Rajavyöhyketoiminta Vanajan avovankilan perheosastolla: Lastensuojelun sosiaalityöntekijöiden sekä vankilan perheosaston perhetyön välisen yhteistyön rakentuminen

Vanajan avovankilan perheosasto on uniikki lastensuojeluyksikkö, jonne vankeusrangaistustaan suorittava vanhempi voi sijoittua yhdessä pienen lapsensa kanssa. Perheosastolla tuetaan vanhemmuutta sekä vahvistetaan vanhemman ja lapsen välistä suhdetta. Tutkielman tarkoituksena on kuvata lastensuojelun sosiaalityöntekijöiden sekä perheosaston perhetyön toimintajärjestelmien välille rakentuvaa yhteistyötä sekä tarkastella yhteistyössä muodostuvaa toiminnan kohdetta. Tutkielmassa hyödynnetään toiminnan teoriaa. Tutkimuskysymyksinä tutkielmassa on 1) millainen toiminnan ja vuorovaikutuksen käsikirjoitus lastensuojelun sosiaalityöntekijöiden ja vankilan perheosaston perhetyöntekijöiden ja -ohjaajien toimintajärjestelmien välisessä yhteistyössä rakentuu sekä 2) millaiset tekijät haastavat lastensuojelun sosiaalityöntekijöiden sekä vankilan perheosaston perhetyöntekijöiden ja -ohjaajien toimintajärjestelmien käsikirjoituksen ylläpitämistä rajapintatyöskentelyssä. Aineistona tutkielmassa toimii kolmen lastensuojelun sosiaalityöntekijän yksilöhaastattelut sekä perheosaston työntekijöiden ryhmähaastattelu. Tämän kvalitatiivisen tutkielman aineiston analyysimenetelmänä on käytetty diskurssianalyysia. Tutkielma auttoi ymmärtämään yhteistyön rakentumista lastensuojelun sosiaalityöntekijöiden sekä perhetyön välillä Vanajan avovankilan perheosaston sijoituksissa. Perheosaston perhetyön sekä lastensuojelun sosiaalityöntekijöiden toimintajärjestelmissä on paljon yhtäläisyyksiä ja molemmat toimintajärjestelmät suuntaavat toimintaansa vahvasti samaan toiminnan kohteeseen, joka luo toimintajärjestelmien väliselle yhteistyölle yhteisesti jaettua merkityksellisyyttä. Yhteiseen toiminnan kohteeseen suuntautuneessa toiminnassa toimintajärjestelmien väliselle yhteistyölle muodostuu yhteistyön tukevista tekijöistä yhteisesti jaettu toiminnan ja vuorovaikutuksen käsikirjoitus. Lapsen edun konstruktiot muodostuvat toimijoiden kertomana miltei yhtäläisiksi ja selittävät yhteistä toiminnan kohdetta. Konstruktioiden pienet näkökulmaerot muodostuvat toimijoiden edustaman organisaation erilaisesta asemasta yhteiskunnassa ja roolista suhteessa lapseen. Toimintajärjestelmien yhteistyössä jännitteet liittyvät huolen käsitteeseen sekä kuvaavat, miten vankilan perheosaston konsepti ei ole vielä täysin vakiintunut lastensuojelun toimintakäytäntöihin

Improvisointia oppimassa : Iso mörkö vai vapaus ilmaista itseään?

Pedagoginen opinnäytetyöni käsittelee improvisointia ja siihen liittyviä asenteita, sen kokemista sekä siihen vaikuttavia tekijöitä, erityisesti ympäristöä. Opinnäytetyö punoo yhteen musiikin, taiteen ja kasvatus-alan ammattilaisten ajatuksia improvisoinnista ja luovasta toiminnasta ja luo näin teoriapohjaa lauluimprovisaatiolle, jonka tutkimus (etenkin improvisoinnin kokemuksen) ainakin Suomessa, on vielä kovin vähäistä. Opinnäytetyön keskeisin lähdemateriaali syntyy tutkimusosuudesta, jonka toteutin pienryhmätoimintana aikuisille lauluoppilailleni musiikkikoulu Alkusoitossa sekä lapsiryhmälle päiväkoti Aarresaaressa. Molemmat kasvatusympäristöt ja oppilaat sekä lapset ovat minulle työni kautta tuttuja. Tutkimuksessa pyrin kokemuksellisen pedagogiikan keinoin aktivoimaan oppilaani toteuttamaan luovat harjoitukset ja lauluimprovisaatiot mahdollisimman vähällä ohjauksella ja painottaen oppilaiden omaa tekemistä, itsearviointia ja kannustamaan omien ratkaisumallien luomiseen. Tutkimuksen luonteen takia, esittelen tarkkaan myös oppilaiden haastattelut, orientoitumislomakkeen vastaukset ja palautteen. Opinnäytetyön tarkoitus ei ole pelkästään esitellä tutkimustuloksia, vaan koko prosessia. Tutkimus osoitti, että niin lapset kuin aikuisetkin kamppailevat samojen asioiden kanssa luovasta toiminnasta ja improvisoinnista puhuttaessa. Kummatkin tiedostavat tekemisensä ja luovat itse usein isoimmat esteet improvisoinnilleen. Ympäristön rooli on merkittävä, vapaan ja luovan toiminnan mahdollistamiseksi. Ohjaajan tai opettajan luova asenne ja halu vuorovaikutukseen, auttaa oppilasta vapautumaan improvisoinnissaan.This Diploma project handles about improvisation and attitudes towards it, experiences and factors which impact to it, especially environment. Diploma project twines together thoughts from professionals of music, arts and education about improvisation and creative action and then creates theory base to vocal improvisation, of which research (especially experiences of improvisation) is still quite slight, at least in Finland . Diploma projects most crucial source material arises from the research part, which I executed with small-group action to my adult students in music school Alkusoitto and to children’s group in daycare center Aarresaari. Both of these educational environments and both student’s and children’s group are familiar to me through my work. In this research I try trough experiential pedagogies to activate my students to execute creative exercises and vocal improvisations with minimum guidance and highlighting their own doing, self valuation and stimulate to create their own models to solutions. By the character of this research , I give you also a full presentation of students interviews, answers from orientation forms and feedback. The purpose of this work is not just to introduce the results of my research, but the whole process. The research proved that both children and adults struggles with same subjects when it comes to creative action and improvisation. Both are aware of their doings and they create themselves those biggest barriers to their improvisation. Meaning of environment is significant so that free and creative action can be possible. Leaders or teachers attitude and willingness to interact, helps student to reach more free improvisation

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Anatomical pancreatic variants in intraductal papillary mucinous neoplasm patients : a cross-sectional study

Background No previous studies have examined the possible relationship between intraductal papillary mucinous neoplasm (IPMN) and the developmental ductal variations of the pancreas, such as an ansa pancreatica and a meandering main pancreatic duct (MMPD). Methods This retrospective cross-sectional study enrolled 214 patients, 108 with IPMN disease and 106 subjects from a community at the tertiary care unit. The main pancreatic duct (MPD) was evaluated in the head of the pancreas by its course, which were non-MMPD: descending, vertical, and sigmoid, or MMPD including loop types, reverse-Z subtypes, and an N-shape, which was identified for the first time in this study. IPMN patients were also evaluated for worrisome features (WF) or high-risk stigmata (HRS), and the extent of IPMN cysts. Results Among IPMN patients, 18.4% had MMPD, which we observed in only 3.0% of the control group (P < 0.001). Patients with MMPD were more likely to belong to the IPMN group compared with non-MMPD patients [odds ratio (OR) 6.4, 95% confidence interval (CI) 2.2-24.9]. Compared with a descending shape MPD, IPMN patients with an N-shaped MPD were more likely to have a cystic mural nodule (OR 5.9, 95% CI 1.02-36.0). The presence of ansa pancreatica associated with more extent IPMN disease (OR 12.8, 95% CI 2.6-127.7). Conclusions IPMN patients exhibited an MMPD more often than control patients. Ansa pancreatica associated with multiple cysts. Furthermore, an N-shape in IPMN patients associated with cystic mural nodules, suggesting that this shape serves as a risk factor for more severe IPMN.Peer reviewe

Impact of pasireotide on postoperative pancreatic fistulas following distal resections

Purpose Postoperative pancreatic fistula (POPF), a difficult complication after surgery, can cause peripancreatic fluid collection and infections in the operative area. In addition, pancreatic fluid is corrosive and can lead to postoperative bleeding. Clinically significant grade B and C fistulas (CR-POPF) increase postoperative morbidity, resulting in a prolonged hospital stay. Delaying adjuvant therapy due to fistula formation in cancer patients can affect their prognosis. In this study, we aimed to determine if pasireotide affects fistula formation, and the severity of other complications in patients following pancreatic distal resections. Data and methods Between 2000 and 2016, 258 distal pancreatectomies were performed at Helsinki University Hospital and were included in our analysis. Pasireotide was administered to patients undergoing distal resections between July 2014 and December 2016. Patients received 900-mu g pasireotide administered twice daily perioperatively. Other patients who received octreotide treatment were analyzed separately. Complications such as fistulas (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), reoperations, and mortality were recorded and analyzed 90 days postoperatively. Results Overall, 47 (18%) patients received pasireotide and 31 (12%) octreotide, while 180 patients (70%) who received neither constituted the control group. There were 40 (16%) clinically relevant grade B and C POPFs: seven (15%) in the pasireotide group, three (10%) in the octreotide group, and 30 (17%) in the control group (p = 0.739). Severe complications categorized as Clavien-Dindo grade III or IV were recorded in 64 (25%) patients: 17 (27%) in the pasireotide group, 4 (6%) in the octreotide group, and 43 (67%) in the control group (p = 0.059). We found no 90-day mortality. Conclusions In this study, pasireotide did not reduce clinically relevant POPFs or severe complications following pancreatic distal resection.Peer reviewe

MRI follow-up for pancreatic intraductal papillary mucinous neoplasm : an ultrashort versus long protocol

Purpose To evaluate whether an ultrashort-protocol (USP) MRI including only T2-weighted HASTE axial and 3D MRCP SPACE sequences adequately measures the largest diameter of the largest cyst and the main pancreatic duct (MPD) and identifies worrisome features (WF) and high-risk stigmata (HRS) when compared to longer protocols (LP, long protocol; SP, short protocol; S-LP, short or long protocol). We also calculated reductions in costs associated with USP. Methods This retrospective study included 183 IPMN patients. Two radiologists compared two imaging sets (USP versus S-LP) per patient, comparing the mean values of the largest cyst and MPD and agreement regarding the presence or absence of cystic or MPD mural nodules and solid pancreatic tumors. The interobserver agreement for cystic mural nodules and WF/HRS was evaluated, using the Bland-Altman plot and Cohen's Kappa. Results A total of 112 IPMN patients were evaluated. For detecting cysts or MPD nodules, WF/HRS, and solid pancreatic tumors, USP and S-LP coincided in 94.9%, 99.1%, 92.4%, and 99.1% of cases, respectively. Both USP and S-LP identified all true cystic mural nodules. The mean size of the largest cyst and MPD was 19.48/19.67 mm and 3.24/3.33 mm using USP versus S-LP, while the mean differences for USP versus S-LP were 0.19 mm and 0.08 mm. The USP cost was 39% of LP cost and 77% of SP. Interobserver agreement was moderate to strong. Conclusions For IPMN surveillance, an ultrashort-protocol MRI provides nearly identical information to the more expensive longer protocols.Peer reviewe

Variations in older people's use of general practitioner consultations and the relationship with mortality rate in Vantaa, Finland in 2003-2014

Objective: It is generally expected that the growth of the older population will lead to an increase in the use of health care services. The aim was to examine the changes in the number of visits made to general practitioners (GP) by the older age groups, and whether such changes were associated with changes in mortality rates. Design and setting: A register-based observational study in a Finnish city where a significant increase in the older population took place from 2003 to 2014. The number of GP visits made by the older population was calculated, the visits per person per year in two-year series, together with respective mortality rates. Subjects: The study population consisted of inhabitants aged 65 years and older (65+) in Vantaa that visited a GP in primary health care. Main outcome measures: The number of GP visits per person per year in the whole older population during the study years. Results: In 2009-2010, there was a sudden drop in GP visits per person in the younger (65-74 years) age groups examined. In the population aged 85+, use of GP visits remained at a fairly constant level. The mortality rate decreased until the year 2008. After that, the positive trend ended and the mortality rate plateaued. Conclusions: Simultaneously with the decline in GP visits per person in the older population, the mortality rate leveled off from its positive trend in 2009-2010. Factors identified being associated with the number of GP consultations were organizational changes in primary health care, economic recession causing retrenchment, and even vaccinations during the swine flu epidemic.Peer reviewe

Ornithine decarboxylase antizyme inhibitor 2 (AZIN2) is a signature of secretory phenotype and independent predictor of adverse prognosis in colorectal cancer

Ornithine decarboxylase (ODC) is the rate-limiting enzyme of polyamine synthesis. The two ODC antizyme inhibitors (AZIN1) and (AZIN2) are regulators of the catalytic activity of ODC. While AZIN1 is a regulator of cell proliferation, AZIN2 is involved in intracellular vesicle transport and secretion. There are no previous reports on the impact of AZIN2 expression in human cancer. We applied immunohistochemistry with antibodies to human AZIN2 on tissue micro- arrays of colorectal cancers (CRC) from 840 patients with a median follow-up of 5.1 years (range 0-25.8). The 5-year disease-specific survival rate was 58.9% (95% CI 55.0-62.8%). High AZIN2 expression was associated with mucinous histology (p = 0.002) and location in the right hemicolon (p = 0.021). We found no association with age, gender, stage, or histological tumor grade. High tumor expression of AZIN2 predicted an unfavorable prognosis (pPeer reviewe