Lasten ja perheiden palvelujen tuottaminen yhteistyössä järjestöjen ja seurakuntien kanssa : toimivat rakenteet ja sopimuskäytännöt

Tämä työpaperi on osa Lapsi- ja perhepalveluiden muutosohjelman (LAPE) toimeenpanon tukea. Lapsi- ja perhepalveluiden muutosohjelmassa tavoitteena on palveluiden painopisteen siirtäminen kaikille yhteisiin ja ennaltaehkäiseviin palveluihin sekä varhaiseen tukeen ja hoitoon. Uudistuksen lähtökohtana ovat lapsen oikeudet, perheiden monimuotoisuus, lapsi- ja perhelähtöisyys sekä voimavarojen vahvistaminen. Työ-paperissa kuvataan järjestötyön merkittävää ja monipuolista osuutta lasten, nuorten ja lapsiperheiden hyvinvoinnin ja terveyden edistämisessä. Lisäksi tarkastellaan kuntien, kuntayhtymien, järjestöjen ja seura-kuntien keskinäisiä toiminta- ja sopimuskäytäntöjä. Tarkastelu on rajattu lapsille, nuorille ja lapsiperheille palveluita, tukea ja toimintaa tuottaviin sosiaali- ja terveysjärjestöihin sekä evankelisluterilaisiin seurakuntiin

Efficacy of a 12-month, monitored home exercise programme compared with normal care commencing 2 months after total knee arthroplasty: a randomized controlled trial

Objective: To evaluate the efficacy of a delayed home exercise programme compared with normal care after primary total knee arthroplasty. Design: Single-blind, prospective, randomized, controlled trial. Participants: A total of 108 participants (61% females, mean age 69 years [standard deviation 8.7]), were randomized to a home-based exercise group (EG, n=53) or to a control group (CG, n=55). Methods: Two months post-operatively, the EG received a home exercise programme, while the CG received no additional guidance. The outcome measurements were: pain and disability, measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); healthrelated quality of life (HRQoL), measured using the Short Form-36 questionnaire (SF-36); maximal walking speed; isometric knee muscle strength; and the Timed Up and Go (TUG) test. Measurements were made at baseline and at 12 months thereafter. Results: At the 12-month follow-up, maximal walking speed (p<0.001) and knee flexion strength (p=0.009) were significantly greater in the EG. Both groups showed similar improvements in all of the WOMAC subscale scores, the SF-36 summary scores and the TUG time. Conclusion: Home-based training was not superior to normal care with regard to pain, disability or HRQoL, but resulted in greater improvement in objectively measured physical performance.peerReviewe

Trauma-related memories in PTSD after interpersonal violence: an ambulatory assessment study

Background: Ambulatory assessment (AA) is increasingly recommended for assessing symptoms of posttraumatic stress disorder (PTSD). Previous AA studies provided new insights into the phenomenology of trauma-related memories, but also divergent findings. Notably, the range of trauma-related memories (a major target of psychotherapeutic interventions) reported in AA studies was as wide as 7.3 to 74.5 per week which might result from different methods used in these studies. Objective: We aimed at assessing the frequency of trauma-related memories in PTSD related to interpersonal violence and investigated whether this frequency is dependent upon the method. Method: For each patient trauma-related memories were assessed using two variants of smartphone-based AA: (1) Event-based sampling (EBS), i.e. participants entered data on each intrusive memory as it occurred; (2) Time-based sampling (TBS), i.e. participants reported the number of trauma-related memories they had experienced during the last two hours after they had been alerted by the smartphone. The numbers reported during the TBS-block were either analysed as reported by the participants or restricted to one per hour (rTBS). The impact of smartphone-assessments on trauma-related memories was assessed during a post-monitoring questionnaire. Results: While trauma-related memories were frequent across assessments, the methodology had a huge impact on the numbers: EBS (median = 7) and rTBS (median = 6) yielded significantly lower weekly numbers of intrusive trauma-related memories than TBS (median = 49). Accordingly, the possibility to report unrestricted numbers of trauma-related memories clearly impacted the results. The post-monitoring questionnaire identified another source for the divergent findings: while feeling disrupted by the smartphone-assessments was unrelated to the numbers reported during EBS, feeling disrupted was related to an increase of trauma-related memories during TBS and rTBS. Conclusions: The method clearly impacts the recorded number of trauma-related memories. Future research should clarify whether other variables (e.g. the subjective stress related to intrusive memories) are less dependent on the methodology

Effect of total knee replacement surgery and postoperative 12 month home exercise program on gait parameters

Objective To evaluate the effects of surgery and a postoperative progressive home exercise program on gait parameters among individuals operated with total knee arthroplasty. Design Single blinded randomized controlled trial. Subjects 108 patients (84 females, 24 males, mean age 69 years). Interventions Patients were equally randomized into an exercise group (EG) and control group (CG). The 12-months progressive home exercise program starting two months postoperatively was compared to usual care. Methods Gait analysis was performed using the Gaitrite electronic walkway system. In addition, knee extension and flexion strength were measured by a dynamometer preoperatively, and pain on visual analog scale (VAS) at two months and 14 months postoperatively. Results At the 12–month follow-up, maximal gait velocity (p = 0.006), cadence (p = 0.003) and stance time (p = 0.039) showed a greater increase among EG than CG. All the other gait parameters improved among both groups, but with not statistically discernible difference between groups. Weak correlations were found between changes in maximal gait velocity and the knee extension (r = −0.31, p = 0.002), flexion strength (r = 0.28, p = 0.004) and pain during loading (r = −0.27, p = 0.005) values. Conclusion The intervention produced statistically significant changes in maximal gait velocity, cadence and stance times in the exercise group compared to controls. Although the average change was small it is of importance that biggest changes occurred in those with low performance.peerReviewe