Autologous reconstructions are associated with greater overall medium-term care costs than implant-based reconstructions in the Finnish healthcare system : A retrospective interim case-control cohort study

Purpose: Previous studies have mainly reported the short-term costs of different reconstruction techniques. Revision operations may increase costs in longer follow-up. Authors report medium-term data on different reconstruction methods. We hypothesised that the reconstruction method would affect not only the duration of reconstruction process but also total costs. Methods: The reconstruction database was reviewed from 2008 to 2019. Women with autologous (deep inferior epigastric perforator, transverse musculocutaneous gracilis and latissimus dorsi [LD] without implant) and implant-based (implant and LD with implant) reconstructions were included. Variables evaluated included age, body mass index, smoking, comorbidities, radiotherapy, complications and readmissions. Risk factors for multiple revision surgeries were analysed. Time to definitive reconstruction and related costs were also calculated. Results: In total, 591 patients with autologous reconstructions and 202 with implant-based reconstructions were included. The median follow-up time was 73 months. Definitive reconstruction was obtained in 443 days in implant-based reconstructions and in 403 days in autologous reconstructions (P = 0.050). Independent risk factors for multiple surgeries were younger age (P < 0.001) and comorbidity (P = 0.008). No statistically significant difference was observed in the rate of overall surgical procedures (P = 0.098), but implant-based reconstructions were more commonly associated with two or more planned operations (P = 0.008). Autologous reconstructions were associated with greater total cost ($22 052 vs.$18 329, P < 0.001). Conclusions: This review of reconstructions over a 12-year study period revealed that autologous reconstructions are associated with greater overall costs, but there is no statistically significant difference in reconstruction time or rate of surgical procedures. However, a full cost assessment between reconstructive techniques requires a much longer follow-up period.publishedVersionPeer reviewe

“There Is Freedom of Religion in Finland, But…” The Helsinki Mosque Debate

In this chapter, we examine statements of Finnish municipal election candidates regarding plans to build a “grand mosque” and cultural centre in central Helsinki. Despite proclaiming support for the universal freedom of religion, the candidates were hesitant to apply it to the mosque case. Opponents of the mosque project emphasized the Christian heritage of Finland and portrayed the proposed mosque as a channel through which foreign conflicts could enter Finnish society. The mosque was also opposed because it was seen as a “political” project instead of a “religious” one. The proponents of the mosque, in turn, considered it to be a “Muslim church” and therefore entitled to the same treatment as Christian houses of worship. The mosque was also seen as important to the local Muslim community, but very few candidates considered the possibility of the mosque (or Islam) making a positive contribution to the broader society. Besides identifying the key discourses, we reflect on them from a religious literacy perspective.Peer reviewe

Long-term prognosis of haemangioblastoma of the CNS: Impact of von Hippel-Lindau disease

Peer reviewe

W(h)ither the academy? An exploration of the role of university social work in shaping the future of social work in Europe

A controversial proposal to pilot the training of child protection social workers through an intensive work-based route in England is being supported and funded by the UK Government. Frontline, the brainchild of a former teacher, locates social work training within local authorities (‘the agency’) rather than university social work departments (‘the academy’) and has stimulated debate amongst social work academics about their role in shaping the direction of the profession. As a contribution to this debate, this paper explores the duality of social work education, which derives its knowledge from both the academic social sciences and the experience of practice within social work agencies. While social work education has traditionally been delivered by the academy, this paper also explores whether the delivery of training in the allied professions of probation and nursing by ‘the agency’ is equally effective. Finally, this paper explores the Helsinki model which achieves a synergy of ‘academy’ and ‘agency’. It suggests that there are alternative models of social work education, practice and research which avoid dichotomies between the ‘academy’ and the ‘agency’ and enable the profession to be shaped by both social work academics and practitioners

Governing Divorce Practices of Somali Finnish Muslims : Does Religious Literacy Matter?

Peer reviewe

Qualitative study of social and healthcare educators' perceptions of their competence in education

Competent educators are needed to ensure that social and healthcare professionals are effective and highly competent. However, there is too little evidence-based knowledge of current and required enhancements of educators' competences in this field. The aim of this study was to describe social and healthcare educators' perceptions of their competence in education. The study had a qualitative design, based on interviews with educators and rooted in critical realism. Forty-eight participants were recruited from seven universities of applied sciences and two vocational colleges in Finland, with the assistance of contact persons nominated by the institutions. The inclusion criterion for participation was employment by an educational institution as a part-time or full-time, social and/or healthcare educator. Data were collected in the period February-April 2018. The participants were interviewed in 16 focus groups with two to five participants per group. The acquired data were subjected to inductive content analysis, which yielded 506 open codes, 48 sub-categories, nine categories and one main category. The educators' competence was defined as a multidimensional construct, including categories of educators' competences in practicing as an educator, subject, ethics, pedagogy, management and organisation, innovation and development, collaboration, handling cultural and linguistic diversity, and continuous professional development. Educators recognised the need for developing competence in innovation to meet rapid changes in a competitive and increasingly global sociopolitical environment. Enhancement of adaptability to rapid changes was recognised as a necessity. The findings have social value in identifying requirements to improve social and healthcare educators' competence by helping educational leadership to improve educational standards, construct a continuous education framework and create national and/or international curricula for teacher education degree programs to enhance the quality of education. We also suggest that educational leadership needs to establish, maintain and strengthen collaborative strategies to provide effective, adaptable support systems, involving educators and students, in their working practices

Social- and Health Care Educators’ Cultural Competence

Introduction and aim: Cultural differences have significant impacts on classroom behaviours and communication in teaching. The aim of this study is to explore social and healthcare educators’ cultural competence in transcultural education. Methodology: Data was collected from semi-structured focus group interviews at universities of applied sciences and vocational colleges. Inductive content analysis was used in the analysis process. Results: Educators’ cultural competence in transcultural education emerges as generic categories: transcultural education, educatorship and ethical attitudes, and underpins by the sub-categories: language and linguistics, different learning styles, integrating multicultural students, cultural knowledge and sensitivity, collaborating and cooperating, self-awareness and openness, and respecting and caring. Conclusion: Cultural competence represents a core competence for social-and health care educators. Educators need to know students’ background, master different learning styles, be flexible in their pedagogical approaches and have an open and ethical attitude.  </p

Breast and other cancers in 1445 blood relatives of 75 Nordic patients with ataxia telangiectasia

Epidemiological studies have consistently shown elevated rates of breast cancer among female blood relatives of patients with ataxia telangiectasia (AT), a rare autosomal recessive disease. A large proportion of the members of AT families are carriers of AT-causing gene mutations in ATM (Ataxia Telangiectasia Mutated), and it has been hypothesised that these otherwise healthy carriers are predisposed to breast cancer. This is an extended and enlarged follow-up study of cancer incidence in blood relatives of 75 patients with verified AT in 66 Nordic families. Blood relatives were identified through population registry linkages, and the occurrence of cancer was determined from cancer registry files in each country and compared with national incidence rates. The ATM mutation carrier probabilities of relatives were assigned from the combined information on location in family, consanguinity, if any, and supplementary carrier screening in some families. Among the 1445 blood relatives of AT patients, 225 cancers were observed, with 170.4 expected, yielding a standardised incidence ratio (SIR) of 1.3 (95% confidence interval (CI), 1.1–1.4). Invasive breast cancer occurred in 34 female relatives (SIR, 1.7; 95% CI, 1.2–2.4) and was diagnosed in 21 women before the age of 55 years (SIR, 2.9; 95% CI, 1.8–4.5), including seven mothers of probands (SIR, 8.1; 95% CI, 3.3–17). When the group of mothers was excluded, no clear relationship was observed between the allocated mutation carrier probability of each family member and the extent of breast cancer risk. We concluded that the increased risk for female breast cancer seen in 66 Nordic AT families appeared to be restricted to women under the age of 55 years and was due mainly to a very high risk in the group of mothers. The findings of breast cancer risk in mothers, but not other likely mutation carriers, in this and other studies raises questions about the hypothesis of a simple causal relationship with ATM heterozygosity