Validating 10-joint juvenile arthritis disease activity score cut-offs for disease activity levels in non-systemic juvenile idiopathic arthritis

Objectives To validate cut-offs of the Juvenile Arthritis Disease Activity Score 10 (JADAS10) and clinical JADAS10 (cJADAS10) and to compare them with other patient cohorts. Methods In a national multicentre study, cross-sectional data on recent visits of 337 non-systemic patients with juvenile idiopathic arthritis (JIA) were collected from nine paediatric outpatient units. The cut-offs were tested with receiver operating characteristic curve-based methods, and too high, too low and correct classification rates (CCRs) were calculated. Results Our earlier presented JADAS10 cut-offs seemed feasible based on the CCRs, but the cut-off values between low disease activity (LDA) and moderate disease activity (MDA) were adjusted. When JADAS10 cut-offs for clinically inactive disease (CID) were increased to 1.5 for patients with oligoarticular disease and 2.7 for patients with polyarticular disease, as recently suggested in a large multinational register study, altogether 11 patients classified as CID by the cut-off had one active joint. We suggest JADAS10 cut-off values for oligoarticular/polyarticular disease to be in CID: 0.0-0.5/0.0-0.7, LDA: 0.6-3.8/0.8-5.1 and MDA: >3.8/5.1. Suitable cJADAS10 cut-offs are the same as JADAS10 cut-offs in oligoarticular disease. In polyarticular disease, cJADAS10 cut-offs are 0-0.7 for CID, 0.8-5.0 for LDA and > 5.0 for MDA. Conclusion I nternational consensus on JADAS cutoff values is needed, and such a cut-off for CID should preferably exclude patients with active joints in the CID group.Peer reviewe

Pain-coping scale for children and their parents : a cross-sectional study in children with musculoskeletal pain

BackgroundIn a chronic pain-causing disease such as juvenile idiopathic arthritis, the quality of coping with pain is crucial. Parents have a substantial influence on their children's pain-coping strategies. This study aimed to develop scales for assessing parents' strategies for coping with their children's pain and a shorter improved scale for children usable in clinical practice.MethodsThe number of items in the Finnish version of the pain-coping questionnaire for children was reduced from 39 to 20. A corresponding reduced scale was created for parental use. We recruited consecutive patients from nine hospitals evenly distributed throughout Finland, aged 8-16 years who visited a paediatric rheumatology outpatient clinic and reported musculoskeletal pain during the past week. The patients and parents rated the child's pain on a visual analogue scale from 0 to 100 and completed pain-coping questionnaires and depression inventories. The selection process of pain questionnaire items was performed using factor analyses.ResultsThe average (standard deviation) age of the 130 patients was 13.0 (2.3) years; 91 (70%) were girls. Four factors were retained in the new, improved Pain-Coping Scales for children and parents. Both scales had 15 items with 2-5 items/factor. The goodness-of-fit statistics and Cronbach's alpha reliability coefficients were satisfactory to good in both scaled. The criterion validity was acceptable as the demographic, disease related, and the depression and stress questionnaires correlated with the subscales.ConclusionsWe created a shorter, feasible pain-coping scale for children and a novel scale for caregivers. In clinical work, the pain coping scales may serve as a visualisation of different types of coping strategies for paediatric patients with pain and their parents and facilitate the identification of families in need of psychological support.Peer reviewe

Defining new clinically derived criteria for high disease activity in non-systemic juvenile idiopathic arthritis: a Finnish multicentre study

ObjectivesTo redefine criteria for high disease activity (HDA) in JIA, to establish HDA cut-off values for the 10-joint Juvenile Arthritis Disease Activity Score (JADAS10) and clinical JADAS10 (cJADAS10) and to describe the distribution of patients’ disease activity levels based on the JADAS cut-off values in the literature.MethodsData on 305 treatment-naïve JIA patients were collected from nine paediatric units treating JIA. The median parameters of the JADAS were proposed to be the clinical criteria for HDA. The cut-off values were assessed by using two receiver operating characteristics curve–based methods. The patients were divided into disease activity levels based on currently used JADAS cut-off values.ResultsWe proposed new criteria for HDA. At least three of the following criteria must be satisfied in both disease courses: in oligoarthritis, two or more active joints, ESR above normal, physician global assessment (PGA) of disease activity ≥2 and parent/patient global assessment (PtGA) of well-being ≥2; in polyarthritis, six or more active joints, ESR above normal, PGA of overall disease activity ≥4 and PtGA of well-being ≥2. The HDA cut-off values for JADAS10 (cJADAS) were ≥6.7 (6.7) for oligoarticular and ≥15.3 (14.1) for polyarticular disease. The distribution of the disease activity levels based on the JADAS cut-off values in the literature varied markedly based on which cut-offs were used.ConclusionNew clinically derived criteria for HDA in JIA and both JADAS and cJADAS cut-off values for HDA were proposed.</div

Validating 10-joint juvenile arthritis disease activity score cut-offs for disease activity levels in non-systemic juvenile idiopathic arthritis

Objectives To validate cut-offs of the Juvenile Arthritis Disease Activity Score 10 (JADAS10) and clinical JADAS10 (cJADAS10) and to compare them with other patient cohorts.Methods In a national multicentre study, cross-sectional data on recent visits of 337 non-systemic patients with juvenile idiopathic arthritis (JIA) were collected from nine paediatric outpatient units. The cut-offs were tested with receiver operating characteristic curve-based methods, and too high, too low and correct classification rates (CCRs) were calculated.Results Our earlier presented JADAS10 cut-offs seemed feasible based on the CCRs, but the cut-off values between low disease activity (LDA) and moderate disease activity (MDA) were adjusted. When JADAS10 cut-offs for clinically inactive disease (CID) were increased to 1.5 for patients with oligoarticular disease and 2.7 for patients with polyarticular disease, as recently suggested in a large multinational register study, altogether 11 patients classified as CID by the cut-off had one active joint. We suggest JADAS10 cut-off values for oligoarticular/polyarticular disease to be in CID: 0.0–0.5/0.0–0.7, LDA: 0.6–3.8/0.8–5.1 and MDA: >3.8/5.1. Suitable cJADAS10 cut-offs are the same as JADAS10 cut-offs in oligoarticular disease. In polyarticular disease, cJADAS10 cut-offs are 0–0.7 for CID, 0.8–5.0 for LDA and >5.0 for MDA.Conclusion International consensus on JADAS cut-off values is needed, and such a cut-off for CID should preferably exclude patients with active joints in the CID group.</div

Avoimen toimintakulttuurin palveluiden itsearviointityökalu

Toimintakulttuurin avoimen linjauksen tueksi on kehitetty palveluiden itsearviointityökalu, joka huomioi kaikkien aiempien avoimen tieteen kansallisten linjausten suositukset. Työkalun tarkoituksena on auttaa tutkimusorganisaatioita palveluiden itsearvioinnissa, kehittämisessä ja saataville asettamisessa.</p

Terveydenhuollon kansalliset laaturekisteripilotit loppusuoralla

Pilottiprojektin tulokset laaturekisterien toiminnan organisoimisesta kannustavat ¬jatkamaan työtä moniammatillisesti ja pitkäjänteisesti. Kansallinen koordinaatio on välttämätöntä laatu- ja vaikuttavuustiedon vertailukelpoisuuden ja hyödyntämisen varmistamiseksi

Toimintaterapia-asiakkaiden kokemuksia ensipsykoosista toipumisesta

Vasta lähiaikoina on herännyt kiinnostus ensipsykoosin varhaiseen tunnistamiseen ja varhaiseen interventioon. Suurin osa mielenterveyspalveluista on suunnattu pitkäaikaismielenterveyspotilaille ja ne eivät välttämättä palvele ensipsykoosin kokenutta asiakasta. Lisää tutkimustietoa tarvitaan siitä, miten asiakas on kokenut psykoosin ja mitkä tekijät hän on kokenut hyödyllisenä toipumisensa mahdollistumisen kannalta. Ilman tämän kaltaista tutkimustietoa on riski, että nykyään olemassa olevat toimintaterapiapalvelut jäävät vaillinaisiksi. Integroidun kirjallisuuskatsauksemme tavoitteena on kerätä tietoa siitä, mitkä asiat ensipsykoosin kokenut asiakas on kokenut hyödyllisenä toipumisensa kannalta. Tiedonhaku tehtiin PubMed, Sage Journals, EBSCO, OTDBASE sekä OTSEEKER tietokannoista. Lopulliseen aineistoomme sisällyttiin seitsemän tutkimusta. Tutkimusaineiston analysointiin käytettiin aineistolähtöistä analyysia. Asiakkaat kokivat merkityksellisen toimintaan osallistumisen, itsensä tutkiskelun ja hyväksymisen sekä ympäristön ja siltä saadun tuen edistävän heidän toipumistaan ensipsykoosista. Merkityksellisen toiminnan tuli vastata asiakkaiden kykyjä, mielenkiinnonkohteita sekä olla sopivassa suhteessa haastavaa. Asiakkaat kokivat merkitykselliseen toimintaan osallistumisen vähentävän koettua stressiä ja ahdistusta, vahvistavan itsetuntoa ja tuovan tarkoitusta ja toivoa elämään. Toimintaterapeutilla on taitoja löytää tapoja saadakseen asiakkaan ääni kuuluviin. Toimintaterapeutilla on myös osaamista ohjata asiakasta osallistumaan toimintoihin, jotka vastaavat hänen tarpeitaan ja kykyjään. Opinnäytetyömme korostaa ensipsykoosin kokeneen asiakkaiden kokemuksia ja näkemyksiä. Opinnäytetyötämme voi hyödyntää toimintaterapeutit, jotka työskentelevät psykoosiasiakkaiden parissa, sekä muut ammattilaiset.Only recently there has been more interest in early recognition and early intervention of psychosis. Most mental health services are directed to people with long term mental illnesses, and these services don’t necessarily meet the needs of the clients who have a first episode psychosis. More research information is needed of how the psychosis has affected the client’s occupational performance and what are the factors that the clients have perceived as helpful in their recovery process. Without this kind of knowledge there is a high risk that the existing occupational therapy services will not meet the needs of this specific client group. The goal of our integrated literature review was to gather information about what did the clients perceive as useful in their recovery. The research search was made from PubMed, Sage Journals, EBSCO, OTDBASE and OTSEEKER. The final data concluded of seven researches. We used a theoretically instructed method to analyze the data. The clients that had experienced first episode psychosis felt that it was useful to engage in meaningful occupations and to accept and reflect upon the experience of psychosis in order to recover. Also the importance of social support was highlighted. The meaningful occupation should be appropriately challenging, interesting and meet the skills of the client. The clients felt that engaging in meaningful occupations reduced the stress and anxiety they experienced and it also strengthened their self-esteem. It also brought them a sense of purpose and hope for the future. The occupational therapists have the skill set for enabling clients to be heard. Occupational therapists have knowledge about how to engage a client in occupations that meet the client’s needs and skills. Our thesis highlights the experiences and perspectives of the clients. Our thesis can be useful for occupational therapists that work in the field of early intervention for people with first episode psychosis, or any other professionals working in this field

"Aikuisia ei riitä joka kurviin?" Sosiaalis-emotionaalisten vaikeuksien ilmeneminen leikki-ikäisillä lapsilla Mikkelin kaupungin päiväkodeissa

Tämän opinnäytetyön tavoitteena oli tutkia lastentarhanopettajien näkemyksiä sosiaalis-emotionaalisten vaikeuksien ilmenemisestä 3–5-vuotiailla lapsilla Mikkelin kaupungin päiväkodeissa. Tavoitteena oli myös selvittää, kuinka päiväkoti voi tukea lapsia, joilla on sosiaalis-emotionaalisia vaikeuksia, ja millaiseksi lastentarhanopettajat kokevat omat valmiutensa auttaa näitä lapsia. Tutkimusote oli kvalitatiivinen eli laadullinen. Aineisto kerättiin puolistrukturoidulla kyselylomakkeella Mikkelin kaupungin päiväkodeissa 3–5-vuotiaiden lasten kanssa työskenteleviltä lastentarhanopettajilta. Vastauksia tuli yhteensä 13 yhdeksästä eri päiväkodista. Aineiston käsittelyssä käytettiin teemoittelua ja sisällönanalyysiä. Tässä opinnäytetyössä nousi esiin, että sosiaalis-emotionaaliset vaikeudet ovat lisääntyneet ja ongelmat tunnistetaan aiempaa paremmin. Vaikeudet ilmenivät hyvin monella eri tavalla. Pojilla vaikeudet olivat yleisempiä ja ulospäin suuntautuvampia, kun taas tytöt oireilivat vähemmän ja oireilu ei ollut yhtä näkyvää. Päiväkodeissa oli monenlaisia keinoja auttaa lasta ja hänen perhettään ja huolen herätessä ne toimivat pääasiassa saman toimintamallin mukaan. Suurin osa lastentarhanopettajista koki koulutuksensa tarjoavan perusvalmiudet sosiaalis-emotionaalisten vaikeuksien tunnistamiseen ja niihin puuttumiseen, mutta lähes kaikki toivoivat silti lisäkoulutusta aiheeseen liittyen. Eniten osaamista vastaajat kokivat saaneensa käytännön kokemuksen kautta, mutta myös omien persoonallisuuden piirteiden ja henkilökohtaisten taitojen koettiin auttaneen lapsen kehityksen tukemisessa. Aiheesta ei juuri löytynyt aiempaa vastaavanlaista tutkimustietoa, mikä tekee tästä opinnäytetyöstä jo itsessään hyödyllisen. Tämä opinnäytetyö auttaa ymmärtämään ilmiötä paremmin ja näkemään sosiaalis-emotionaaliset vaikeudet aikaisempaa monipuolisemmin ja selkeämmin. Se toimii myös hyvänä tietopakettina aiheesta. Lisäksi opinnäytetyötä voidaan hyödyntää esimerkiksi lastentarhanopettajien koulutuksen kehittämisessä.The aim of this bachelor's thesis was to survey how the kindergarten teachers experience the social-emotional difficulties that appear among the children of 3 to 5-year-old in the public day nurseries of the city of Mikkeli. Also, the goal was to study the ways in which a day nursery could support the children displaying these difficulties, and how the individual kindergarten teachers see their own capabilities to help these children. The research approach is considered as qualitative. The research material of the thesis was collected by semi-structured questionnaires sent to the kindergarten teachers working with 3 to 5-year-old children in the public day nurseries of the city of Mikkeli. In all, the answers of 13 persons were received, from total of 9 different day nurseries. This material was processed by use of theming and content analysis. In this thesis it was discovered, that the social-emotional difficulties have increased in their prevalence and the methods of detecting these problems have improved. These difficulties appeared in many ways. The problems were more common and extroverted among the boys, while the girls showed smaller number of problems, often with less visible symptoms. When the problems appeared, the different day nurseries had, in general, much in common in their practices, having many ways of assisting the children and their families. The majority of the kindergarten teachers indicated that their education had given them the basic skills needed to identify and intervene the social-emotional difficulties, yet almost everyone wished for additional training on the subject. Also, it was generally felt that the most of the useful skills were obtained in practice through working experience, and that the own personal character and individual skills were helpful too in supporting a development of the children. Hardly any research of this level was found concerning the research subject, thus making this thesis useful on it's own. The thesis helps to understand the issue more deeply, and to view the social-emotional difficulties in a clear and more diverse manner. It also provides a good information source of these difficulties. The thesis could also be used for purpose such as developing the kindergarten teacher education