Mitä hyötyä tehohoidosta? : Tehohoitoa sisältäneiden hoitojaksojen vaikuttavuuden arviointi

Intensive care is to be provided to patients benefiting from it, in an ethical, efficient, effective and cost-effective manner. This implies a long-term qualitative and quantitative analysis of intensive care procedures and related resources. The study population consists of 2709 patients treated in the general intensive care unit (ICU) of Helsinki University Hospital. Study sectors investigate intensive care patients mortality, quality of life (QOL), Quality-Adjusted Life-Years (QALY units) and factors related to severity of illness, length of stay (LOS), patient s age, evaluation period as well as experiences and memories connected with the ICU episode. In addition, the study examines the qualities of two QOL measures, the RAND 36 Item Health Survey 1.0 (RAND-36) and the 5 Item EuroQol-5D (EQ-5D) and assesses the correlation of the test results. Patients treated in 1995 responded to the RAND-36 questionnaire in 1996. All patients, treated from 1995-2000, received a QOL questionnaires in 2001, when 1 7 years had lapsed from the intensive treatment. Response rate was 79.5 %. Main Results 1) Of the patients who died within the first year (n = 1047) 66 % died during the intensive care period or within the following month. The non-survivors were more aged than the surviving patients, had generally a higher than average APACHE II and SOFA score depicting the severity of illness, their ICU LOS was longer and hospital stay shorter than of the surviving patients (p < 0.001). Mortality of patients receiving conservative treatment was higher than of those receiving surgical treatment. Patients replying to the QOL survey in 2001 (n = 1099) had recovered well: 97 % of those lived at home. More than half considered their QOL as good or extremely good, 40 % as satisfactory and 7 % as bad. All QOL indexes of those of working-age were considerably lower (p < 0.001) than comparable figures of the age- and gender-adjusted Finnish population. The 5-year monitoring period made evident that mental recovery was slower than physical recovery. 2) The results of RAND-36 and EQ-5D correlated well (p < 0.01). The RAND-36 profile measure distinguished more clearly between the different categories of QOL and their levels. EQ-5D measured well the patient groups general QOL and the sum index was used to calculate QALY units. 3) QALY units were calculated by multiplying the time the patient survived after ICU stay or expected life-years by the EQ-5D sum index. Aging automatically lowers the number of QALY units. Patients under the age of 65 receiving conservative treatment benefited from treatment to a greater extent measured in QALY units than their peers receiving surgical treatment, but in the age group 65 and over patients with surgical treatment received higher QALY ratings than recipients of conservative treatment. 4) The intensive care experience and QOL ratings were connected. The QOL indices were statistically highest for those recipients with memories of intensive care as a positive experience, albeit their illness requiring intensive care treatment was less serious than average. No statistically significant differences were found in the QOL indices of those with negative memories, no memories or those who did not express the quality of their experiences.

Medicines information sources and services for consumers : A special focus on the Internet and people with depression

The range of consumer health and medicines information sources has diversified along with the increased use of the Internet. This has led to a drive to develop medicines information services and to better incorporate the Internet and e-mail into routine practice in health care and in community pharmacies. To support the development of such services more information is needed about the use of online information by consumers, particularly of those who may be the most likely to use and to benefit from the new sources and modes of medicines communication. This study explored the role and utilization of the Internet-based medicines information and information services in the context of a wider network of information sources accessible to the public in Finland. The overall aim was to gather information to develop better and more accessible sources of information for consumers and services to better meet the needs of consumers. Special focus was on the needs and information behavior among people with depression and using antidepressant medicines. This study applied both qualitative and quantitative methods. Consumer medicines information needs and sources were identified by analyzing the utilization of the University Pharmacy operated national drug information call center (Study I) and surveying Finnish adults (n=2348) use of the different medicines information sources (Study II). The utilization of the Internet as a source of antidepressant information among people with depression was explored by focus group discussions among people with depression and with current or past use of the antidepressant(s) (n=29, Studies III & IV). Pharmacy response to the needs of consumers in term of providing e-mail counseling was assessed by conducting a virtual pseudo customer study among the Finnish community pharmacies (n=161, Study V). Physicians and pharmacists were the primary sources of medicines information. People with mental disorders were more frequent users of telephone- and Internet-based medicines information sources and patient information leaflets than people without mental disorders. These sources were used to complement rather than replace information provided face-to-face by health professionals. People with depression used the Internet to seek facts about antidepressants, to share experiences with peers, and for the curiosity. They described that the access to online drug information was empowering. Some people reported lacking the skills necessary to assess the quality of online information. E-mail medication counseling services provided by community pharmacies were rare and varied in quality. Study results suggest that rather than discouraging the use of the Internet, health professionals should direct patients to use accurate and reliable sources of online medicines information. Health care providers, including community pharmacies should also seek to develop new ways of communicating information about medicines with consumers. This study determined that people with depression and using antidepressants need services enabling interactive communication not only with health care professionals, but also with peers. Further research should be focused on developing medicines information service facilitating communication among different patient and consumer groups.

Effects of the digital subtitling software on the subtitling process : A survey among Finnish professional television subtitlers

Tutkielma käsittelee suomalaisten televisiotekstittäjien ammatillisuutta, käännösprosessia ja digitaalisten tekstitysohjelmien vaikutuksia tekstitysprosessiin ammattitekstittäjien näkökulmasta. Suomen television digitalisoituminen on aiheuttanut mullistuksia myös tekstitysalalla kun tekstitettävä kuvamateriaali on ryhdytty toimittamaan käännöstoimistoille ja tekstittäjille digitaalisena. Teoriaosuudessa käsitellään käännös- ja tekstitystutkimusta sekä koulutusta Suomessa, ammattitaitoa ja ammatillisuutta sekä kääntämisen apukeinoja. Tekstittäminen esitellään erikoistuneena kääntämisen muotona. On kuitenkin myös huomioitava, että kääntäminen on yksi vaihe tekstitysprosessissa. Teoriaosuus päättyy suomalaisten televisiotekstittäjien arjen ja työkentän nykytilanteen käsittelyyn – tekstittäjät työskentelevät monenlaisilla työehdoilla ja laadun kriteerit saatetaan joutua arvioimaan uudelleen. Empiirisen osan alussa esitetään, että suomalaisia televisiotekstittäjiä on haastateltu yllättävän vähän, ja Jääskeläisen ajatuksiin nojaten mainitaan, että tekstittämisen alalla on vielä paljon tutkimatta – etenkin suomalaisesta tekstitysprosessista löytyy tutkittavaa. Tutkimuskohde on ammatikseen televisioon tekstityksiä tekevät kääntäjät. Suomalaiselle tekstitykseen erikoistuneelle käännöstoimistolle työskenteleville tekstittäjille lähetettiin alkutalvesta 2008 kyselylomake, jolla kartoitettiin sekä monivalintakysymyksillä että avoimilla kysymyksillä heidän ammatillisuuttaan, työmenetelmiään, käännös- ja tekstitysprosessiaan, ammattiylpeyttään ja -identiteettiään, ajanhallintaansa, sekä heidän käyttämäänsä digitaalista tekstitysohjelmaa. Tutkimuksessa kävi ilmi, että lähes kolmanneksella vastaajista on ammatistaan neutraali tai jopa negatiivinen käsitys. Näitä tekstittäjiä yhdistää se seikka, että kaikilla on alle 5 vuotta kokemusta alalta. Valtaosa vastanneista on kuitenkin ylpeitä siitä, että toimivat suomen kielen ammattilaisina. Tekstitysprosessi oli lomakkeessa jaettu esikatseluvaiheeseen, käännösvaiheeseen, ajastamisvaiheeseen ja korjauskatseluvaiheeseen. Tekstittäjät pyydettiin mm. arvioimaan tekstitysprosessinsa kokonaiskestoa. Kestoissa ilmeni suuria eroavaisuuksia, joista ainakin osa korreloi kokemuksen kanssa. Runsas puolet vastaajista on hankkinut digitaalisen tekstitysohjelmiston käyttöönsä ja osa ajastaa edelleen käännöstoimistossa muun muassa ohjelmiston kalleuden vuoksi. Digitaalisen ohjelmiston myötä tekstitysprosessiin ja työkäytänteisiin on tullut muutoksia, kun videonauhureista ja televisioista on siirrytty pelkän tietokoneen käyttöön. On mahdollista tehdä etätyötä kaukomailta käsin, kääntää ja ajastaa lomittain tai tehdä esiajastus ja kääntää sitten. Digitaalinen tekniikka on siis mahdollistanut tekstitysprosessin muuttumisen ja vaihtoehtoiset työmenetelmät, mutta kaikista menetelmistä ei välttämättä ole tekstittäjälle hyötyä. Perinteinen tekstitysprosessi (esikatselu, repliikkijakojen merkitseminen käsikirjoitukseen, kääntäminen ja repliikkien laadinta, korjaukset ja tarkastuskatselu) vaikuttaa edelleen tehokkaimmalta. Vaikka työkäytänteet eroavat toisistaan, kokonaiskäsitys on se, että digitalisoitumisen alkukangertelujen jälkeen tekstittäjien työskentely on tehostunut.

The One and The Many : In the works of Heraclitus, Parmenides and Lao Zi

This paper concentrates on Heraclitus, Parmenides and Lao Zi. The focus is on their ideas on change and whether the world is essentially One or if it is composed of many entities. In the first chapter I go over some general tendences in Greek and Chinese philosophy. The differences in the cultural background have an influence in the ways philosophy is made, but the paper aims to show that two questions can be brought up when comparing the philosophies of Heraclitus, Parmenides and Lao Zi. The questions are; is the world essentially One or Many? Is change real and if it is, what is the nature of it and how does it take place? For Heraclitus change is real, and as will be shown later in the chapter, quite essential for the sustainability of the world-order (kosmos). The key-concept in the case of Heraclitus is Logos. Heraclitus uses Logos in several senses, most well known relating to his element-theory. But another important feature of the Logos, the content of real wisdom, is to be able to regard everything as one. This does not mean that world is essentially one for Heraclitus in the ontological sense, but that we should see the underlying unity of multiple phenomena. Heraclitus regards this as hen panta: All from One, One from All. I characterize Heraclitus as epistemic monist and an ontological pluralist. It is plausible that the views of Heraclitus on change were the focus of Parmenides’ severe criticism. Parmenides held the view that the world is essentially one and that to see it as consisting of many entities was the error of mortals, i.e. the common man and his philosophical predecessors. For Parmenides what-is, can be approached by two routes; The Way of Truth (Aletheia) and The Way of Seeming (Doxa). Aletheia essentially sees the world as one, where even time is an illusion. In Doxa Parmenides is giving an explanation of the world seen as consisting of many entities and this is his contribution to the line of thought of his predecessors. It should be noted that a strong emphasis is given to the Aletheia, whereas the world-view given is in Doxa is only probable. I go on to describe Parmenides as ontological monist, who gives some plausibility to pluralistic views. In the work of Lao Zi world can be seen as One or as consisting of Many entities. In my interpretation, Lao Zi uses Dao in two different senses; Dao is the totality of things or the order in change. The wu-aspect (seeing-without-form) attends the world as one, whereas the you-aspect attends the world of many entities. In wu-aspect, Dao refers to the totality of things, when in you-aspect Dao is the order or law in change. There are two insights in Lao Zi regarding the relationship between wu- and- you-apects; in ch.1 it is stated that they are two separate aspects in seeing the world, the other chapters regarding that you comes from wu. This naturally brings in the question whether the One is the peak of seeing the world as many. In other words, is there a way from pluralism to monism. All these considerations make it probable that the work attributed to Lao Zi has been added new material or is a compilation of oral sayings. In the end of the paper I will go on to give some insights on how Logos and Dao can be compared in a relevant manner. I also compare Parmenides holistic monism to Lao Zi’s Dao as nameless totality (i.e. in its wu-aspect). I briefly touch the issues of Heidegger and the future of comparative philosophy.

"Mielessä häämötti punainen mekko" : Laihduttaminen, pukeutuminen ja sukupuoli Painonvartijat-yrityksen menestystarinoissa

Tutkielman aiheena ovat Painonvartijat-yrityksen mainonnassa käytetyt menestystarinat. Tutkielmassa kysytään, minkälaisia merkityksiä menestystarinoissa annetaan muutokselle ja miten yrityksen mainonnassa tuotetaan kulttuurisesti hyväksyttäviä sukupuolitettuja ruumiita. Tutkimus kuuluu naistutkimuksen alaan ja siinä tarkemmin feministisen lihavuustutkimuksen kenttään. Tutkielman lähtökohtana on, että lihavuuden merkitykset eivät tyhjene ainoastaan lääke- ja ravitsemustieteellisiin näkemyksiin, vaan lihavuutta ja laihduttamista tulee tarkastella useista eri näkökulmista. Lihavuus ja laihduttaminen rakentuvat tutkielmassa kulttuurisesti määrittyneinä ilmiöinä. Tutkimusaineistona on vuoden 2003 alusta alkaen ilmestyneen Painonvartijat-lehden laihdutustarinan muotoon kirjoitetut artikkelit (10 artikkelia) sekä Suomen Painonvartijoitten www-sivuilla julkaistut menestystarinat (18 tarinaa). Niissä käydään läpi Painonvartijoitten laihdutusohjelmalla tavoitepainonsa saavuttaneiden laihdutuskokemuksia. Tutkimukseni kohteena ovat naisten menestystarinat. Aineistoni lukemista ovat ohjanneet seuraavanlaiset kysymykset: mitä laihduttaminen menestystarinoitten mukaan on, miten sukupuoli näyttäytyy menestystarinoissa, miten ruumis kerrotaan. Analyysin edetessä olen kirjoittanut tarinoista koostuvan aineistoni teemoittain uudeksi tarinaksi asettamalla aineistoni keskusteluyhteyteen eri teorioitten kanssa. Tutkielmassa analysoidaan, miten menestystarinoissa kuvaillaan laihduttamista ruokavalion muutoksena ja miten niissä rakennetaan sukupuolta ruoan ja syömisen kautta. Minkälaisia syömisen tapoja laihdutustarinoissa esitetään ja minkälaisia syöjiä niiden kautta rakennetaan? Lisäksi tutkielmassa analysoidaan, miten menestystarinoissa kuvaillaan laihduttamista ruumiin muokkauksena ja miten niissä rakennetaan hyväksyttäviä naisruumiita vaatteiden ja pukeutumisen kuvailun kautta. Tutkielman viimeisessä luvussa pysähdytään vielä hetkeksi pohtimaan ruumiin muutoksen ja muuttumattomuuden vaatimusten jännitettä menestystarinoissa. Minkälaista ruumiinpolitiikkaa menestystarinoissa rakennetaan ja minkälaista vastustavaa lukureittiä menestystarinoihin on mahdollista rakentaa? Laihduttamisessa epäonnistumisen stigma asetetaan menestystarinoissa vankasti yksilöön. Sen sijaan onnistuneella laihduttamisella on vaikutuksensa yksilöä laajempaan joukkoon. Naisen ruokailun rajoittamisen opettelun kautta toteutettava ruumiin ulkoisten rajojen kontrolloiminen heijastelee naisen oletettua sisäistä maailmaa ja sosiaalisten suhteiden tilaa. Uusissa ruokavalinnoissa korostuvat rasvattomat valinnat ja kohtuudella nautitut makeat herkut. Painonvartijat-ruokapuhe tuottaa varsin stereotyyppisen kuvan naisista syöjinä, jotka valitsevat lautasilleen "kevyitä vaihtoehtoja": salaattia, kasviksia, kanaa, kalaa. Suomalainen kotiruoka ja puhtaat raaka-aineet esitetään nostalgisessa diskurssissa laihduttajalle parhaana vaihtoehtona. Roskaruoan ja einesten sijaan laihduttajan perheessä nautitaan kunnon kotiruokaa. Laihduttamisesta ei ole hyötyä ainoastaan perheen äidille, vaan koko perheelle kun mies laihtuu "siinä sivussa" ja lapset saavat terveelliset ruokatottumukset perintönä kotoaan. Yhdessä nautittu ja äidin rakkaudella valmistama perheateria heijastelee perheen suhteiden tilaa. Painonvartijoitten menestystarinoissa rakennetaan normatiivista kuvaa perheestä, joka koostuu kahdesta toisiaan täydentävästä eri sukupuolta olevasta vanhemmasta ja heidän lapsistaan. Vaatekaapin sisällön uusiminen konkretisoi muutoksen ja toiveena on, ettei muutosta tarvitse tehdä enää koskaan uudelleen. Kiristävien vaatteiden pitäisikin toimia varoituksen signaalina painonvartijalle siitä, milloin on taas aika palata ruotuun ja kaivaa laihdutusmateriaali esille, sillä lihominen merkitsisi jälleen kaiken laihtumalla saavutetun muutoksen menettämistä. Menestyksekkäimmillään painonvartija omaksuu itsetarkkailun ja -hallinnan osaksi omaa identiteettiään loppuiäkseen. Lihomisen pelko muotoutuu painonvartijasubjektissa osaksi sekä lihavan että laihan painonvartijan identiteettiä. Uusien mahdollisuuksien avautumisen ja uuden rohkeuden löytämisen rinnalla menestystä mitataan kuitenkin useissa tarinoissa heteroseksuaalisen halun kohteena olemisen kautta. Uusissa vartalonmyötäisissä pienissä vaatteissa laihduttanut nainen on lihavaa naista naisellisempi - todisteena tästä toimivat etupäässä vastakkaisen sukupuolen edustajien myönteiset huomionosoitukset. Menestystarinat tarinamuotona luovat varsin ehyitä kertomuksia, joissa normeista poikkeavat naiset tuovat vaatetarinoissaan kyllä esiin syrjinnän ja ulossulkemisen kokemuksiaan, mutta ratkaisu ongelmiin on aina itsensä muuttaminen.

"America Would Lose Its Soul" : The Immigration Restriction Debate, 1920-1924

Vuosien 1830 ja 1924 välillä Yhdysvaltoihin muutti noin 35 miljoonaa eurooppalaista. Tämä niinkutsuttu "maahanmuuton vuosisata" päättyi varsin äkillisesti kun Yhdysvallat päätti rajoittaa maahanmuuttoa 1920-luvulla. Vuosina 1921 ja 1924 säädetyt lait asettivat kansallisuuteen perustuvat kiintiöt kaikille eurooppalaisille maahanmuuttajille; vuoden 1924 laki myös lopetti kokonaan japanilaisten maahanmuuton. Tämä työ tutkii näihin kiintiölakeihin johtanutta maahanmuuttajavastaisuuden kasvua sekä etenkin lakien ympärillä käytyä keskustelua. Pääpaino on kongressissa esitetyissä maahanmuuton vastaisissa argumenteissa. Nämä jakautuivat karkeasti ottaen kolmeen kategoriaan: maahanmuuton vastustajat sanoivat, että siirtolaisten vaikutus taloudelliseen tilanteeseen oli epäsuotuisa, siirtolaisten rodullinen ja kulttuurinen "laatu" oli huonontunut, ja siirtolaiset olivat radikaaleja ja bolshevismiin taipuvaisia. Erityistä huolta herätti maahanmuuttajien vaikutus Amerikan kulttuuriseen, rodulliseen ja poliittiseen yhtenäisyyteen. Huoli kansakunnan yhtenäisyydestä oli tulosta paitsi siirtolaisten määrästä myös amerikkalaisessa yhteiskunnassa tapahtuneista muutoksista. Erityisen tärkeitä olivat työväenliikkeen vaikutusvallan kasvu ja teollisuusjohtajien pyrkimys pysäyttää se. Maahanmuuttajien "bolshevismi" olikin käyttökelpoinen argumentti paitsi maahanmuuttajia myös amerikkalaisia työläisiä vastaan: teollisuusjohtajat painottivat että lakot ja työväenliike olivat tulosta siirtolaisten mukanaan tuomista "epäamerikkalaisista" ajatusmalleista, eivät yhteiskunnan epäoikeudenmukaisuudesta. Kongressin keskustelun lisäksi työssä käsitellään myös eri yhteiskunnallisten ryhmien ja vaikuttajien kantaa siirtolaisuuteen. Keskusteluun maahanmuutosta vaikuttivat etenkin eugenistit ja muut sosiaalitieteilijät, jotka väittivät itä- ja eteläeurooppalaisten olevan rodullisesti anglosakseja huonompia. Tämän väitteen vaikutusvaltaa lisäsivät yhteiskunnassa vallalla olleet ennakkoluulot, ja monet yhdistykset ja liikkeet (mm. Ku Klux Klan ja erilaiset isänmaalliset järjestöt) olivatkin tärkeitä rajoittamisen kannattajia. Keskustelu maahanmuutosta painottui ideologisiin ja tunteellisiin kysymyksiin, mutta rajoitusten taustalla oli myös konkreettisempia tekijöitä. Yhteiskunnan teollistuminen ja kaupungistuminen olivat pienentäneet siirtolaisista koituvaa taloudellista hyötyä: siirtolaisia ei enää tarvittu raivaamaan uusia viljelysmaita, kun taas tuotannon koneistuminen vähensi työvoiman tarvetta huomattavasti. Pitkän aikavälin taloudellisten tekijöiden roolin merkitys käy ilmeiseksi kun otetaan huomioon, että muut maahanmuuttomaat (esim. Kanada ja Australia) eivät juuri rajoittaneet siirtolaisuutta tänä aikana vaikka niissäkin esiintyi runsaasti rodullista ja kulttuurista maahanmuuttajavastaisuutta. Pääsyy rajoitusten vähäisyyteen näissä maissa oli juuri maahanmuuttajien tuoma taloudellinen hyöty, sekä teollisena työvoimana että maanviljelijöinä. Vaikka kiintiölakiehdotusten ympärillä käytiin kiivasta väittelyä, kongressi kuitenkin hyväksyi lait varsin suurella enemmistöllä. Siirtolaisia itseään lukuunottamatta varsin harvat näkivät lait haitallisina, kun taas useat erilaiset ryhmät katsoivat hyötyvänsä maahanmuuton rajoittamisesta. Avainsanat: siirtolaisuus, maahanmuutto, Yhdysvallat, 1920-luku, kiintiölait, maahanmuuton rajoittaminen

Personality and social psychological studies on computer-mediated communication in school settings

The present study examined how personality and social psychological factors affect third and fourth graders' computer-mediated communication. Personality was analysed in terms of the following strategies: optimism, pessimism and defensive pessimism. Students worked either individually or in dyads which were paired homogeneously or heterogeneously according to the strategies. Moreover, the present study compared horizontal and vertical interaction. The study also examined the role that popularity plays, and students were divided into groups based on their popularity level. The results show that an optimistic strategy is useful. Optimism was found to be related to the active production and processing of ideas. Although previous research has identified drawbacks to pessimism in achievement settings, this study shows that the pessimistic strategy is not as debilitating a strategy as is usually assumed. Pessimistic students were able to process their ideas. However, defensive pessimists were somewhat cautious in introducing or changing ideas. Heterogeneous dyads were not beneficial configurations with respect to producing, introducing, or changing ideas. Moreover, many differences were found to exist between the horizontal and vertical interaction; specifically, the students expressed more opinions and feelings when teachers took no part in the discussions. Strong emotions were observed especially in the horizontal interaction. Further, group working skills were found to be more important for boys than for girls, while rejected students were not at a disadvantage compared to popular ones. Schools can encourage emotional and social learning. The present study shows that students can use computers to express their feelings. In addition, students who are unpopular in non-computer contexts or students who use pessimism can benefit from computers. Participation in computer discussions can give unpopular children a chance to develop confidence when relating to peers.

ADHD-aikuisten psykologinen kuntoutus : Neljän uuden lyhytintervention tutkimus

ADHD (attention deficit hyperactivity disorder) is developmental neurobiological disability. In adults, the prevalence of ADHD has been estimated to be about 4 %. In addition to the difficulties of attention, the problems in executive functioning are typical. The psychiatric comorbidities are common. The most extensively studied treatments are pharmacological. There is also evidence about the usefulness of the cognitive-behavioural therapy (CBT) in the treatment of adults with ADHD. There are some preliminary results about the effectiveness of cognitive training and hypnosis in children, but there is no scientific proof in adults. This dissertation is based on two intervention studies. In the first study, the usefulness of the new group CBT (n = 29) and the maintenance of the symptom reduction in the follow-up of six months were studied. In the second study, the usefulness of short hypnotherapy (n = 9), short individual CBT (n = 10) and computerized cognitive training (n = 9) were examined by comparing groups with each other and to the control group (n = 10). The participation in the group CBT and the participants' satisfaction were good. There were no changes in self-reports during waiting period of three months. After the rehabilitation, the symptoms decreased. Participants having symptom reduction during rehabilitation maintained their benefit through 6-month follow-up period. In a combined ADHD symptom score based on self-reports, seven participants in the hypnotherapy, six in the CBT, two in the cognitive training and two controls improved. Using independent evaluations, improvement was found in six of the hypnotherapy, seven of the CBT, two of the cognitive training and three of the control participants. There was no treatment-related improvement in cognitive performance. Thus, in the hypnotherapy and CBT groups, some encouraging improvement was seen. In the cognitive training group, there was improvement in the trained tasks but no generalization of the improvement. The results support the earlier results from the usefulness of CBT in the treatment of adults with ADHD. Also the hypnotherapy seems a useful rehabilitation. More research is needed to evaluate the usefulness of cognitive training. These promising results warrant further studies with more participants and with longer treatment duration. Also different measures of cognitive functioning and quality of life are needed. It is important in addition to the medication to arrange psychosocial interventions for the ADHD adults.

Sosiaalisen verkostoanalyysin soveltuminen yhteisöllisen verkko-oppimisen tutkimiseen

Tietotekniikan kehittyessä lisääntyy sekä tietotyön tekijöiden tarve että paine tehostaa opetusta tietotekniikan avulla. Tietotyöläisten tarvitsemien taitojen opettamiseen tarvitaan uutta pedagogiikkaa, jossa korostetaan tietojen ja sääntöjen seuraamisen sijaan taitoja, itsenäisyyttä ja oppimaan oppimista. Tietotekniikankäyttäminen opetuksessa tuo omat haasteensa oppimistilanteisiin. Sosiokonstruktiivinen, yhteisöllinenverkko"-oppiminen onkin nousemassa perinteisen opettajajohtoisen opetuksen haastajaksi. Suomessa kehitetty Tutkiva oppiminen on yksi tämän viitekehyksen mukaisista pedagogisista menetelmistä. Koska sosiokonstruktiivinen teoria korostaa ihmisten välisiä suhteita yli yksittäisen ihmisen toiminnan, alan tutkimuksenkin on otettava kantaa tutkimustilanteessa esiintyviin vuorovaikutussuhteisiin. Tähän perinteiset psykologiset ja pedagogiset menetelmät eivät sovellu, kun taas sosiaalitieteissä suhteellisen vanha analyysimenetelmä, SVA eli sosiaalinen verkostoanalyysi, on tarkoitettu nimen\-omaan ihmisryhmien analysoimiseen. SVA:n sovellukset psykologian ja yhteisöllisen oppimisen alueilla ovat kuitenkin vasta alustavia, eikä luotettavaa näyttöä menetelmän soveltumisesta saatika hyödyllisistä tuloksista vielä ole. Tämän tutkimuksen on tarkoitus selvittää, onko SVA sovellettavissa tälle tutkimuksen alueelle. Tässä tutkimuksessa SVA:ta käytettiin 23 peruskoulu- ja lukioluokan Tutkivan oppimisen menetelmällä toteutettujen oppimistilanteiden tutkimiseen. Tulokset osoittavat, että SVA soveltuu yhteisöllisen verkko-oppimisen tutkimiseen, sillä tästä aineistosta löytyi alustavia SVA:n tunnuslukuja, jotka ovat yhteydessä oppimistilanteen laatuun. Tulokset ovat myös pitkälti sosiokonstruktiivisen teorian mukaisia: kurssin hyöty nousee, kun useat oppilaat kirjoittavat korkealaatuisia viestejä ja osallistuvat kattavasti eri keskusteluihin. Avainsanat: Tutkiva oppiminen, sosiokonstruktivismi, pedagogiikka, yhteisöllisyys, yhteisöllinen verkko-oppiminen, Fle3, SVA, sosiaalinen verkostoanalyysi, koulu, opetus.

Widening Perspectives of Teacher Education : Studies on theory-practice relationship, reflection, research and professional development

This dissertation examined the research-based teacher education at the University of Helsinki from different theoretical and practical perspectives. Five studies focused on these perspectives separately as well as overlappingly. Study I focused on the reflection process of graduating teacher students. The data consisted of essays the students wrote as their last assignment before graduating, where their assignment was to examine their development as researchers during their MA thesis research process. The results indicated that the teacher students had analysed their own development thoroughly during the process and that they had reflected on theoretical as well as practical educational matters. The results also pointed out that, in the students’ opinion, personally conducted research is a significant learning process. -- Study II investigated teacher students’ workplace learning and the integration of theory and practice in teacher education. The students’ interviews focused on their learning of teacher’s work prior to education. The interviewees’ responses concerning their ‘surviving’ in teaching prior to teacher education were categorized into three categories: learning through experiences, school as a teacher learning environment, and case-specific learning. The survey part of the study focused on integration of theory and practice within the education process. The results showed that the students who worked while they studied took advantage of the studies and applied them to work. They set more demanding teaching goals and reflected on their work more theoretically. -- Study III examined practical aspects of the teacher students’ MA thesis research as well as the integration of theory and practice in teacher education. The participants were surveyed using a web-based survey which dealt with the participants’ teacher education experiences. According to the results, most of the students had chosen a practical topic for their MA thesis, one arising from their work environment, and most had chosen a research topic that would develop their own teaching. The results showed that the integration of theory and practice had taken place in much of the course work, but most obviously in the practicum periods, and also in the courses concerning the school subjects. The majority felt that the education had in some way been successful with regards to integration. -- Study IV explored the idea of considering teacher students’ MA thesis research as professional development. Twenty-three teachers were interviewed on the subject of their experiences of conducting research about their own work as teachers. The results of the interviews showed that the reasons for choosing the MA thesis research topic were multiple: practical, theoretical, personal, professional reasons, as well as outside effect. The objectives of the MA thesis research, besides graduating, were actual projects, developing the ability to work as teachers, conducting significant research, and sharing knowledge of the topic. The results indicated that an MA thesis can function as a tool for professional development, for example in finding ways for adjusting teaching, increasing interaction skills, gaining knowledge or improving reflection on theory and/or practice, strengthening self-confidence as a teacher, increasing researching skills or academic writing skills, as well as becoming critical and being able to read scientific and academic literature. -- Study V analysed teachers’ views of the impact of practitioner research. According to the results, the interviewees considered the benefits of practitioner research to be many, affecting teachers, pupils, parents, the working community, and the wider society. Most of the teachers indicated that they intended to continue to conduct research in the future. The results also showed that teachers often reflected personally and collectively, and viewed this as important. -- These five studies point out that MA thesis research is and can be a useful tool for increasing reflection doing with personal and professional development, as well as integrating theory and practice. The studies suggest that more advantage could be taken of the MA thesis research project. More integration of working and studying could and should be made possible for teacher students. This could be done in various ways within teacher education, but the MA thesis should be seen as a pedagogical possibility.

Matka koulun kestävän kehittämisen maisemassa

A Journey in the Landscape of Sustainable School Development “A Journey in the Landscape of Sustainable School Development” is a story of the Sorrila School development process. This research deals with a school development project as a process, and as a part of international projects on Education for Sustainable Development, with ENSI (Environment and School Initiatives) being the most important. The main purpose of the study was to analyze the change process as a general phenomenon as well as the learning connected to it. The research describes the development period 2001–2008 at the Sorrila Primary school. The research questions are as follows: 1. What did pupils learn during the research and development period? 2. How did the coordinating teacher develop personally? 3. How were the ENSI targets and other closely linked projects reached? 4. What was the feedback from the pupils, their parents and other teachers at the school? 5. How did the developing process proceed in 2001–2008? The method used was integrating action research, which also had ethnographical elements. Narrative was the form of the data as well as the manner of reporting. The method as a whole was integrating, ethnographical action research as a story. The research data consisted mostly of Knowledge Forum notes written by the teacher-researcher. Knowledge Forum is an Internetbased collaborative knowledge-building programme. Pupils’, parents’ and other teachers’ feedback, newspaper articles and students’ writings complied the data, which consists of material from seven years. Sustainable development was the basis of the school improvement. The targets of the United Nations Decade of Education for Sustainable Development (2005–2014) were part of the development projects. According to the research results the school was seen as part of complex systems where manifold and interactive learning took place. The learning of pupils, teachers and the school as a community can be characterised socioculturally. The school was able to reach a level of collaborative transformative learning. As well as several concrete projects, such as Comenius school project, school development consisted of networking at many levels. Along with the projects and networking, the school was able to apply the pedagogy of connection, by carrying out integrative and cross-disciplinary themes and using various learning and teaching methods. International cooperation was a natural part of the work. A figure of Aunt Green, the role model of the teacher researcher, was an innovation which resembled a change agent. The other role of the teacherresearcher as a coordinator, was important for her own professional development. According to the results the change process, which relied on sustainable school development, led the school along a road of positive renewals. It was not a series of projects but an ongoing process. The objectives of the international projects were accomplished to a great extent during the research period. According to the principles of action research, the main results were put forward in order to help others to develop their schools. Frictions and problems as well as positive experiences and rejecting dualities were seen as change forces. Keywords: education for sustainable development (ESD), sustainable school development, teacher professional development, integrating, pedagogy of connection, transformative learning

Lukemisen vaikeuden kuntoutus ensiluokkalaisilla : Kolme pedagogista interventiota

Remediation of Reading Difficulties in Grade 1. Three Pedagogical Interventions Keywords: initial teaching, learning to read, reading difficulties, intervention, dyslexia, remediation of dyslexia, home reading, computerized training In this study three different reading interventions were tested for first-graders at risk of reading difficulties at school commencement. The intervention groups were compared together and with a control group receiving special education provided by the school. First intervention was a new approach called syllable rhythmics in which syllabic rhythm, phonological knowledge and letter-phoneme correspondence are emphasized. Syllable rhythmics is based on multi-sensory training elements aimed at finding the most functional modality for every child. The second intervention was computerized training of letter-sound correspondence with the Ekapeli learning game. The third intervention was home-based shared book reading, where every family was given a story book, and dialogic reading style reading and writing exercises were prepared for each chapter of the book. The participants were 80 first-graders in 19 classes in nine schools. The children were matched in four groups according to pre-test results: three intervention and one control. The interventions took ten weeks starting from September in grade 1. The first post-test including several measures of reading abilities was administered in December. The first delayed post-test was administered in March, the second in September in grade 2, and the third, “ALLU” test (reading test for primary school) was administered in March in grade 2. The intervention and control groups differed only slightly from each other in grade 1. However, girls progressed significantly more than boys in both word reading and reading comprehension in December and this difference remained in March. The children who had been cited as inattentive by their teachers also lagged behind the others in the post-tests in December and March. When participants were divided into two groups according to their initial letter knowledge at school entry, the weaker group (maximum 17 correctly named letters in pre-test) progressed more slowly in both word reading and reading comprehension in grade 1. Intervention group and gender had no interaction effect in grade 1. Instead, intervention group and attentiveness had an interaction effect on most test measures the inattentive students in the syllable rhythmic group doing worst and attentive students in the control group doing best in grade 1. The smallest difference between results of attentive and inattentive students was in the Ekapeli group. In grade 2 still only minor differences were found between the intervention groups and control group. The only significant difference was in non-word reading, with the syllable rhythmics group outperforming the other groups in the fall. The difference between girls’ and boys’ performances in both technical reading and text comprehension disappeared in grade 2. The difference between the inattentive and attentive students cold no longer be found in technical reading, and the difference became smaller in text comprehension as well. The difference between two groups divided according to their initial letter knowledge disappeared in technical reading but remained significant in text comprehension measures in the ALLU test in the spring of grade 2. In all, the children in the study did better in the ALLU test than expected according to ALLU test norms. Being the weakest readers in their classes in the pre-test, 52.3 % reached the normal reading ability level. In the norm group 72.3 % of all students attained normal reading ability. The results of this study indicate that different types of remediation programs can be effective, and that special education has been apparently useful. The results suggest careful consideration of first-graders’ initial reading abilities (especially letter knowledge) and possible failure of attention; remediation should be individually targeted while flexibly using different methods.

Kiusaamisen kasvot kasvatusyhteisössä : Päivähoitoyksikön esimiesten kokemuksia ja näkemyksiä työpaikkakiusaamisesta

The subject of my research was analyzing how psychological violence appears in educational communities in both preschool and kindergarten environments. The superiors of every daycare unit (a total of 80 units) in Vantaa were asked to tell about their own views and experiences of psychological violence in educational communities. In addition I cleared out the superior’s views on what the role of workplace counseling is in clearing out cases of psychological violence. A workplace always consists of people connected through work and the workplace creates a context for psychological violence. Working is public in an educational environment, as also customers set expectations and make wishes on how the work should be done. Different thoughts on what the working community should be creates pressure for the workers. My aim was to find out about the superior’s views on different types of psychological violence in the workplace, how one’s personality effects on an experience on psychological violence, the superior’s abilities and possibilities on noticing psychological violence in an early stage and the necessity of intervention. I also wanted to map the superior’s views and experiences on the value of workplace counseling in straightening out cases of psychological violence. The research point of view used was triangulation with hermeneutical and phenomenological features. The research method used was a semistructured questionnaire with a few open questions used to seek answers for the problems that have come up in the research. I analyzed the collected data partly from quantitative and partly from qualitative point of views, and also my aim was to understand psychological violence in the workplace as a phenomena in the communities within the early phases of education and to give this worker-to-worker mobbing a face. As a result of my research, I found out that the psychological violence inside the educational communities is more passive and scheming than aggressive or straightforward. The most important outcome of my research was finding a risk factor, where the superior is in danger of being the target of workplace psychological violence. Out the superiors who answered the questionnaire, 12% told they had been the target of this psychological violence after being transferred in to an old unit to work as the new superior. I hope this result will be of use when changes similar to this are known to take place. Avainsanat – Nyckelord – Keywords Psychological violence, educational enviroment, moral and ethic at work, role of the superior, role of a workplace consultant

Dietary elecrolytes and cyclosporine toxicity. Experimental studies in spontaneuosly hypertensive rats

Cyclosporine-A (CsA) is widely used after organ transplantation to prevent rejection and in the treatment of autoimmune diseases. Hypertension and nephrotoxicity are common side-effects of CsA. Studies in patients on the prevention of the side-effects of CsA are difficult to conduct because the patients often receive a combination of different drugs thus making study of the side-effects of a single drug impossible. A challenge in experimental studies has been the lack of an animal model in which the side-effects concomitantly occur. Epidemiological data show an association between sodium (Na) intake and blood pressure. There is also evidence on low dietary intake of magnesium (Mg) and potassium (K) and high blood pressure. Our study was designed to develop an experimental model to study the side-effects of CsA in spontaneously hypertensive rats (SHR). On high dietary sodium, CsA caused hypertension, left ventricular hypertrophy (LVH), narrowing of the coronary arteries, small myocardial infarctions, and proteinuria, reduced creatinine clearance and histopathological renal injury in SHR. Loss of Mg into the urine caused by CsA resulted in Mg depletion in the tissues. Renal excretion of dopamine was reduced and the renin-angiotensin-aldosterone system was activated. We investigated the effects of dietary Mg and/or K and the calcium antagonist drug, isradipine, on the prevention of CsA toxicity. Dietary supplementation of Mg alone or in combination with K prevented from the deleterious pathophysiological and histopathological changes in the kidneys and the heart. K alone had little effect. Isradipine protected better than Mg from LVH, but the combination of isradipine and Mg was the most effective. Isradipine did not, however, protect against Mg loss. In our animal model, the combination of high dietary Na and treatment with CsA accelerated the development of the cardiovascular and renal changes clinically known as the side-effects of CsA. Dietary supplementation of Mg and K and reduction of Na intake and the calcium antagonist drug isradipine prevent from the deleterious effects of CsA.

Molecular classification of familial colorectal and endometrial carcinoma

Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common known clearly hereditary cause of colorectal and endometrial cancer (CRC and EC). Dominantly inherited mutations in one of the known mismatch repair (MMR) genes predispose to HNPCC. Defective MMR leads to an accumulation of mutations especially in repeat tracts, presenting microsatellite instability. HNPCC is clinically a very heterogeneous disease. The age at onset varies and the target tissue may vary. In addition, families that fulfill the diagnostic criteria for HNPCC but fail to show any predisposing mutation in MMR genes exist. Our aim was to evaluate the genetic background of familial CRC and EC. We performed comprehensive molecular and DNA copy number analyses of CRCs fulfilling the diagnostic criteria for HNPCC. We studied the role of five pathways (MMR, Wnt, p53, CIN, PI3K/AKT) and divided the tumors into two groups, one with MMR gene germline mutations and the other without. We observed that MMR proficient familial CRC consist of two molecularly distinct groups that differ from MMR deficient tumors. Group A shows paucity of common molecular and chromosomal alterations characteristic of colorectal carcinogenesis. Group B shows molecular features similar to classical microsatellite stable tumors with gross chromosomal alterations. Our finding of a unique tumor profile in group A suggests the involvement of novel predisposing genes and pathways in colorectal cancer cohorts not linked to MMR gene defects. We investigated the genetic background of familial ECs. Among 22 families with clustering of EC, two (9%) were due to MMR gene germline mutations. The remaining familial site-specific ECs are largely comparable with HNPCC associated ECs, the main difference between these groups being MMR proficiency vs. deficiency. We studied the role of PI3K/AKT pathway in familial ECs as well and observed that PIK3CA amplifications are characteristic of familial site-specific EC without MMR gene germline mutations. Most of the high-level amplifications occurred in tumors with stable microsatellites, suggesting that these tumors are more likely associated with chromosomal rather than microsatellite instability and MMR defect. The existence of site-specific endometrial carcinoma as a separate entity remains equivocal until predisposing genes are identified. It is possible that no single highly penetrant gene for this proposed syndrome exists, it may, for example be due to a combination of multiple low penetrance genes. Despite advances in deciphering the molecular genetic background of HNPCC, it is poorly understood why certain organs are more susceptible than others to cancer development. We found that important determinants of the HNPCC tumor spectrum are, in addition to different predisposing germline mutations, organ specific target genes and different instability profiles, loss of heterozygosity at MLH1 locus, and MLH1 promoter methylation. This study provided more precise molecular classification of families with CRC and EC. Our observations on familial CRC and EC are likely to have broader significance that extends to sporadic CRC and EC as well.