Kuuleminen alaikäisen osallisuuden vahvistajana ja tiedonsaannin varmistajana hallintomenettelyssä

YK:n lapsen oikeuksien sopimuksen tavoitteena on ollut alaikäisen aseman vahvistaminen yhdenvertaisena yksilönä eli oikeussubjektina niin lain edessä kuin yhteiskunnassa. Sopimuksen tavoitteena on ollut vaikuttaa sopimusvaltioiden lainsäädäntöön ja käytäntöihin. Samalla on kehittynyt myös lapsioikeudellinen ajattelu. Keskeisinä periaatteina sopimuksessa on lapsen edun ensisijaisuus ja lapsen osallisuus. Tämän tutkimuksen punaisena lankana toimii osallisuusperiaate. Suomalainen lainsäädäntö sisältää erilaisia ikärajoja ja käsitteitä, joilla on merkitystä alaikäisen aseman määräytymiseen eli mahdollisuuteen vaikuttaa omassa asiassaan. Käytössä ei ole yhtenäistä käsitteistöä osallisuudesta ja sen tasoista. Monessa yhteydessä mielipiteen selvittäminen ja kuuleminen rinnastetaan toisiinsa, vaikka niillä on omat roolinsa prosessissa. Mielipiteen selvittäminen ei ole määrämuotoinen toimi, vaan kyse on näkemysten ja ajatusten sekä tahtotilan esittämisestä. Kuuleminen taas on menettelyllinen toimi. Siihen sisältyy oikeus esittää näkemyksiä, mutta myös selvityksiä ja siihen liittyy vielä päätöksen perusteena olevien tietojen läpikäyminen. Kuuleminen on keino varmistua, että päätöksentekijällä on käytössään oikeat tiedot ja vain oikeat tiedot. Jos asianosainen havaitsee tiedoissa puutteita, avautuu hänelle mahdollisuus ennen päätöstä korjata puutteet. Lapsen oikeuksien sopimuksessa mielipiteen selvittäminen ja kuuleminen on eroteltu omiksi kohdiksi. Tätä eroa on pyritty myös tässä tutkimuksessa avaamaan. Mielipiteen selvittämisen voi katsoa vahvistavan alaikäisen oikeutta osallistua oman asiansa käsittelyyn. Kuuleminen menettelyllisenä oikeusturvatakeena vahvistaa osallisuutta, koska kuulemiseen sisältyy esittää mielipiteensä ennen päätöksentekoa sekä saada tietoa omasta asiastaan ja siihen vaikuttavista seikoista. Tarkastelu on kohdistunut hallintomenettelyyn, eli viranomaisessa tapahtuvaan hallintoasian käsittelyyn

Yläkoulun oppilaanohjaus toimijuuden vahvistajana : peruskoulun 8. - 9.-luokkalaisten käsityksiä oppilaanohjauksesta

Tutkimuksen tarkoituksena oli selvittää peruskoulun 8.–9.-luokkalaisten näkemyksiä oppilaanohjauksesta oppiaineena. Oppilaanohjauksen sisältö on määritelty opetussuunnitelman perusteissa vuodelta 2004. Lähtökohtana oli ajatus, että oppilaanohjaus on oppiaine, joka vahvistaa oppilaiden toimijuutta. Tutkimusaineistona käytettiin kyselylomakkeella saatua tietoa. Opetussuunnitelmassa olevat oppilaanohjauksen tavoitteet olivat nuorille tehdyn kyselylomakkeen taustalla. Kyselylomake sisälsi sekä monivalinta- että avoimia kysymyksiä. Tutkimuksessa on sekä kvantitatiivinen että kvalitatiivinen aineisto. Tutkimuksessa käytettiin kahta tutkimusmenetelmää. Aineiston analysoimisessa hyödynnettiin sekä tilastollista tarkastelua että sisällönanalyysia. Tutkimuksessa tarkasteltiin opetussuunnitelmateoriaa ja opetussuunnitelman merkitystä opetusta ohjaavana tekijänä. Tämän lisäksi pohdittiin oppilaanohjausta oppiaineena. Oppilaanohjaus on haastava, koska sillä ei ole varsinaista omaa tieteellistä taustaa samalla tavalla kuin monella muulla oppiaineella. Oppilaanohjaus ammentaa teoriansa ja pedagogiset mallinsa ohjausta koskevasta tutkimuksesta. Ohjaus puolestaan on hybridi eli monen tieteenalan risteyskohdassa oleva ja sisällöltään moniulotteinen. Ohjaus käsitteenä on laaja ja sisältää hyvin muodollisen institutionaalisen puolen lisäksi vapaamuotoisempaa ohjausta. Ohjausta tehdään ammattimaisesti hyvin erilaisissa yhteisöissä. Huomion arvoista on, että ohjaus on vuorovaikutteinen tapahtuma. Tavoitteena on vahvistaa ohjattavan omaa toimintakykyä eli toimijuutta. Peruskoulun opetussuunnitelman perusteissa on yhtenä yleisenä tavoitteena osallisuuden vahvistaminen. Osallisuus on normatiivinen käsite. Nuorilla on oikeus osallistua ja olla osallisena itseään koskevissa asioissa. Nuorilla on myös oikeus olla vaikuttamassa yhteiskunnallisiin asioihin, vaikka heillä ei ole täysiä poliittisia oikeuksia. Osallisuusajatuksen taustalla pitää olla myös konkreettisempi ilmenemismuoto. Tässä tutkimuksessa toimijuus on nostettu keskeiseksi. Nuori tarvitsee toimijuutta, jotta voi osallistua eli olla mukana toiminnassa ja tekemässä päätöksiä. Nuorilla oli kyselyn perusteella hyvä käsitys oppilaanohjauksesta oppiaineena ja vastauksista kävi ilmi myös toimijuuden ajatus. Nuorille oli selvästi haastavaa ilmaista omia odotuksiaan oppiaineelle tai analysoida niiden toteutumista. Suurin osa oli kokenut saaneensa apua ja tukea nivelvaiheisiin eli siirtymävaiheisiin. Kuitenkin osa koki jääneensä ilman tukea. Tärkeää olisi saada kaikille tunne, että heitä tuetaan ja kuullaan elämän ratkaisevissa muutostilanteissa

Determination of physical emulsion stabilization mechanisms of wood hemicelluloses via rheological and interfacial characterization

Materials manufacturing industries seek efficient, economic, and sustainable compounds for stabilizing dispersed systems such as emulsions. In this study, novel, abundant biobased hydrocolloids spruce galactoglucomannans (GGM) and birch glucuronoxylans (GX) were obtained from a forestry biorefining process and characterized as versatile stabilizers of rapeseed oil-in-water emulsions. For the first time, GGM and GX isolated by pressurized hot water extraction (PHWE) of spruce and birch saw meal, respectively, were studied in emulsions. The PHWE wood hemicelluloses—polysaccharides with relatively low molar mass—facilitated the formation of emulsions with small average droplet size and efficiently prevented droplet coalescence. GGM and GX lowered the surface tension of emulsions’ oil–water interface and increased the viscosity of the continuous phase. However, viscosity of the wood hemicellulose-based systems was low compared to that of commercial polymeric stabilizers. GGMstabilized emulsions with varying oil volume fractions were characterized in terms of their rheological properties, including large amplitude oscillation shear (LAOS) measurements, and compared to emulsions prepared with a classical small-molecular surfactant, Tween20. The physical emulsion stabilization mechanisms of GGM and GX are suggested as steric repulsion assisted by Pickering-type stabilization. Wood hemicelluloses have potential as highly promising future bioproducts for versatile industrial applications involving colloidal systems and soft materials.Peer reviewe

Gastrointestinal Symptoms and Dopamine Transporter Asymmetry in Early Parkinson's Disease

Background The neurophysiological correlates of gastrointestinal symptoms (GISs) in Parkinson's disease (PD) are not well understood. It has been proposed that in patients with a gastrointestinal origin of PD dopaminergic neurodegeneration would be more symmetric. Objectives The aim is to assess the associations between GISs and asymmetry of nigrostriatal dopaminergic neurodegeneration in PD. Methods Ninety PD patients were assessed using motor and GIS scales and I-123-FP-CIT SPECT. We calculated the asymmetry index and the predominant side of motor symptoms and dopamine transporter (DAT) imaging defect and assessed their association with GISs. Results There were no significant differences in GISs between symmetric and asymmetric dopaminergic defect. Left predominant defect was related to more GIS and higher constipation scores. Conclusions GISs were associated with left predominant reduction in putaminal DAT binding but not asymmetry per se. It remains open whether left-sided DAT deficit is related to more pronounced GI involvement or symptom perception in PD. (c) 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.Peer reviewe

Diagnostic accuracy of glabellar tap sign for Parkinson's disease

Glabellar tap or reflex (GR) is an old bedside clinical test used in the diagnostics of Parkinson's disease (PD), but its diagnostic value is unclear. This study examines the diagnostic validity and reliability of GR in PD in relation to brain dopaminergic activity. GR was performed on 161 patients with PD, 47 patients with essential tremor (ET) and 40 healthy controls immediately prior to dopamine transporter (DAT) [I-123]FP-CIT SPECT scanning. The binding ratios were investigated with consideration of the GR result (normal/abnormal). In addition, the consistency of the GR was investigated with 89 patients after a mean follow-up of 2.2 years. PD and ET patients had higher GR scores than healthy controls (p 0.36). Over follow-up, the GR changed from abnormal to normal in 20% of PD patients despite the presence of clinically typical disease. The sensitivity and specificity of GR for differentiating PD from ET were 78.3% and 36.2%, respectively. Although GR has been used by clinicians in the diagnostics of PD, it does not separate PD from ET. It also shows considerable inconsistency over time, and abnormal GR has no relationship with dopamine loss. Its usefulness should be tested for other clinical diagnostic purposes.Peer reviewe

Diagnostic value of micrographia in Parkinson's disease : a study with [I-123]FP-CIT SPECT

Micrographia is a common symptom of Parkinson's disease (PD), and it may precede other motor symptoms. Despite the high prevalence of micrographia in PD, its neurobiological mechanisms are not known. Given that levodopa may alleviate consistent micrographia and that nondopaminergic essential tremor (ET) is not associated with micrographia, micrographia could possibly be used as an ancillary diagnostic method that reflects nigrostriatal dopamine function. We evaluated the usefulness of micrographia as a simple one-sentence writing test in differentiating PD from ET. A total of 146 PD patients, 42 ET patients and 38 healthy controls provided writing samples and were scanned with brain [I-123]FP-CIT dopamine transporter (DAT) SPECT imaging with ROI-based and voxelwise analyses. The diagnostic accuracy of micrographia was evaluated and compared to that of DAT binding. Compared to ET and healthy controls, PD patients showed micrographia (consistent, 25.6% smaller area of handwriting sample in PD compared to ET, p = 0.002, and 27.2% smaller area of handwriting compared to healthy controls, p = 0.004). PD patients showed 133% more severe progressive micrographia compared with ET patients (median b = - 0.14 in PD, b = - 0.06 in ET, p = 0.021). In early unmedicated cognitively normal patients, consistent micrographia showed 71.2% specificity and 87.5% sensitivity in PD versus ET differentiation, but micrographia had no correlation with striatal or extrastriatal [I-123]FP-CIT binding in patients with PD. The one-sentence micrographia test shows moderately good accuracy in PD versus ET differentiation. The severity of micrographia has no relationship with DAT binding, suggesting nondopaminergic mechanism of micrographia in PD. ClinicalTrials.gov identifier: NCT02650843 (NMDAT study).Peer reviewe

Fecal microbiome alterations in treatment-naive de novo Parkinson's disease

Gut microbiota alterations in Parkinson's disease (PD) have been found in several studies and are suggested to contribute to the pathogenesis of PD. However, previous results could not be adequately adjusted for a potential confounding effect of PD medication and disease duration, as almost all PD participants were already using dopaminergic medication and were included several years after diagnosis. Here, the gut microbiome composition of treatment-naive de novo PD subjects was assessed compared to healthy controls (HC) in two large independent case-control cohorts (n = 136 and 56 PD, n = 85 and 87 HC), using 16S-sequencing of fecal samples. Relevant variables such as technical batches, diet and constipation were assessed for their potential effects. Overall gut microbiome composition differed between PD and HC in both cohorts, suggesting gut microbiome alterations are already present in de novo PD subjects at the time of diagnosis, without the possible confounding effect of dopaminergic medication. Although no differentially abundant taxon could be replicated in both cohorts, multiple short chain fatty acids (SCFA) producing taxa were decreased in PD in both cohorts. In particular, several taxa belonging to the family Lachnospiraceae were decreased in abundance. Fewer taxonomic differences were found compared to previous studies, indicating smaller effect sizes in de novo PD.Peer reviewe

Gastrointestinal Symptoms and Dopamine Transporter Asymmetry in Early Parkinson's Disease

Background: The neurophysiological correlates of gastrointestinal symptoms (GISs) in Parkinson's disease (PD) are not well understood. It has been proposed that in patients with a gastrointestinal origin of PD dopaminergic neurodegeneration would be more symmetric.Objectives: The aim is to assess the associations between GISs and asymmetry of nigrostriatal dopaminergic neurodegeneration in PD.Methods: Ninety PD patients were assessed using motor and GIS scales and 123 I-FP-CIT SPECT. We calculated the asymmetry index and the predominant side of motor symptoms and dopamine transporter (DAT) imaging defect and assessed their association with GISs.Results: There were no significant differences in GISs between symmetric and asymmetric dopaminergic defect. Left predominant defect was related to more GIS and higher constipation scores.Conclusions: GISs were associated with left predominant reduction in putaminal DAT binding but not asymmetry per se. It remains open whether left-sided DAT deficit is related to more pronounced GI involvement or symptom perception in PD. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.</p

Diagnostic accuracy of glabellar tap sign for Parkinson's disease

Glabellar tap or reflex (GR) is an old bedside clinical test used in the diagnostics of Parkinson's disease (PD), but its diagnostic value is unclear. This study examines the diagnostic validity and reliability of GR in PD in relation to brain dopaminergic activity. GR was performed on 161 patients with PD, 47 patients with essential tremor (ET) and 40 healthy controls immediately prior to dopamine transporter (DAT) [123I]FP-CIT SPECT scanning. The binding ratios were investigated with consideration of the GR result (normal/abnormal). In addition, the consistency of the GR was investigated with 89 patients after a mean follow-up of 2.2 years. PD and ET patients had higher GR scores than healthy controls (p p = 0.09). There were no differences in the ratio of abnormal to normal GRs between the PD and ET groups (73% vs. 64% abnormal, respectively, p = 0.13) or in DAT binding between PD patients with abnormal and normal GRs (p > 0.36). Over follow-up, the GR changed from abnormal to normal in 20% of PD patients despite the presence of clinically typical disease. The sensitivity and specificity of GR for differentiating PD from ET were 78.3% and 36.2%, respectively. Although GR has been used by clinicians in the diagnostics of PD, it does not separate PD from ET. It also shows considerable inconsistency over time, and abnormal GR has no relationship with dopamine loss. Its usefulness should be tested for other clinical diagnostic purposes.</p

Diagnostic value of micrographia in Parkinson's disease: a study with [I-123]FP-CIT SPECT

Micrographia is a common symptom of Parkinson's disease (PD), and it may precede other motor symptoms. Despite the high prevalence of micrographia in PD, its neurobiological mechanisms are not known. Given that levodopa may alleviate consistent micrographia and that nondopaminergic essential tremor (ET) is not associated with micrographia, micrographia could possibly be used as an ancillary diagnostic method that reflects nigrostriatal dopamine function. We evaluated the usefulness of micrographia as a simple one-sentence writing test in differentiating PD from ET. A total of 146 PD patients, 42 ET patients and 38 healthy controls provided writing samples and were scanned with brain [123I]FP-CIT dopamine transporter (DAT) SPECT imaging with ROI-based and voxelwise analyses. The diagnostic accuracy of micrographia was evaluated and compared to that of DAT binding. Compared to ET and healthy controls, PD patients showed micrographia (consistent, 25.6% smaller area of handwriting sample in PD compared to ET, p = 0.002, and 27.2% smaller area of handwriting compared to healthy controls, p = 0.004). PD patients showed 133% more severe progressive micrographia compared with ET patients (median b = - 0.14 in PD, b = - 0.06 in ET, p = 0.021). In early unmedicated cognitively normal patients, consistent micrographia showed 71.2% specificity and 87.5% sensitivity in PD versus ET differentiation, but micrographia had no correlation with striatal or extrastriatal [123I]FP-CIT binding in patients with PD. The one-sentence micrographia test shows moderately good accuracy in PD versus ET differentiation. The severity of micrographia has no relationship with DAT binding, suggesting nondopaminergic mechanism of micrographia in PD. ClinicalTrials.gov identifier: NCT02650843 (NMDAT study).</p