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  • Häikiö, Kaarina (Helsingin yliopisto, 2015)
    The purpose of this study is to shed light on the status of the patient in health policies implemented in order to secure patients access to care and to improve the quality of the care. The study focuses on patients and the treatment guarantee from the viewpoints of government and nongovernmental organisations in 2004-2010. The treatment guarantee is the only segment of legislation that gives patients concrete assurance of access to treatment and quality care. The experiences of patients and organisations in combination with inconsistencies in official follow-up data reinforce the need for this study. The three-level theoretical framework of the study based on the discourse-historical approach in Ruth Wodak s linguistic model. It builds on the impressive background of period pieces and modern-day diagnostics (zeitdiagnose), special phenomena such as the notion of patients as actors in the health policy debate, and language management. The task of the study is to describe the status of patients in the context of the treatment guarantee, as well as to outlines the relationship of public health organisations and government authorities to the reform in national health policy over the period 2004-2010. The study addresses questions about the status of patients and questions about the viewpoints of government and public health organisations concerning the treatment guarantee. The research material comprises documents from government and organisations, data from interviews with experts, and articles from the Helsingin Sanomat daily newspaper. Content analysis occasionally shifts to discourse analysis in the course of the study. The government authorities expected the treatment guarantee as a major health care reform, but according to the experts' interviews it did no turn out that way partly due to the weak implementation. National government authorities and public health organisations differ in use of the concept of a treatment guarantee. The public health organisations were not concerned about a usage threshold for use the concept of a treatment guarantee. Government authorities had different practices in use the concept. At the beginning of the research period, the Ministry of Social Affairs and Health , unlike other government authorities, shunned the concept. When the matter was dealt with in Parliament, however, the opposition referred to the concept of a treatment guarantee. Perceptions about the content of the treatment guarantee varied among the actors, and its application changed during the research period. Narrowly speaking it meant that access to treatment was only provided within a certain time frame. The treatment guarantee was usually written without mentioning the patient. If the patient was mentioned in the documents from the government and public health organisations he or she was usually referred to as an object. There were signs of imminent change in the preparatory documents of the Health Care Act in 2010. The documents still described the patient as an object, but they were also described as an actor. In documents from public health organisations, the patient was perceived as an active player in a generally positive way. In documents from the government, the patient was positively perceived as an object. In parliament, when the legislative process for the treatment guarantee drew to a close, members of parliament began speaking more about the economy and less about the patients, nor were the patient viewed as a potential voter. Public health organisations discussed the empowerment of patients just before the reform, but the trend quickly diminished after the legal reforms were initiated in March 2005.These organisations wrote about the treatment guarantee as a patient right as late as 2006. According to the data from experts interviews the treatment guarantee did not give protection to patient.
  • Kivikangas, J Matias (Helsingin yliopisto, 2015)
    Arguably, the emotions elicited by playing are the reason why people play digital games. Social interaction is an important source of emotion during game play, but research on it is rather sparse. In this dissertation I briefly review the emotion-theoretic literature in order to better understand what emotion means in the context of games, and how this should be taken into account when measuring emotions related to a game experience. Study I presents a review of the use of psychophysiological methods in game research. I show that the theoretical background behind these methods generally tends to be neglected. This could be remedied by a theoretical framework that integrates the understanding of emotions and explicitly describes the links between different emotion measures and the theoretical concepts they are professed to reflect. I present my proposition for the first step towards such a framework in Study II. I employ the sociality characteristics framework by de Kort and IJsselsteijn (2008) and my interpretation of the social factors in order to study the effect of the central social context factors on the emotional game experience. Study III presents evidence that in addition to tonic physiological levels, the relationship between the participants also affects the momentary, phasic responses to the key game events victory and defeat. In particular, although physiological signals can, to a certain extent, be used to assess emotional experiences (such as positive responses to a victory), in some cases the typical psychophysiological mappings may even be completely opposite. Interpreting these signals requires a broader theoretical understanding than what is typically acknowledged. Study IV supports the earlier findings that competition is experienced more positively than cooperation but that the effect is dependent on gender, as this was found only in males. For females, there was no difference between the two modes, and no difference in negative activation. In addition, self-reports concerning social presence suggested that this concept is not always associated with higher positive emotions, while a form of friendly rivalry (associated with lower social presence) might be experienced positively a finding apparently new in existing literature. Finally, Study V provides insight into the practical significance of the measurements with a predictive validity study, showing practical effects how the certain kinds of game experiences may lead to greater game use and preference, but that these links are not as simple as previously suggested. In sum, this work offers new knowledge on how social context factors are generally related to the game experience, on how emotions can be studied in game research and what theoretical considerations should be taken into account, and on the emotional effects of particular social context factors during play. The results are mainly useful for further basic game research, but they have also potential implications for general emotion research, the game industry, and in the long run, society at large.
  • Rämä, Irene (Helsingin yliopisto, 2015)
    This three-part thesis explores the interaction of a teacher and pupils in a Finnish comprehensive school. The studied class is a special education class with six pupils with autism spectrum disorder (ASD). Individuals with ASD have challenges in interaction, communication and social behaviour. The interactional acts of the study participants are examined from varying perspectives. The theoretic framework of this study focuses on the structural elements of the interaction in educational situations. These elements are the mutual co-regulation of the participants (the interaction theory of Alan Fogel), the teacher s tacit knowledge and the pupils communicative spontaneity with the supporting prompts. Moreover, the pupils educational goals linked to interaction, communication and social behaviour are analysed. Through this analysis, the reciprocal relationships between the goals and the relationship with the educational goals presented in the general curriculum of the school are explored. The data is aggregated from a larger data set of the ISE Research Group in the University of Helsinki. The data mainly consists of video recordings from authentic educational situations and individual IEP documents of the pupils. The time span of the data covers the years from 2006 to 2014. The video clips were analysed through applied conversation analysis, and the educational goals were analysed by systematically comparing the goals to the categorization classes found in the International Classification of Functioning, Disability and Health (ICF). The results of the study are seamlessly intertwined with the activity of the teacher and stress the significance of quality and a pupil-sensitive teaching style in the special education context. The pedagogically sensitive activity of the teacher is described with the construct of dynamic sensitivity, which consists of the teacher s personal and professional attributes, teaching experience and tacit knowledge. The shared interaction environment, which is formed by mutual co-regulation with the pupils, is an integral part of generating this dynamic sensitivity.
  • Käyhkö, Leena (Helsingin yliopisto, 2015)
    New learning environments have opened the boundaries of schools by connecting them with different societal agencies outside schools. In European and national education policies and systematic curriculum contents, entrepreneurship education has been given increasingly significant attention, and entrepreneurship has become a social context or environment of learning. In entrepreneurship education research, only few studies have been conducted in the educational sciences. Researchers have pointed out the need for holistic educational science to act as a complement for business and a non-axiological ´neutral´ emphasis in approaching entrepreneurship and its theory. The present study focuses on entrepreneurship education as a boundary zone between school and society where traditional pedagogical practice is reconsidered as a question of learning theory. The study draws from cultural-historical activity theory and its theories about learning. As they have largely been focused on the classroom teaching and teaching methods, analyses of pedagogical practice have lacked the societal bond and historicity of the relationship between education and societal practice. To investigate the theoretical foundations of the relationship between school and society, the study addresses two theoretical orientations: John Dewey s philosophy of school and Engeström s theory of expansive learning. Based on their critiques of the theory of education the study contains a case study on entrepreneurship education. The case study was used as a window for context exploration, and it underlines the challenge of educational and learning theory. The case study material has been collected from the entrepreneurship education course of a high school specializing in entrepreneurship. The material contains both the ethnographic course implementation and interviews, documentary material and an intervention. The data analysis aimed to determine the internal dynamics, mechanisms and contradictions in the relationship between school and society in learning. A learning environment is conceptualized as an activity system. The implementation of its methodological solutions in the research was to investigate the socially mediated pedagogical practice, to explore the boundary object of people who are members of different communities and have a variety of interests, and to explore the school activity by tracing its local origin and by designing its future. The results of the study are summarized into four theses which direct attention to: (1) the dualist conceptualization of entrepreneurship, (2) the ontology of knowledge in entrepreneurship education, (3) diversity and multivoicedness as contexts of learning in the boundary between school and society, and (4) teachers as agency of pedagogical development. From the epistemological point of view school faces a new paradox in entrepreneurship education: the opening of the school to society carries a risk that society is understood as detached from the practices of societal life and treated as abstract, value-free and ahistorical reality. Keywords: activity system, entrepreneurship education, boundary-object, expansive learning, dialogical knowledge, co-configuration, partnership and learning environment
  • Eränpalo, Tommi (Helsingin yliopisto, 2015)
    Abstract This dissertation deals with young people s civic skills and how these competences can be developed particularly in civics education at school by means of gamification. The dissertation consists of four sub-studies written in article form as well as a summary. The articles examine young people s civic behaviour from the perspective of conceptions of democracy, civic competence and civic identity. The current generation of youth and young adults seems to be shunning the traditional structures of civic participation and political decision making. Young people are re-evaluating their own roles in civic discussion and are often choosing methods that are outside the official channels. To further develop civic activism, this state of affairs should be changed, since our future decision makers will ultimately emerge from this group of people. The role of the school is seen as essential in scientific debate on the subject. The dissertation commences with the question of how deceptive the suggestion is that young people are passive, and how civic education didactics need new ways to recognise students involvement in civic matters. This query is addressed by means of finding new methods for civics education, using, for example, gamification and dialogue education. The intention of the dissertation is to answer the following questions: a) What aspects of young people s civic skills can be detected in the deliberation resulting from game playing? b) How should civics education at school be developed to strengthen young people s inclusion in civic affairs? The Grounded theory method is applied in the study. Each dissertation article introduces a new perspective on the research phenomenon, and the analysis of the research material proceeds in stages revealing new information on young people s civic competence. The theoretical conclusions of the study are presented in the summary. The first article focuses on the public image of young people s civic competence, which has been marked by pessimism in the early 21st century. This negative image has been publicly debated in conjunction with international surveys indicating young people s passive behaviour in civic orientation (CIVED 1999 and ICCS 2009). The article looks for a new perspective by ques-tioning the pessimistic interpretations of these surveys. It also presents new research evidence of a more active youth culture. The second and third articles venture deeper into the world of young people s civic competence. The image of young people being passive is often maintained by the conventional discussion culture in schools, one that avoids open ideological and political debate and does not particularly encourage deliberation on civic matters. The articles raise issues concerning the atmosphere in the classroom as well as the role of the student in education and society as a whole. It also presents the Act now! game, developed by the author and the author s students. The game aims to provide a framework for dealing with civic issues by means of deliberation. The fourth article introduces the concept of dialogue in education, and a comparative Scandinavian example of it. The Act now! game was played in Finland, Sweden and Norway. The article focuses on dialogue education as part of young people s civics education, and examines the features that emerge from analysing civic identity among Scandinavian youth. The summary presents the results in a way that is typical to the Grounded theory method. It then provides a summarizing analysis of them. The results justify claiming that teaching methods involving deliberation in civic education stimulate and strengthen young people s participatory civic orientation as well as their civic competence. The summary also speculates on the possibilities of increasing young people s motivation to participate in civic issues. The competences that arise from young people s deliberation indicate how the young are capable of responding to civic responsibility. The results also high-light the democratic-political need to create a forum in which young people may engage in civic deliberation. The ongoing curricular reform in Finnish primary and secondary schools will emphasise student involvement as well as creating a new and more active role for students. Accordingly, the results of this study can be implemented in civics teaching. They also suggest that deliberation instruments such as the Act Now! game could be used as a solution to didactic needs on a wider scale. A game-like method offers an example of dialogical teaching that enables a path to deliberation. Keywords: Civic competence, deliberation, gamification, inclusion
  • Losoi, Heidi (Helsingin yliopisto, 2015)
    Despite extensive research, there is considerable diversity and debate concerning the expected recovery course and the etiology of persistent symptoms after mild traumatic brain injury (MTBI). In recent years, resilience, which is defined as an ability to recover from adversity, has emerged as one potential psychological construct associated with outcome from MTBI. The aim of this study was to investigate the psychometric properties of the Finnish version of the Resilience Scale (RS) and its short version (RS-14), their use in MTBI research, and to examine the association between resilience and outcome from MTBI. In addition, this study aimed to thoroughly and prospectively report the recovery from MTBI in previously healthy adults. The psychometric properties of the Finnish version of the RS were examined with a convenience sample of 243 participants. Working aged participants with MTBI (n=74) without pre-injury neurological or mental health problems and orthopedically injured trauma controls (n=40) were recruited from the Emergency Department of Tampere University Hospital. Participants filled out self-report questionnaires about demographic variables, resilience, post-concussion symptoms, fatigue, insomnia, pain, post-traumatic stress, depressive symptoms, and quality of life at 1, 6, and 12 months following injury. Neuropsychological examination was conducted for the patients with MTBI and for the controls at 1 month after injury and for the MTBI group at 6 months. Data regarding return to work of the MTBI group was also gathered. The Finnish version of the Resilience Scale (RS) and its short version (RS-14) have good psychometric properties and can be reliably used in MTBI research. Greater resilience was associated with fewer post-concussive symptoms and better quality of life, whereas lower resilience was associated with more symptoms and lower quality of life. Resilience was also a significant predictor of self-reported fatigue following MTBI even when controlling for factors known to be associated with fatigue (depression, sleep disorders, and pain). In this sample of previously healthy adults, MTBI had a good prognosis. By six months following injury, patients with MTBI did not differ as a group from non-head injury trauma controls on cognition, fatigue, or mental health, and by 12 months their level of post-concussion symptoms and quality of life was similar to that of controls. Almost all (96%) patients with MTBI returned to work/normal activities (RTW) within the follow-up of one year. Patients reporting ongoing mild post-concussion syndrome (PCS) at the 12-month follow-up did not have more severe brain or bodily injuries than those without PCS. A large percentage (62.5%) of those with persistent PCS had a modifiable psychological risk factor (i.e., depression, possible post-traumatic stress disorder, and/or low resilience) at the beginning of recovery.
  • Jansson, Satu-Mari (Helsingin yliopisto, 2015)
    Theatre and drama as forms of learning in organisations This dissertation concerns theatre and drama as a form of learning in organisational contexts. When developing human resources and activities in organisations, people are usually seen as rational human beings, which means overlooking their emotional side. The object of development is seen to be a rational professional who is filled with information as a commodity, which can then be shifted as such from one person to another. This view does not take into account the fact that people create new knowledge as they bring together their own understandings, motivations and emotions when solving mutual problems. This study suggests that when facing the challenges of working life, organisations need more comprehensive viewpoints and methods. In addition, the emotions and cognition are interconnected, which is why in organisational development people s emotions should be considered. Hence in the process of organisational development, the arts, and especially theatre and drama, can offer a full spectrum of methods for activating learning. Through theatre and drama, meaning is created by doing, as meaning is given form through physical movement and visuality, as well as kinetically. To examine this phenomenon, I have brought together activity theory, developmental work research and the arts. I construe theatre both as an object of intervention and as an intervention method. The dissertation consists of five articles and a summary. The summary answers the following two research questions: 1) How can theatre and drama be construed as forms of learning in work? 2) How can activity theory and the methodology of developmental work research enrich the analysis of theatre and drama? My empirical interventions for the research involved the Rovaniemi Theatre Lapland s Regional Theatre and the executive board of one of the units of University of Applied Sciences. The Rovaniemi Theatre offers an example of the changes that are occurring in the theatre field, the learning challenges that theatres are facing, and theatre as a form of learning for professionals in organisational development. In the case of the Rovaniemi Theatre, the logic of intervention research is applied for the first time in a professional theatre context. In 2008-2009 I worked for 15 months in a development project where I engaged all of the theatre s employees in order to analyse and understand their ongoing development. Their work practices were broadening, as some performances were being rehearsed without scripts, using group improvisation or devising instead. I gathered research data throughout the project: observations, interviews and video material. The second intervention concerned the development of change management in the context of University of Applied Sciences (during 2013). In this project I brought together cultural-historical activity theory, developmental work research and Forum Theatre. Forum Theatre was initially created by Augusto Boal to promote political change through a theatrical method and format. As part of the intervention we rehearsed a theatrical performance based on Forum Theatre. We wrote a script and rehearsed a performance consisting of three scenes. The methodology of developmental work research intertwined with the scriptwriting process, although we devised the performance originally without a script. The research data were gathered at the beginning of the project by interviewing the executive board, and the three-hour intervention was videotaped. After six months I interviewed several managers who had participated in the intervention, and a photo workshop was held where they photographed their learning experiences and the effects of the project. What combines the two interventions is that I applied the theoretical concept of developmental contradiction, which is widely used amongst researchers in developmental work research. Contradictions emerge in the change and development of work, and are felt in the work as disturbances, interruptions and problems (Engeström, 1985; 2004a; 2004b). These contradictions are experienced as conflicts, dilemmas and work-related new meaning makings (Engeström and Sannino, 2011). In view of this, to prevent the separation of emotions and cognition in organisational development we need new theoretical concepts. The concept of personal sense of work (Leontjev, 1977, 120) is one such solution. In organisational change, employees build a new relationship with their work, one in which the emotions are involved. Unless new connections can be made, emotional conflict may result. The idea that theatre and drama can be used to activate learning in the workplace and in human resource development, however, has yet to truly emerge. This dissertation is the first attempt to describe how theatre and drama can be analysed as forms of learning in organisations with the help of developmental work research and how the emotions play a key role in work development. The present dissertation provides insight into work development in the context of theatrical intervention and the emotions during the development process, as employees deal with their personal sense of work (Leontjev, 1977, 120). The study also shows how theatrical interventions, can be carried out for organisations, and how the processing of emotions engendered by work development can be focused on.
  • Torppa, Ritva (Helsingin yliopisto, 2015)
    The cochlear implant (CI) provides a sensation of hearing for deaf-born children. However, many CI children show poor language outcomes, which may be related to the deficiency of CIs in delivering pitch. This thesis studies the development of those neural processes and behavioural skills linked to the perception of pitch which may play a role in language acquisition. We measured with event-related brain potentials (ERPs) the neural discrimination of and attention shift to changes in music, the perception of word and sentence stress and related acoustic cues, and the auditory working memory (forward digit span) in 4̶ 13-year-old normally hearing (NH) and early-implanted children. We studied how the development of these aspects is related to musical activities known to advance brain development and perceptual skills in the NH population, and whether the perception of music is connected to word stress or visuospatial perception in NH adults. With regard to the development of neural responses, we found for the CI children usually well-formed ERP waveforms resembling those found for the NH children. However, some brain responses implied impoverished processing for the CI children, especially for timbre and pitch. The CI children who sang regularly at home were advantaged over the other CI children for the development of attention shift, which was linked to improved auditory working memory, implying better neural discrimination, an advantaged development of neural networks for attention and better updating of auditory working memory for the CI singers. For the CI children perception of word and sentence stress improved with improving discrimination of pitch (f0) and intensity and auditory working memory. Only the CI children participating in supervised musical activities performed and developed similarly to the NH children in these skills. The perception of musical rhythm improved with improving word stress and visuospatial perception for the NH adults. The results indicate that (i) perception of music and speech are connected not only via pitch and timbre, but also via rhythm, and (ii) the combination of singing at home and taking part in supervised musical activities, using also rhythmic exercises and visual cues, might be the best way to optimize pitch-related abilities, underlying cognitive functions, spoken language skills and quality of life for early-implanted children.
  • Waris, Petra (Helsingin yliopisto, 2015)
    The onset of schizophrenia before the age of 18 is commonly categorized as early onset schizophrenia. It accounts for less than 4% of all cases of schizophrenia, the prevalence of which is about 1% worldwide. Premorbid abnormalities seem to be very typical, and prognosis is often poor. Besides the negative and positive symptoms, severe neurocognitive deficits also occur. Schizophrenia and pervasive developmental disorders share a common history. From 1970 onwards these disorders have been regarded as separate conditions. These disorders have different ages of onset as well as developmental courses. Nevertheless, the clinical symptoms as well as the results of genetic and neuroimaging studies overlap. The participants in this thesis were adolescent schizophrenia patients (n = 18; 7 males, 11 females). The mean age of the participants at recruitment was 15.6 years (studies I-III) and at the time of psychological assessment 16.2 years (study IV). Study IV also included 15 adolescents with PDD without psychotic disorder (n = 15; 7 males, 8 females). Their mean age at recruitment was 16.1 years. All participants had a primary IQ over 70. Study I of this thesis assessed the possible comorbidity of early onset schizophrenia and pervasive developmental disorders. We found that a total of 44% of adolescents with schizophrenia had some pervasive developmental disorder already in childhood. However, most of the adolescents had a correct comorbid diagnosis until the onset of psychotic symptoms and the diagnosis of schizophrenia. Study II evaluated the number and nature of catatonic features among adolescents with schizophrenia. A further comparison was made of the nature and numbers of those features between adolescents suffering from schizophrenia alone and those schizophrenia patients with comorbid pervasive developmental disorder. All adolescents with schizophrenia presented many lifetime catatonic features. Adolescents with schizophrenia and comorbid pervasive developmental disorder had an earlier onset of catatonic features, more catatonic features and a greater variety of catatonic features compared to schizophrenia patients without comorbidity. Study III aimed to assess the developmental skills of adolescents with schizophrenia. All of the adolescents with schizophrenia exhibited some developmental delays. Adolescents with schizophrenia and comorbid pervasive developmental disorders exhibited more delays in developmental skills than did those schizophrenia adolescents without comorbidity. Study IV investigated neurocognition and social cognition between adolescents suffering from schizophrenia alone, those schizophrenia patients with comorbid pervasive developmental disorder and adolescents with pervasive developmental disorder only. The profiles of the neurocognitive abilities and disabilities between these three groups differed. The adolescents with schizophrenia and comorbid pervasive developmental disorder did not have more severe problems than the other two groups. The comorbid group displayed a combination of the visual strengths those are typical for PDDs and the deficits in processing speed associated with schizophrenia. These study findings showed that among adolescents with early onset schizophrenia is a subgroup of adolescents with comorbid pervasive developmental disorder. The symptoms of these adolescents seem to be more severe, and this subgroup should be taken into account in psychiatric services and rehabilitation.
  • Kärki, Ilari (Helsingin yliopisto, 2015)
    This study examined the values of education and the teaching aims of the education policy concerning Finnish basic education. In Finland, political decision-makers and civil servants are responsible for education policy. The most important documents governing basic education are the Basic Education Act, the Basic Education Decree, the Government Decree on the General National Objectives and Distribution of Lesson Hours in Basic Education, the National Core Curriculum for Basic Education, the Government Programme, and the Development Plan for Education and Research. These documents, formulated during the research time period, composed one part of the research data. Many national and international actors strive to influence the objectives and definitions of education policy. In Finland, the most influential actors are the Confederation of Finnish Industries EK (earlier the Union of Industries and Employers TT), the Central Organisation of Finnish Trade Unions SAK, the Finnish Confederation of Salaried Employees STTK, the Trade Union of Education in Finland OAJ, and the Association of Finnish Local and Regional Authorities. The political target programmes and reports of these actors concerning basic education were included in the research data. One of the most influential international actors is the European Union, whose political target programmes concerning basic education, as well as reports of the administration of the Evangelical Lutheran Church of Finland concerning basic education, were also included in the research data. The research method used was content analysis. With this method, all education and teaching aims concerning basic education presented in the research data were classified according to the value types of the value theory of Shalom Schwartz (1992). On the basis of the analysis, models were designed describing the relations of the values. These models enabled examining how the objectives were divided between different value types and value dimensions. The values in the data were illustrated with specific value maps that enabled comparing values and observing changes in them. Furthermore, the values in the data were compared with the values in different periods of society and education policy, and with the values prevalent among Finnish people. Over the long term values have shifted in Finnish society towards the strengthening of individualistic values and the weakening of collectivistic values. The ideological basis for this shift has been liberalism. Neoliberalism, which strongly emphasizes individualistic values and targets a market-led society, has been seen to have achieved a firm foothold in education policy and in society as a whole, determining their goals and methods. One of the objectives of this study was to examine how the values in the research data correlate with the values of neoliberalism, which emphasizes individualistic values, and with the values of communitarianism, Christianity and Christian ethics, which emphasize collectivistic values. The majority of the analyzed political documents, target programmes and reports exemplified more collectivistic than individualistic values in their objectives. The collectivistic values were emphasized most strongly in the reports of the administration of the Evangelical Lutheran Church of Finland. Correspondingly, the individualistic values were emphasized most strongly in the target programmes and reports of the Confederation of Finnish Industries EK and its predecessor, the Union of Industries and Employers TT, as well as of the European Union. The study results do not support the views presented in research literature that values typical of neoliberalism are emphasized in Finnish education policy. On the other hand, by focusing on the original national core curriculums for basic education 1994 and 2004 before insertions and modifications to the latter document, values typical of neoliberalism are seen to have been emphasized in the education policy concerning basic education. However, the results of this study reveal a trend of changes in values in the documents governing basic education, with the emphasis shifting from individualistic values towards more collectivistic values. Keywords: values, education policy, neoliberalism, basic education, education and teaching aims, Christian values, communitarianism
  • Pyyry, Noora (Helsingin yliopisto, 2015)
    In this thesis, the key themes of 1) knowing and 2) participation are examined in relation to creative and meaningful practical engagement with one's everyday surroundings, i.e. 'dwelling with' the world. These themes are explored both within the research process and in the context of young people's, and particularly teenage girls' hanging out. This research is inspired by the Situationist practice of dérive, and draws from participatory research tradition, posthuman feminist thinking and non-representational theorization. 'Dwelling with' is approached with an acknowledgement of the capacity of the material world to produce effects in human bodies: things and spaces thus take part in the - seemingly trivial, but often highly affectual - everyday encounters that make dwelling with possible. Ergo, also 'data' is approached in a new way. The power of words and other representations is not ignored, but they are taken as 'doings': they are performative. Representations are thus not evidence of a separate reality that lies behind them. In the thesis, attention is placed on the creative potential of experimentation. Fieldwork for this thesis happened in three phases. The first phase in 2011 was a pilot study conducted in Helsinki in connection to a 9th grade geography course (participants were 15 to 16 years). The second phase took place in San Francisco in 2012 and was conducted via school, but separately from schoolwork. The participants in this study we 7th graders (12 to 13 years). The third phase in 2013 took place in Helsinki, again as part of a 9th grade geography course (participants were 15 to 16 years). First, the thesis explores how participatory methods can be used to support young people's role as co-researchers, foster their engagement in the research process and carve space for alternative knowledges. Together with the playful topic of hanging out, these methods can cultivate a relaxed atmosphere in the research situations. This is especially important when working in the school context. The methods also help balance power relations and address topics that could otherwise be left unnoticed. Second, the thesis shows how photography can be used as a method for multisensory 'thinking with' the world. This creative method is connected to movement in photo-walks. This practice is argued to foster young people's engagement with their everyday surroundings, and the research process, by linking action and understanding. This engagement opens up possibilities for spatial-embodied reflection. Later, the photographs serve as fieldnotes that take part in the thinking process and inspire action in the form of reflection in photo-talks. In this thesis, photographs are not considered as data of 'what was there' , rather they are understood to have productive power in the research process. Third, the thesis introduces the concept of hanging out -knowing. This knowing becomes possible through dwelling with: it takes place in everyday encounters. Hanging out -knowing is non-instrumental multisensory reflection about one's place in the world. Because hanging out is playful and wonderfully purposeless, space is cleared for the inspiring experience of enchantment. In these moments of being moved by something, new reflection can emerge. The moment of enchantment is always accidental, but it can be cultivated by artistic methods, such as photo-walking. Finally, the thesis argues that by hanging out at a shopping mall teenage girls participate in the world. Because hanging out lacks rigid plans, moments of enchantment become possible. This openness towards the world fosters dwelling with one's surroundings, in this case the shopping mall. By hanging out, girls disturb the rhythm of consumption. Improvisation with things and spaces produces a micro-atmosphere of play that interferes with the atmosphere of consumption at the mall. Through participation by being and by actively marking and claiming spaces as theirs, girls create momentary 'hangout homes' for themselves. Hanging out produces alternative modes of engagement with the city. Creative experimentation cultivates lively and mixed-use public spaces, and adds to making urban life vibrant and thought-provoking.
  • Kosonen, Kari (Helsingin yliopisto, 2015)
    Over the past decades the sense making of learners by means of various external models and representations has received educational researchers heightened attention (Ainsworth, 2006; Hay and Kinchin, 2006; Furberg et al., 2013). Similarly, the particular function of domain-specific concepts in the transformation of learners thinking and understanding remains an issue repeatedly approached from the perspective of various theoretical frameworks and empirical findings (Land, Rattray et al., 2014; Meyer and Land, 2005). The present doctoral thesis sheds light on how the learners that aim to understand multifaceted conceptual objects can be supported by the instructional tools sensitive to the specific conceptual organization of these phenomena. The thesis includes four studies. Studies I-III focused on the development and testing of an instructional meta-model based on frequent expository text structures with blind readers. Study IV explored the use of modeling language based on this model in a domain-specific pedagogical setting in higher education. Studies I-III aimed to develop and explore the use of a conceptual meta-model in guiding the young blind participants to process such complex conceptual objects as expository texts in reading for understanding. The context of Study IV remarkably differed from the contexts of Studies I-III due to the specific conceptual dimensions of the topic of the investigated seminar, which were qualitative and mixed methods. While the pedagogical challenges of Studies I-III were related to the participants blindness and their problems in cognitive functioning and with the structures of the processed text, the conceptual complexity of the topic of the investigated seminar on qualitative and mixed methods, in turn, constituted the main pedagogical challenge in Study IV. The meta-model was used as a generic conceptual frame in designing the context-specific modeling language to highlight some crucial concepts and conceptual relations suggested to be used in digital concept mapping. To circumvent the limitations of the conventional hierarchical structure of concept maps the modeling language used was endowed with specific elements, language codes. These codes were meant to afford the processing of both static conceptual relations and various practice related and functional dependencies in the domain when the participants created concept maps on qualitative and mixed methods. In all four studies the participants activities investigated were theoretically conceptualized and operationalized as various forms of orienting activity mediated by cultural tools. This theoretical focus of the present dissertation study is based on the Cultural Historical Theory founded by Vygotsky and psychological activity theory-framework. However this framework is integratively implemented capitalizing on some contemporary theoretical perspectives and practical approaches in pedagogical design and developmental psychology. Consequently, learners activity and instructional discussion are explored as joint orienting activity shaped by cultural tools. This activity is considered to organize various relations and properties underlying the phenomenon being concerned with a point of view that constitutes the perspectival understanding of this phenomenon. The case-study research strategy implemented in the research made it possible to analytically generate a large body of findings that inform practitioners about the potentially applicable ways of using the approach investigated in pedagogical settings. In Study I the participant was found to have internalized the elements of the meta-model as a thinking tool in processing and reflecting on a wide variety of conceptual topics. The findings from both Studies II and III shed light on how the use of the elements of the meta-model allowed the intervener to adjust his guidance to the current form of the blind participants thinking. In Study II the participant s elaborative questions in processing expository texts were found to have transformed in respect to their analyticity and predicted better than previously the content of the texts processed. In Study III the participant was found to gradually incorporate some of the elements of the meta-model as part of his text-structuring actions, which increasingly drew his attention to the frequent expository text-structures that he was previously prone to ignore or misinterpret. In Study IV the participants were found to repeatedly implement some of the contextualized and digitalized elements of the meta-model in elaborating on various dimensions of the field of qualitative and mixed methods as well as the related practices. This repeated use of selected codes supported the maintenance of some conceptual stability of the informational content of the elaborations in the participants concept maps. The teacher of the investigated seminar was found to repeatedly lean on these elaborations in guiding the participants in how to further deepen their knowledge on qualitative and mixed methods.
  • Nevanen, Saila (Helsingin yliopisto, 2015)
    This research focuses on one arts education project which was carried out in Helsinki in early childhood education centres and schools. This study is an evaluation research which concentrates on art education s connections to learning, wellbeing and communality; it views kindergarten and school as arts learning environments and at arts education as a multiprofessional col-laboration between teachers and artists. The arts education project, which was started in Helsinki in 2000, was offered to children who were under school age (3 6 years old) and at ele-mentary school age (7 9 years old). The data consists of interviews of the teachers, artists and principals of the kindergartens (N=23), the narratives of the closing report (N=9) and the follow-up materials of the project. The method of the research was multidimensional evaluation. The research includes five independent articles and a summary that con-nects the entirety of the research. Each theme is included in one independ-ent article, each of which was published in international peer-reviewed journals. Article I analyses the multiprofessional collaboration between teachers and artists. Article II focuses on the possibilities of arts education in developing learning abilities. Article III explores kindergarten and school as learning environments of arts education. Article IV highlights the evalua-tion of the arts education project through a multidimensional evaluation method. The last article, number V, analyses the long-term impacts of the arts education project in kindergartens and schools. The results show that well-executed, long-lasting arts education projects may support and promote children s wellbeing and their learning abilities. It was easy to motivate and direct the children in activities that connected target-oriented work with natural play. Arts education can also be used to strengthen the unity of the community between early childhood education centres, schools and neighbourhoods. The multiprofessional collaboration between the teachers and artists con-nected their skills and professional abilities, but successful cooperation also required the ability to handle additional interests and tensions. The long-term impact evaluation showed that five out of ten participating kindergartens still continue the developmental work started in the project. The project work was also seen as an excellent way to continue or update training.
  • Litmanen, Topi (Helsingin yliopisto, 2015)
    This dissertation explores how higher education students experience their studies. Experiences were studied at three interconnected levels: cognitive, motivational and emotional; they were defined respectively as the student s perceptions of the learning environment, study-related personal goals and emotional experiences in the learning situation. The general research questions were: 1) What are the components of successful and unsuccessful engagement with the learning environment? 2) How do students experience different kinds of learning environments, and what kinds of roles do experiences and emotions have in the learning process? 3) To what extent are experiences of the learning environment related to the features of the faculty and student qualities? Four empirical studies were conducted to address these questions. Studies I, II and IV were quantitative and applied self-report questionnaires, and Study I also had a follow-up setting. Study III was also a follow-up study, in which experience sampling conducted with mobile phones was accompanied with qualitative interview data. Study I explored what kinds of study-related goals students have at the beginning of their studies and how they relate to their study progress. The participants (N=133) were theology students, who at the beginning of their studies were asked to complete a questionnaire about their personal goals. Study success was followed for the first three years of their studies. The results showed that students whose study-related goals were important and stressful, and who reported progress in achieving them, advanced more rapidly in their studies. Study II focused on how students experiences of their learning environment are related to their well-being and academic self-concept. The participants were 610 medical students. Structural equation modelling was used to investigate the relationships between the variables under study. Experiences about the learning environment were related to how interested the students were in their studies or how exhausted they had become as a result of them. In turn, interest and exhaustion were related to higher levels of academic self-concept. A cross-sectional design was used to compare experiences between different medical schools. Novice PBL (Problem Based Learning) students experienced higher levels of exhaustion, no differences were found in the later phases of studies. Thus, the PBL environment appeared challenging, but only during the first years of study. Study III followed the experiences of nine student teachers for two 14-day follow-ups. The first follow-up consisted mostly of lectures and ordinary small-group work. The second period ran parallel to the completion of an intensive inquiry-based project that was the focus of the present study. A multivariate analysis of variance revealed that studying during the inquiry-based period produced stronger experiences of being challenged as well as more negative emotional experiences than the teacher-centred period. However, the interview data indicated that the participants enjoyed the inquiry-based period. In Study IV, the objective was to study the relations between approaches to learning and both the disciplines of the students and their perceptions of the learning environment. Altogether 2,509 students from different fields participated in the study. The results indicated that both approaches to learning and the discipline have an effect on students experiences of the learning environment. The dissertation showed that combining different cognitive, motivational and emotional perspectives and using a variety of methodologies helps to build a more comprehensive picture of how higher education students experience their studies. The most important findings of this thesis were: 1) Successful engagement with the learning environment is not merely about seeing the studies as important, being satisfied with the faculty or career choice, or seeing oneself as capable of achieving the tasks. Stress, worry about competence and to some extent exhaustion are important components of engagement in studies. 2) Negative affects, experiences of high levels of challenge and exhaustion may be essential parts of the process of gradually learning to take responsibility for both individual and collaborative learning processes. 3) Students experiences of their learning environment are not related to a single feature or set of features, but are connected to both their approaches to learning and the characteristics of the learning environment, such as the pedagogy used.
  • Lindgren, Maija (Helsingin yliopisto, 2015)
    Psychosis is usually preceded by a prodromal period. This phase is characterized by psychotic-like symptoms, attenuated positive symptoms not severe enough to reach a psychotic level. For example, a person may hear voices that are not real. The objective of this study was to investigate whether it is possible and useful to screen for psychosis risk in an unselected clinical adolescent population seeking help for psychiatric symptoms. By finding which symptoms predict transition to a severe psychiatric illness, these risk symptoms can be identified early, enabling effective intervention. This study collected data on adolescent psychiatric patients aged 15 18 years in Helsinki during the years of 2003 2004 and 2007 2008. The participants were screened using the Prodromal Questionnaire (PQ) for prepsychotic symptoms, completed by 731 adolescents. The Structured Interview for Prodromal Syndromes (SIPS) was administered to 174 adolescents to ascertain their psychosis risk status, and broad cognitive testing was done. The participants were followed via patient files and the national hospital discharge register for 3 9 years. A third of the adolescents were identified as psychosis risk patients, but psychosis incidence during follow-up was low, and psychosis risk was not specifically predictive of psychosis. Hospital admissions for psychotic disorder were predicted by the depersonalization symptom intensity of the questionnaire and the positive symptom intensity of the interview. In addition, psychosis risk status predicted psychiatric hospitalizations overall during the following years. Visuospatial performance was poorer among the adolescents with a psychosis risk compared to other patients. Particularly poorer verbal performance was associated with stronger negative symptoms among adolescent patients, regardless of the psychosis risk status. Psychosis risk was associated with suicidal ideation among the adolescent psychiatric patients, but did not predict an increased risk of severe, hospital-treated self-harm during follow-up. The best predictor of intentional self-harm was emotional inexpressivity. Psychotic-like symptoms are common in general adolescent psychiatric services, but the development of psychosis is rare, and predicting psychosis with psychotic-like symptoms is not possible in the clinical environment. However, identifying and treating psychotic-like symptoms is important, as not only are they often distracting experiences in themselves, they can also be associated with cognitive deficits and suicidality, predict hospitalizations, and thus indicate a more serious disorder.
  • Dhir, Amandeep (Helsingin yliopisto, 2015)
    The purpose of this dissertation is to increase understanding of the nature of Internet Addiction (IA) among adolescents (aged 12 to 18 years), focusing on what IA is and how it is measured. Particular emphasis is given to the measurement of IA, and different variables are considered in order to deepen understanding of its various aspects. Accordingly, five studies have been conducted. Study I examines various Internet uses and gratifications (U&G) among adolescent Internet users by developing a valid and reliable 27-item Internet gratification scale (N = 1,914); Study II investigates the role of adolescents’ demographic, technology accessibility, unwillingness to communicate attributes, and sought Internet U&Gs in predicting their tendency to experience IA (N = 1,914); Study III examines the effect of adolescent Internet users’ background characteristics (e.g., demographics, technology accessibility, unwillingness to communicate attributes) on predicting different Internet U&Gs and heavy Internet use among adolescents (N = 1,914); Study IV investigates the psychometric properties of the Compulsive Internet Use Scale (CIUS), and the relationship between the CIUS and adolescent Internet users’ background characteristics (e.g., demographics, ICT accessibility and Problematic ICT use) (N = 2,369); and Study V focuses on the development and validation of WhatsApp (WA) addiction scales for adolescents (N = 405). Cross-sectional research and psychometric theory based analysis reveal the following findings. First, a valid and reliable Internet U&G instrument (27- item) addresses six dimensions of Internet U&G, namely information seeking, exposure, connecting, coordination, social influence, and entertainment (Study I). Second, the following are risk factors for adolescent IA: being male, lower academic performance, high daily time spent on Internet use, strict Internet parenting at home, higher approach avoidance and reward seeking, looking for more connecting, coordination and social influence seeking, and pursuing lower information seeking and exposure gratifications (Study II). Third, older females, adolescents with higher academic performance, higher reward seeking and lower daily Internet use content gratifications such as information seeking & exposure; male, adolescents seeking higher approach avoidance and reward seeking tend to seek higher social gratifications such as connecting & coordination; and higher approach avoidance and reward seeking tendencies predicted process gratifications such as social influence & entertainment (Study III). Fourth, the CIUS possesses good psychometric properties with fairly high reliability, homogeneity and validity. Male, older adolescents, those with lower academic performance, lower life satisfaction, active Internet use (including daily Internet use, excessive Internet use and overall Internet activity) and problematic Internet use significantly predicted compulsive Internet use among adolescents. The study confirmed the findings of Study II (Study IV). Fifth, three original IA scales were adjusted to access WhatsApp (WA) addiction among adolescents. The data showed that they were valid and reliable self-reporting instruments. In addition, a shorter version of each of the three adapted instruments and a 16-item unified scale were also developed and validated. All five studies (Studies I, II, III, IV, V) examined various perspectives on the conceptualization of IA with a strong focus on the measurement and development of valid and reliable instruments to measure IA To conclude, the results indicate that not all adolescents equally experience IA; rather, some are more vulnerable than others. The studies have clarified situations, attributes or behaviors that lead to IA among adolescents. Moreover, new Internet U&Gs have been identified to help to conceptualize IA. In addition, the developed and validated instruments (27-item Internet U&G, 14-item CIUS, 14-item WA addiction test, 8-item and 10-item compulsive WA use) will serve as handy tools for teachers, educational psychologists, and counsellors. By utilizing these instruments, one can easily screen compulsive Internet users from a normal population and provide vulnerable students with timely help and support. The present study confirms the findings of earlier IA literature available in the context of Internet users from a wider age group, and different cultural and demographic settings. The current studies are important, especially because the target user group is adolescent Internet users (aged 12 to 18 years) who have been overlooked in IA and Internet U&G literature. These findings also emphasize the importance of recognizing IA as a problem among adolescents, which many adolescents unknowingly are or become vulnerable to be in daily life settings. The findings are valuable in terms of education and research.
  • Meretniemi, Maija (Helsingin yliopisto, 2015)
    This dissertation uses the approach of history of ideas and consepts to examine how the concepts of a good home and spiritual motherhood were seen by kindergarten teachers. These concepts were the guiding principles of Finnish kindergartens from approximately 1890 to 1950. The key research problem explored in the dissertation is the tension between the private and the public in the intellectual foundations of kindergarten activities, in the objectives of these activities and in the self-understanding of kindergarten teachers. The dissertation poses the following questions: How was the concept of spiritual motherhood, as emphasised in the kindergarten ideology, manifested in the professional dialogue of kindergarten teachers? What meanings were ascribed to it and what tensions were involved in its interpretations? What kinds of physical environments and everyday practices did kindergarten teachers create in kindergartens based on the concept of a good home? What arguments did kindergarten teachers use when responding to proposals and calls to expand the kindergarten day care to a full-time day care? The research material includes the diaries and letters of the major actors involved in the early stages of kindergarten education, archival resources related to the education, and biographical and interview material from providers of kindergarten education. The key figures in the study are Hanna Rothman and Elisabeth Alander, both pioneers of kindergarten education, and Elsa Borenius, who developed kindergarten work. Through these individuals, this dissertation analyses the reception aforementioned concepts as well as their processing and application in the education and work of kindergarten teachers. Introduced by Friedrich Fröbel and Henriette Schrader-Breymann, the concepts of a good home and spiritual motherhood were adopted in Finnish kindergarten work largely in their original form. The concepts were shaped by the religious convictions of Hanna Rothman and Elisabeth Alander: spiritual motherhood was close to religious motherhood, and kindergarten work in its early stages was viewed as Christian social missionary work in a pedagogical framework. As a spiritual mother, the female kindergarten educator had to place herself in the service of love for the benefit of those close to her. This expectation created tensions in education and easily resulted in teachers becoming exhausted in their work. The principle of spiritual motherhood guided the professional image of kindergarten teachers for several decades and linked the kindergarten closely with the private, rather than the public, sphere. Maternal qualities were considered professional requirements which weakened the connection between kindergarten teaching and the worlds of school and academia. Initially, kindergarten teaching was an ambivalent profession lying between motherhood and teaching. It was a caring occupation characterised by a strict ethical code and unselfishness. The Christian values of the kindergarten came under scrutiny as the work began to develop into a public social service. The ideal of a good home informed the planning of kindergarten facilities as home-like environments based on the teachers own bourgeois homes. Kindergarten teachers themselves designed the kindergarten facilities and furniture. The kitchen was considered particularly important. The sense of community and social growth were promoted through both pedagogy of work and common activities in the kindergarten. The ideal of the home, emphasis on the link between mother and child, and part-time day care in the kindergarten constituted a practice that was difficult to break when calls for the expansion of full-time day care began to come from various directions of society in the 1940s and 1950s. Kindergarten teachers opposed full-time day care by appealing to children s own good and and the principle of home as the primary environment for child rearing before school age. The teachers felt that part-time day care could satisfy the need for early childhood education. To resolve the issue of full-time day care, the kindergarten teachers suggested as early as the late 1940s that mothers work part-time or receive a maternity salary . From 1918 onwards, separate groups were established in kindergartens for school children in full-time day care, but these groups did not develop as anticipated. The ideological tradition of the pioneers of kindergarten education emphasised religion, spiritual motherhood and Fröbel s pedagogy. The rules of the Ebeneser Foundation, which provided training in the field, were tied to Christian values. This tradition conduced to the uniformity of kindergarten teacher education, but also separated it from other teacher education and may have hampered its academic development. The `shine of spiritual motherhood´wore off when the realities of the profession set in. Changes in social policy began to affect day care arrangements only after the end of my research period. The ideal of the home remained unchanged, although what originally began as private kindergarten work gradually developed into a publicly funded and managed activity. Keywords: History of the kindergarten, a good home, spiritual motherhood, pedagogy of work, part-time day care, full-time day care, day care for schoolchildren
  • Aarnio, Matti (Helsingin yliopisto, 2015)
    Today's medical education faces the challenge of developing students competencies to resolve ever more complex problems in collaboration with other professionals. Problem-based learning (PBL) has proven useful for developing many of the competencies needed in modern healthcare. In PBL students collaboratively construct knowledge to explain and solve problems related to real-life situations. In such knowledge construction, dealing with conflicting ideas and knowledge has the potential to enhance student learning while also developing teamwork and critical thinking, skills that are central to multi-professional healthcare teams. The studies that make up the present doctoral thesis explored how students deal with conflicts on knowledge and how they are facilitated to handle such conflicts in PBL tutorial discussions. In addition, the thesis focuses on how to help students learn teamwork skills and critical thinking. Study I examined how to teach teamwork skills to first-year medical students and how to motivate them to learn these skills. The teamwork skills focused on verbal communication in PBL tutorial sessions and in healthcare teams. Feedback on the teamwork skills module from three consecutive classes of first-year students was analysed. Students motivation to learn teamwork skills increased significantly when the introduction to the topic was improved by more clearly pointing out the clinical relevance of such skills. Study II focused on how conflicts on knowledge were dealt with in PBL tutorial group discussions. Four video-recorded tutorial sessions including 33 first-year medical and dental students were analysed. Conflicts on knowledge were found to be relatively rare and generally fairly brief. This was due to a lack of collaborative and thorough argumentation, as well as a lack of questions that would elicit elaboration on the issues. Study III examined tutor facilitation during tutorial discussions, and particularly how the facilitation helped students to collaboratively resolve conflicts on knowledge. The study focused on the tutors in the same video-recorded tutorial sessions as in Study II. The tutors typically intervened by confirming what the students had said or by giving explanations, but they rarely asked questions that would stimulate elaboration on knowledge. During conflicts on knowledge the tutors gave more explanations, but did little to encourage the students to elaborate on conflicting ideas. Study IV focused on medical students conceptions of critical thinking in preclinical PBL. The aim was to find out how the students defined critical thinking, how they perceived it in preclinical PBL and what they expected it to be in clinical practice. The students typically understood critical thinking as judging the reliability of sources of information. Few students understood critical thinking to mean reflecting on their own thinking or viewing things from different perspectives. Students conceptions of critical thinking may have prevented them from seeing the connection between critical thinking in preclinical PBL and critical thinking in clinical practice. The present thesis sheds light on the processes of collaborative knowledge construction related to dealing with conflicting knowledge and ideas in PBL tutorial discussions. The results confirmed prior research findings, which have shown that students rarely deal with conflicting ideas and knowledge, and they point to the central role of the tutor in facilitating students to address these matters in tutorial discussions. The findings also revealed that engaging in deep inquiry during conflicts on knowledge was challenging for both students and tutors. The results further underlined the importance of clearly pointing out to students how they will benefit from the skills learned in preclinical PBL, such as teamwork and critical thinking, in their future professions. Based on these findings, new ideas for improving learning from conflicting ideas in small-group discussions are introduced. Future studies are encouraged to continue exploring the many exciting avenues opened by the present doctoral thesis.
  • Neittaanmäki-Perttu, Noora (Helsingin yliopisto, 2015)
    ABSTRACT Background and purpose: As the skin cancer burden continues to increase, there is an urgent need for novel methods for the early detection of skin cancers, and for new cost-effective treatments. The hyperspectral imaging system (HIS) is a novel technique which offers the dual advantages of allowing the imaging of large skin areas rapidly and non-invasively. Daylight photodynamic therapy (DL-PDT), with the advantages of excellent tolerability and convenience, is an attaractive therapy for actinic keratoses (AK) and field cancerization.This thesis aimed to enable early and effective treatment of common premalignancies of photo-damaged skin.The first purpose of this thesis was to evaluate the feasibility of HIS in the detection of field cancerized skin and in the detection of ill-defined borders of lentigo maligna (LM) and lentigo maligna melanoma (LMM). In addition, this thesis aimed to further develop the treatment of field cancerized skin with photodynamic therapy using a novel photosensitizer in combination with daylight (DL-PDT), and to evaluate the cost-effectiveness of DL-PDT. Methods: This thesis included four non-sponsored prospective clinical studies. The novel prototype HIS, used in studies I-II, was developed for the study at the VTT Technical Research Centre of Finland. The technique enabled in vivo imaging of the skin prior to surgical procedures and produced abundance maps of the affected skin areas. The results were verified by histopathology. Study III was randomized double-blinded intra-individual split-face trial comparing novel photosensitizer formulation, 5-aminolaevulinate nanoemulsion (BF-200 ALA) with methyl-5-aminolaevulinate (MAL) in DL-PDT of AKs. In addition to blinded clinical and histological treatment efficacy, tolerability of the treatment was assessed. Study IV evaluated the cost-effectiveness of MAL-DL-PDT compared to conventional MAL-LED-PDT. Results: In studies I-II HIS showed its feasibility in both the detection of subclinical borders of ill-defined lentigo malignas (LM) and lentigo maligna melanomas (LMM), and in the detection of early subclinical actinic keratoses (AK). In study I HIS accurately detected 20 of 23 (87%) of the LM/LMM borders as confirmed by histology. HIS was useful i.e. detected the lesion borders more accurately than a clinician using Wood s light in 11 of 23 (47.8%) cases. Six re-excisions could have been avoided with HIS. In 3/23 cases (13%) HIS was not in concordance with the histopathology, which in two cases HIS showed lesion extension which was not verified histologically (wrong positive) and in one case HIS missed the subclinical extension (wrong negative). In study II with 12 patients and 52 clinical AKs, HIS accurately detected all the clinical lesions in addition to numerous areas of subclinical damage. HIS findings matched the histopathological findings in all 33 biopsied areas (AK, n=28, photo-damaged skin, n=5), revealing 16 subclinical lesions of which 10 were not detected by fluorescence diagnosis. In study III (13 patients, 177 lesions) in a per patient (half-face) analysis BF-200 ALA cleared thin AKs more effectively than did MAL (p=0.027). In per lesion analysis the complete clearance rates were 84.5% for BF-200 ALA, and 74.2% for MAL (p=ns). The area response rates, including also the new appeared lesions (i.e.preventive effect), were 79.8% for BF-200 ALA and 65.6% for MAL, p=0.044. Histologically, DL-PDT effectively cleared all the signs of dysplasia in 61.5% lesions treated with BF-200 ALA and in 38.5% with MAL (p=ns). The mean decrease in p53 expression was 54.4% with BF-200 ALA, 34 % with MAL (p=ns). DL-treatment was nearly painless with both photosensitizers. BF-200 ALA and MAL DL-treatments were similarly tolerated as regards to adverse reactions. In study IV 70 patients (210 target lesions) randomized to receive DL-PDT or LED-PDT with MAL, at six months the patient complete response rates were 15 of 35 (42.9%) and 24 of 35 (68.6%), (p=0.030) and lesion clearance rates were 72.4% and 89.2%, respectively (p=0.0025). DL-PDT required significantly less time at the clinic (p less than 0.0001) and could be used with lower total costs ( 132) compared to conventional LED-PDT ( 170), p=0.022. However, in terms of cost-effectiveness MAL-DL-PDT was found to give less value for money compared to MAL-LED-PDT. The incrementl cost-effectiveness ratio (ICER) showed the monetary gain of 147 per unit of effectiveness lost. Thus, the use of DL-PDT instead of LED-PDT would decrease the healing probability but only low incremental cost savings would be achieved. The costs per complete responder were 308 for MAL DL-PDT and 248 for MAL LED-PDT, p= 0.004. Conclusions: The more accurate pre-surgical assessment of the subclinical borders of LM and LMM with HIS could lead to fewer re-excixions, which furthermore could reduce the burden to both patients and clinics. In addition, the early non-invasive detection of skin field cancerization could enhance the treatment process by revealing the as yet subclinical areas in need of treatment, and could possibly aid the monitoring of treatment efficacy. Even though HIS was found to be useful in these two indications, more studies are warranted to qualify the optimal mathematical algorithms for diagnostic use.The use of novel a photosensitizer formulation, BF-200 ALA, in DL-PDT could lead in lower costs and increase the efficacy. Interestingly, the efficacy of DL-PDT with BF-200 ALA was approaching the efficacy achieved with conventional LED-PDT. As field cancerized skin should be treated as a chronic disease requiring repeated treatments, DL-PDT offers a painless and convenient option for this purpose. However, DL-PDT with MAL provided less value for money compared to conventional MAL-PDT. The cost-effectiveness of BF-200 ALA in DL-PDT for AKs needs further studies.
  • Laakasuo, Michael (Helsingin yliopisto, 2015)
    In our previous studies it has been found that a phenomenon labeled tilting is a form of moral anger. When players are in tilt they make a series of bad decisions, chase their losses and express anger by cursing their opponents. In the context of tilting, the players also report episodes of memory loss. Additionally, we also developed a scale that measures the level of a player's poker experience, and we found evidence to suggest that poker experience is associated with mature self-reflection skills. We also found that the likelihood of a poker player making the correct decision in poker decision making tasks increased as a function of self-reflection and poker experience. In Study 1 I found evidence supporting the hypothesis that the regulation of emotions is an important part of the skill set of poker players. Specifically, if poker players have read a story about betrayal where they are asked to take the position of the victim before they make their decisions in poker decision making tasks, they make mathematically worse decisions than those participants who have only read a control story. The effect was moderated by the presence of a pair of moving eyes placed on the screen, which were used as proxy for the social environment. The results support the hypothesis that tilting is related to moral anger, or at least some form of anger that seems consistent with the events taking place in the social context. In Study 2, I assessed the associations between the HEXACO personality inventory -revised and poker experience. I obtained evidence supporting the notion that emotional stability is positively associated with accumulated poker experience. In Study 3 I showed that poker experience does not seem to be correlated with emotional intelligence, selfishness, self-control problems, social alienation or lowered levels of life satisfaction. I also note that these measures correlate with instruments measuring problem gambling. However, I observed either no correlations, or correlations hinting towards health benefits, between these instruments and poker experience. I concluded that problem gambling instruments need further development Taken together our results indicate that there are numerous benefits in approaching the field of gambling studies from a non-clinical angle.