To feel at home in a new country:integration strategies and teacher perceptions on supporting immigrant students’ integration in basic education

Abstract. This thesis discusses immigrant students’ integration process in basic education in the Finnish context. Integration is described from inclusive point of view as being a two-way process which is affected both by the person integrating and the surrounding society. Integration process is approached on many levels: administrational, individual, cultural, psychological, and in the light of theories of integration. Thus, the focus is on the integration happening at the school world. The aim of this research is to familiarize oneself with the concepts related to integration and find out ways to support and understand immigrant students’ integration process at school. This study is useful especially for all teachers and educators in a more multicultural world and classrooms. This study is qualitative and the data is analyzed with thematic content analysis. The data was collected as half-structured interviews. The empirical part consists of interviews with preparatory class teachers and a cultural mentor. The approach to analysis was deductive; the empirical part was researched in relation to theoretical framework. The aim is to broaden and deepen already existing theories with empirical data. The results of the study show that integration is a process which is affected by the factors such as motivation, personality, families, cultures and background. It is important that immigrant children feel welcome and their roots are respected to be able to integrate into the new society. According to theories and the participants, there are ways to support immigrant students’ integration at school. It is especially important that teachers and the whole school community work together towards multicultural atmosphere and all can feel as being respected members of the community. Also families have a huge influence on integration process of their children and teachers should take this into consideration. Teachers’ intercultural competence is a considerably positive matter both in interaction with families and working with immigrant children. This is why intercultural competence should be enabled to develop during teacher education. Teachers can support their students through appreciating and utilizing different cultural backgrounds in the classroom and by using various teaching methods. Mother tongue education is an important way to support children’s identities and can work as a cultural link to former home country. In addition to the themes discussed in relation to theories, the participants consider functional learning important to support social integration between all children at school and so promoting multicultural atmosphere. Multi-professional network is also experienced important. In addition, participants demand concrete statements to preparatory curriculum including skills to achieve during the preparatory education. In administrational level, the decisions for example about the location of living have to be faster to enable feelings of stability and continuation in lives to develop which are necessary for integration.Tiivistelmä. Tämä Pro gradu -tutkielma pohtii maahanmuuttajaoppilaiden integraatioprosessia Suomen perusopetuksessa. Integraatiota lähestytään inklusiivisesta näkökulmasta. Integraation nähdään kaksisuuntaisena prosessina, jolloin integraatioon vaikuttavat niin integroituva henkilö kuin ympäröivä yhteiskunta. Integraatioprosessia käsitellään monella tasolla: hallinnollisella, yksilöllisellä, kulttuurisella, psykologisella, ja integraatioteorioiden valossa. Huomio on kuitenkin keskittynyt integraatioon koulumaailmassa. Tutkimuksen tarkoitus on tutustuttaa lukija integraation käsitteistöön ja etsiä keinoja tukea ja ymmärtää maahanmuuttajaoppilaiden integraatioprosessia koulussa. Tämä tutkimus on erityisen hyödyllinen kaikille opettajille ja kasvattajille monikulttuuristuvassa maailmassa ja luokkahuoneissa. Tutkimus on laadullinen ja tutkimusaineisto on analysoitu temaattista sisällönanalyysiä käyttäen. Tutkimusaineisto kerättiin puolistrukturoidun haastattelurungon avulla. Empiirinen osa koostuu valmistavan luokan opettajien ja kulttuurimentorin haastatteluista. Analyysissä käytettiin deduktiivista lähestymistapaa: empiiristä osaa tutkittiin teoreettisen viitekehyksen pohjalta. Tarkoitus on laajentaa ja syventää jo olemassa olevia teorioita empiiristä tutkimusaineistoa käyttäen. Tutkimuksen tuloksista voi tulkita, että integraatio on prosessi, johon vaikuttavat useat tekijät. Näitä tekijöitä ovat muun muassa motivaatio, persoonallisuus, perhe, kulttuuri ja tausta. Jotta integroituminen uuteen yhteiskuntaan on mahdollista, on tärkeää, että maahanmuuttaja tuntee itsensä tervetulleeksi ja taustansakin arvostetuksi. Teorioiden ja haastateltavien mukaan maahanmuuttajaoppilaiden integroitumiseen koulussa löytyy keinoja. On erityisen tärkeää, että opettajat ja koko kouluyhteisö työskentelevät yhdessä kohti monikulttuurista ilmapiiriä ja kaikki voivat tuntea olevansa arvostettuja jäseniä yhteiskunnassa. Myös perheillä on suuri merkitys lastensa integraatioprosessissa, ja opettajien pitäisi ottaa tämä huomioon. Opettajien interkulttuurinen kompetenssi on positiivisesti vaikuttava asia yhteistyössä kodin kanssa ja myös työskenneltäessä maahanmuuttajalasten kanssa. Tämän takia interkulttuurisen kompetenssin pitäisi päästä kehittymään opettajakoulutuksen aikana. Opettajat voivat tukea oppilaitaan myös monipuolisilla opetustyyleillä ja kunnioittamalla ja hyödyntämällä erilaisia kulttuuritaustoja luokkahuoneessa. Oman äidinkielen opetus on tärkeä tapa tukea lapsen identiteettiä ja se voi toimia kulttuurisena linkkinä aiempaan kotimaahan. Teorioista nousseiden teemojen lisäksi haastateltavat kokivat toiminnallisen oppimisen tärkeäksi. Toiminnallinen oppiminen tukee oppilaiden sosiaalista integraatiota koulussa ja näin edistää monikulttuurista ilmapiiriä. Moniammatillinen verkosto koetaan myös tärkeäksi. Lisäksi haastateltavat vaativat lisää konkreettisia lausuntoja valmistavan luokan opetussuunnitelmaan, määritellen esimerkiksi taidot, jotka pitäisi saavuttaa valmistavassa luokassa opiskelun aikana. Hallinnollisella tasolla päätökset esimerkiksi asuinpaikasta tulisi olla nopeita, jotta jatkumon ja pysyvyyden tunne elämässä mahdollistuisivat. Nämä asiat ovat myös edellytyksiä kotoutumiselle

Trends in Keratoplasty Procedures During 2 Decades in a Major Tertiary Referral Center in Finland : 1995 to 2015

Purpose:The purpose of this study was to analyze trends in number, age-adjusted frequency, and type of keratoplasty in a major tertiary referral center, relative to patient and graft characteristics.Methods:A retrospective registry study of 1574 patients who in 1995 to 2015 underwent keratoplasty in the Helsinki University Eye Hospital (HUEH). Graft type and sequence, patient characteristics, and date of surgery were recorded. Main outcome measures were annual number, type, and age-adjusted frequency of keratoplasty; patient and graft characteristics; graft procurement; and national population-adjusted frequency of keratoplasty.Results:In HUEH, from 1995 to 2015, a total of 2191 keratoplasties were performed with 48% of the grafts procured intramurally; 76% were primary and 24% regrafts. The age-adjusted frequency of primary penetrating keratoplasty decreased by 52% from 0.96 to 0.46 per 100,000. The corresponding frequency of primary Descemet stripping automated endothelial keratoplasty increased by 367% from 0.3 to 1.4 after 2006, finally accounting for 68% of primary grafts. Men underwent primary penetrating keratoplasty (median 48 vs. 67 yrs, P = 0.0001) and anterior lamellar keratoplasty (median 37 vs. 46 yrs, P = 0.0015) at a younger age than women. Interval to the first regraft was comparable between sexes (median 2.2 vs. 1.9 yrs, respectively, P = 0.17). The national median population-adjusted frequency of keratoplasties was 3.2 per 100,000 from 2009 to 2015, and HUEH accounted for a median of 69% of them.Conclusions:The increased frequency of keratoplasty in HUEH resulted from rapid adoption of Descemet stripping automated endothelial keratoplasty after 2006 and was facilitated by centralizing graft procurement to HUEH and the National Cell and Tissue Center Regea.Peer reviewe

Paikkakunnan brändääminen keinona vastata muuttotappiokuntien ahdinkoon:tapausesimerkkinä Kauhava

Tiivistelmä. Väestön vähentyminen ja vanheneminen uhkaavat pieniä muuttotappiokuntia. Tarkastelen tutkielmassani paikkakuntien brändäämistä tapausesimerkki Kauhavan kautta ja pohdin, onko kuntabrändäämisellä mahdollisuus vaikuttaa muuttotappiokuntien yleiseen taantumukselliseen suuntaan. Brändäämisellä tarkoitetaan brändin rakentamistyötä, jolla pyritään luomaan brändättävälle kohteelle positiivinen tunnettuus erilaisten tunnistautumis- ja erottautumisominaisuuksien kautta. Kuntabrändäämisellä sen sijaan viitataan kuntalaisten ja kunnan viestinnällisestä vuorovaikutussuhteesta syntyneiden mielikuvien ja kokemuksien luomaan lopputulokseen, joka pyritään kunnan puolesta brändäämään sellaiseksi, joka houkuttelee kuntaan uusia asukkaita, yrityksiä, investointeja ja verotuloja. Kuntabrändejä rakennetaan kuntajohdossa, mutta kuntabrändin muodostumisessa kuntalaiset ja kuntaorganisaatioiden työntekijät vaikuttavat brändin toteutumiseen. Yleisen kuntabrändäämisen kirjallisuuskatsauksen ja Kauhavan kaupungin aineistojen sekä Tilastokeskuksen tilastojen perusteella en pysty osoittamaan, että kuntabrändääminen on ainakaan Kauhavan tapauksessa ratkaisu muuttotappiokunnan ongelmiin. Kauhavan asukasluku jatkaa laskuaan, muuttotappiollisuus jatkuu vuodesta toiseen, syntyneisyys pysyy kuolleisuutta alempana samaan aikaan, kun imagotutkimuksissa asukkaat osoittavat tyytymättömyyttään, mikä näkyy asukaskyselyjen Kauhavan huonoissa arvioissa ja palautteessa. Kauhavan talous- ja työllisyystilanne on pysynyt vielä toistaiseksi hyvällä tasolla, mutta ottaen huomioon väestörakenteen vanhenemisen ja asukasluvun jatkuvan vähentymisen ja muuttotappioiden vuosittaisen määrän — myös kaupungin budjetin ylijäämäisyys ja työllisyystilanne voivat olla uhattuna tulevaisuudessa. En kuitenkaan pysty tekemään sellaista johtopäätöstä, joka kumoaisi kuntabrändäämisen hyödyt kokonaan. Kuitenkin Kauhavaan liittyen kuntabrändäämisen toimivuuden voi ainakin kyseenalaistaa, koska talouden, väestökehityksen ja asukkaiden tyytyväisyyden perusteella Kauhava ei ole onnistunut saavuttamaan tiettyjä tavoitteitaan, kuten imagon kohennusta, joka on kaupunginkin mukaan epäonnistunut. Kauhavan nykytilan kehityksen arviointia vaikeuttaa se, että kaupunkistrategia ja sen tavoitteet ovat edelleen voimassa vuoteen 2025 asti, sosiaali- ja terveydenhuollon sekä pelastustyön palvelut ovat vasta siirtyneet kunnilta hyvinvointialueille ja valtion talouden epävarmuudet ja korkojen nousu mietityttävät. On vielä epäselvää, miten nämä mainitut asiat vaikuttavat muuttotappiokuntien talouksiin, kun otetaan huomioon, miten suuri rahoitus kunnilla on valtionosuuksina

Hepatic Ultrasonography Compared with Computed Tomography and Magnetic Resonance Imaging at Diagnosis of Metastatic Uveal Melanoma

Purpose To evaluate the consistency of hepatic ultrasonography (US) with staging computed tomography (CT) and magnetic resonance imaging (MRI), to analyze why US was inconsistent with CT/MRI, and to compare CT/MRI. DESIGN Reliability analysis. METHODS Two hundred fifteen patients whose primary uveal melanoma was managed in the Helsinki University Hospital and who were diagnosed with hepatic metastases by US within 60 days of staging CT/MRI from January 1999 to December 2016, were included. Patients attended a real-life follow-up schedule including hepatic US, liver function tests (LFT), and a confirmatory CT/MRI. We evaluated the consistency of US with staging CT/MRI regarding the presence and number of metastases. RESULTS The enrolled patients underwent 215 US, 167 CT, and 69 MRI examinations, and 67% of them had biopsy-confirmed metastases. Screening was regular for 98% of the patients, and 66% were asymptomatic. US was fully consistent with CT/MRI in detecting metastases in 113 (53%) patients, in 63 (29%) CT/MRI showed more metastases, and in 16 (7%) less metastases than US. CT/MRI was inconsistent with US in 23 (11%) patients. The sensitivity of US in detecting metastases was 96% (95% confidence interval, 92-98). US failed to suggest metastases in 10 patients. LFT were abnormal in six of them, and a newly-detected hepatic lesion was present by US in four. CONCLUSIONS Hepatic US is a sensitive screening modality in detecting metastases in patients with primary uveal melanoma, if combined with LFT and in case of any new detected lesion, a confirmatory MRI.Peer reviewe

Metastatic uveal melanoma managed with best supportive care

Non peer reviewe

Finnish gelsolin amyloidosis causes significant disease burden but does not affect survival: FIN-GAR phase II study

Abstract Background Hereditary gelsolin (AGel) amyloidosis is an autosomal dominantly inherited systemic amyloidosis that manifests with the characteristic triad of progressive ophthalmological, neurological and dermatological signs and symptoms. The National Finnish Gelsolin Amyloidosis Registry (FIN-GAR) was founded in 2013 to collect clinical data on patients with AGel amyloidosis, including altogether approximately one third of the Finnish patients. We aim to deepen knowledge on the disease burden and life span of the patients using data from the updated FIN-GAR registry. We sent an updated questionnaire concerning the symptoms and signs, symptomatic treatments and subjective perception on disease progression to 240 members of the Finnish Amyloidosis Association (SAMY). We analyzed the lifespan of 478 patients using the relative survival (RS) framework. Results The updated FIN-GAR registry includes 261 patients. Symptoms and signs corresponding to the classical triad of ophthalmological (dry eyes in 93%; corneal lattice amyloidosis in 89%), neurological (numbness, tingling and other paresthesias in 75%; facial paresis in 67%), and dermatological (drooping eyelids in 86%; cutis laxa in 84%) manifestations were highly prevalent. Cardiac arrhythmias were reported by 15% of the patients and 5% had a cardiac pacemaker installed. Proteinuria was reported by 13% and renal failure by 5% of the patients. A total of 65% of the patients had undergone a skin or soft tissue surgery, 26% carpal tunnel surgery and 24% at least unilateral cataract surgery. As regards life span, relative survival estimates exceeded 1 for males and females until the age group of 70–74 years, for which it was 0.96. Conclusions AGel amyloidosis causes a wide variety of ophthalmological, neurological, cutaneous, and oral symptoms that together with repeated surgeries cause a clinically significant disease burden. Severe renal and cardiac manifestations are rare as compared to other systemic amyloidoses, explaining in part the finding that AGel amyloidosis does not shorten the life span of the patients at least for the first 75 years

Brachytherapy of Choroidal Melanomas Less Than 10 mm in Largest Basal Diameter Comparison of 10-mm and 15-mm Ruthenium Plaques

Purpose: To compare tumor control, vision, and complications between patients with a choroidal melanoma of Design: Retrospective, comparative case series. Participants: One hundred sixty-four consecutive patients with a choroidal melanoma of Methods: Diagnosis was based on growth or high-risk characteristics. The apical dose was 100 to 120 Gy aiming to deliver >= 250 Gy to the sclera. Plaque positioning was modeled retrospectively. An increase of >= 0.3 mm in thickness and >= 0.5 mm in LBD indicated local recurrence. Outcomes were compared with cumulative incidence analysis and Cox regression. Median follow-up time for patients still alive was 8.4 years. Main Outcome Measures: Recurrence rate, low vision, blindness, radiation maculopathy, and optic neuropathy. Results: Melanomas treated with the 10-mm plaque were smaller (median thickness, 1.9 mm vs. 2.6 mm; LBD, 7.1 mm vs. 8.6 mm) and located closer to foveola (median, 2.0 mm vs. 2.8 mm) than those treated with the 15-mm plaque (P <0.001). The 2 plaques provided a safety margin in 43% versus 40% eyes, provided no safety margin to guard foveola in 17% versus 33%, and did not entirely cover tumor mainly close to the disc in 32% versus 18% of eyes, respectively (P = 0.052). The incidence of a local recurrence was comparable (13% vs. 15% at 10 years; P = 0.31) and associated with plaque positioning (hazard ratio [HR], 2.81 for no safety margin; P = 0.041). At 5 years, the incidence of low vision was 14% versus 24%, and that of blindness was 3% versus 6%. Distance to the foveola was associated with loss of both levels of vision (HR, 0.65 per 1 mm vs. 0.68 per 1 mm; P Conclusions: The 10-mm ruthenium plaque contributes to better visual preservation, particularly with tumors close to fovea, without increase in local recurrence rate, and may therefore be preferable to the 15-mm plaque. (C) 2020 by the American Academy of OphthalmologyPeer reviewe

Metastatic uveal melanoma : The final frontier

Publisher Copyright: © 2022Treatment of primary intraocular uveal melanoma has developed considerably, its driver genes are largely unraveled, and the ways to assess its risk for metastases are very precise, being based on an international staging system and genetic data. Unfortunately, the risk of distant metastases, which emerge in approximately one half of all patients, is unaltered. Metastases are the leading single cause of death after uveal melanoma is diagnosed, yet no consensus exists regarding surveillance, staging, and treatment of disseminated disease, and survival has not improved until recently. The final frontier in conquering uveal melanoma lies in solving these issues to cure metastatic disease. Most studies on metastatic uveal melanoma are small, uncontrolled, retrospective, and do not report staging. Meta-analyses confirm a median overall survival of 10–13 months, and a cure rate that approaches nil, although survival exceeding 5 years is possible, estimated 2% either with first-line treatment or with best supportive care. Hepatic ultrasonography and magnetic resonance imaging as surveillance methods have a sensitivity of 95–100% and 83–100%, respectively, to detect metastases without radiation hazard according to prevailing evidence, but computed tomography is necessary for staging. No blood-based tests additional to liver function tests are generally accepted. Three validated staging systems predict, each in defined situations, overall survival after metastasis. Their essential components include measures of tumor burden, liver function, and performance status or metastasis free interval. Age and gender may additionally influence survival. Exceptional mutational events in metastases may make them susceptible to checkpoint inhibitors. In a large meta-analysis, surgical treatment was associated with 6 months longer median overall survival as compared to conventional chemotherapy and, recently, tebentafusp as first-line treatment at the first interim analysis of a randomized phase III trial likewise provided a 6 months longer median overall survival compared to investigator's choice, mostly pembrolizumab; these treatments currently apply to selected patients. Promoting dormancy of micrometastases, harmonizing surveillance protocols, promoting staging, identifying predictive factors, initiating controlled clinical trials, and standardizing reporting will be critical steppingstones in reaching the final frontier of curing metastatic uveal melanoma.Peer reviewe

High-risk Pathologic Features Based on Presenting Findings in Advanced Intraocular Retinoblastoma A Multicenter, International Data-Sharing American Joint Committee on Cancer Study

Purpose: To determine the value of clinical features for advanced intraocular retinoblastoma as defined by the eighth edition of the American Joint Committee on Cancer (AJCC) cT3 category and AJCC Ophthalmic Oncology Task Force (OOTF) Size Groups to predict the high-risk pathologic features. Design: International, multicenter, registry-based retrospective case series. Participants: Eighteen ophthalmic oncology centers from 13 countries over 6 continents shared evaluations of 942 eyes enucleated as primary treatment for AJCC cT3 and, for comparison, cT2 retinoblastoma. Methods: International, multicenter, registry-based data were pooled from patients enrolled between 2001 and 2013. High-risk pathologic features were defined as AJCC categories pT3 and pT4. In addition, AJCC OOTF Size Groups were defined as follows: (1) less than half, (2) more than half but less than two thirds, (3) more than two thirds of globe volume involved, and (4) diffuse infiltrating retinoblastoma. Main Outcome Measures: Statistical risk of high-risk pathologic features corresponding to AJCC cT3 subcategories and AJCC OOTF Size Groups. Results: Of 942 retinoblastoma eyes treated by primary enucleation, 282 (30%) showed high-risk pathologic features. Both cT subcategories and AJCC OOTF Size Groups (P < 0.001 for both) were associated with high-risk pathologic features. On logistic regression analysis, cT3c (iris neovascularization with glaucoma), cT3d (intraocular hemorrhage), and cT3e (aseptic orbital cellulitis) were predictive factors for high-risk pathologic features when compared with cT2a with an odds ratio of 2.3 (P = 0.002), 2.5 (P = 0.002), and 3.3 (P = 0.019), respectively. Size Group 3 (more than two-thirds globe volume) and 4 (diffuse infiltrative retinoblastoma) were the best predictive factors with an odds ratio of 3.3 and 4.1 (P < 0.001 for both), respectively, for high-risk pathologic features when compared with Size Groups 1 (i.e., < 50% of globe volume). Conclusions: The AJCC retinoblastoma staging clinical cT3c-e subcategories (glaucoma, intraocular hemorrhage, and aseptic orbital cellulitis, respectively) as well as the AJCC OOTF Size Groups 3 (tumor more than two thirds of globe volume) and 4 (diffuse infiltrative retinoblastoma) both allowed stratification of clinical risk factors that can be used to predict the presence of high-risk pathologic features and thus facilitate treatment decisions. (C) 2022 by the American Academy of Ophthalmology.Peer reviewe