45 research outputs found
Onko rahanpesulla asianomistajaa?
TiivistelmĂ€ - Referat â Abstract
Rahanpesulla tarkoitetaan tekoa tai tekokokonaisuutta, jonka pÀÀmÀÀrĂ€nĂ€ on peittÀÀ tai hĂ€ivyttÀÀ rikoksen tuottaman hyödyn tai omaisuuden alkuperĂ€. Rahanpesemiseen liittyy taloudellista hyötyĂ€ tuottaneen esirikoksen tekijĂ€n pyrkimys rikoksesta saadun taloudellisen hyödyn alkuperĂ€n salaamiseen. Rahanpesemisen jĂ€lkeen hyöty lopulta kuitenkin palautuu esirikoksen tekijĂ€lle, joko omistusâ tai hallintaoikeuksin. Rahanpesurikosten tausta on vahvasti kansainvĂ€linen: rahanpesun kriminalisointi perustuu kansainÂŹvĂ€lisiin instrumentteihin ja EUâlainsÀÀdĂ€ntöön. Rahanpesun kriminalisoinnin tavoitteet kansainvĂ€lisissĂ€ instrumenteissa ovat laajentuneet alkuperĂ€isestĂ€ kansainvĂ€lisen laittoman huumausainekaupan torjunnasta turvaamaan kansainvĂ€lisen rahoitusjĂ€rjestelmĂ€n puhtautta ja luotettavuutta sekĂ€ demokraattisen yhteiskuntajĂ€rjestelmĂ€n suojelua yleisesti vakavan rikollisuuden haitoilta. Viimeaikaisessa kehityksessĂ€ erityisesti terrorismin torjunta sen rahoitukseen puuttumalla on ollut keskiössĂ€ rahanpesurikosten tavoitteiden mÀÀrittĂ€misessĂ€.
Suomen rikosoikeudessa yleisesti hyvĂ€ksytyn kĂ€sityksen mukaan kriminalisoinneilla pyritÀÀn saavuttamaan yhteiskunnallisesti ajatellen jotain arvokasta: oikeushyvien suojelua. Oikeushyvien suojelun periaate on kiinteĂ€ssĂ€ yhteydessĂ€ asianomistajaâaseman mÀÀrittĂ€miseen, sillĂ€ Suomen rikosoikeudessa asianomistajana lĂ€htökohtaisesti pidetÀÀn sitĂ€, joka on rikoksella vĂ€littömĂ€sti loukatun, kriminalisoinnin suojeluobjektina olevan oikeushyvĂ€n haltija. TĂ€mĂ€n vuoksi kunkin rangaistussÀÀnnön suojeluobjektin tunteminen on keskeistĂ€ vastattaessa kysymykseen asianomistajan asemasta. Rahanpesun suojeluobjekti on kuitenkin jÀÀnyt sekĂ€ kansainvĂ€lisisissĂ€ instrumenteissa ettĂ€ kansallisella tasolla epĂ€mÀÀrĂ€iseksi ja yhĂ€ laajenevaksi argumentoinniksi, eikĂ€ kysymykseen rahanpesun asianomistajuudesta ei kuitenkaan ole helppo antaa yksiselitteistĂ€ vastausta.
Oikeuskirjallisuudessa useimmiten on todettu, ettÀ rahanpesulla ei ole asianomistajaa. TÀmÀ nÀkemys perustuu ajatukselle siitÀ, ettÀ rahanpesun kriminalisoinnilla suojattavat oikeushyvÀt ovat ensisijaisesti yhteisöllisiÀ ja abstrakteja. Rahanpesu kriminalisoimalla pyritÀÀnkin ensisijaisesti suojelemaan yhteisöllisiÀ oikeushyviÀ, kuten rahoitusjÀrjestelmÀn puhtautta ja demokraattista yhteiskuntajÀrjestystÀ, mutta kriminalisoinnin viimekÀtisenÀ tavoitteena on kuitenkin suojella esirikoksen kriminalisoinnilla turvattua oikeushyvÀÀ. Rahanpesun kohteena ollut omaisuus voidaan tietyissÀ tapauksissa kuitenkin tuomita esirikoksella loukatulle vahingonkorvauksena tai edunpalautuksena.
Kysymys rahanpesun asianomistajasta on kohtuullisen helposti ratkaistavissa tilanteessa, jossa esirikoksella ei ole asianomistajaa. TĂ€llainen tilanne on esimerkiksi huumausainerikoksessa. KĂ€ytĂ€nnön ratkaisutilanteet voivat kuitenkin liittyĂ€ kaikkiin taloudellista hyötyĂ€ tuottaviin rikoksiin, jolloin kysymys rahanpesun asianomistajasta muuttuu monimutkaisemmaksi. Vaikka rangaistussÀÀnnöllĂ€ ensisijaisesti suojeltu oikeusÂŹhyvĂ€ olisikin yhteisöllinen, voidaan sillĂ€ tavoitella myös henkilöllisten oikeushyvien suojelua. Siten rahanpesun tunnusmerkistön tĂ€yttĂ€vĂ€llĂ€ teolla voidaan loukata ensisijaisten, yhteisöllisten suojeluobjektien lisĂ€ksi myös henkilöllisiĂ€ oikeushyviĂ€, esimerkiksi omaisuudensuojaa. MikĂ€li rahanpesun tunnusmerkistön tĂ€yttĂ€vĂ€llĂ€ teolla aiheutetaan vĂ€litöntĂ€ vahinkoa suojelun kohteena olevan oikeushyvĂ€n haltijalle siten, ettĂ€ on mahdollista esittÀÀ tĂ€llĂ€ perusteella yksityinen oikeudellinen korvausvaade, asianomistajan aseman saavuttamisen edellytykset tĂ€yttyvĂ€t myös rahanpesussa. Harkinnassa on otettava huomioon myös oikeudenmukaisen oikeudenkĂ€ynnin ja acces to justice â vaatimusten tĂ€yttyminen: joissa asianomistajan asema rahanpesuoikeudenkĂ€ynnissĂ€ voi olla esirikoksen uhrille ainoa keino esittÀÀ vahingonkorvausvaatimuksia niistĂ€ menetyksistĂ€, joita esirikos on hĂ€nelle aiheuttanut
PerhevÀkivallan tunnistaminen, siihen puuttuminen ja työntekijÀn toiminta perhevÀkivaltatilanteessa
Pro gradu-tutkielman ensimmÀinen osa on julkaisuharkintaan lÀhetetty tieteellinen artikkeli: PerÀaho H, LeppÀkoski T, Koivisto A-M, KylmÀ J & Paavilainen E. 2015. PerhevÀkivallan tunnistaminen ja siihen puuttuminen sairaalassa: onko tÀydennyskoulutuksella merkitystÀ. Tutkimuksen tarkoitus on kuvata sairaanhoitopiirin työntekijöiden valmiuksia tunnistaa perhevÀkivaltaa ja puuttua siihen. Tarkoituksena on myös kuvata työntekijöiden moniammatillista yhteistyötÀ ja tÀydennyskoulutustarpeita perhevÀkivaltaan liittyen. Aineisto on kerÀtty kyselylomakkeella sÀhköisesti. Vastausprosentti on 13.4 % (n=295). Aineiston analysoinnissa on kÀytetty kvantitatiivisia ja kvalitatiivisia menetelmiÀ.
Vastaajat kokevat perhevÀkivallan osapuolten tunnistamisen ja vÀkivaltaan puuttumisen vaikeana. Vain viidenneksellÀ vastaajista on kÀytössÀ toimintamalli perhevÀkivaltaan puuttumiseksi ja reilu kolmannes tekee yhteistyötÀ muiden auttajatahojen kanssa perhevÀkivallan osapuolten auttamiseksi. Vastaajilla, jotka eivÀt ole osallistuneet työnantajan jÀrjestÀmÀÀn tÀydennyskoulutukseen, on heikommat valmiudet tunnistaa ja puuttua perhevÀkivaltaan, he tekevÀt vÀhemmÀn yhteistyötÀ muiden auttajatahojen kanssa ja ovat harvemmin tietoisia yhteisestÀ toimintamallista.
Pro gradu-tutkielman toisen osan muodostaa tutkimuksen kyselylomakkeen avoimien vastauksien ja perusteluiden analyysi. PerhevÀkivallan tunnistamisessa on merkitystÀ mm. potilaan kÀyttÀytymisen havainnoimisella, hoitosuhteessa tapahtuvalla vuorovaikutuksella, perhevÀkivallan ulkoisten merkkien havainnoimisella sekÀ työntekijÀn aktiivisuudella, kokemuksella ja intuitiolla. PerhevÀkivallan tunnistamista vaikeuttaa potilaan toiminta asian salaamiseksi sekÀ perhevÀkivallan haasteellisuus ilmiönÀ. Myös perhevÀkivaltaan puuttumista vaikeuttavat potilaasta johtuvat syyt ja lisÀksi työntekijÀn ammattitaidon puute. Kun perhevÀkivallan puuttumisen toimintamallia kÀytetÀÀn, se auttaa tekemÀÀn yhteistyötÀ ja organisoimaan perhevÀkivaltatyön tekemistÀ. Työntekijöiden keskeiset yhteistyötahot perhevÀkivaltatilanteessa ovat sosiaalityöntekijÀ ja poliisi.
ENGLISH SUMMARY
The first part of this Masterâs thesis consists of a research article which has been sent for publication consideration: PerĂ€aho H, LeppĂ€koski T, Koivisto A-M, KylmĂ€ J & Paavilainen E. 2015. Identifying and intervening in domestic violence: does an updating education matter? The purpose of this study is to describe the skills of the healthcare staff in identifying and intervening in domestic violence in a district hospital. Also the multi-professional collaboration and the needs of education of the staff were studied. Information was collected by an electronic query. Response rate was 13.4 %. The data was analyzed using both quantitative and qualitative methods.
The respondents find both identifying and intervening in domestic violence difficult. One fifth of the respondents uses hospital districts guideline of intervening in domestic violence. One third of the respondents collaborates with different supporting authorities when meeting the victim or the perpetrator of domestic violence. The respondents who had not been participated in updating education arranged by the employer, had lower ability to identify and intervene in domestic violence, to perform multi-professional collaboration and to pursue the districts guideline of intervening in domestic violence. Updating education effects in the staffâs ability to provide adequate care to the patients suffering from domestic violence. It is justified to arrange updating education systematically also in the future.
The second part of the Masterâs thesis consists of the analysis of the questionnaires open answers and arguments. Interaction with the patient, observing the patients behavior and external signs of violence and staff memberâs activity, experience and intuition have existent significance in identifying domestic violence. The difficulties in identifying the domestic violence are often due to patientâs actions to hide the violent experiences and the challenges that this phenomenon holds. The intervention in domestic violence is often complicated by the patient but also because the staff is lacking competence in dealing with it. When the guideline of intervening in domestic violence is used, it helps the staff to collaborate and organize the work concerning the victims and the perpetrators of the domestic violence. The respondents co-operate most commonly with social workers and police officers
KestÀvyysnÀkökulmia marjanjalostusteollisuuden tuotteen elinkaaressa
TiivistelmĂ€. TyössĂ€ tarkastellaan suomalaisen mansikkahillon elinkaarta tavoitteena löytÀÀ kustakin vaiheesta kestĂ€vyyden kannalta merkittĂ€vimmĂ€t kohdat. KestĂ€vyyden mittareita ovat esimerkiksi veden ja energian kulutus. Samalla pyritÀÀn selvittĂ€mÀÀn, onko kriittisille vaiheille parempia vaihtoehtoja. Tutkimus on tehty kirjallisuuskatsauksena hyödyntĂ€mĂ€llĂ€ alan julkaisuja ja viranomaislĂ€hteitĂ€. Elinkaari on työssĂ€ jaettu raaka-aineen valmistukseen, marjojen jalostukseen, logistiikkaan ja lopputuotteen vaiheisiin. Tuloksena löydettiin kestĂ€vyyden kannalta keskeisiĂ€ kohtia, esimerkiksi mansikan viljelyn aikainen kastelu, logistiikkaketju sekĂ€ jalostuksessa kĂ€ytettĂ€vĂ€ teknologia. TyössĂ€ havaittiin myös, ettĂ€ olisi tarpeellista tehdĂ€ lisĂ€vertailua ulkomaisen ja suomalaisen mansikan vĂ€lillĂ€.Sustainability perspectives in the life cycle of a product manufactured in berry processing industry. Abstract. This thesis considers strawberry jamâs life cycle aiming to find the critical points from sustainabilityâs point of view. The parameters to measure sustainability can be for example water and energy consumption. In addition, the thesis is targeted to find possible alternatives for the possibly unsustainable processes. Research was done as literature review utilizing literature and public administrationâs publications. The life cycle is divided into strawberry farming, processing of the berries, logistics and end product use and recycling. As a result, it was found out that the key points in sustainability include watering the strawberry fields, logistic chain and the technology used in processing the berries. It was also discovered that additional research would be recommended to compare foreign and domestic strawberry farming
The Molecular Basis for Oat Intolerance in Patients with Celiac Disease
BACKGROUND: Celiac disease is a small intestinal inflammatory disorder characterized by malabsorption, nutrient deficiency, and a range of clinical manifestations. It is caused by an inappropriate immune response to dietary gluten and is treated with a gluten-free diet. Recent feeding studies have indicated oats to be safe for celiac disease patients, and oats are now often included in the celiac disease diet. This study aimed to investigate whether oat intolerance exists in celiac disease and to characterize the cells and processes underlying this intolerance. METHODS AND FINDINGS: We selected for study nine adults with celiac disease who had a history of oats exposure. Four of the patients had clinical symptoms on an oats-containing diet, and three of these four patients had intestinal inflammation typical of celiac disease at the time of oats exposure. We established oats-avenin-specific and -reactive intestinal T-cell lines from these three patients, as well as from two other patients who appeared to tolerate oats. The avenin-reactive T-cell lines recognized avenin peptides in the context of HLA-DQ2. These peptides have sequences rich in proline and glutamine residues closely resembling wheat gluten epitopes. Deamidation (glutamineâglutamic acid conversion) by tissue transglutaminase was involved in the avenin epitope formation. CONCLUSIONS: We conclude that some celiac disease patients have avenin-reactive mucosal T-cells that can cause mucosal inflammation. Oat intolerance may be a reason for villous atrophy and inflammation in patients with celiac disease who are eating oats but otherwise are adhering to a strict gluten-free diet. Clinical follow-up of celiac disease patients eating oats is advisable
Histological, immunohistochemical and mRNA gene expression responses in coeliac disease patients challenged with gluten using PAXgene fixed paraffin-embedded duodenal biopsies
Clinical practice: Coeliac disease
Coeliac disease (CD) is an immune-mediated systemic condition elicited by gluten and related prolamines in genetically predisposed individuals and characterised by gluten-induced symptoms and signs, specific antibodies, a specific human leukocyte antigen (HLA) type and enteropathy. The risk of coeliac disease is increased in first-degree relatives, certain syndromes including Down syndrome and autoimmune disorders. It is thought to occur in 1 in 100â200 individuals, but still only one in four cases is diagnosed. Small-bowel biopsy is no longer deemed necessary in a subgroup of patients, i.e. when all of the following are present: typical symptoms or signs, high titres of and transglutaminase antibodies, endomysial antibodies, and HLA-type DQ2 or DQ8. In all other cases, small-bowel biopsy remains mandatory for a correct diagnosis. Therapy consists of a strictly gluten-free diet. This should result in complete disappearance of symptoms and of serological markers. Adequate follow-up is considered essential. Conclusion: Although small-bowel biopsy may be omitted in a minority of patients, small-bowel biopsy is essential for a correct diagnosis of CD in all other cases. Diagnostic work-up should be completed before treatment with gluten-free diet instituted
Safety of Adding Oats to a Gluten-free Diet for Patients with Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies
Background & Aims: Patients with celiac disease should maintain a gluten-free diet (GFD), excluding wheat, rye, and barley. Oats might increase the nutritional value of a GFD, but their inclusion is controversial. We performed a systematic review and meta-analysis to evaluate the safety of oats as part of a GFD in patients with celiac disease. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases for clinical trials and observational studies of the effects of including oats in GFD of patients with celiac disease. The studies reported patientsâ symptoms, results from serology tests, and findings from histologic analyses. We used the GRADE approach to assess the quality of evidence. Results: We identified 433 studies; 28 were eligible for analysis. Of these, 6 were randomized and 2 were not randomized controlled trials comprising a total of 661 patientsâthe remaining studies were observational. All randomized controlled trials used pure/uncontaminated oats. Oat consumption for 12 months did not affect symptoms (standardized mean difference: reduction in symptom scores in patients who did and did not consume oats, â0.22; 95% CI, â0.56 to 0.13; P = .22), histologic scores (relative risk for histologic findings in patients who consumed oats, 0.24; 95% CI, 0.01â4.8; P = .35), intraepithelial lymphocyte counts (standardized mean difference, 0.21; 95% CI, reduction of 1.44 to increase in 1.86), or results from serologic tests. Subgroup analyses of adults vs children did not reveal differences. The overall quality of evidence was low. Conclusions: In a systematic review and meta-analysis, we found no evidence that addition of oats to a GFD affects symptoms, histology, immunity, or serologic features of patients with celiac disease. However, there were few studies for many endpoints, as well as limited geographic distribution and low quality of evidence. Rigorous double-blind, placebo-controlled, randomized controlled trials, using commonly available oats sourced from different regions, are needed
Dietary aspects in the diagnosis and treatment of Coeliac Disease
Keliakiassa vehnÀn, ohran ja rukiin valkuaisaineet aiheuttavat ohutsuolen limakalvolle tulehduksen, joka asteittain etenee suolinukan madaltumiseen (villusatrofia). Keliakian diagnoosi on perustunut villusatrofian löytymiseen koepalasta ohutsuolen limakalvolta. Keliakian hoitona on elinikÀinen tiukka gluteeniton dieetti, missÀ tulee vÀlttÀÀ vehnÀÀ, ohraa ja ruista. Kaura on hyvÀksytty Suomessa yli kymmenen vuotta osaksi keliakiadieettiÀ.
VÀitöskirjatyön tarkoituksena oli selvittÀÀ dieetin merkitystÀ diagnostiikassa ja hoidossa. Kahdessa ensimmÀisessÀ osatyössÀ selvitettiin kauran vaikutusta elÀmÀnlaatuun, oireisiin, limakalvomuutoksiin. LisÀksi selvitettiin kuinka laajasti keliakiapotilaat kÀyttÀvÀt kauraa ja mitÀ he siinÀ arvostavat. TÀtÀ varten satunnaistettiin 39 pitkÀÀn hoidossa olleita keliakiapotilasta kÀyttÀmÀÀn vuoden ajan 50 grammaa kauraa tai jatkamaan entisellÀ kaurattomalla dieetillÀ. ElÀmÀnlaatua selvitettiin Psycholocigal General Well-Being ja suolisto-oireita Gastrointestinal Sympton Rating Scale kyselyillÀ; lisÀksi tutkittiin ohutsuolikoepalat ja keliakiavasta-aineet. Kauran kÀyttö ei vaikuttanut elÀmÀnlaatuun. Kauraa kÀyttÀvillÀ oli tilastollisesti merkitsevÀsti enemmÀn ripulia; samalla myös ummetusoireet keskimÀÀrin lisÀÀntyivÀt, mutta ei merkittÀvÀsti. LisÀksi kauraryhmÀssÀ oli ohutsuolikoepaloissa nÀhtÀvissÀ enemmÀn tulehdusta, mutta tulehdus ja oireet eivÀt korreloineet keskenÀÀn. Villusmuutoksia ei kehittynyt kumpaankaan ryhmÀÀn seuranta-aikana.
Suomen keliakialiitossa on 14 000 jÀsentÀ, nÀistÀ tuhannelle satunnaisesti valikoidulle lÀhettiin kysely, jolla selvitettiin kuinka laajasti kauraa kÀytetÀÀn ja monipuolistaako kaura dieettiÀ. Kaikkiaan 710 jÀsentÀ vastasi. Kauraa kÀytti sÀÀnnöllisesti 73% keliaakikoista ja 55% ihokeliaakikoista; 94% vastanneista kokivat kauran monipuolistavan gluteenitonta dieettiÀ ja pitivÀt kauraa tÀrkeÀnÀ lisÀnÀ. LisÀksi yli 85% arvosti kauran saatavuutta, makua ja halpaa hintaa. Tavallisin syy vÀlttÀÀ kauraa oli pelko gluteenijÀÀmistÀ ja mahdollisista sivuvaikutuksista. Kauran kÀytön oli lopettanut 14% vastanneista  syynÀ olivat erilaiset oireet, kuten vatsavaivat, ja osalla myös ihottuma.
Kolmannessa osastyössÀ selvitettiin ovatko teollisesti puhdistettujen vehnÀtÀrkkelysjauhojen sisÀltÀmÀt pienet gluteenimÀÀrÀt haitallisia keliaakikoille. TÀtÀ selvittÀmÀÀn 57 uutta keliaakikkoa satunnaistettiin kÀyttÀmÀÀn vehnÀtÀrkkelyspohjaista tai tÀysin gluteenitonta dieettiÀ. Ennen ruokavaliohoidon aloittamista ja vuoden seuranta-ajan jÀlkeen potilailta katsottiin ohutsuolikoepalat, keliakiavasta-aineet, elÀmÀnlaatu ja luuntiheys. VehnÀtÀrkkelyspohjainen gluteeniton dieetti oli hyvin siedetty ja turvallinen, eikÀ nÀiden kahden ryhmÀn vÀlillÀ ollut eroa mitattaessa edellÀ mainittuja muuttujia.
NeljÀnnessÀ osatyössÀ tutkittiin, voidaanko gluteenialtistusta tai gluteenitonta dieettiÀ kÀyttÀÀ diagnostiikassa, kun villusatrofiaa ei ollut vielÀ todettu. 41 potilasta satunnaistettiin saamaan ylimÀÀrÀistÀ gluteenialtistusta tai aloittamaan gluteeniton dieettihoito. NÀillÀ potilailla epÀiltiin keliakiaa, ohutsuolen limakalvolla olivat epiteelin ΄Ύ+tulehdussolut lisÀÀntyneet, mutta villusatrofiaa ei voitu todeta. Ohutsuolen tulehdussolut ja keliakiavasta-aineet tutkittiin ennen ja kuuden kuukauden altistuksen tai hoidon jÀlkeen. Tutkimuksessa tehtiin kliininen arvio selvittÀmÀÀn gluteeniherkkyyttÀ  tÀhÀn kuului oireiden, vasta-aineiden ja histologian vaste ruokavaliolle, ja lisÀksi sukuhistoria sekÀ liitÀnnÀissairaudet. Viisi potilasta altistusryhmÀssÀ ja kuusi hoitoryhmÀssÀ todettiin kliinisesti ja koepalalla arvioiden gluteeniherkiksi. Kaikilla heillÀ oli keliakiaan sopiva perimÀ. Tulokset tarkistettiin uudella menetelmÀllÀ, jossa keliakiapotilaan ohutsuolen limakalvolta mÀÀritetÀÀn transglutaminaasi 2 spesifisiÀ IgA kertymiÀ: tutkituista yhdestÀtoista kaikilla paitsi yhdellÀ todettiin nÀitÀ kertymiÀ. Löydös yhdessÀ keliakiaan sopivan perimÀn kanssa vahvistaa nÀiden potilaiden sairastavan alkavaa keliakiaa.
KÀytettyjen mittarien mukaan kaura ei vaikuta keliakiapotilaiden elÀmÀnlaatuun, mutta se on laajasti otettu kÀyttöön osana gluteenitonta dieettiÀ, hyvin siedetty ja monipuolistaa dieettiÀ. Kliinikoiden tulee kuitenkin muistaa, ettÀ kaura voi aiheuttaa joillekin potilaille oireita, mitkÀ eivÀt kuitenkaan vaikuta liittyvÀn ohutsuolivaurioon. Kaura voidaan useimmiten turvallisesti liittÀÀ osaksi gluteenitonta hoitoa. VehnÀtÀrkkelyspohjainen gluteeniton dieetti on hyvin siedetty. Gluteenittomalla hoidolla tai altistuksella on mahdollista osoittaa gluteeniherkkyys potilailla, joilla ei vielÀ voida todeta suolinukan madaltumista. Transglutaminaasi-2 spesifiset IgA kertymÀt ohutsuolen limakalvolla vahvistavat kliinistÀ arviota. KeliakiamÀÀritelmÀÀ on aiheellista laajentaa villusatrofiasta kohti geneettistÀ gluteeni-intoleranssia.Coeliac disease is a chronic inflammatory disorder of the small intestine induced by dietary proteins in wheat, rye and barley. Traditionally, the diagnosis of the disease is made by showing gluten-dependent villous atrophy in small bowel mucosal specimens. The mucosal damage develops from inflammation to crypt hyperplasia and finally to villous atrophy. The treatment of coeliac disease is a strict life-long gluten-free diet. In Finland oats have been accepted for more than 10 years as part of an otherwise gluten-free diet (GFD), but it has never been shown how patients with coeliac disease have adopted oats, and what is the impact of an oats-containing diet on the quality of life. Wheat is clearly toxic for coeliac patients, but open questions remain as to its role in the diagnosis and treatment of the disease. It has been debatable whether trace amounts of gluten are harmful; such contaminations are possible for instance in wheat starch-based products which have been rendered gluten-free. It is also evident that demonstrating gluten dependency is an essential part of coeliac diagnosis in borderline cases.
The aim of this study was to establish how oats affects the dietary treatment of coeliac disease, the focus being on quality of life, and how patients nationwide have adopted the use of oats. In addition, the safety of the wheat-starch-based GFD in the treatment of coeliac disease was assessed. Further, the role of gluten or GFD in the diagnosis and treatment of early developing coeliac disease, when mucosal atrophy is not yet evident, was investigated. To evaluate the effect of oats-containing diet on symptoms, histology and quality of life, 39 biopsy-proven treated coeliac disease patients were randomized to take either 50 g of oats-containing gluten-free products for one year, or to continue their current diet which did not contain oats. Quality of life and gastrointestinal symptoms were measured by the Psychological General Well-Being questionnaire (PGWB) and Gastrointestinal Symptom Rating Scale (GSRS), respectively. Small bowel mucosal morphology, serum endomysial (EmA) and transglutaminase (tTG) antibodies were assessed. Quality of life did not differ between these study groups, but patients on oats-containing diet suffered significantly more often from diarrhoea. This notwithstanding, there was a simultaneous trend toward more severe constipation in the oats-group than in individuals on the traditional diet. Mucosal integrity was not disturbed by oats. There were more mucosal intestinal intraepithelial lymphocytes ( IELs) in the oats group, but no correlation between symptoms and inflammation. One thousand out of 14 000 members of the Finnish Coeliac Society were randomly chosen to evaluate how they had adopted oat in their GFD, and how they felt that oats diversified the diet: Altogether 710 responded: 73% of coeliac disease and 55% of dermatitis herpetiformis patients were currently using oats. More than 80% of patients using oats appreciated the taste, felt that oats constituted an important part of the diet that the availability of oats was good at low costs, and 94% thought that oats diversified their GFD. Fourteen per cent of patients had stopped taking oats, mostly due to adverse symptoms. The fear of contamination and side-effects was the most common reason in those who had not started to take oats. Fifty-seven newly detected coeliac disease patients were randomized to receive a wheat-starch-based or naturally GFD. Clinical response, quality of life evaluated by standardized questionnaire, small-bowel mucosal morphology, serology and bone mineral density (BMD) were measured before and after one year on GFD. Wheat-starch-based gluten-free products were well tolerated and there were no differences between the groups in the measured parameters. A prospective randomized study was carried out to assess whether patients with suspected coeliac disease and increased density of ΄Ύ+IELs have a gluten sensitive disorder. Forty-one adults with increased density of ΄Ύ+IELs without villous atrophy were randomized to gluten challenge or GFD treatment. Small bowel morphology, serum EmA and tTG-ab were assessed before and after a follow-up of six months. A new clinical score was introduced to measure gluten dependency; it comprised data on symptoms, associated conditions, family history, serology and histology before and after the dietary intervention. Five patients in the challenge group and six in the gluten-free group were considered to be clinically gluten-sensitive; all of them had human leucocyte antigen (HLA) DQ2 or DQ8. Tissue transglutaminase 2-targeted mucosal IgA deposits have been shown to be a reliable marker of gluten-sensitivity even in the absence of villous atrophy; 10 out of the 11 clinically sensitive subjects had these mucosal antibodies.
According to the prospective study (I) and the nationwide inquiry (II), oats was widely accepted and well tolerated, and patients felt that oats diversified the GFD. Oats may induce abdominal complaints in some patients, and physicians should be aware of this. Nevertheless, oats can be safely included in a GFD in the majority of coeliac patients. This study showed that a wheat starch-based GFD was well tolerated despite possible trace amounts of gluten present in the products in question. By gluten-free treatment or challenge it is possible to reveal clinical gluten sensitivity even in patients who do not (yet) fulfil the current diagnostic criteria for coeliac disease. It is time to widen the diagnostic criteria from small bowel mucosal atrophy towards genetic gluten intolerance. The study also showed that the presence of transglutaminase 2-targeted mucosal IgA deposits, being a good diagnostic tool even in developing coeliac disease, is associated with gluten dependency. Which patients with genetic gluten intolerance without villous atrophy will benefit from GFD is a subject for further studies
In a society with a combative social debate, the knowledge about BDSM shines with its absence : a literature review about BDSM connected to violence, norms and consent
Syftet med denna kunskapsöversikt var att sammanstÀlla och undersöka kunskap kring BDSM kopplat till vÄld, samtycke och normer. Genom att samla in forskning frÄn en bredd av olika fÀlt introducerade denna studie olika perspektiv pÄ BDSM till socialt arbete. För mÀnniskor som arbetar med individer som misstÀnks vara vÄldsutsatta eller möter mÀnniskor som utövar BDSM Àr det viktigt att kunna skilja pÄ BDSM-utövning frÄn vÄld och övergrepp. Analysen av de 28 relevanta kÀllorna redovisades i tre teman. VÄld och BDSM som visade att Àven om det finns klara skillnader gÀllande samtycke och syfte mellan vÄld och BDSM ser vissa mÀnniskor BDSM som vÄld. Sexuella normer, samtycke och BDSM uppmÀrksammade att BDSM-gemenskaper bÄde har en mer komplex förstÄelse och ett tydligare sÀtt att kommunicera kring samt förhandla fram samtycke Àn övriga samhÀllet. BDSM:s stigmatisering och dess konsekvenser uppmÀrksammade bemötandet av BDSM-utövare och behovet av mer kunskap och förstÄelse, speciellt inom mÀnniskobehandlande yrken.The aim for this literature review was to compile and examine research on the topic of BDSM connected to consent, norms, and violence. By collecting research from different scientific fields, this study introduced the different perspectives of BDSM to the field of social work. It is important for people who work with individuals who practice BDSM or people that might be subjected to violence to maintain knowledge about how to differentiate abuse and violence from BDSM. The analysis of the twenty-eight studies are declared in three themes. Violence and BDSM which showed that despite the clear differences in consent and purpose between violence and BDSM there are still people who see BDSM as abusive. Sexual norms, consent and BDSM highlighted how BDSM-communities have both a more complex understanding surrounding consent as well as more clear-cut way of communicating and negotiating it compared to the rest of society. BDSMs stigmatization and its consequences  highlighted the treatment of BDSM-practitioners and the need for more knowledge and understanding especially when it comes to professions that are supposed to help people.
PerhevÀkivallan tunnistaminen, siihen puuttuminen ja työntekijÀn toiminta perhevÀkivaltatilanteessa
Pro gradu-tutkielman ensimmÀinen osa on julkaisuharkintaan lÀhetetty tieteellinen artikkeli: PerÀaho H, LeppÀkoski T, Koivisto A-M, KylmÀ J & Paavilainen E. 2015. PerhevÀkivallan tunnistaminen ja siihen puuttuminen sairaalassa: onko tÀydennyskoulutuksella merkitystÀ. Tutkimuksen tarkoitus on kuvata sairaanhoitopiirin työntekijöiden valmiuksia tunnistaa perhevÀkivaltaa ja puuttua siihen. Tarkoituksena on myös kuvata työntekijöiden moniammatillista yhteistyötÀ ja tÀydennyskoulutustarpeita perhevÀkivaltaan liittyen. Aineisto on kerÀtty kyselylomakkeella sÀhköisesti. Vastausprosentti on 13.4 % (n=295). Aineiston analysoinnissa on kÀytetty kvantitatiivisia ja kvalitatiivisia menetelmiÀ.
Vastaajat kokevat perhevÀkivallan osapuolten tunnistamisen ja vÀkivaltaan puuttumisen vaikeana. Vain viidenneksellÀ vastaajista on kÀytössÀ toimintamalli perhevÀkivaltaan puuttumiseksi ja reilu kolmannes tekee yhteistyötÀ muiden auttajatahojen kanssa perhevÀkivallan osapuolten auttamiseksi. Vastaajilla, jotka eivÀt ole osallistuneet työnantajan jÀrjestÀmÀÀn tÀydennyskoulutukseen, on heikommat valmiudet tunnistaa ja puuttua perhevÀkivaltaan, he tekevÀt vÀhemmÀn yhteistyötÀ muiden auttajatahojen kanssa ja ovat harvemmin tietoisia yhteisestÀ toimintamallista.
Pro gradu-tutkielman toisen osan muodostaa tutkimuksen kyselylomakkeen avoimien vastauksien ja perusteluiden analyysi. PerhevÀkivallan tunnistamisessa on merkitystÀ mm. potilaan kÀyttÀytymisen havainnoimisella, hoitosuhteessa tapahtuvalla vuorovaikutuksella, perhevÀkivallan ulkoisten merkkien havainnoimisella sekÀ työntekijÀn aktiivisuudella, kokemuksella ja intuitiolla. PerhevÀkivallan tunnistamista vaikeuttaa potilaan toiminta asian salaamiseksi sekÀ perhevÀkivallan haasteellisuus ilmiönÀ. Myös perhevÀkivaltaan puuttumista vaikeuttavat potilaasta johtuvat syyt ja lisÀksi työntekijÀn ammattitaidon puute. Kun perhevÀkivallan puuttumisen toimintamallia kÀytetÀÀn, se auttaa tekemÀÀn yhteistyötÀ ja organisoimaan perhevÀkivaltatyön tekemistÀ. Työntekijöiden keskeiset yhteistyötahot perhevÀkivaltatilanteessa ovat sosiaalityöntekijÀ ja poliisi.
ENGLISH SUMMARY
The first part of this Masterâs thesis consists of a research article which has been sent for publication consideration: PerĂ€aho H, LeppĂ€koski T, Koivisto A-M, KylmĂ€ J & Paavilainen E. 2015. Identifying and intervening in domestic violence: does an updating education matter? The purpose of this study is to describe the skills of the healthcare staff in identifying and intervening in domestic violence in a district hospital. Also the multi-professional collaboration and the needs of education of the staff were studied. Information was collected by an electronic query. Response rate was 13.4 %. The data was analyzed using both quantitative and qualitative methods.
The respondents find both identifying and intervening in domestic violence difficult. One fifth of the respondents uses hospital districts guideline of intervening in domestic violence. One third of the respondents collaborates with different supporting authorities when meeting the victim or the perpetrator of domestic violence. The respondents who had not been participated in updating education arranged by the employer, had lower ability to identify and intervene in domestic violence, to perform multi-professional collaboration and to pursue the districts guideline of intervening in domestic violence. Updating education effects in the staffâs ability to provide adequate care to the patients suffering from domestic violence. It is justified to arrange updating education systematically also in the future.
The second part of the Masterâs thesis consists of the analysis of the questionnaires open answers and arguments. Interaction with the patient, observing the patients behavior and external signs of violence and staff memberâs activity, experience and intuition have existent significance in identifying domestic violence. The difficulties in identifying the domestic violence are often due to patientâs actions to hide the violent experiences and the challenges that this phenomenon holds. The intervention in domestic violence is often complicated by the patient but also because the staff is lacking competence in dealing with it. When the guideline of intervening in domestic violence is used, it helps the staff to collaborate and organize the work concerning the victims and the perpetrators of the domestic violence. The respondents co-operate most commonly with social workers and police officers