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Tässä pedagogisessa opinnäytetyössä pohditaan, kuinka pianonsoitonopettajan pedagoginen ajattelu ja ammattitaito muusikkona kehittyivät koulutuksen aikana. Tähän vaikuttivat sekä pedagogiset opinnot että opinnäyteproduktion valmistelu. Produktion edetessä tekijä joutui pohtimaan useita asioita, joita oppilaat kohtaavat opiskellessaan pianonsoittoa. Työssä käydään läpi harjoitteluun ja esiintymiseen vaikuttavia tekijöitä. Lisäksi tekijä pohtii, kuinka opinnot vaikuttivat opettajan arviointikykyihin. Tämän prosessin yhteydessä tekijä huomasi myös, kuinka tärkeitä pedagogiset opinnot ovat käytännön kannalta. Tekijä oppi reflektoimaan omaa toimintaansa ja ymmärsi, että opetuksen pitää olla oppilaslähtöistä. Työssä pohditaan, millä tavoin opettaja voi vaikuttaa oppilaiden motivaatioon kannustavasti ja oppilasta tukien. Tekijä pohti myös, mitkä tekijät vaikuttavat opettajan omaan motivoitumiseen ja työssä jaksamiseen.Työssä kuvataan, miten oppilaitoksen opetussuunnitelmilla ja yleisillä asenteilla voi vaikuttaa oppilaiden ja opettajien viihtyvyyteen
Aihe opinnäytetyöhön tuli Oulun yliopistollisen sairaalan, operatiivisen tulosalueen, pään ja kaulan sairauksien vastuualueelta, missä oltiin kehittämässä lääkehoidon osaamista iv-näyttöjen osalta. Näyttöjen kehittäminen on tärkeää, koska jokaisen sairaanhoitajan tulee suorittaa uusimuotoinen neste- ja lääkehoidon lupa (iv-lupa). Iv-lupaprosessi on tärkeä osa hoitajan työtä. Hoitajien motivoiminen sekä ammatillisen kasvun tu-keminen on osoittautunut käytännössä haasteelliseksi. Opinnäytetyön tarkoituksena on kehittää nykyistä neste- ja lääkehoidon iv-lupaprosessia laadultaan paremmaksi sekä kehittää hoitajien lääkehoidon osaamista tuottamalla malli suonensisäisen lääkitsemisen näytöille. Tavoitteena voi-daan nähdä, että näytöt ovat sekä näytönvastaanottajalle, näytönantajalle sekä sairaanhoitopiirin johdolle mahdollisimman laadukas, asianmukainen sekä toimiva prosessi, mikä mahdollisesti li-sää hoitohenkilökunnan työhyvinvointia, edesauttaa ammatillista kasvua ja parantaa potilasturval-lisuutta. Opinnäytetyö toteutettiin projektina. Projektiin sisältyvän kyselyn avulla selvitettiin, miten näytön-vastaanottajat ja näytönantajat olivat kokeneet näytöt osana lääkehoidon oppimista. Lisäksi selvi-tettiin, mitä kehitettävää näytönvastaanottajat ja näytönantajat ovat havainneet lääkehoidon näyt-töjen oppimisprosessissa. Kysely toteutettiin sähköpostitse käyttäen webropol-palvelua. Kysy-mykset olivat sekä avoimia että monivalintakysymyksiä. Vastaukset analysoitiin käyttäen sisäl-lönanalyysiä. Tutkimustulosten ja kirjallisuuden perusteella opinnäytetyön kehittämistyönä valmistui iv-näytöille ohjeistus ja malli. Ohjeistus ja malli ovat käytössä Oysissa nykyisellä operatiivisella vastuualueella. Ohjeistus ja malli toimivat näytönvastaanottajille tukena ottaessaan vastaan iv-näyttöjä. Ohje on löydettävissä Oysin intranetistä ja sitä voi tarvittaessa hyödyntää myös muilla vastuualueilla.
Abstract This study focuses on early attachment and its effects on later cognitive development and mental well-being in Finnish twins and singletons. Altogether 84 infants, including both singletons (N = 27) and twins (N = 57), were assessed at 18 months of age to determine their infant–mother and infant–father attachment using the Preschool Assessment of Attachment (PAA), a modification of the Ainsworth infant classification system. In the whole sample, approximately one third (37%) of the children were assessed as using avoidant/defended insecure (Type A), one third (35%) secure/balanced (Type B), one fifth (20%) resistant/coercive insecure (Type C) and the rest insecure other (IO, 8%) attachment strategy with their mothers, while the corresponding percentages of attachment strategies with fathers were 36%, 33%, 28% and 3%, respectively. The results yielded a difference in the maternal attachment between twins and singletons; the twins were more often Type B attached than the singletons. At 36 months the children were tested with the Stanford-Binet test for measuring their intelligence level. Children with Type A or Type B attachment pattern attained the highest IQ. High socio-economic status of the family and mature pregnancy (≥ 37 weeks) were also significantly linked with higher intelligence levels. At the age of 48 months, the children’s mental well-being was assessed by using CBCL (Child Behavior Checklist, Achenbach) questionnaires completed by the mothers of 22 singletons and 51 twins and the fathers of 20 singletons and 60 twins. Type A attachment strategy with the mother among singleton toddlers was significantly associated with higher CBCL scores reported by mothers, concerning withdrawal, somatic problems and total internalizing symptoms, whereas among twins there were no such correlations. In addition, on the basis of the parental reports singletons had significantly more behavioural and emotional symptoms than the twins.
Purpose Negative mental well-being may hinder, and positive mental well-being facilitate physical activity (PA) when one’s daily routines are compromised. COVID-19 posed challenges to both mental well-being and PA, in Finland especially for those over 70, who faced the strictest restrictions. Therefore, the aim was to investigate the relationships of mental well-being with PA during the COVID-19 in two cohorts of different ages. Methods Data came from two population-based studies. Participants of the longitudinal TRAILS study (N = 162, 58% women, 60-61 years) were representative of their age cohort. Participants of the randomized controlled trial PASSWORD (N = 272, 60% women, 72-88 years) had attended a year-long multicomponent physical training intervention during 2017-2019. Self-reported changes in PA (increased vs. no change/decreased; decreased vs. no change/increased) and PA frequency (1-7; from “not at all” to “approximately daily”) during the COVID-19 were collected from April 2020 to June 2020 (PASSWORD) or July 2021 (TRAILS). Positive mental well-being was assessed by positive affect from the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF, score 1-5). Negative mental well-being indicators were negative affect (I-PANAS-SF, score 1-5) and depressive symptoms (TRAILS: General Behavioral Inventory, score 0-3; PASSWORD: Geriatric Depression Scale, score 0-15). Relationships between mental well-being and PA were analyzed using logistic and linear regression models, adjusted by sex and, in PASSWORD, age. Results Positive affect was positively associated with increased PA (odds ratio (OR)=1.751-2.661, p = 0.013-0.034) and PA frequency (B = 0.489-0.550, p < 0.001-0.009) in both studies, and inversely with decreased PA in the PASSWORD (OR = 0.633, p = 0.024). Higher negative affect and depressive symptoms were associated with decreased PA in the PASSWORD (OR = 2.134, p = 0.004 and OR = 1.310, p < 0.001, respectively). Additionally, depressive symptoms were associated with lower PA frequency in both studies (TRAILS: B=-0.876, p = 0.004; PASSWORD: B=-0.105, p = 0.002). Conclusions Positive mental well-being was consistently and positively associated with PA during COVID-19 in older adults. Higher negative mental well-being was more clearly associated with poor PA behaviors in the older cohort facing stronger restrictions. Supporting positive mental well-being may be as important as reducing negative mental well-being to facilitate physically active lifestyle among older adults during exceptional circumstances.
Background Physical inactivity is an important factor in the development of sarcopenia. This cross-sectional study explores the prevalence of sarcopenia and associations of physical activity (PA) with sarcopenia in two exercise trial populations. These study groups are clinically meaningful community-dwelling populations at increased risk for sarcopenia: older adults not meeting the PA guidelines and those with a recent hip fracture (HF). Methods Data from 313 older adults who did not meet the PA guidelines (60% women; age 74.5 ± 3.8, body mass index 27.9 ± 4.7) and 77 individuals with HF diagnosed on average 70 ± 28 days earlier (75% women; age 79.3 ± 7.1, body mass index 25.3 ± 3.6) were included in this study. Grip strength and muscle mass (Dual-energy X-ray absorptiometry [DXA] in older adults not meeting the PA guidelines and bioimpedance analysis in participants with HF) were used to assess sarcopenia according to the European Working Group in Older People 2019 (EWGSOP2) criteria. The current level of PA was self-reported using a question with seven response options in both study groups and was measured with a hip-worn accelerometer for seven consecutive days in older adults not meeting the PA guidelines. Results The prevalence of sarcopenia and probable sarcopenia was 3% (n = 8) and 13% (n = 41) in the older adults not meeting the PA guidelines and 3% (n = 2) and 40% (n = 31) in the HF group, respectively. In the age- and sex-adjusted logistic regression model, the lowest levels of self-reported PA were associated with increased probable sarcopenia and sarcopenia risk in older adults not meeting the PA guidelines (OR 2.8, 95% CI, 1.3–6.1, p = 0.009) and in the HF group (OR 3.9, 95% CI, 1.4–11.3, p = 0.012). No significant associations between accelerometer-measured PA and probable sarcopenia or sarcopenia were found. Conclusions Probable sarcopenia is common among community-dwelling older adults not meeting the PA guidelines and very common among individuals recovering from HF who are able to be involved in exercise interventions. In addition, since low PA is associated with higher probable sarcopenia and sarcopenia risk, it is recommended to screen for sarcopenia and promote regular physical activity to prevent sarcopenia in these populations.
Background Physical activity is crucial to maintain older adults’ health and functioning, but the health benefits of particular activity intensities remain unclear. The aim of this cross-sectional study was to peruse the distribution of physical activity, and to investigate the associations of particular physical activity intensities with body composition and physical function among older adults. Methods The sample comprised of 293 community-dwelling sedentary or at most moderately active older adults (42% men, mean age 74 ± 4 years). Physical activity was measured with a hip-worn tri-axial accelerometer over seven consecutive days, and investigated in detailed intensity range and in categories of sedentary, light and moderate-to-vigorous activity. Fat percent and appendicular lean mass were measured with DXA. Physical function was assessed by six-minutes walking test (6-min walk), maximal walking speed over 10 m (10-m walk) and Short Physical Performance Battery (SPPB). Associations were estimated with partial correlation adjusted for sex and age. Results Participants spent on average 602 min per day sedentary, 210 min in light activity and 32 min in moderate-to-vigorous activity. Light and moderate-to-vigorous activity were negatively associated with fat percent (r = − 0.360 and r = − 0.384, respectively, p < 0.001 for both), and positively with SPPB, 10-m walk and 6-min walk results (r = 0.145–0.279, p < 0.01, for light and r = 0.220–0.465, p < 0.001, for moderate-to-vigorous activity). In detailed investigation of the intensity range, associations of physical activity with fat percent, 6-min walk and 10-m walk were statistically significant from very light intensity activity onward, whereas significant associations between physical activity and SPPB were observed mostly at higher end of the intensity range. Sedentary time was positively associated with fat percent (r = 0.251, p < 0.001) and negatively with 6-min walk (r = − 0.170, p < 0.01). Conclusion Perusing the physical activity intensity range revealed that, among community-dwelling sedentary or at most moderately active older adults, physical activity of any intensity was positively associated with lower fat percent and higher walking speed over long and short distances. These findings provide additional evidence of the importance of encouraging older adults to engage in physical activity of any intensity. More intervention studies are required to confirm the health benefits of light-intensity activity.
Background - Treatments should be customized to patients to improve patients’ health outcomes and maximize the treatment benefits. We aimed to identify meaningful data-driven trajectories of incident type 2 diabetes patients with similarities in glycated haemoglobin (HbA1c) patterns since diagnosis and to examine their clinical and economic relevance. Materials and methods - A cohort of 1540 patients diagnosed in 2011–2012 was retrieved from electronic health records covering primary and specialized healthcare in the North Karelia region, Finland. EHRs data were compiled with medication purchase data. Average HbA1c levels, use of medications, and incidence of micro- and macrovascular complications and deaths were measured annually for seven years since T2D diagnosis. Trajectories were identified applying latent class growth models. Differences in 4-year cumulative healthcare costs with 95% confidence intervals (CIs) were estimated with non-parametric bootstrapping. Results - Four distinct trajectories of HbA1c development during 7 years after T2D diagnosis were extracted: patients with “Stable, adequate” (66.1%), “Slowly deteriorating” (24.3%), and “Rapidly deteriorating” glycaemic control (6.2%) as well as “Late diagnosed” patients (3.4%). During the same period, 2.2 (95% CI 1.9–2.6) deaths per 100 person-years occurred in the “Stable, adequate” trajectory increasing to 3.2 (2.4–4.0) in the “Slowly deteriorating”, 4.7 (3.1–6.9) in the “Rapidly deteriorating” and 5.2 (2.9–8.7) in the “Late diagnosed” trajectory. Similarly, 3.5 (95% CI 3.0–4.0) micro- and macrovascular complications per 100 person-years occurred in the “Stable, adequate” trajectory increasing to 5.1 (4.1–6.2) in the “Slowly deteriorating”, 5.5 (3.6–8.1) in the “Rapidly deteriorating” and 7.3 (4.3–11.8) in the “Late diagnosed” trajectory. Patients in the “Stable, adequate” trajectory had lower accumulated 4-year medication costs than other patients. Conclusions - Data-driven patient trajectories have clinical and economic relevance and could be utilized as a step towards personalized medicine instead of the common “one-fits-for-all” treatment practices.
This study investigated whether personality traits moderate the effects of a 12-month physical or combined physical and cognitive training interventions on physical and cognitive functioning. Participants were community-dwelling 70–85-year-old adults (n = 314). They were randomly assigned to physical training (weekly supervised walking/balance and strength/balance training, home exercises 2–3×/wk and moderate aerobic activity) or to a physical and cognitive training group (the same physical training and computer training on executive functions 3–4×/wk). The outcomes assessed at baseline and post-intervention were physical (maximum gait speed, six-minute walking distance, dual-task cost on gait speed) and cognitive functioning (Stroop, Trail-Making Test-B, verbal fluency, CERAD total score). Personality traits (NEO-PI-3, n = 239) were assessed post-intervention. Personality traits did not moderate intervention effects on physical functioning. Higher openness was associated with greater improvement in CERAD scores, especially in the physical and cognitive training group (group×time×trait B = -0.08, p = .038). Lower neuroticism (time×trait B = -0.04, p = .021) and higher conscientiousness (time×trait B = 0.04, p = .027) were associated with greater improvement in CERAD scores in both groups. Personality traits had mostly null moderating effects across physical and cognitive outcomes, with the possible exception of CERAD score. Individuals with more adaptive personality traits gained more on global cognitive scores during a 12-month training intervention.
Background Executive functions underlie self-regulation and are thus important for physical activity and adaptation to new situations. The aim was to investigate, if yearlong physical and cognitive training (PTCT) had greater effects on physical activity among older adults than physical training (PT) alone, and if executive functions predicted physical activity at baseline, after six (6m) and twelve months (12m) of the interventions, one-year post-intervention follow-up and an extended follow-up during COVID-19 lockdown. Methods Data from a single-blinded, parallel-group randomized controlled trial (PASSWORD-study, ISRCTN52388040) were utilized. Participants were 70–85 years old community-dwelling men and women from Jyväskylä, Finland. PT (n = 159) included supervised resistance, walking and balance training, home-exercises and self-administered moderate activity. PTCT (n = 155) included PT and cognitive training targeting executive functions on a computer program. Physical activity was assessed with a one-item, seven-scale question. Executive functions were assessed with color-word Stroop, Trail Making Test (TMT) B-A and Letter Fluency. Changes in physical activity were modeled with multinomial logistic models and the impact of executive functions on physical activity with latent change score models. Results No significant group-by-time interaction was observed for physical activity (p>0.1). The subjects were likely to select an activity category higher than baseline throughout the study (pooled data: B = 0.720–1.614, p<0.001–0.046). Higher baseline Stroop predicted higher physical activity through all subsequent time-points (pooled data: B = 0.011–0.013, p = 0.015–0.030). Higher baseline TMT B–A predicted higher physical activity at 6m (pooled data: B = 0.007, p = 0.006) and during COVID-19 (B = 0.005, p = 0.030). In the PT group, higher baseline Letter Fluency predicted higher physical activity at 12m (B = -0.028, p = 0.030) and follow-up (B = -0.042, p = 0.002). Conclusions Cognitive training did not have additive effects over physical training alone on physical activity, but multicomponent training and higher executive function at baseline may support adaptation to and maintenance of a physically active lifestyle among older adults.
This study investigated the impact of multimorbidity patterns on physical activity and capacity outcomes over the course of a year-long exercise intervention, and on physical activity 1 year later. Participants were 314 physically inactive communitydwelling men and women aged 70–85 years, with no contraindications for exercise at baseline. Physical activity was selfreported. Physical capacity measurements included five-time chair-stand time, 6-minute walking distance, and maximal isometric knee-extension strength. The intervention included supervised and home-based strength, balance, and walking exercises. Multimorbidity patterns comprised physician-diagnosed chronic disease conditions as a predictor cluster and body mass index as a measure of obesity. Multimorbidity patterns explained 0%–12% of baseline variance and 0%–3% of the change in outcomes. The magnitude and direction of the impact of unique conditions varied by outcome, time point, and sex. Multimorbid older adults with no contraindications for exercise may benefit from multimodal physical training.
Background The aim of this study is to investigate whether combined cognitive and physical training provides additional benefits to fall prevention when compared with physical training alone in older adults. Methods This is a prespecified secondary analysis of a single-blind, randomized controlled trial involving community‐dwelling men and women aged 70 to 85 years who did not meet the physical activity guidelines. The participants were randomized into combined physical and cognitive training (PTCT, n=155) and physical training (PT, n=159) groups. PT included supervised and home-based physical exercises following the physical activity recommendations. PTCT included PT and computer-based cognitive training. The outcome was the rate of falls over the 12-month intervention (PTCT, n=151 and PT, n=155) and 12-month postintervention follow-up (PTCT, n=143 and PT, n=148). Falls were ascertained from monthly diaries. Exploratory outcomes included the rate of injurious falls, faller/recurrent faller/fall-related fracture status, and concern about falling. Results Estimated incidence rates of falls per person-year were 0.8 (95% CI 0.7–1.1) in the PTCT and 1.1 (95% CI 0.9–1.3) in the PT during the intervention and 0.8 (95% CI 0.7–1.0) versus 1.0 (95% CI 0.8–1.1), respectively, during the postintervention follow-up. There was no significant difference in the rate of falls during the intervention (incidence rate ratio [IRR] 0.78; 95% CI 0.56–1.10, p=0.152) or in the follow-up (IRR=0.83; 95% CI 0.59–1.15, p=0.263). No significant between-group differences were observed in any exploratory outcomes. Conclusion A yearlong PTCT intervention did not result in a significantly lower rate of falls or concern about falling than PT alone in older community‐dwelling adults.
Gait speed is a measure of health and functioning. Physical and cognitive determinants of gait are amenable to interventions, but best practices remain unclear. We investigated the effects of a 12‐month physical and cognitive training (PTCT) on gait speed, dual‐task cost in gait speed, and executive functions (EFs) compared to physical training (PT) (ISRCTN52388040). Community‐dwelling older adults, who did not meet physical activity recommendations, were recruited (n=314). PT included supervised walking/balance (once weekly) and resistance/balance training (once weekly), home exercises (2‐3 times weekly) and moderate aerobic activity 150 minutes/week in bouts of >10 minutes. PTCT included the PT and computer training (CT) on EFs 15‐20 minutes, 3‐4 times weekly. The primary outcome was gait speed. Secondary outcomes were 6‐minute walking distance, dual‐task cost in gait speed, and EF (Stroop and Trail Making B‐A). The trial was completed by 93% of the participants (age 74.5 [SD3.8] years; 60% women). Mean adherence to supervised sessions was 59‐72% in PT and 62‐77% in PTCT. Home exercises and CT were performed on average 1.9 times/week. Weekly minutes spent in aerobic activities were 188 (median 169) in PT and 207 (median 180) in PTCT. No significant interactions were observed for gait speed (PTCT‐PT, 0.02; 95%CI ‐0.03, 0.08), walking distance (‐3.8; ‐16.9, 9.3) or dual‐task cost (‐0.22; ‐1.74, 1.30). Stroop improvement was greater after PTCT than PT (‐6.9; ‐13.0, ‐0.8). Complementing physical training with EFs training is not essential for promotion of gait speed. For EF’s, complementing physical training with targeted cognitive training provides additional benefit.