Lapsen seksuaalisen hyväksikäytön vaikutukset psyykkiseen kehitykseen

Tiivistelmä. Lapsen seksuaalinen hyväksikäyttö on laaja ja monitasoinen ilmiö. Kyseessä on lapsuutta voimakkaasti rikkova tapahtuma tai tapahtumasarja, joka vaikuttaa laajasti uhrin myöhempään elämään. Lapsen seksuaalinen hyväksikäyttö on traumaattinen tapahtuma lapsuudessa, johon liittyy traumalle tyypillisiä selviytymiskeinoja. Psyykkisiä seurauksia seksuaalisesta hyväksikäytöstä ilmenee muun muassa emotionaalisissa taidoissa ja sosiaalisessa kanssakäymisessä muiden ihmisten kanssa. Lapsen seksuaalista hyväksikäyttöä on tutkittu kattavasti maailmanlaajuisesti. Ilmiötä leimaa kuitenkin sukupuolittuneisuus, jossa uhrit ovat naispuolisia ja tekijät miespuolisia. Tutkimustarve miespuolisten uhrien kokemuksista ja naispuolisten tekijöiden teoista on ilmeinen. Ulkomaisten tutkimusten yleistettävyys suomalaiseen yhteiskuntaan on myös haastavaa, joten paikallista suomalaista tutkimusta aiheesta tarvitaan lisää. Seksuaalisen hyväksikäytön tarkasteluun vaikuttavat aina vallitseva aika ja kulttuuri. Seksuaalista hyväksikäyttöä voidaan tarkastella esimerkiksi juridisesta, lastensuojelullisesta ja psykologisesta näkökulmasta

Induktiovaiheessa olevien varhaiskasvatuksen erityisopettajien kokemuksia mentoroinnista ja työhyvinvoinnista

Tiivistelmä. Induktiovaiheella tarkoitetaan tietynlaista välitilaa siirryttäessä opinnoista työelämään. Tässä tutkimuksessa induktiovaihe määritellään yhdestä vuodesta viiteen vuoteen kestäväksi. Induktiovaiheessa annetut tuen muodot, kuten mentorointi, ovat merkittävässä roolissa ammatti-identiteetin kehittymiselle. Mentoroinnin kaksi päätavoitetta ovat uran ja ammatillisen kehityksen tukeminen sekä psykososiaalisen ja emotionaalisen tuen tarjoaminen työntekijälle. Mentoroinnilla on merkittävä rooli työhyvinvoinnissa. Työhyvinvointi voidaan määritellä psykologiseksi kokemukseksi sekä aktiiviseksi toiminnaksi. Tässä tutkimuksessa sitä tarkastellaan fyysisten, psyykkisten ja sosiaalisten tekijöiden kautta. Tämän tutkimuksen tavoitteena oli saada käsitys siitä, millaisena työuransa alkuvaiheessa olevat varhaiskasvatuksen erityisopettajat kuvaavat mentorointiansa ja työhyvinvointiansa. Tutkimme myös, koetaanko mentoroinnin ja työhyvinvoinnin välillä olevan yhteyttä, sekä erittelimme tekijöitä, joista varhaiskasvatuksen erityisopettajien työhyvinvointi koostuu. Tutkimuksen lähestymistapa oli laadullinen, fenomenologis-hermeneuttinen tutkimus. Tutkimusaineisto kerättiin helmikuussa 2023 haastattelemalla neljää induktiovaiheessa olevaa varhaiskasvatuksen erityisopettajaa. Aineisto analysoitiin tulkitsevan fenomenologisen analyysin eli IPA:n (interpretative phenomenological analysis) avulla. Tämän tutkimuksen mukaan mentorointi on erittäin tärkeä tukimuoto induktiovaiheessa oleville varhaiskasvatuksen erityisopettajille. Mentorointia toteutettiin pareittain sekä ryhmissä. Mentorointimallina olivat perehdytysmentorointi ja vertaismentorointi. Työhyvinvointi koettiin tässä tutkimuksessa pääosin hyväksi. Eniten työhyvinvointia tukivat toimiva yhteistyö, vertaistuki, mentorointi sekä työn joustavuus. Työhyvinvointia eniten kuormittivat haastavat vuorovaikutustilanteet. Tutkimuksessa mentorointi ja työhyvinvointi näyttäytyivät yhtenäisenä kokonaisuutena, joiden välinen suhde on vahvasti positiivinen. Mentorointi käsitteenä ilmeni tutkimuksessa monimuotoisena, jolle ei ollut yhtä selkeää määritelmää.Early childhood special education teachers’ experiences about mentoring and well-being at work in the induction phase. Abstract. Induction phase is a certain kind of intermediate state when transitioning from studies to working life. In this study the induction phase is defined to last from one to five years. The forms of support given in the induction phase, such as mentoring, play a significant role in the development of professional identity. The two main goals of mentoring are to support career and professional development and to provide psychosocial and emotional support to the employee. Mentoring plays a significant role in well-being at work. Well-being at work can be defined as a psychological experience and an active action. In this study we examine it through physical, psychological and social factors. The aim of this study was to gain an understanding of how early childhood special education teachers describe their mentoring and well-being at work. We also investigated whether there is perceived to be a connection between mentoring and well-being at work, and detailed the factors that make up the well-being of early childhood special education teachers. The research approach of this master’s thesis was qualitative, phenomenological-hermeneutic research. The data was collected in February 2023 by interviewing four early childhood special education teachers in the induction phase. The data was analyzed using interpretative phenomenological analysis, also known as IPA. According to the results of this study, mentoring is a very important form of support for early childhood special education teachers in the induction phase. Mentoring was carried out in pairs and in groups. The mentoring models were introductory mentoring and peer mentoring. Wellbeing at work was perceived to be mostly good in this study. The most important factors supporting the work well-being were functional cooperation, peer support, mentoring and job flexibility. Challenges in interaction situations weakened the well-being at work the most. In this study, mentoring and well-being at work appeared as a unified phenomenon. The relationship between these two is strongly positive. Mentoring as a concept appeared diverse, for which there was no single clear definition

Cost-Effectiveness Modelling of Sequential Biologic Strategies for the Treatment of Moderate to Severe Rheumatoid Arthritis in Finland

Abstract: Objective: The main objective was to compare the cost-effectiveness of therapeutic options in moderate or severe rheumatoid arthritis (RA) when a clinical response to a first TNF-blocker, either etanercept (ETA), adalimumab (ADA), or infliximab (INF), is insufficient. Methods: Effectiveness criteria were defined as remission (RS), low disease activity (LDAS), and moderate to high disease activity (MHDAS). Cost-effectiveness was derived as cost per day in RS and in LDAS using simulation modelling to assess six sequential biologic strategies over 2 years. Each sequential treatment strategy was composed of three biologic agents and included a first anti-TNF agent, ETA, ADA or INF, followed by either abatacept (ABA) or rituximab (RTX) as a second therapeutic option in case of an insufficient response, followed by another anti-TNF agent in case of further insufficient response. Results: Over two years and taking into account biologic costs, the following estimated mean costs per day in RS and LDAS were respectively of �829 and �428 for the biologic sequence composed of ADA-ABA-ETA, �1292 and �516 for the sequence ADA-RTX-ETA, �829 and �429 for the sequence ETA-ABA-ADA, �1292 and �517 for the sequence ETA-RTX-ADA, �840 and �434 for the sequence INF-ABA-ETA, and �1309 and �523 for the sequence INF-RTX-ETA. Conclusion: The treatment sequences including ABA as the second biologic option appear more cost-effective than those including RTX in a patients with moderate to severe RA and an insufficient response to a first anti-TNF agent. Keywords: Cost-effectiveness, rheumatoid arthritis, biologics, modelling

Cost–utility of different treatment strategies after the failure of tumour necrosis factor inhibitor in rheumatoid arthritis in the Finnish setting

Objective. To evaluate the cost–utility of different treatment strategies in severe RA after TNF-inhibitor failure

Automated text message enhanced monitoring versus routine monitoring in early rheumatoid arthritis: a randomized trial

OBJECTIVE:Frequent monitoring of early rheumatoid arthritis (RA) patients is required for achieving good outcomes. We studied the influence of text message (SMS) enhanced monitoring on early RA outcomes.METHODS:We randomized 166 early, disease-modifying antirheumatic drug naive RA patients to SMS-enhanced follow-up or routine care. All patients attended visits at 0, 3, and 6 months, and a follow-up visit at 12 months. Treatment was at the physicians' discretion. The intervention included 13 SMSs during weeks 0-24 with questions concerning medication problems (yes/no) and disease activity (patient global assessment [PGA], scale 0-10). If response SMSs indicated medication problems or PGA exceeded predefined thresholds the patients were contacted. Primary outcome was 6-month Boolean remission (no swollen or tender joints, normal CRP). Quality of life (QOL, Short Form 36) and 28-joint disease activity scores (DAS28) were assessed.RESULTS:Six and 12-month follow-up data were available for 162 and 157 patients. In the intervention group, 47% (38/82) of the patients reported medication problems and 49% (40/82) of the patients reported SMS-PGAs above the alarm limit. Remission rates in the intervention and control groups were 51% and 42% at 6 months (p=0.34); and 57% and 43% at 12 months (p=0.17). The respective DAS28 scores were 1.92±1.12 and 2.22±1.11 at 6 months (p=0.09); and 1.79±0.91 and 2.08±1.22 at 12 months (p=0.28). No differences in QOL were observed.CONCLUSION:The study failed the primary outcome despite a trend favoring the intervention group. This may be explained by the notably high overall remission rates. This article is protected by copyright. All rights reserved.</p

Childhood socioeconomic status and lifetime health behaviors : The Young Finns Study

Background: Differences in health behaviors partly explain the socioeconomic gap in cardiovascular health. We prospectively examined the association between childhood socioeconomic status (SES) and lifestyle factors in adulthood, and the difference of lifestyle factors according to childhood SES in multiple time points from childhood to adulthood. Methods and results: The sample comprised 3453 participants aged 3-18 years at baseline (1980) from the longitudinal Young Finns Study. The participants were followed up for 31 years (N = 1675-1930). SES in childhood was characterized as reported annual family income and classified on an 8-point scale. Diet, smoking, alcohol intake and physical activity were used as adult and life course lifestyle factors. Higher childhood SES predicted a healthier diet in adulthood in terms of lower consumption of meat (beta +/- SE -3.6 +/- 0.99, p <0.001), higher consumption of fish (1.1 +/- 0.5, p = 0.04) and higher diet score (0.14 +/- 0.044, p = 0.01). Childhood SES was also directly associated with physical activity index (0.059 +/- 0.023, p = 0.009) and inversely with the risk of being a smoker (RR 0.90 95%CI 0.85-0.95, p <0.001) and the amount of pack years (-0.47 +/- 0.18, p = 0.01). Life course level of smoking was significantly higher and physical activity index lower among those below the median childhood SES when compared with those above the median SES. Conclusions: These results show that childhood SES associates with several lifestyle factors 31 years later in adulthood. Therefore, attention could be paid to lifestyle behaviors of children of low SES families to promote cardiovascular health. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Ascendancy of weekly low-dose methotrexate in usual care of rheumatoid arthritis from 1980 to 2004 at two sites in Finland and the United States

Objectives. To analyse consecutive patients with RA in usual rheumatology care between 1980 and 2004 at two settings for the proportion of patients taking MTX, interval from patient presentation to MTX prescription and radiographic and functional status outcomes