding. Therefore, they are tools for the doctor to construct a description of the medical problem collaboratively with the patient. The results add to the results of previous studies on questions in medical consultation, but also suggest some corrections. They provide additional evidence for the idea that different types of syntactic constructions are useful in different types of settings. However, they also show that the variety of questions that doctors use is more manifold and diverse than the variety introduced in earlier studies and textbooks.

Kuvan ja tekstin välissä : Kuvateksti uutiskuvan ja lehtijutun elementtinä

The study focuses on picture captions: their grammar and interplay with photographs and their position as semi-independent elements of the news stories. The research was conducted in the framework of critical discourse analysis, social semiotic visual theory and fennistic syntactical research. The data consist of 441 press photographs, 1,815 captions and a number of news items from Finnish dailies. The generic structure potential of the caption includes the caption headline, the caption proper, i.e. the verbalization of the picture content, and the frame. In the data, 41 per cent of the captions have a headline, and 44 per cent contain a caption proper. Characteristic of the caption proper is omission of the finite verb and the use of the present tense, both of which have decreased in Finnish papers during the 20th century. The caption proper is typically a main clause, and both subordinate clauses and participal phrases occur mostly in the frame. While comparing caption variants attached to the same pictures, the processes and their participants proved to be identified considerably identically, following the news agency captions. Instead, the reader?s interpretations of a picture could be directed by framing it in different ways. For example, the caption may focus on the only person depicted, deal with a whole group, or give an abstract account of the situation. The caption is a paratext, a typographically marked, semi-independent element of a news story. Between the headline and the caption, four semantic relations have been identified. The caption may be a paraphrase of the headline, or a close-up illustrating an abstract headline with a concrete example. If the name of the person depicted is their only common factor, the relation between the caption and the headline is additive. A specifying caption will give more details than the headline. The caption may complete, repeat, or summarize the body copy. Naturally, most captions completing the story verbalize the content of the picture. As the caption is often based on the story, it may even repeat the body copy verbatim. The summarizing function is probably becoming increasingly important, as most Finnish newspapers have abandoned the use of a separate standfirst.

Toiminta ja tarkoite : Tutkimus suomen pronominista

The study describes the use and meaning of the Finnish demonstrative pronouns, focus being on the pronoun "tämä" (roughly 'this'). The Finnish demonstrative system is a three way one, the other two demonstratives are "tuo" ('that') and "se" ('it'). The data consisted of 12 half hours of video- and tape-recorded face-to-face and telephone conversations. The method for the study was ethnomethodological conversation analysis (CA); in addition to CA, the theoretical framework consisted of functional linguistics and linguistic anthropology. First, the study dealt with the syntactic distribution of the three demonstratives. The pronouns were analysed according to whether they are before or after the verb, and whether they compose an NP on their own or are determinants of a lexical NP. The study suggested that the form and the placement of the NP presents the referent as continuous/discontinuous or given/new. Givenness of a referent was defined as "identified adequately for the purposes of the on-going action". The so-called dislocated utterances were considered separately. It was found that left-dislocations are used for inserting referents in a particular relation to the on-going activity. Right-dislocations offer a solution for the sometimes competing motivations of newness and continuity: they are used for securing the identifiability of a referent that is implied to be continuous. Second, the study focussed on analysing the meaning of the pronouns according to three dimensions of reference: referential, indexical and relational. It was found that the demonstratives can organize interactional or spatial context. When organizing interactional context, the demonstrative pronouns express the role of identifying the referent in relation to the on-going activity. The pronoun "tämä" expresses that the referent is referentially open and the characterization of the referent is given in the on-going turn. Furthermore, it expresses asymmetry of the indexical ground: it expresses that the participants of a conversation do not share a mutual understanding of the activity at that particular time. In addition, the referent of the pronoun "tämä" is central for understanding the on-going action. Centrality could be understood as the relational feature of the pronoun. However, it is a consequence of the referential and indexical features of "tämä". The pronoun "tuo" also expresses referential openness, but it implies indexical symmetry. The pronoun "se" implies that the referent is known enough, and implies indexical symmetry. When used spatially, the pronouns may refer to a physical space or to a situation. They express or imply that the speaker is inside or outside the referent. The pronoun "tämä" implies inclusion, and the pronoun "tuo" expresses exclusion.

Lumometsän syli : Anni Swanin satusymbolismi 1896-1923

Lumometsän syli, Anni Swanin satusymbolismi 1896-1923 on suomenkielisen satukirjallisuuden poetiikkaa ja 1900-luvun alun modernia naiseutta selvittävä feministiseen tutkimustraditioon liittyvä tutkimus. Sen kohteena ovat lasten- ja nuortenkirjailija Anni Swanin (1875-1958) satukokoelmat vuosilta 1901-1923 ja Uusi Suometar -lehden sadunomaiset novellit vuosilta 1896-1904. Tutkimus tuo uutta tietoa lastenkirjallisuuden osalta 1900-luvun alun modernin ihmisen problematiikasta. Se sisältää naissubjektin kehityskaaren ja sisäisen kasvun kohti naistaiteilijuutta. Yksityiskohtaisen tarkastelun kohteina ovat sadut Veli ja sisar (1917), Ihmekukka (1905), Marjaanan helmikruunu (1912), Aaltojen salaisuus (1901), Jääkukka (1905), Tyttö ja kuolema (1917), Merenkuningatar ja hänen poikansa (1905), Lumolinna (1905) ja Tarina Kultasirkasta (1901). Tutkimuksessa tarkastellaan Swanin satujen poeettista kieltä ja naiseuden tematiikkaa ranskalaisen postmodernin ajan feministisen viitekehyksen valossa. Siinä keskeisiä ovat Julia Kristevan psykoanalyyttispohjaiset näkemykset ja Hélène Cixous´n sekä Luce Irigarayn ajatukset feminiinisestä kirjoituksesta. Sadut kontekstualisoidaan ajankohdan symbolistiseen taidevirtaukseen ja Suomen taiteen kultakauteen. Satuja tulkitaan naiskirjailijan lajina ja erityisenä naisen metaforisen ilmaisun muotona. Satujen feministinen lukutapa purkaa perinteisiä lukemiskonventioita ja merkitsee satutekstin lukemista "toisin". Se avaa varhaista modernia naiseutta ja sille ominaista naisen ilmaisukielen erityisyyttä sekä mykkää ei-kielellistä, melankolian ilmaisua. Tutkimus tuo esiin uudenlaisen naiskirjailijan aistimusvoimaisen kielen. Swanin satusymbolismi on luonnon kauneuden synesteettista ja aistimusvoimaista kerrontaa, jolle on luonteenomaista aistiestetiikka, metaforisuus, metonymisyys ja metamorfoosit. Swan vahvistaa osaltaan naisen sankaruutta, omaa ilmaisukieltä ja ääntä. Tuloksena paljastuu satuperinteeseen verrattuna uudenlaisia tyttöyden, äitiyden, naistaiteilijuuden ja perheen malleja ja niiden representaatioita. Satumallit osoittautuvat aikanaan moderneiksi tyttösankareiksi, osin ambivalenteiksi uudenlaista naiseutta ja suhteessa oloa heijastaviksi ja ovat siten varhaisia feministisen sadun tunnusmerkkejä. Tutkimus selvittää, miten Swan rakentaa omaperäisen satusymboliikan. Satumetsä on luonnonkauniin suomalaismetsän symbolinen mielenmaisema ja samanaikaisesti sadun myyttis-symbolinen topos. Swanin luontokäsitys sisältää luonnonsuojelun ja varhaisen ekokriittisen näkemyksen. Tutkimus osoittaa Swanin satujen kytkeytyvän 1900-luvun alun modernismiin ja Suomen taiteen kultakauteen. Swan on suomenkielisen symbolistisen taidesadun kehittäjä ja feministisen sadun aloittaja.

Hallinnon lehdistötiedotteiden kieli

This study seeks to answer the question of what the language of administrative press releases is like, and how and why it has changed over the past few decades. The theoretical basis of the study is provided by critical text analysis, supplemented with, e.g., the metafunction theory of Systemic Functional Grammar, the theory of poetic function, and Finnish research into syntax. The data includes 83 press releases by the City of Helsinki Public Works Department, 14 of which were written between 1979 and 1980 (old press releases), and 69 of which were written between 1998 and 1999 (new press releases). The analysis focuses on the linguistic characteristics of the releases, their changes and variation, their relation to other texts and the extra linguistic context, as well as their genre. The core research method is linguistic text analysis. It is supplemented with an analysis of the communicative environment, based on the authors' interviews and written documents. The results can be applied to the improvement of texts produced by the authorities and even by other organizations. The linguistic analysis focuses on features that transform the texts in the data making them guiding, detailed, and poetic. The releases guide the residents of the city using modal verbal expressions and performative verbs that enable the mass media to publish the guiding expressions on their own behalf as such. The guiding is more persuasive in the new press releases than in the old ones, and the new ones also include imperative clauses and verbless directives that construct direct interaction. The language of the releases is made concrete and structurally detailed by, e.g., concrete vocabulary, proper nouns and terms, as well as definitions, adverbials and comparisons, which are used specifically to present places and administrative organizations in detail. The rhetorical features in the releases include alliteration and metaphors, which are found in the new releases especially in the titles. The emphasized features are used to draw the readers' attention and to highlight the core contents of the texts. The new releases also include words that are colloquial in style, making the communicative situations less official. Structurally, the releases have changed from being letter-like to a more newsflash-like format. The changes in the releases can be explained by the development towards more professional communications and the more market-oriented ideology adopted in the communicative environment. Key words: change in administrative language, press releases, critical text analysis, linguistic text analysis

On Toponymic Constructions as an Alternative to Naming Patterns in Describing Finnish Lake Names

This thesis combines a computational analysis of a comprehensive corpus of Finnish lake names with a theoretical background in cognitive linguistics. The combination results on the one hand in a description of the toponymic system and the processes involved in analogy-based naming and on the other hand some adjustments to Construction Grammar. Finnish lake names are suitable for this kind of study, as they are to a large extent semantically transparent even when relatively old. There is also a large number of them, and they are comprehensively collected in a computer database. The current work starts with an exploratory computational analysis of co-location patterns between different lake names. Such an analysis makes it possible to assess the importance of analogy and patterns in naming. Prior research has suggested that analogy plays an important role, often also in cases where there are other motivations for the name, and the current study confirms this. However, it also appears that naming patterns are very fuzzy and that their nature is somewhat hard to define in an essentially structuralist tradition. In describing toponymic structure and the processes involved in naming, cognitive linguistics presents itself as a promising theoretical basis. The descriptive formalism of Construction Grammar seems especially well suited for the task. However, now productivity becomes a problem: it is not nearly as clear-cut as the latter theory often assumes, and this is even more apparent in names than in more traditional linguistic material. The varying degree of productivity is most naturally described by a prototype-based theory. Such an approach, however, requires some adjustments to onstruction Grammar. Based on all this, the thesis proposes a descriptive model where a new name -- or more generally, a new linguistic expression -- can be formed by conceptual integration from either a single prior example or a construction generalised from a number of different prior ones. The new model accounts nicely for various aspects of naming that are problematic for the traditional description based on analogy and patterns.

Le naturalisme finlandais : Une conception entropique du quotidien

Le naturalisme finlandais. Une conception entropique du quotidien. Finnish Naturalism. An Entropic Conception of Everyday Life. Nineteenth century naturalism was a strikingly international literary movement. After emerging in France in the 1870s, it spread all over Europe including young, small nations with a relatively recent literary tradition, such as Finland. This thesis surveys the role and influence of French naturalism on the Finnish literature of the 1880s and 1890s. On the basis of a selection of works of six Finnish authors (Juhani Aho, Minna Canth, Kauppis-Heikki, Teuvo Pakkala, Ina Lange and Karl August Tavaststjerna), the study establishes a view of the main features of Finnish naturalism in comparison with that of French authors, such as Zola, Maupassant and Flaubert. The study s methodological framework is genre theory: even though naturalist writers insisted on a transparent description of reality, naturalist texts are firmly rooted in general generic categories with definable relations and constants on which European novels impose variations. By means of two key concepts, entropy and everyday life , this thesis establishes the parameters of the naturalist genre. At the heart of the naturalist novel is a movement in the direction of disintegration and confusion, from order to disorder, from illusion to disillusion. This entropic vision is merged into the representation of everyday life, focusing on socially mediocre characters and discovering their miseries in all their banality and daily grayness. By using Mikhail Bakhtin s idea of literary genres as a means of understanding experience, this thesis suggests that everyday life is an ideological core of naturalist literature that determines not only its thematic but also generic distinctions: with relation to other genres, such as to Balzac s realism, naturalism appears primarily to be a banalization of everyday life. In idyllic genres, everyday life can be represented by means of sublimation, but a naturalist novel establishes a distressing, negative everyday life and thus strives to take a critical view of the modern society. Beside the central themes, the study surveys the generic blends in naturalism. The thesis analyzes how the coalition of naturalism and the melodramatic mode in the work of Minna Canth serves naturalisms ambition to discover the unconscious instincts underlying daily realities, and how the symbolic mode in the work of Juhani Aho duplicates the semantic level of the apparently insignificant, everyday naturalist details. The study compares the naturalist novel to the ideological novel (roman à these) and surveys the central dilemma of naturalism, the confrontation between the optimistic belief in social reform and the pessimistic theory of determinism. The thesis proposes that the naturalist novel s contribution to social reform lies in its shock effect. By means of representing the unpleasant truth the entropy of everyday life it aims to scandalize the reader and make him aware of the harsh realities that might apply also to him.

Expert Identity in Development of Core-Task-Oriented Working Practices for Mastering Demanding Situations

The point of departure in this dissertation was the practical safety problem of unanticipated, unfamiliar events and unexpected changes in the environment, the demanding situations which the operators should take care of in the complex socio-technical systems. The aim of this thesis was to increase the understanding of demanding situations and of the resources for coping with these situations by presenting a new construct, a conceptual model called Expert Identity (ExId) as a way to open up new solutions to the problem of demanding situations and by testing the model in empirical studies on operator work. The premises of the Core-Task Analysis (CTA) framework were adopted as a starting point: core-task oriented working practices promote the system efficiency (incl. safety, productivity and well-being targets) and that should be supported. The negative effects of stress were summarised and the possible countermeasures related to the operators' personal resources such as experience, expertise, sense of control, conceptions of work and self etc. were considered. ExId was proposed as a way to bring emotional-energetic depth into the work analysis and to supplement CTA-based practical methods to discover development challenges and to contribute to the development of complex socio-technical systems. The potential of ExId to promote understanding of operator work was demonstrated in the context of the six empirical studies on operator work. Each of these studies had its own practical objectives within the corresponding quite broad focuses of the studies. The concluding research questions were: 1) Are the assumptions made in ExId on the basis of the different theories and previous studies supported by the empirical findings? 2) Does the ExId construct promote understanding of the operator work in empirical studies? 3) What are the strengths and weaknesses of the ExId construct? The layers and the assumptions of the development of expert identity appeared to gain evidence. The new conceptual model worked as a part of an analysis of different kinds of data, as a part of different methods used for different purposes, in different work contexts. The results showed that the operators had problems in taking care of the core task resulting from the discrepancy between the demands and resources (either personal or external). The changes of work, the difficulties in reaching the real content of work in the organisation and the limits of the practical means of support had complicated the problem and limited the possibilities of the development actions within the case organisations. Personal resources seemed to be sensitive to the changes, adaptation is taking place, but not deeply or quickly enough. Furthermore, the results showed several characteristics of the studied contexts that complicated the operators' possibilities to grow into or with the demands and to develop practices, expertise and expert identity matching the core task. They were: discontinuation of the work demands, discrepancy between conceptions of work held in the other parts of organisation, visions and the reality faced by the operators, emphasis on the individual efforts and situational solutions. The potential of ExId to open up new paths to solving the problem of the demanding situations and its ability to enable studies on practices in the field was considered in the discussion. The results were interpreted as promising enough to encourage the conduction of further studies on ExId. This dissertation proposes especially contribution to supporting the workers in recognising the changing demands and their possibilities for growing with them when aiming to support human performance in complex socio-technical systems, both in designing the systems and solving the existing problems.

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

Visual search and eye movements: Studies of perceptual span

In visual search one tries to find the currently relevant item among other, irrelevant items. In the present study, visual search performance for complex objects (characters, faces, computer icons and words) was investigated, and the contribution of different stimulus properties, such as luminance contrast between characters and background, set size, stimulus size, colour contrast, spatial frequency, and stimulus layout were investigated. Subjects were required to search for a target object among distracter objects in two-dimensional stimulus arrays. The outcome measure was threshold search time, that is, the presentation duration of the stimulus array required by the subject to find the target with a certain probability. It reflects the time used for visual processing separated from the time used for decision making and manual reactions. The duration of stimulus presentation was controlled by an adaptive staircase method. The number and duration of eye fixations, saccade amplitude, and perceptual span, i.e., the number of items that can be processed during a single fixation, were measured. It was found that search performance was correlated with the number of fixations needed to find the target. Search time and the number of fixations increased with increasing stimulus set size. On the other hand, several complex objects could be processed during a single fixation, i.e., within the perceptual span. Search time and the number of fixations depended on object type as well as luminance contrast. The size of the perceptual span was smaller for more complex objects, and decreased with decreasing luminance contrast within object type, especially for very low contrasts. In addition, the size and shape of perceptual span explained the changes in search performance for different stimulus layouts in word search. Perceptual span was scale invariant for a 16-fold range of stimulus sizes, i.e., the number of items processed during a single fixation was independent of retinal stimulus size or viewing distance. It is suggested that saccadic visual search consists of both serial (eye movements) and parallel (processing within perceptual span) components, and that the size of the perceptual span may explain the effectiveness of saccadic search in different stimulus conditions. Further, low-level visual factors, such as the anatomical structure of the retina, peripheral stimulus visibility and resolution requirements for the identification of different object types are proposed to constrain the size of the perceptual span, and thus, limit visual search performance. Similar methods were used in a clinical study to characterise the visual search performance and eye movements of neurological patients with chronic solvent-induced encephalopathy (CSE). In addition, the data about the effects of different stimulus properties on visual search in normal subjects were presented as simple practical guidelines, so that the limits of human visual perception could be taken into account in the design of user interfaces.