Monilukutaito ensimmäisellä luokalla : Kuvaus yhdestä luokasta

Tutkimuksen tarkoituksena oli selvittää, mitä monilukutaidon sisältöjä ensimmäisessä luokassa käsitellään. Lisäksi tavoitteena oli tuoda esille lapsinäkökulma, eli oppilaiden näkökulmaa moniluku-taidon sisältöihin. Teoreettisena viitekehyksenä hyödynnettiin aiempaa tutkimusta monilukutaidosta. Monilukutaidon sisältöjä jäsennettiin Leinon (2014) ja Kallionpään (2014) erittelyillä sekä useiden aiheeseen liittyvien kansainvälisten tutkimusten pohjalta. Apuna sisältöjen määrittelyssä käytettiin myös perusopetuksen opetussuunnitelman perusteita (Opetushallitus 2014a), joka esittelee monilukutaidon yhtenä laaja-alaisen osaamisen taitona. Tutkimusaineisto kerättiin yhdessä peruskoulun ensimmäisessä luokassa kevätlukukauden loppu-puolella. Aineisto koostui luokkatilanteiden kolmen viikon havainnointiaineistosta, sekä oppilaiden tekemistä piirustuksista, joita saatiin yhteensä 28 kappaletta. Tutkimus suoritettiin etnografisena havainnointina, joka oli luonteeltaan säännöllistä ja havainnointi kohdistui kaikkiin ensimmäisen luokan oppiaineisiin. Havainnoinnin apuna käytettiin tätä tutkimusta varten tehtyä havainnointilomaketta. Havainnointijakson päätteeksi oppilaita pyydettiin apukysymysten avulla piirtämään monilukutaitoon liittyen. Koko tutkimusaineisto analysoitiin laadullisen, teoriaohjaavan sisällönanalyysin mukaan. Tulokseksi saatiin, että monilukutaidon sisällöt olivat tutkitulla ensimmäisellä luokalla vielä hyvin perinteisiä. Oppitunneilla hyödynnettiin eniten perinteistä painettua mediaa, mutta vielä vähän digitaalista materiaalia ja multimodaalisuutta. Teknisiin tietoihin ja taitoihin sekä mediatuntemukseen liittyviä sisältöjä esiintyi, vaikka nykypäivän teknologian käyttö olikin vähäistä. Informaation hallintaan liittyviä sisältöjä ei tullut niin voimakkaasti esille. Sosiaaliset taidot monilukutaidossa ilmenivät muutamissa tilanteissa. Monilukutaidon sisältöjä havaittiin enemmän lukuaineissa kuin taito- ja taideaineissa. Tutkitun luokan oppilaiden kokemusmaailmassa esiintyivät taas voimakkaasti teknologiset laitteet ja välineet, joita oppilaat hyödynsivät lukemiseen ja kirjoittamiseen. Myös kouluun liittyvä perinteinen media oli vahvasti esillä oppilaiden piirroksissa. Tutkimuksen pohjalta todettiin, että monilukutaito pitää sisällään hyvin monenlaisia taitoja, joiden tarkempaa jäsentelyä tarvittaisiin jatkossa perusopetuksessa

Eroosio- ja oikomishoitopotilaiden suun terveyden edistäminen : omahoidon materiaalia Varkauden suun terveydenhuollon eroosio- ja oikomishoitopotilaille

Poikkeavat olosuhteet suussa voivat aiheuttaa komplikaatioita suun terveydelle. Hyvä suun omahoito on siis erityisen tärkeää sekä eroosion ehkäisyssä ja hoidossa että oikomishoidossa. Hampaiden eroosiota eli hampaiden kemiallista kulumista esiintyy paljon nuorilla ja nuorilla aikuisilla. Se on lisääntymässä varsinkin virvoitus- ja energiajuomien käytön yleistyessä. Puutteellinen suun omahoito lisää hampaiden reikiintymisriskiä oikomishoidonaikana, sillä oikomishoitokojeet toimivat lisäretentiona suun haitallisille bakteereille. Oikomishoitopotilaat ovat usein kouluikäisiä lapsia. Siksi on tärkeää informoida potilaan lisäksi hänen huoltajiaan suun ja hampaiden hoidosta sekä oikomishoi-dossa käytettävien kojeiden oikeanlaisesta käytöstä. Tämä opinnäytetyö toteutettiin kehittämistyönä. Tuotokset valmistettiin kahtena erillisenä PowerPoint – diasarjana. Niiden sisältö valmistettiin kerätyn teoriatiedon pohjalta ottaen samalla huomioon toimeksiantajan toiveet. Opin-näytetyön toimeksiantaja oli Varkauden suun terveydenhuolto. Tarkoituksena oli tehdä suun omahoidon materiaaleja eroosio- ja oikomishoitopotilaille. Molempien kohderyhmien materiaali valmistettiin Varkauden suun terveydenhuollon odotusaulan taulutelevisiossa näytettäviksi. Suuhygienistit voivat käyttää omahoidon materiaalia myös potilaiden henkilökohtaisessa omahoidonohjauksessa. Tavoitteena on parantaa eroosio- ja oikomishoitopotilaiden suun omahoitoa, ja pidemmän aikavälin kuluessa vaikuttaa positiivisesti heidän suun terveyteensä. Tuotoksista pyydettiin väliarviointia Varkauden suun terveydenhuollon henkilökunnalta kyselylomakkeen muodossa. Lisäksi toimeksiantaja antoi suullista palautetta. Palaute oli rakentavaa ja auttoi kehittämään tuotoksia heidän toi-veidensa mukaisiksi ja lopulliseen muotoonsa. Tämän opinnäytetyön käyttöoikeuksista allekirjoitettiin käyttöoikeussopimus toimeksiantajan kanssa. Sopimuksen kautta toimeksiantajalle annettiin lupa jatkokehittää ja käyttää tuotoksia omissa tarkoituksissaan. Toimeksiantajan suunnitelmissa on esimerkiksi laittaa tuottamamme materiaalit internettiin omille verkkosivuilleen, jossa ne ovat suuremman yleisön tavoitettavissa. Lisäksi opinnäytetyöntekijät saavat käyttää ja jatkokehittää tuotoksiaan.An abnormal circumstance in the mouth can cause complications for oral health. Therefore, good oral self-care is of a particular importance, both in prevention of dental erosion and in the orthodontic treatment. Tooth erosion, or teeth dry wear, occurs a lot among youngsters and young adults. It is increasing as a result of the widespread use of soft and energy drinks. The lack of oral self-care increases the risk of dental decay as orthodontic instruments are always the source of extra retention for the adverse bacteria found in the mouth. Orthodontic patients are often school-age children. This is the reason why properly informing both the patient and their carers about oral self-care instructions and information on the correct use of orthodontic devices is important. This thesis was carried out as a development work. The contents of the final work were produced on the basis of the existing theoretical knowledge, while taking into account the wishes of the client, Dental Health Care of Varkaus. The aim of the work was to create self-care materials for two specific groups: erosion and orthodontic patients. The final work was produced in the form of PowerPoint-slideshow, which was specifically created to be shown on the flat-screen in the lobby of Dental Healthcare. Moreover, dental hygienists will be able to use the materials for patients´ personal oral self-care education. The aim of the work was to improve the quality of oral self-care in cases of erosion and orthodontic patients. In addition, this work will have a positive impact on patients’ oral health in the future.The staff of Dental Healthcare was requested to give feedback in the form of a questionnaire. Furthermore, the client provided feedback also in verbal form. Received feedback was constructive and helped to develop materials for the better. The final versions of the work were improved by using the received feedback. The access rights to this work were specified in a license agreement with the client. Through the agreement, the client is authorized to further develop and use the materials for its own purposes. For example, the client plans to post the materials on their own website, where they will be available for a larger audience. In addition, the original creators of this thesis work are also allowed to use and further develop it

Therapy outcome related to adalimumab trough levels in pediatric patients with inflammatory bowel disease

Objectives We evaluated the relationship between serum concentration and efficacy of adalimumab (ADA), an anti-tumor necrosis factor-alpha agent, in pediatric patients with inflammatory bowel disease (PIBD). Materials and methods This retrospective cross-sectional study traced 75 patients with PIBD (Crohn's disease, n = 57) treated with ADA at two tertiary centers in Finland in 2012-2018. Drug levels and drug antibody titers were chart-reviewed, and the treatment continuation rate of ADA therapy was evaluated. We also assessed the impact of trough levels in the first 3 months on the continuation of ADA within one year of therapy. Results ADA was introduced at a median age of 13.4 years, and the median disease duration was 2.7 years. During the first year, 22 patients (29%) discontinued ADA due to either loss of response (20%, n = 15) or anti-drug antibody formation (5.3%, n = 4). Regarding trough levels in the first 3 months, 9/16 patients (56%) with trough levels 7.5 mg/L at 3 months discontinued treatment during the first year (p = .005). At the last follow-up (median 1.5 years), 52% of the 75 patients were on maintenance therapy and had a median trough level of 8.8 mg/L. Conclusion Higher trough levels in the first 3 months of adalimumab treatment are associated with lower rates of discontinuation due to loss of response during the first year.Peer reviewe

Tyrosinemia

English summar

Differential diagnosis and long-term outcomes of non-atrophic duodenal changes in children

Peer reviewe

Frequency and clinical significance of histologic upper gastrointestinal tract findings in children with inflammatory bowel disease

Objective Assessment of the upper gastrointestinal tract (UGI) may enable more personalized treatment strategies in pediatric inflammatory bowel disease (IBD). However, data on the frequency and significance of these findings remain limited. Methods Data on 132 pediatric IBD patients with systematic UGI sampling were collected and the baseline characteristics and presence of complications compared between those with and without histological UGI findings. The control group comprised 162 children who received no diagnoses. Results Seventy-six children had ulcerative colitis (UC), 47 Crohn's disease (CD) and nine IBD unclassified. UGI findings were more common in IBD patients than controls (69.7% vs. 30.9%, respectively, p < .001), particularly in the stomach (62.1% vs. 16.8%; p < .001). Among IBD patients, findings were more common in CD than in UC (80.9% vs. 63.2%; p = .038), particularly in the duodenum (21.3% vs. 2.6%, p = .001). Four patients had UGI granulomas consistent with CD. Hypoalbuminemia (OR 3.22; 95% CI 1.18-8.79) and failure to thrive (2.82; 1.17-6.78) increased the likelihood of UGI findings in IBD. In CD, perianal morbidity was less common in those with than in those without UGI findings (13.2% vs. 44.4%; p = .032) whereas in UC, UGI findings increased the risk for co-morbidities (18.8% vs. 3.6%; p = .059). The long-term outcomes did not differ between patients with or without UGI findings. Conclusions Histologic UGI findings were more common in children with IBD than in children with no gastrointestinal diagnoses. In CD, UGI findings were more frequent than in UC, especially in the duodenum. In UC, UGI findings were associated with more complex disease.Peer reviewe

Parental Mental Well-Being and Frequency of Adult-Child Nature Visits : The Mediating Roles of Parents’ Perceived Barriers

Regular access to green space has been shown to provide several health benefits for children. However, children today spend less time outdoors. Thus, it has become important to understand what drives and limits children’s activities in nature. Based on a Finnish online survey of 1463 parents of children aged 2–7 conducted in 2019, the current study examined parents’ perceived barriers to visiting nature with their children. It also examined how parental mental well-being is related to families’ frequency of nature visits, and whether this association is mediated by different categories of parents’ perceived barriers. Eleven out of 12 barriers were largely perceived by parents as reasons that did not prevent them from visiting nature with their children. Next, factor analysis indicated a three-factor solution to the barriers. The results of a multiple mediation analysis showed that better parental mental well-being was associated with more frequent adult-child nature visits, and this relationship was partially mediated by a “lack of competence and logistics” and a “lack of time and interest”, but not by “insecurity and fear”. The results indicated that parents with poor mental well-being were more likely to perceive barriers to visiting nature, which in turn appeared to be related to a higher likelihood of having children who visited nature less frequently

Parental Mental Well-Being and Frequency of Adult-Child Nature Visits: The Mediating Roles of Parents’ Perceived Barriers

Regular access to green space has been shown to provide several health benefits for children. However, children today spend less time outdoors. Thus, it has become important to understand what drives and limits children’s activities in nature. Based on a Finnish online survey of 1463 parents of children aged 2–7 conducted in 2019, the current study examined parents’ perceived barriers to visiting nature with their children. It also examined how parental mental well-being is related to families’ frequency of nature visits, and whether this association is mediated by different categories of parents’ perceived barriers. Eleven out of 12 barriers were largely perceived by parents as reasons that did not prevent them from visiting nature with their children. Next, factor analysis indicated a three-factor solution to the barriers. The results of a multiple mediation analysis showed that better parental mental well-being was associated with more frequent adult-child nature visits, and this relationship was partially mediated by a “lack of competence and logistics” and a “lack of time and interest”, but not by “insecurity and fear”. The results indicated that parents with poor mental well-being were more likely to perceive barriers to visiting nature, which in turn appeared to be related to a higher likelihood of having children who visited nature less frequently

Type 1 tyrosinemia in Finland: a nationwide study

Background Introduction of nitisinone and newborn screening (NBS) have transformed the treatment of type 1 tyrosinemia, but the effects of these changes on the long-term outcomes remain obscure. Also, the predictors for later complications, the significance of drug levels and the normalization of laboratory and imaging findings are poorly known. We investigated these issues in a nationwide study. Results Type 1 tyrosinemia was diagnosed in 22 children in 1978-2019 in Finland. Incidence was 1/90,102, with a significant enrichment in South Ostrobothnia (1/9990). Median age at diagnosis was 5 (range 0.5-36) months, 55% were girls and 13 had homozygotic Trp262X mutation. Four patients were detected through screening and 18 clinically, their main findings being liver failure (50% vs. 100%, respectively, p = 0.026), ascites (0% vs. 53%, p = 0.104), renal tubulopathy (0% vs. 65%, p = 0.035), rickets (25% vs. 65%, p = 0.272), growth failure (0% vs. 66%, p = 0.029), thrombocytopenia (25% vs. 88%, p = 0.028) and anaemia (0% vs. 47%, p = 0.131). One patient was treated with diet, seven with transplantation and 14 with nitisinone. Three late-diagnosed (6-33 months) nitisinone treated patients needed transplantation later. Kidney dysfunction (86% vs. 7%, p = 0.001), hypertension (57% vs. 7%, p = 0.025) and osteopenia/osteoporosis (71% vs. 14%, p = 0.017) were more frequent in transplanted than nitisinone-treated patients. Blood/serum alpha-fetoprotein decreased rapidly on nitisinone in all but one patient, who later developed intrahepatic hepatocellular carcinoma. Liver values normalized in 31 months and other laboratory values except thrombocytopenia within 18 months. Imaging findings normalized in 3-56 months excluding five patients with liver or splenic abnormalities. Low mean nitisinone concentration was associated with higher risk of severe complications (r = 0.758, p = 0.003) despite undetectable urine succinylacetone. Conclusions Prognosis of type 1 tyrosinemia has improved in the era of nitisinone, and NBS seems to provide further benefits. Nevertheless, the long-term risk for complications remains, particularly in the case of late diagnosis and/or insufficient nitisinone levels.Peer reviewe