Varhainen vuorovaikutus ja raskaudenaikainen mielikuvatyö perhevalmennuksessa

Opinnäytetyö pohjautuu Turun sosiaali- ja terveystoimen sekä Turun ammattikorkeakoulun yhteistyöhankkeena toteutettavaan Neuvolatoiminta 2010-luvulle (Kymppi-hankkeen) Valmiina Vanhemmuuteen -osaprojektiin. Hankkeen tarkoituksena on perhevalmennusmateriaalin kokonaisvaltainen uudistaminen sekä materiaalin yhtenäistäminen eri Turun äitiysneuvoloiden kesken. Opinnäytetyön tarkoituksena on kirjallisuuskatsauksen avulla tuottaa laadukasta ja tutkittuun tietoon perustuvaa tietoa vanhemman ja lapsen välisestä varhaisesta vuorovaikutuksesta sekä sen vaikutuksesta lapsen tulevalle kehitykselle. Viimeaikaisten tutkimusten perusteella voidaan todeta, että varhainen vuorovaikutus on yksi tärkeimmistä osista lapsen kehityksessä. Lapsen ensimmäisten elinvuosien merkitys on ymmärretty yhä paremmin neurobiologisen tietämyksen lisääntyessä ja tieto varhaisen vuorovaikutuksen kauaskantoisesta merkityksestä lisääntyy nopeasti. Vanhemman ja lapsen vuorovaikutussuhde alkaa jo raskausaikana ja kehittyy edelleen lapsen syntymän jälkeen. Vanhempien kiinnittymisellä lapseen jo raskausaikana on merkitystä positiivisen vuorovaikutussuhteen kehittymiselle. Raskaudenaikaisten mielikuvien ennustavuus tulevasta vuorovaikutussuhteesta on merkittävä tutkimustulos perhevalmennuksen kannalta. Raskaudenaikaisen mielikuvatyöskentelyn avulla perhevalmennuksessa on mahdollisuus vanhemman ja lapsen vuorovaikutussuhteen vahvistamiseen. Vanhemman ja lapsen varhaisen vuorovaikutuksen tukemisen näkökulma tulisi olla perhevalmennuksessa läsnä jokaisella valmennuskerralla, sillä varhainen vuorovaikutussuhde on läsnä kaikessa lapsen kanssa olemisessa. Keskeinen merkitys on sillä, että terveydenhoitaja on sisäistänyt varhaisen vuorovaikutuksen tukemisen näkökulman ja se näkyy kokonaisvaltaisena työotteena läpi koko perhevalmennuksen. Opinnäytetyön liitteenä olevassa käsikirjaosiossa on teoriapohjan lisäksi esitelty käytännön ideoita ja toteuttamisehdotuksia perhevalmennuksen ryhmätapaamisille raskaudenaikaisesta mielikuvatyöstä ja varhaisen vuorovaikutuksen tukemisesta.This thesis is based on the Ready for Parenthood Project, which is a subproject of the Upgrading Maternity and Child Health Care Clinics to the 21st Century Project (Kymppi -project), a co-operative project between the Turku Municipal Social Services and Health Care Department and the Turku University of Applied Sciences. The aim of this development project is the complete revision of all family training materials, as well as the harmonization of materials used by the different Turku Maternal Health Clinics. Through a systematic literature review of recent research, this thesis aims to generate information on early parent-child interaction and its effects on a child’s future development. Based on the latest research it can be argued that the early parent-infant interaction is one of the most important factors in a child’s development. The significance of the early years of a child’s life has become better understood with the increase in neurobiological knowledge. Moreover, information on the far-reaching significance of early parent-infant interaction continues to rapidly increase. The parent-infant relationship begins already during pregnancy and develops further after the child’s birth. Parental attachment to the child already during the pregnancy has a positive influence on the development of the relationship. Research indicating a predictive link between prenatal mental representations and the future parent-infant relationship is a significant finding for family training. Through focusing on prenatal mental representations, family training has a possibility to strengthen the parent-infant relationship. The perspective of supporting early parent-infant interaction should be included in every family training session as the early parent-infant relationship is present in everything that involves childcare. It is very important that the public health nurse internalizes the significance of strengthening early parent-infant interaction, and that this approach is maintained throughout the whole family training process. In the manual attached to the thesis, in addition to the presentation of the theoretical framework, practical suggestions are made for family training group sessions on how to strengthen early parent-infant interaction through prenatal mental representation exercises

Analgesic antipyretic use among young children in the TEDDY study : No association with islet autoimmunity

Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Results: Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). Conclusions: ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection