Kauniaisten alakoululaisten painonhallintaan liittyvä ennaltaehkäisy ja ohjaus kouluterveydenhuollossa

TIIVISTELMÄ Airas Marjukka, Alho Laura & Laitinen Katja. Kauniaisten alakoululaisten painonhallintaan liittyvä ennaltaehkäisy ja ohjaus kouluterveydenhuollossa. Syksy 2018 57 s., 2 liitettä Diakonia-ammattikorkeakoulu, Hoitotyön koulutusohjelma, terveydenhoitaja (AMK). Opinnäytetyömme tarkoituksena oli vanhemmille suunnatulla kyselyllä selvittää, mitä ylipainon riskitekijöitä Kauniaisten alakoulujen perheillä oli ja mistä painonhallintaan liittyvistä seikoista perheet kokivat tarvitsevansa lisätietoa. Edelleen selvitimme, mikä oli vanhempien näkemys kouluterveydenhuollon roolista lasten painonhallinnan ehkäisyssä ja hoidossa sekä minkälaisia toiveita heillä oli esittää kouluterveydenhuollolle. Kouluterveydenhoitajille suunnatulla kyselyllä selvitimme, mitä vaikeuksia kouluterveydenhoitajat kokivat lapsen ylipainon käsittelyssä ja hoidossa. Ylipainon riskistekijöitä alakoululaisten perheillä olivat epäluottamus kansallisiin ravitsemussuosituksiin, lasten makeisten ja limonadien käyttö sekä ruutuajan suuri määrä. Myös vanhempien tietämättömyys ylipainon ja lihavuuden ennaltaehkäisystä ja hoidosta sekä sen seuraamuksista oli merkittävä riskitekijä. Näistä seikoista perheet tarvitsevat tietoa. Myös konkreettisia ruokavalio- ja elintapaneuvoja kaivattiin. Perheistä suuri osa ei pitänyt kouluterveydenhuoltoa paikkana, jossa keskustelisi lapsensa ylipainosta. Aihe nähtiin arkana, eikä siitä haluttu puhuttavan lapselle. Kouluterveydenhuollossa on mahdollisuus vanhempien kyselytutkimuksesta saatujen tietojen perusteella keskittyä niihin riskitekijöihin, joita perheillä on lapsen ylipainon ja lihavuuden suhteen sekä antaa vanhempien tarvitsemaa tietoa painonhallintaan liittyen. Huomioiden, että tutkimustulosten perusteella kouluterveydenhuoltoa ei nähdä luontevana paikkana ehkäistä tai hoitaa lapsen ylipainoa ja lihavuutta, tärkeätä on tavoittaa mahdollisimman suuri osuus vanhemmista esimerkiksi vanhempainilloissa tai luennolla. Ylipainon ennaltaehkäisyssä ja hoidossa tarvitaan empaattista, arvostavaa, motivoivaa ja vanhemmat osallistavaa työotetta. Avainsanat: ennaltaehkäisy, Kauniainen, kouluterveydenhoitaja, kysely, ohjaus, lapsen lihavuus, lapsen ylipaino  ABSTRACT Airas Marjukka, Alho Laura, and Laitinen Katja. Preventive weight management and guidance in school health care at Kauniainen elementary school. 57 p., 2 appendices. Language: Finnish. Autumn 2018. Diaconia University of Applied Sciences. Degree Programme in Nursing, Option in Health Care. Degree: Public Health Nurse. The objective of the thesis was to find out the major risk factors contributing to obesity and how preventive guidance should be administered at Kauniainen elementary schools. The information was gathered by conducting a survey for the parents. Furthermore we examined parents view of what the role school health care should have in preventing and treatment of overweight. Another survey aimed at the school nurses asked about the difficulties encountered in preventive guidance and overweight care. The main factors contributing to the obesity of the students were the distrust of national nutrition guidelines, sweets and soft drinks and amount of time spent with computers or television. The parents’ ignorance of the prevention and care of obesity and of the health risks related to it was also noted. The parents should be given advice about said matters. Concrete instruction related to healthy diet and lifestyle are required. The majority of the parents do not see the school health care as the proper place for discussing their children’s’ weight issues. This is a sensitive subject and most parents want to discuss within the family rather than have an ‘outsider’ talk to the child. The school health care can focus on identified factors that cause obesity and also give the weight maintenance information required by parents. Noting the school health care is not seen by the parents as a natural place for guidance, it is the most important to reach as many of them as possible in lectures or parents’ evenings. The prevention and care of obesity require empathetic, a motivating and appreciative approach to work as well as getting the parents involved. Keywords: preventing, Kauniainen, school nurse, questionnaire, guiding, child obesit

Tiedonhallinta ja aluekehittäminen : strategisen suunnittelun näkökulma

Siirretty Doriast

Lasten iän arviointi arkeologisessa luuaineistossa alahampaiden puhkeamisen perusteella:kahden menetelmän vertailu

Tiivistelmä. Tutkielmassani tutkin lasten iänmääritystä hampaiden ja niiden puhkeamisen perusteella käyttäen apuna kahta menetelmää sekä sitä, saadaanko näillä eri menetelmillä erilaiset tulokset. Toinen menetelmistä perustuu Douglas Ubelakerin kuvasarjaan, jossa on esitettynä kuvin hampaiden kehityksen ja puhkeamisen vaiheet. Toinen menetelmistä on uudempi ja siinä käytetään Atlas tietokoneohjelmaa. Suomessa ei ole tehty aiemmin vastaavaa menetelmien vertailua arkeologisten aineistojen yhteydessä. Aineistona tutkielmassani käytin lasten alaleukoja, jotka on kaivettu Oulun Tuomiokirkon kaivauksilta 1996 ja 2002, sekä Iin Haminan kaivauksilta 2009, yhteensä 68 alaleukaa. Valintaperusteena aineistolle oli se, että kaikissa alaleuoissa oli joko puhkeamassa olevia hampaita nähtävillä tai edes yksi hammas jäljellä. Tutkimuksessani ei varsinaisesti voi arvioida kumpi menetelmistä olisi tarkempi suomalaisessa arkeologisessa aineistossa, koska oikeat iät eivät ole tiedossa. Pääsääntöisesti Atlas arvioi aineistoa vanhemmaksi verrattuna Ubelakeriin. Ubelakerin menetelmällä saa nuoremmistakin yksilöistä tehtyä hyvin arvioinnin. Kahden menetelmän käyttö täydentää toisiaan ja auttaa näkemään kokonaisuutta, jos toisen menetelmän kohdalla olisi arvioinnissa epäröintiä

The prevalence of foot health problems in people living with a rheumatic condition: a cross-sectional observational epidemiological study

This study aimed to determine the prevalence of foot health problems in people living with any rheumatic condition and explore potential associations with exposure variables. A cross-sectional observational epidemiological design was applied. The participants were recruited from one regional patient association in southwest Finland. The data were collected in January-February 2019 and included the Self-reported Foot Health Assessment Instrument (S-FHAI) and demographic questions. In total, 495 responses were obtained. Overall, participants had many foot problems. The point prevalence of self-reported foot problems was 99 per 100 people living with a rheumatic condition. The most prevalent problems were foot pain (73%), dry soles (68%), thickened toenails (58%) and cold feet (57%). Lower educational attainment, increased amount of daily standing and accessing medical or nursing care for foot problems were associated with poorer foot health. The results reveal a high frequency of foot pain among people with rheumatic conditions. The study highlighted the importance of person-centred care and the biological focus that underpins and impacts foot health (what we understand, what we do, and our health-seeking behaviour). Interventions to promote biopsychosocial approaches to personalised foot care could advance people's readiness, knowledge and skill to care for their own feet.</p

Ideal cardiovascular health in childhood-Longitudinal associations with cardiac structure and function : The Special Turku Coronary Risk Factor Intervention Project (STRIP) and the Cardiovascular Risk in Young Finns Study (YFS)

Background: Ideal cardiovascular health (CVH), defined by the American Heart Association, is associated with incident cardiovascular disease in adults. However, association of the ideal CVH in childhood with current and future cardiac structure and function has not been studied. Methods and results: The sample comprised 827 children participating in the longitudinal Special Turku Coronary Risk Factor Intervention Project (STRIP) and The Cardiovascular Risk in Young Finns Study (YFS). In STRIP, complete data on the seven ideal CVH metrics and left ventricular (LV) mass measured with echocardiography were available at the age of 15 (n= 321), 17 (n= 309) and 19 (n= 283) years. In YFS, the cohort comprised children aged 12-18 years (n = 506) with complete ideal CVH metrics data from childhood and 25 years later in adulthood, and echocardiography performed in adulthood. In STRIP, ideal CVH score was inversely associated with LV mass during childhood (P = 0.036). In YFS, childhood ideal CVH score was inversely associated with LV mass, LV end-diastolic volume, E/e' ratio, and left atrium end-systolic volume in adulthood (all P <0.01). In addition, improvement of the ideal CVH score between childhood and adulthood was inversely associated with LV mass, LV end-diastolic volume, E/e' ratio, and left atrium end-systolic volume (all P Conclusions: Childhood ideal CVH score has a long-lasting effect on cardiac structure and function, and the association is evident already in childhood. Our findings support targeting the ideal CVHmetrics as part of primordial prevention of cardiovascular diseases. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Peer reviewe

Childhood socioeconomic status and lifetime health behaviors : The Young Finns Study

Background: Differences in health behaviors partly explain the socioeconomic gap in cardiovascular health. We prospectively examined the association between childhood socioeconomic status (SES) and lifestyle factors in adulthood, and the difference of lifestyle factors according to childhood SES in multiple time points from childhood to adulthood. Methods and results: The sample comprised 3453 participants aged 3-18 years at baseline (1980) from the longitudinal Young Finns Study. The participants were followed up for 31 years (N = 1675-1930). SES in childhood was characterized as reported annual family income and classified on an 8-point scale. Diet, smoking, alcohol intake and physical activity were used as adult and life course lifestyle factors. Higher childhood SES predicted a healthier diet in adulthood in terms of lower consumption of meat (beta +/- SE -3.6 +/- 0.99, p <0.001), higher consumption of fish (1.1 +/- 0.5, p = 0.04) and higher diet score (0.14 +/- 0.044, p = 0.01). Childhood SES was also directly associated with physical activity index (0.059 +/- 0.023, p = 0.009) and inversely with the risk of being a smoker (RR 0.90 95%CI 0.85-0.95, p <0.001) and the amount of pack years (-0.47 +/- 0.18, p = 0.01). Life course level of smoking was significantly higher and physical activity index lower among those below the median childhood SES when compared with those above the median SES. Conclusions: These results show that childhood SES associates with several lifestyle factors 31 years later in adulthood. Therefore, attention could be paid to lifestyle behaviors of children of low SES families to promote cardiovascular health. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Childhood Psychosocial Environment and Adult Cardiac Health : A Causal Mediation Approach

Introduction: This study used causal mediation analysis to assess the life-course associations of a favorable childhood psychosocial environment with left ventricular mass and diastolic function in adulthood and the extent to which adult health behaviors mediate these associations. Methods: The sample included 880 participants (56% women) from the Young Finns Study with data on the childhood environment from 1980, adult health behaviors (smoking, physical activity, diet, and BMI) from 2001 and an echocardiographic assessment of the left ventricular mass (g/m(2.7)) and diastolic function (E/e' ratio; higher values indicating a lower diastolic function) from 2011. The associations of the childhood environment with the left ventricular mass and E/e' ratio and mediation pathways through health behaviors were assessed using marginal structural models that were controlled for age, sex, and time-dependent confounding by adult socioeconomic position (measured as educational attainment) via inverse probability weighting. The data were analyzed in 2018-2019. Results: The mean age in 2011 was 41 (range 34-49) years. Those above versus below the median childhood score had a 1.28 g/m(2.7) lower left ventricular mass (95% CI = -2.63, 0.07) and a 0.18 lower E/e' ratio (95% CI = -0.39, 0.03). There was no evidence for indirect effects from childhood environments to left ventricular outcomes through adult health behaviors after controlling for time-dependent confounding by the adult socioeconomic position (indirect effect beta = -0.30, 95% CI = -1.22, 0.63 for left ventricular mass; beta = -0.04, 95% CI = -0.18, 0.11 for E/e' ratio). The results after multiple imputation were similar. Conclusions: A favorable childhood environment is associated with more optimal cardiac structure and function in adulthood. After accounting for socioeconomic positions, adult health behaviors explain little of the associations. (C) 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.Peer reviewe

CVD risk factors and surrogate markers-Urban-rural differences

Aims: Disparity in cardiovascular disease (CVD) mortality and risk factor levels between urban and rural regions has been confirmed worldwide. The aim of this study was to examine how living in different community types (urban-rural) in childhood and adulthood are related to cardiovascular risk factors and surrogate markers of CVD such as carotid intima-media thickness (IMT) and left ventricular mass (LVM). Methods: The study population comprised 2903 participants (54.1% female, mean age 10.5 years in 1980) of the Cardiovascular Risk in Young Finns Study who had been clinically examined in 1980 (age 3-18 years) and had participated in at least one adult follow-up (2001-2011). Results: In adulthood, urban residents had lower systolic blood pressure (-1 mmHg), LDL-cholesterol (-0.05 mmol/l), lower body mass index (-1.0 kg/m(2)) and glycosylated haemoglobin levels (-0.05 mmol/mol), and lower prevalence of metabolic syndrome (19.9 v. 23.7%) than their rural counterparts. In addition, participants continuously living in urban areas had significantly lower IMT (-0.01 mm), LVM (1.59 g/m(2.7)) and pulse wave velocity (-0.22 m/s) and higher carotid artery compliance (0.07%/10 mmHg) compared to persistently rural residents. The differences in surrogate markers of CVD were only partially attenuated when adjusted for cardiovascular risk factors. Conclusions: Participants living in urban communities had a more favourable cardiovascular risk factor profile than rural residents. Furthermore, participants continuously living in urban areas had less subclinical markers related to CVD compared with participants living in rural areas. Urban-rural differences in cardiovascular health might provide important opportunities for optimizing prevention by targeting areas of highest need.Peer reviewe