Terminologian merkitys, käytöksen taustalla vaikuttavat syyt sekä ennaltaehkäisevät toimet ja interventiot

Tiivistelmä. Tämän kuvailevan kirjallisuuskatsauksen tavoitteena on määritellä nuorten häiritsevän käyttäytymisen syitä, sekä pohtia millaisilla ennaltaehkäisevillä keinoilla ja interventiolla voisimme pyrkiä tukemaan nuoren käyttäytymistä. Opettajat kokevatkin usein, etteivät he osaa tukea häiritsevästi käyttäytyviä nuoria tarpeeksi tehokkaasti. Inkluusion vuoksi yhä useampi häiritsevästi käyttäytyvä nuori opiskelee yleisopetuksessa, jolloin myös luokanopettajien tulisi tuntea erilaiset matalan kynnyksen menetelmät, sekä tehokkaammat interventiot. Häiritsevä käyttäytyminen vaatii lisäksi koko koulun yhteisiä toimintamalleja sekä selkeitä käytösodotuksia. Kuitenkin näiden keinojen avulla voimme parantaa sekä oppilaiden, että opettajien hyvinvointia. Tutkimuskysymyksieni kannalta oleellista on määritellä ei-toivottua käyttäytymistä kuvaava termi, joka valikoitui tässä tutkielmassa historian viitekehyksen, sekä terminologian analyysin pohjalta häiritseväksi käyttäytymiseksi. Käsitteen valinnan lisäksi kuvailen häiritsevää käyttäytymistä, sekä esittelen erilaiset tuen muodot, sekä opetusjärjestelyt. Nuoren häiritsevä käyttäytyminen näkyy monella eri tavalla, joten häiritsevän käyttäytymisen tunnistamisessa oleellista onkin oppilaan tuntemus. Joskus häiritsevän käyttäytymisen ennaltaehkäisyssä sekä oppilaan kohtaamisessa hyödyllistä saattaa olla tunnistaa häiritsevän käyttäytymisen taustalla olevia syitä. Nuoren häiritsevä käyttäytyminen saattaa liittyä lapsuuden kiintymyssuhteen muodostumisen ongelmiin, temperamenttiin, kotioloihin, mielenterveyteen sekä mahdollisiin diagnooseihin. Vaikka syyt voivat auttaa nuoren kohtaamisessa, usein syiden pohtiminen ei anna suoraa vastausta häiritsevän käyttäytymisen ennaltaehkäiseviin toimiin. Oppilaan käyttäytymisen tukeminen ja ennaltaehkäisy voidaan jakaa luokkaympäristön matalan kynnyksen keinoihin, sekä intensiivisimpiin interventioihin. Tutkimuksen luotettavuus perustuu laajaan lähteiden tulkintaan, sekä tutkimusten tarkkaan rajaamiseen. Tutkimusten tulosten tavoitteena on esitellä erilaisia tutkittuja interventioita, joiden avulla voidaan tutkitusti edistää häiritsevästi käyttäytyvän oppilaan käyttäytymistä.Abstract. This descriptive literature review is focusing on adolescents disruptive behaviour, it’s causes and ways to prevent it at school with different forms of intervention. Teachers often find their abilities of preventing disruptive behaviour limited and disruptively behaving students exhausting. Because of inclusion, this problem has become more apparent. Teachers should be more aware of different forms of interventions so they can support students who exhibit disruptive behaviour. The most important is to have a school enviroment with clear behavioural expectations and patterns which help students predict effects of their behaviour. With this we can improve both teachers and students well-being. This descriptive literature first defines what term we should be using when speaking to adolescents with behavioural problems. This thesis chose disruptive behaviour due analysing terminology and history. In addition to the choice of teminology, I describe forms of disruptive behavior, as well as various forms of support, as well as intensive interventions. The adolescents disruptive behavior is manifested in many different ways, so the student’s knowledge is essential in identifying the disruptive behaviour. Sometimes, in the prevention of disruptive behaviour, as well as in the encounter of a student, it may be helpful to identify the underlying causes of the disruptive behaviour. The young person’s disruptive behaviour may be related to childhood attachment problems, temperament, home conditions, mental health, and possible co-diagnoses. While causes can help with teacher-student relationships, often considering the causes does not provide a direct response to preventative actions for disruptive behaviour. Supporting and preventing student behaviour can be divided into low-threshold means in the classroom environment, as well as the most intensive interventions. The reliability of a study is based on an extensive reflection on theory and concepts, a comparison of different studies, and a discussion with a researcher familiar with the topic. The aim of the results of the study is to present the various interventions studied, which can be used to promote the behavior of a student who behaves in a disruptive way

”Positiivisten kokemusten saaminen korostuu, kun muu elämä heittää häränpyllyä”:yläkoulun opettajat tukemassa kodin ulkopuolelle sijoitettujen nuorten koulunkäyntiä yhteistyössä sijaishuollon kanssa

Tiivistelmä. Kodin ulkopuolelle sijoitettujen nuorten on todettu suoriutuvan koulusta heikommin, kuin muiden oppilaiden. Sijoitettujen nuorten on myös todettu olevan erityisen haavoittuvassa asemassa traumaattisten menneisyyden kokemuksien kautta, joiden kauaskantoiset vaikutukset näkyvät niin koulussa kuin nuorten mielenterveydessä. Tässä pro gradu- tutkielmassa keskityttiin tutkimaan yläkoulun opettajien näkemyksiä kodin ulkopuolelle sijoitettujen nuorten koulunkäynnin tukemisesta sekä yhteistyöstä sijaishuollon kanssa. Tavoitteena oli selvittää, millaisin keinoin yläkoulun opettajat tukevat sijoitettuja nuoria. Toinen tavoite oli selvittää, millaisia kokemuksia yläkoulun opettajilla on sijaishuollon kanssa tehtävästä yhteistyöstä. Lisäksi tutkimuksessa nousi esiin sijoittujen nuorten koulunkäyntiin liittyviä haasteita. Tutkielma toteutettiin yleisenä laadullisena tutkimuksena ja aineisto kerättiin kyselylomakkeelle, joka lähetettiin 25 Oulun kaupungin rehtorille. Rehtorit jakoivat kyselyn oman koulunsa aineenopettajille ja erityisopettajille. Tutkimukseen osallistui 12 opettajaa, joista 7 oli aineenopettajia ja 5 erityisopettajia. Aineiston analyysissä käytettiin aineistonlähtöistä sisällönanalyysiä. Tutkimuksen tulokset mukaan yläkoulun opettajat tukevat sijoitettuja nuoria monin eri tavoin, jotka ovat kiinteästi yhteydessä heidän tunnistamiinsa sijoitettujen nuorten haasteisiin. Kuitenkin tärkeimmäksi tukemisen keinoksi nousi opettajan ja sijoitetun nuoren välinen suhde ja nuoren kohtaaminen tasa-arvoisesti ja ymmärtävästi. Tässä isossa roolissa oli nuoren traumaattisen taustan huomaaminen, joka tuki opettajien tapaa kohdata nuori vuorovaikutuksessa. Tuloksissa tuli myös ilmi, että sijaishuollon kanssa tehtävä yhteistyö oli erityisen tärkeä tukikeino, mutta opettajien kokemukset sijaishuollon kanssa toimimisesta olivat vaihtelevia. Tutkielma tarjoaa uutta tietoa siitä, millaisiin asioihin sijoitettujen nuorten tukemisessa tulisi koulun näkökulmasta kiinnittää huomiota ja millaista yhteistyö sijaishuollon kanssa on opettajien kokemana“Gaining positive experiences is emphasized when the rest of life gets out of hand” : middle school teachers supporting out-of-home care youth and cooperating with foster care. Abstract. Out-of-home care youth have been found to perform worse in school than other students. In addition, foster care youth have been found to be in a particularly vulnerable position through traumatic past experiences that have far-reaching effects of which can be seen in school performance and youth’s mental health. In this master’s thesis, the focus was to examine middle school teachers’ views on supporting the schooling of young people placed in out-of-home care and cooperation with foster care. The goal was to find out in which ways middle school teachers support young people who live in out-of-home care. Another goal was to find out what kind of experiences middle school teachers have with cooperation with foster care. In addition, the study revealed what type of challenges youth in foster care struggle with. The study was carried out as a general qualitative study and the research material was collected by using electronic survey, which was sent to 25 principals in the city of Oulu. Principals distributed the survey to subject teachers and special education teachers in their own school. 12 teachers participated in the study, of which 7 were subject teachers and 5 were special education teachers. The analysis of the data was carried out as material-based content analysis. According to the results of the study, middle school teachers supported youth placed in out-of-home care in multiple ways, which were closely connected to the challenges they identified. However, the most important means of support was the understanding and supporting relationship between the teacher and youth. Noticing youth’s traumatic background played a big role in and guided the teachers’ interaction with youth. The results also revealed that cooperation with foster care was a particularly important way to support youth in out-of-home care, but the teachers’ experiences of working with foster care varied. The study offers new information on what kind of issues the school should pay attention to when supporting out-of-home care youth and what the teachers’ experience of cooperation with foster care is like

Quality and utilization of the Finnish clinical practice guideline in schizophrenia: evaluation using AGREE II and the vignette approach

Purpose: This study aims to evaluate the quality of the Finnish clinical practice guideline related to schizophrenia care and how it can be utilized in psychiatric services.Participants and methods: The data were collected from one psychiatric ward and seven psychiatric outpatient units situated in two cities in Southern Finland. A total of 49 professionals working in these sites participated in this study. A descriptive study design was adopted. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument with six domains including 23 items was used to assess the quality of the guideline, whereas a vignette was implemented to describe how staff would use the guideline in hypothetical cases in daily practice. The analysis of AGREE II was based on rating each of the 23 items on a seven-point scale and calculating a quality score for the six domains. To describe the utilization of the guideline, eight key recommendations of the guideline were deductively rated out of the respondents’ answers.Results: The results showed that the “scope and purpose” of the guideline were well described, but “applicability” was insufficient. The overall quality of the guideline was high (73%). Almost one fifth of the respondents were in agreement with key recommendations.Conclusion: The overall quality of Guideline for Schizophrenia was good, but its “applicability” and utilization should be improved.<br /

Range Quantile Queries: Another Virtue of Wavelet Trees

We show how to use a balanced wavelet tree as a data structure that stores a list of numbers and supports efficient {\em range quantile queries}. A range quantile query takes a rank and the endpoints of a sublist and returns the number with that rank in that sublist. For example, if the rank is half the sublist's length, then the query returns the sublist's median. We also show how these queries can be used to support space-efficient {\em coloured range reporting} and {\em document listing}.Comment: Added note about generalization to any constant number of dimensions

The Impact of a Web-Based Course Concerning Patient Education for Mental Health Care Professionals: Quasi-Experimental Study

Background: Continuing education has an important role in supporting the competence of health care professionals. Although Web-based education is a growing business in various health sectors, few studies have been conducted in psychiatric settings to show its suitability in demanding work environments.Objective: We aimed to describe the impact of a Web-based educational course to increase self-efficacy, self-esteem, and team climate of health care professionals. Possible advantages and disadvantages of the Web-based course are also described.Methods: The study used nonrandomized, pre-post intervention design in 1 psychiatric hospital (3 wards). Health care professionals (n=33) were recruited. Self-efficacy, self-esteem, and team climate were measured at 3 assessment points (baseline, 8 weeks, and 6 months). Possible advantages and disadvantages were gathered with open-ended questions at the end of the course.Results: Our results of this nonrandomized, pre-post intervention study showed that health care professionals (n=33) had higher self-efficacy after the course, and the difference was statistically significant (mean 30.16, SD 3.31 vs mean 31.77, SD 3.35; P=.02). On the other hand, no differences were found in the self-esteem or team climate of the health care professionals before and after the course. Health care professionals found the Web-based course useful in supporting their work and relationships with patients. The tight schedule of the Web-based course and challenges in recruiting patients to use the patient education program with health care professionals were found to be the disadvantages.Conclusions: Web-based education might be a useful tool to improve the self-efficacy of health care professionals even in demanding work environments such as psychiatric hospitals. However, more studies with robust and sufficiently powered data are still needed

A digital waveguide-based approach for Clavinet modeling and synthesis

The Clavinet is an electromechanical musical instrument produced in the mid-twentieth century. As is the case for other vintage instruments, it is subject to aging and requires great effort to be maintained or restored. This paper reports analyses conducted on a Hohner Clavinet D6 and proposes a computational model to faithfully reproduce the Clavinet sound in real time, from tone generation to the emulation of the electronic components. The string excitation signal model is physically inspired and represents a cheap solution in terms of both computational resources and especially memory requirements (compared, e.g., to sample playback systems). Pickups and amplifier models have been implemented which enhance the natural character of the sound with respect to previous work. A model has been implemented on a real-time software platform, Pure Data, capable of a 10-voice polyphony with low latency on an embedded device. Finally, subjective listening tests conducted using the current model are compared to previous tests showing slightly improved results

Trends in the use of coercive measures in Finnish psychiatric hospitals: a register analysis of the past two decades

BackgroundCoercive measures is a topic that has long been discussed in the field of psychiatry. Despite global reports of reductions in the use of restraint episodes due to new regulations, it is still questionable if practices have really changed over time. For this study, we examined the rates of coercive measures in the inpatient population of psychiatric care providers across Finland to identify changing trends as well as variations in such trends by region.MethodsIn this nationwide registry analysis, we extracted patient data from the national database (The Finnish National Care Register for Health Care) over a 20-year period. We included adult patients admitted to psychiatric units (care providers) and focused on patients who had faced coercive measures (seclusion, limb restraints, forced injection and physical restraints) during their hospital stay. Multilevel logistical models (a polynomial model of quadratic form) were used to examine trends in prevalence of any coercive measures as well as the other four specified coercive measures over time, and to investigate variation in such trends among care providers and regions.ResultsBetween 1995 and 2014, the dataset contained 226,948 inpatients who had been admitted during the 20-year time frame (505,169 treatment periods). The overall prevalence of coercive treatment on inpatients was 9.8%, with a small decrease during 2011–2014. The overall prevalence of seclusion, limb restraints, forced injection and physical restraints on inpatients was 6.9, 3.8, 2.6 and 0.8%, respectively. Only the use of limb restraints showed a downward trend over time. Geographic and care provider variations in specific coercive measures used were also observed.ConclusionsDespite the decreasing national level of coercive measures used in Finnish psychiatric hospitals, the overall reduction has been small during the last two decades. These results have implications on the future development of structured guidelines and interventions for preventing and more effectively managing challenging situations. Clinical guidelines and staff education related to the use of coercive measures should be critically assessed to ensure that the staff members working with vulnerable patient populations in psychiatric hospitals are ethically competent.</p

Stem cells are the most sensitive screening tool to identify toxicity of GATA4-targeted novel small-molecule compounds

Safety assessment of drug candidates in numerous in vitro and experimental animal models is expensive, time consuming and animal intensive. More thorough toxicity profiling already in the early drug discovery projects using human cell models, which more closely resemble the physiological cell types, would help to decrease drug development costs. In this study we aimed to compare different cardiac and stem cell models for in vitro toxicity testing and to elucidate structure-toxicity relationships of novel compounds targeting the cardiac transcription factor GATA4. By screening the effects of eight compounds at concentrations ranging from 10 nM up to 30 µM on the viability of eight different cell types, we identified significant cell type- and structure-dependent toxicity profiles. We further characterized two compounds in more detail using high-content analysis. The results highlight the importance of cell type selection for toxicity screening and indicate that stem cells represent the most sensitive screening model, which can detect toxicity that may otherwise remain unnoticed. Furthermore, our structure-toxicity analysis reveals a characteristic dihedral angle in the GATA4-targeted compounds that causes stem cell toxicity and thus helps to direct further drug development efforts towards non-toxic derivatives