Lasten leikkitarinoiden teemojen ja tunnesisältöjen yhteys internalisoiviin oireisiin

Strukturoidut leikkitarinamenetelmät mahdollistavat lapsen sisäisen maailman tutkimisen ikätasoisella tavalla, mutta tutkimusta leikkitarinoiden erityispiirteistä internalisoivasti oireilevilla lapsilla on tehty melko vähän. Erityisen vähän tutkimusta on tehty kliinisillä aineistoilla. Tutkimuksen aineistona oli 106 Taysin lastenpsykiatrian klinikalla tutkimuksissa ja hoidossa ollutta lasta sekä 40 verrokkilasta. Lasten mediaani-ikä oli vuotta vuotta. Lapsille tehtiin MSSB-leikkitarinatutkimus ja heidän oireitaan kartoitettiin äitien täyttämillä CBCL-oirekyselylomakkeilla. Lapset jaettiin oireettomiin sekä internalisoivasti, eksternalisoivasti tai sekamuotoisesti oireileviin. Tavoitteena oli selvittää internalisoivasti oireilevien lasten leikkitarinoiden erityispiirteitä verrattuna muulla tavalla oireilevien sekä oireettomien lasten tarinoihin. Internalisoivasti oireilevien lasten leikkitarinoissa havaittiin neutraalia tunnesisältöä enemmän kuin muilla ryhmillä. Surua tarinoiden esittämisessä internalisoivasti oireilevilla lapsilla esiintyi hieman vähemmän kuin oireettomilla lapsilla. Löydös voisi selittyä internalisoivien oireiden ilmiasulla; tunneilmaisu on latistunutta ja oireet sisäänpäin kääntyneitä. Ahdistuneisuutta tai äidin negatiivisia representaatioita havaittiin internalisoivasti oireilevilla lapsilla vähän eikä merkitseviä eroja ryhmien välillä havaittu. Isän representaatiot olivat internalisoivasti oireilevilla lapsilla useammin positiivisia/neutraaleja verrattuna oireettomien ja sekamuotoisesti oireilevien lasten ryhmään

Recovery Assessment of Open-heart Cardiac Surgery Patients Using Heart Rate Variability Parameters

Surgical operation causes short-term stress changing the balance of the autonomic nervous system (ANS). The ANS activity can be assessed through heart rate variability (HRV). This work aims to evaluate the recovery process of open-heart cardiac surgery patients under two post-surgery physiotherapy interventions using HRV parameters. Ten-minute ECG recordings were performed on 17 open-heart cardiac surgery patients pre-operatively (PREOP) and during three consecutive post-operative days (POD1, POD2 and POD3). The recovery process was promoted using two different physiotherapy techniques: positive expiratory pressure (PEP, N = 9) and inspiratory training (IMT, N = 8). Common HRV parameters (SDNN, LF power and SD1) were calculated for each patient and statistical analyses were performed. The results show significant differences between HRV parameters pre- and post-operatively, and there was a reduction of all three investigated HRV parameters in the POD1 for both groups. HRV parameters average values increased between POD1 to POD3 for both intervention groups indicating that patients were eventually starting to recover from the surgery. Statistically significant difference between PEP and IMT interventions was not discovered (e.g., p = 0.54 for SDNN, PREOP vs. POD3). Based on the results, all studied HRV parameters are potential indicators of the short-term recovery after cardiac surgery.Peer reviewe

Lasten leikkitarinoiden teemojen ja tunnesisältöjen yhteys internalisoiviin oireisiin

Strukturoidut leikkitarinamenetelmät mahdollistavat lapsen sisäisen maailman tutkimisen ikätasoisella tavalla, mutta tutkimusta leikkitarinoiden erityispiirteistä internalisoivasti oireilevilla lapsilla on tehty melko vähän. Erityisen vähän tutkimusta on tehty kliinisillä aineistoilla. Tutkimuksen aineistona oli 106 Taysin lastenpsykiatrian klinikalla tutkimuksissa ja hoidossa ollutta lasta sekä 40 verrokkilasta. Lasten mediaani-ikä oli vuotta vuotta. Lapsille tehtiin MSSB-leikkitarinatutkimus ja heidän oireitaan kartoitettiin äitien täyttämillä CBCL-oirekyselylomakkeilla. Lapset jaettiin oireettomiin sekä internalisoivasti, eksternalisoivasti tai sekamuotoisesti oireileviin. Tavoitteena oli selvittää internalisoivasti oireilevien lasten leikkitarinoiden erityispiirteitä verrattuna muulla tavalla oireilevien sekä oireettomien lasten tarinoihin. Internalisoivasti oireilevien lasten leikkitarinoissa havaittiin neutraalia tunnesisältöä enemmän kuin muilla ryhmillä. Surua tarinoiden esittämisessä internalisoivasti oireilevilla lapsilla esiintyi hieman vähemmän kuin oireettomilla lapsilla. Löydös voisi selittyä internalisoivien oireiden ilmiasulla; tunneilmaisu on latistunutta ja oireet sisäänpäin kääntyneitä. Ahdistuneisuutta tai äidin negatiivisia representaatioita havaittiin internalisoivasti oireilevilla lapsilla vähän eikä merkitseviä eroja ryhmien välillä havaittu. Isän representaatiot olivat internalisoivasti oireilevilla lapsilla useammin positiivisia/neutraaleja verrattuna oireettomien ja sekamuotoisesti oireilevien lasten ryhmään

Inspiratory training and immediate lung recovery after resective pulmonary surgery : A randomized clinical trial

Background: Prompt and uneventful recovery after resective pulmonary surgery benefits patients by decreasing length and total costs of hospital stay. Postoperative physiotherapy has been shown to be advantageous for patient recovery in several studies and lately inspiratory muscle training (IMT) physiotherapy has been used also in thoracic patients. This randomized controlled trial intended to evaluate whether IMT is an efficient and feasible method of physiotherapy compared to water bottle positive expiratory physiotherapy (PEP) immediately after lung resections. Methods: Forty-two patients were randomly allocated into two intervention groups: water bottle PEP (n=20) and IMT group (n=22). Patients were given physiotherapeutic guidance once a day and patients were also instructed to do independent exercises. Measurements of pulmonary function were compared between the treatment groups according to intention to treat by using two-way repeated measures analysis of variances at three time points (preoperative, first postoperative day, and second postoperative day). Walking distance was measured at first and second postoperative day and similarly, evaluation of postoperative air leak during exercises was performed. Physiotherapy was modified or temporarily interrupted, if necessary, because of the air leak. Results: Postoperative pulmonary function tests were equal between the intervention groups. Air leak was relatively common after lung resections: 31% of all patients had mild or moderate/severe air leak at first postoperative day and 14% of all patients had mild to severe air leak at second postoperative day respectively. There were no statistically significant differences in occurrence of air leak between intervention groups, but water resistance had to be reduced or physiotherapy discontinued significantly more often among the water bottle PEP group patients (P=0.01). Walking distance improved slightly faster in the IMT group between the first and the second postoperative day when compared to the water bottle PEP group, but the difference between the groups was not statistically significant. Conclusions: IMT physiotherapy is equally effective to water bottle PEP training in postoperative physiotherapy after lung resection surgery evaluated with pulmonary function tests and walking distance. In addition, IMT physiotherapy is safe and more feasible form of physiotherapy during postoperative air leak compared to water bottle PEP.publishedVersionPeer reviewe

A randomized trial comparing inspiratory training and positive pressure training in immediate lung recovery after minor pleuro-pulmonary surgery

Background: Two respiratory physiotherapy modalities were compared in a randomized controlled trial on patients undergoing minor pleuro-pulmonary surgery. Methods: Forty-five patients were randomly allocated into positive expiratory pressure (PEP) therapy (n=23) and inspiratory muscle training (IMT) groups (n=22). Individualized group specific physiotherapeutic guidance was administered preoperatively, and once a day postoperatively. Patients also performed independent exercises and kept a logbook. Pain was assessed on a numerical reference scale (NRS). Volumetric pulmonary function values and walking distance were recorded preoperatively, and on first (POD1) and second postoperative days (POD2). Pre- and postoperative values were compared using two-way repeated measures analysis of variance. Results: Patient characteristics and pleuro-pulmonary interventions were similar between the groups. Thoracotomy was performed in 14/45 and video assisted surgery (VATS) in 31/45 of cases. Preoperative volumetric pulmonary functions were normal or slightly decreased in 29/45, and fell significantly (P<0.001) on the first postoperative day (POD1) and improved but remained significantly lower on the second postoperative day. The recovery of mean FEV1, FIV1 and FIVC values was greater in the IMT than in the PEP group between POD1 and POD2, but without significant difference. The corresponding relative to preoperative values were higher in the IMT group, with a significant difference in FEV1 (P=0.045). Also relative PEF and FIV1 values seemed to be slightly higher in the IMT compared to the PEP group, but not significantly. Average NRS values for pain were lower in the IMT group (P=0.010) but only on POD1. Air leak was noted in 4/45 patients, two in each group, on POD1, and two in PEP groups and one in IMT group on POD2. Mean measured walking distances between groups did not differ. Mean hospital stay was 4 days in the PEP group and 3 days in the IMT group. There was no hospital mortality. Conclusions: Pulmonary function values decreased significantly after minor lung resections, supporting rehabilitative respiratory physiotherapy to avoid postoperative pulmonary complications (PPCs). Both PEP and IMT training were well tolerated and equally efficient when comparing spirometry values at three time points. IMT appeared advantageous regarding relative FEV1 recovery and immediate postoperative pain.publishedVersionPeer reviewe