Moniammatillinen perhevalmennus Hyvinkäällä

Tämä opinnäytetyö on kehittämishanke, jonka aiheena on moniammatillisen perhevalmennuksen luominen Hyvinkäälle. Hankkeen tavoitteena oli muodostaa Hyvinkäälle perhevalmennusmalli, jossa eri ammattiryhmät toimivat yhdessä lasta odottavien perheiden parhaaksi. Tavoitteiden saavuttamiseksi osana kehittämishanketta tehtiin tutkimusosio. Tutkimusosiossa työryhmän jäsenet kirjoittivat vapaamuotoisia esseitä ajatuksistaan hyvästä ja toimivasta perhevalmennuksesta. Lähestymistapana käytettiin tulevaisuuden muistelua. Esseet analysoitiin sisällön-analyysin avulla. Monianmmatillisen työryhmän ajatusten pohjalta Hyvinkäälle kehitettiin perhevalmennusmalli, jonka tarkoitus on tukea vauvaperheen arjessa selviytymistä ja mahdollistaa vertaistuen saaminen. Kaikki tutkimukseen osallistuneet työntekijät määrittelivät hyvän perhevalmennuksen lähes samoilla tekijöillä. Hyvä perhevalmennus tavoittaa kaikki ensisynnyttäjät ja on sisällöltään tulevia vanhempia kiinnostava ja motivoiva. Tutkimukseen osallistuneiden työntekijöiden mielestä valmennuksissa tulisi olla enemmän asiaa parisuhteesta ja arjesta vauvan kanssa. Valmennuksen tulisi valmentaa elämään synnytyksen jälkeen, ei synnytykseen. Tutkimukseen osallistuneet työntekijät näkivät oman roolinsa perhevalmennuksen toteuttajana asiantuntijana olemiseksi. He toimivat vanhempien kannustajina ja oppaina vanhemmuuden tiellä. aikki työryhmän jäsenet pitivät perhevalmennusta tärkeänä, mutta myös erittäin haasteellisena. Onnistuneen valmennuksen nähtiin lisäävän vertaistuen mahdollisuutta ja vanhempien onnistumisen tunnetta van-hempina. Haasteina nähtiin etenkin niiden perheiden motivoiminen, joille perhe-valmennuksesta olisi eniten hyötyä mutta jotka usein jäävät sen ulkopuolelle omasta halustaan.. Avainsanat: Perhevalmennus, moniammatillisuus, vertaistuki, vanhemmuusThis master’s thesis is development project which topic was to create and describe multiprofessional family coaching model in city of Hyvinkää. Development pro-jects goal was develop family coaching model, where the different professional groups work together for expecting families’ best interest. To reach the aim of the study pool research was done. The research material was collected with the help of informal essays. Approaching model in this study was recalling future. The recalling of future is approaching model where the participants will jump to the future and find out concrete ways to make future better. The contents were analyzed by using contents analysis. The purpose was to illustrate the multi professional group’s conception of good family coaching and develop new model of family coaching. Family coaching model of Hyvinkää was based multi-professionals groups ideas. Family coaching model helps to support family’s whit their daily life and allow peer support. All the research participants identified almost the same factors of good family coaching. A good family coaching helps prepare firsttime mothers and has interesting and motivating contents for future parents. According to the participants of research, the family coaching could include more issues concerning the couple’s relationship and their daily life with the baby. Family coaching should be about early parenthood and not only about labour. The research participants see their role in family coaching as accomplished experts who are acting as inspirers to the parents and guides to parenthood. All the participants considered family coaching important but also very challenging. Successful coaching increased the possibilities of peer support and the parents’ feelings of becoming successful parents. It was challenging to find ways of motivating those families which willingly stay away from coaching but would be most benefited from it. Keywords: family coaching, multi-professionalism, peer support, parenthoo

Skenaariotyöskentelyllä tietoa tulevaisuuden sosiaali- ja terveyspalveluista ja osaamistarpeista

The aim of the two development projects was to provide information about the future of digital social- and health care and the necessary future competencies. Data acquisition was carried out by scenario work in the future workshops. The workshops were attended total of 73 people. The participants worked in the social and health care, both in the public and private sectors, in ICT companies, in educational organizations, and in the third sector. Among the participants were also ordinary citizens. The workshops were remotely connected and data was collected into electronic bulletin boards. The workshops produced total of 25 scenarios, which found eight different themes: information management, quantified self, remote services, robotics - automation of manual labour, multiprofessionality, digital architecture, customer-oriented services and the customer's responsibility, and human encounter. Future competency consisted of ten areas of expertise, which classified into three broader categories: basic know-how of social and health care professionals, special know-how of social and health care professionals and the collective know-how of social and health care and technology professionals. The special know-how also includes information systems and software development skills. Scenario work provided preliminary information about the future social and health services and qualifications. This information will be used in further development projects of digital services as well as more widely in education planning. The future workshops provided information about the scenario method and its compatibility with development activities.Kahden kehittämishankkeen tavoitteena oli tuottaa tietoa sosiaali- ja terveydenhuollon digitaalisista tulevaisuuksista ja tulevaisuudessa tarvittavasta osaamisesta. Tiedonhankinta toteutettiin skenaariotyöskentelynä tulevaisuustyöpajoissa. Työpajoihin osallistui yhteensä 73 henkilöä. Osallistujat työskentelivät sosiaali- ja terveydenhuollossa julkisella ja yksityisellä sektorilla, ICT-yrityksissä, koulutusorganisaatioissa sekä kolmannella sektorilla, mukana oli myös kansalaisia. Työpajoissa hyödynnettiin myös etäyhteyttä ja aineisto koottiin sähköisille ilmoitustauluille. Työpajoissa tuotettiin yhteensä 25 skenaariota, joista löytyi kahdeksan erilaista teemaa: tiedonhallinta, biohakkerointi, etäpalvelut, robotiikka – suorittavan työn automatisointi, moniammatillisuus, digiarkkitehtuuri, asiakaslähtöisyys ja asiakkaan vastuu sekä inhimillinen kohtaaminen. Tulevaisuuden osaaminen muodostui kymmenestä osaamisalueesta, jotka edelleen luokiteltiin kolmeen laajempaan luokkaan: sosiaali- ja terveydenhuollon ammattilaisen perusosaaminen, sosiaali- ja terveydenhuollon ammattilaisen erikoisosaaminen, teknologian ja sosiaali- ja terveydenhuollon ammattilaisen yhteinen osaaminen. Sosiaali- ja terveydenhuollon ammattilaisen erikoisosaamiseen sisältyy myös tietojärjestelmien ja ohjelmistojen kehittämisosaaminen. Skenaariotyöskentelyllä saatiin alustavaa tietoa tulevaisuuden sosiaali- ja terveyspalveluista ja osaamistarpeista. Tätä tietoutta käytetään kehittämishankkeissa digitaalisten palvelujen kehittämisessä sekä laajemmin koulutussuunnittelussa. Tulevaisuustyöpajoissa saatiin tietoa myös skenaariotyöskentelystä ja sen soveltuvuudesta kehittämistoiminnalle

Early-life exposure to common virus infections did not differ between coeliac disease patients and controls

Aim Our aim was to compare the presence of various common viruses (rhinovirus, enterovirus, adenovirus, Epstein-Barr virus, cytomegalovirus, norovirus, parechovirus) in stool and nasal swab samples as well as virus-specific antibodies in serum samples between children who developed coeliac disease and controls. Methods A case-control study was established based on the DIABIMMUNE Study cohorts. During the study, eight Estonian children and 21 Finnish children aged 1.5 years to five years developed coeliac disease and each was matched with a disease-free control. Nasal swabs and stool samples were taken at the age of three to six months and the serum samples at the time of diagnosis. Results Rhinovirus ribonucleic acid was detected in the nasal swabs from five coeliac disease children, but none of the control children (p = 0.05). There were no statistically significant differences in the level of viral antibodies between cases and controls. Enterovirus immunoglobulin G class antibodies were found more frequently in the Estonian than in the Finnish children (63% versus 23%, p = 0.02). Conclusion This study did not find any marked overall differences in laboratory-confirmed common viral infections between the children who developed coeliac disease and the controls. However, rhinovirus infections were detected slightly more often in those patients who developed coeliac disease.Peer reviewe

Exploring the risk factors for differences in the cumulative incidence of coeliac disease in two neighboring countries : the prospective DIABIMMUNE study

Background: During the last several decades the prevalence of coeliac disease (CD) has increased worldwide. Aim: To compare the cumulative incidence of CD between Estonian and Finnish children and to identify the risk factors. Materials and methods: Children were recruited as part of the DIABIMMUNE Study. In the birth cohort (BC) 258 children from Estonia and 305 from Finland, and in the young children's cohort (YCC) 1363 and 1384 children were followed up, respectively. The diagnosis of CD was made in accordance with the ESPGHAN guidelines-the presence of IgA-tTG antibodies and small bowel villous atrophy. Results: During the study period 29 children developed CD. The cumulative incidence of CD was significantly higher in Finland (0.77% vs 0.27%; P = 0.01). No difference was seen between the children with CD and the controls in the duration of breastfeeding or the age at cereal introduction. The BC children with CD had had significantly more episodes of infections with fever by the age of 12 months compared to the controls (3.4 vs 1.4; P = 0.04). Conclusion: The 5-year cumulative incidence of childhood CD is significantly higher in Finland than in Estonia. Sequential infections early in life may increase the risk for developing CD. (C) 2016 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.Peer reviewe

Maturation of Gut Microbiota and Circulating Regulatory T Cells and Development of IgE Sensitization in Early Life

Recent studies suggest that the cross-talk between the gut microbiota and human immune system during the first year of life is an important regulator of the later development of atopic diseases. We explored the changes in the gut microbiota, blood regulatory T cells, and atopic sensitization in a birth-cohort of Estonian and Finnish children followed from 3 to 36 months of age. We describe here an infant Treg phenotype characterized by high Treg frequency, the maturation of Treg population characterized by a decrease in their frequency accompanied with an increase in the highly activated Treg cells. These changes in Treg population associated first with the relative abundance of Bifidobacterium longum followed by increasing colonization with butyrate producing bacteria. High bifidobacterial abundance in the neonatal microbiota appeared to be protective, while colonization with Bacteroides and E. coli was associated with later risk of allergy. Estonian children with lower risk of IgE mediated allergic diseases than Finnish children showed an earlier maturation of the gut microbiota, detected as earlier switch to an increasing abundance of butyrate-producing bacteria, combined with an earlier maturation of Treg cell phenotype and total IgE production. The children with established allergic diseases by age 3 showed a decreased abundance of butyrate producing Faecalibacterium. These results suggest that as well as the maintenance of a bifidobacterial dominated gut microbiota is important during the first weeks of life, the overtake by butyrate producing bacteria seems to be a beneficial shift, which should not be postponed.Peer reviewe

Rhinoviruses in infancy and risk of immunoglobulin E sensitization

Previous data about the role of viruses in the development of allergic immunoglobulin E (IgE) sensitization are contradictory. The aim of this study was to determine the possible associations between exposure to different viruses (rhinovirus, enterovirus, norovirus, and parechovirus) during the first year of life and IgE sensitization. Viruses were analyzed from stool samples collected monthly from infants participating in a prospective birth cohort study. From that study, 244 IgE sensitized case children and 244 nonsensitized control children were identified based on their allergen-specific IgE antibody levels at the age of 6, 18, and 36 months. Stool samples (n = 4576) from the case and control children were screened for the presence of rhinovirus, enterovirus, norovirus, and parechovirus RNA by reverse transcription quantitative polymerase chain reaction. The study showed that rhinovirus was the most prevalent virus detected, present in 921 (20%) samples. None of the viruses were associated with IgE sensitization in the full cohort but after stratifying by sex, the number of rhinovirus positive samples was inversely associated with IgE sensitization in boys (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.69-0.94; P = 0.006). There was also a temporal relation between rhinoviruses and IgE sensitization, as rhinovirus exposure during the first 6 months of life was associated with a reduced risk of subsequent IgE sensitization in boys (OR: 0.76; 95% CI: 0.6-0.94; P = 0.016). In conclusion, early exposure to rhinoviruses was inversely associated with IgE sensitization but this protective association was restricted to boys.Peer reviewe

The Dynamics of the Human Infant Gut Microbiome in Development and in Progression toward Type 1 Diabetes

SummaryColonization of the fetal and infant gut microbiome results in dynamic changes in diversity, which can impact disease susceptibility. To examine the relationship between human gut microbiome dynamics throughout infancy and type 1 diabetes (T1D), we examined a cohort of 33 infants genetically predisposed to T1D. Modeling trajectories of microbial abundances through infancy revealed a subset of microbial relationships shared across most subjects. Although strain composition of a given species was highly variable between individuals, it was stable within individuals throughout infancy. Metabolic composition and metabolic pathway abundance remained constant across time. A marked drop in alpha-diversity was observed in T1D progressors in the time window between seroconversion and T1D diagnosis, accompanied by spikes in inflammation-favoring organisms, gene functions, and serum and stool metabolites. This work identifies trends in the development of the human infant gut microbiome along with specific alterations that precede T1D onset and distinguish T1D progressors from nonprogressors

Contribution of rare and common variants to intellectual disability in a sub-isolate of Northern Finland

The contribution of de novo variants in severe intellectual disability (ID) has been extensively studied whereas the genetics of mild ID has been less characterized. To elucidate the genetics of milder ID we studied 442 ID patients enriched for mild ID (>50%) from a population isolate of Finland. Using exome sequencing, we show that rare damaging variants in known ID genes are observed significantly more often in severe (27%) than in mild ID (13%) patients. We further observe a significant enrichment of functional variants in genes not yet associated with ID (OR: 2.1). We show that a common variant polygenic risk significantly contributes to ID. The heritability explained by polygenic risk score is the highest for educational attainment (EDU) in mild ID (2.2%) but lower for more severe ID (0.6%). Finally, we identify a Finland enriched homozygote variant in the CRADD ID associated gene.Peer reviewe

Stabilising selection on immune response in male black grouse Lyrurus tetrix

Illnesses caused by a variety of micro- and macro- organisms can negatively affect individuals’ fitness, leading to the expectation that immunity is under positive selection. However, immune responses are costly and individuals must trade-off their immune response with other fitness components (e.g. survival or reproductive success) meaning that individuals with intermediate response may have the greatest overall fitness. Such a process might be particularly acute in species with strong sexual selection because the condition-dependence of male secondary sexual-traits might lead to striking phenotypic differences amongst males of different immune response levels. We tested whether there is selection on immune response by survival and reproduction in yearling and adult male black grouse (Lyrurus tetrix) following an immune challenge with a novel antigen and tested the hypothesis that sexual signals and body mass are honest signals of the immune response. We show that yearling males with highest immune response to these challenges had higher survival, but the reverse was true for adults. Adults with higher responses had highest mass loss and adult males with intermediate immune response had highest mating success. Tail length was related to baseline response in adults and more weakly in yearlings. Our findings reveal the complex fitness consequences of mounting an immune response across age classes. Such major differences in the direction and magnitude of selection in multiple fitness components is an alternative route underpinning the stabilizing selection of immune responses with an intermediate immune response being optimal