Early acts and spaces for peer support : development evaluation of early intervention and family support in Family Centres of Helsinki City Social Services Department

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.The purpose of this study is to describe and evaluate the work of early intervention and family support in Family Centres of Helsinki City Social Services Department. The subject matter in this study is approached by using community social work perspective. The research data consists of descriptions of early intervention and family support working models. Descriptions have been gathered from the workers of play parks, social and family work, families with children home service, family houses and groups and projects in two phases: first by a questionnaire and thereafter worker joint development process. This study is a part of the development process of early intervention and family support in Family Centres. The data was analysed by applying theory engaged examination and content analysis. Evaluation method is description and the purpose is to create an overview the work of early intervention and family support and its development needs. The approach to research is development evaluation. The workers described in the questionnaire 393 different working models. Based on analysis working methods of direct client work were defined as follows: family work, group work, community work, multicultural work and information about the services. Working methods of indirect client work were defined as multiprofessional network and strengthening of the working methods of early intervention and family support. Based on the questionnaire workers saw supporting parenthood and strengthening of social networks needs for the work. Experienced results of the working methods were positive and their achievements were experienced in family and group work. Based on workers experience working methods close to basic work were considered to be effective. Workers evaluate that the working methods brought a change to client's life situation (medium 8,31 on scale 1-10). The descriptions prepared in the development process examine early intervention and family support in three levels: community, department and worker/working place. Local co-operation and group work were described by all functions. This study investigates also the descriptions of the workers from play parks from the community and community social work perspective. Parks are described as spaces of community, where participation and empowerment is made possible. The work of early intervention and family support is not a uniform collection of working methods which would be similar to all functions. All functions do it by taking into account the basic work and its specific features. Based on the analysis of descriptions I suggest looking at the early intervention and family support from developmental, social and operational point of view. Operational viewpoint is intervention and support on individual and community level. Through these elements both universal and selective needs of children and their families is visible in early intervention and family support. The changes in working environment have an impact on the development of the work. In this study four development strategies have been created from community social work basis. In these strategies the aim, elements and methods of work have been combined. Strategies are proactive and preventive work, services close to community, work centred on the social network and shared responsibility of practitioners and citizens

Varhaisia tekoja, vertaistuen tiloja : Varhaisen tuen työn kehittävä arviointi Helsingin kaupungin sosiaaliviraston perhekeskuksissa

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Tämän tutkimuksen tehtävänä on kuvata ja arvioida varhaisen tuen työtä Helsingin kaupungin sosiaaliviraston perhekeskuksissa yhteisösosiaalityön näkökulmasta. Tutkimuksen aineistona ovat varhaisen tuen työmuotojen kuvaukset, joita on kerätty leikkipuistojen, kotipalvelun, sosiaalityön ja -ohjauksen, perhetalojen ja -ryhmien sekä kehittämishankkeiden työntekijöiltä kahdessa vaiheessa, ensin sähköisellä kyselyllä (kartoitus) ja sitten työntekijöiden yhteisessä kehittämisprosessissa. Tutkimus on osa perhekeskusten varhaisen tuen työn kehittämistä. Aineiston analysoinnissa käytetään teoriasidonnaista tarkastelua ja sisällön analyysia. Arvioinnin metodina on kuvailu ja arvioinnin tarkoituksena muodostaa kokonaiskuva varhaisen tuen työstä ja sen kehittämistarpeista. Tutkimuksellinen lähestymistapa on kehittävä arviointi. Työntekijät kuvasivat kartoituksessa 393 työmuotoa, joista analyysin perusteella suoran asiakastyön työmuodoiksi muotoutuivat perhekohtainen työ, ryhmämuotoinen työ, aluetyö, monikulttuurinen työ sekä palveluista tiedottaminen. Välillisen asiakastyön työmuodoiksi muotoutuivat moniammatillinen toiminta ja verkostotyö sekä varhaisen tuen työotteen vahvistaminen. Kartoituksen perusteella vanhemman tukeminen ja sosiaalisen verkoston vahvistaminen nähtiin työntekijöiden kokemina tarpeina työlle. Työmuotojen koetut tulokset olivat positiivisia ja ne koettiin tulevan perhekohtaisessa ja ryhmämuotoisessa työssä. Työntekijöiden kokemuksen mukaan perustehtävälähtöiset työmuodot olivat varsin vaikuttavia. Heidän arvionsa mukaan työmuotojen tuottama muutos asiakkaan elämäntilanteeseen oli keskiarvoisesti 8,31 (asteikolla 1-10). Kehittämisprosessin tuloksena syntyneissä kuvauksissa on löydettävissä alue-, virasto- sekä työntekijä ja -yhteisötason varhaista tukemista. Alueellinen yhteistyö ja ryhmätoiminta ovat kaikkien toimintojen kuvaamaa yhteistä varhaisen tuen työtä. Tutkimuksessa tarkasteltiin leikkipuistojen työntekijöiden varhaisen tuen työn kuvauksia yhteisöllisyyden ja yhteisösosiaalityön näkökulmasta. Leikkipuistot näyttäytyivät yhteisöllisinä tiloina, joissa kuvausten perusteella toteutuu asiakkaiden osallisuus ja voimaantuminen. Varhaisen tuen työ ei muodosta yhtenäistä ja kaikille toiminnoille samankaltaista työmuotokokonaisuutta, vaan eri toiminnot toteuttavat työtä perustehtävästä ja sen erityispiirteistä käsin. Varhaisen tuen työn kuvausten tarkastelun perustella ehdotan varhaista tukea tarkasteltavaksi kehityksellisestä, yhteiskunnallisesta ja toiminnallisesta näkökulmasta. Toiminnallinen näkökulma toteutuu yksilö- ja yhteisötason puuttumisena ja tukemisena. Näiden elementtien kautta varhaisen tuen toiminnassa näkyy sekä universaali, ehkäisevä, kaikille suunnattujen palveluiden näkökulma sekä kohdennettu, lapsen ja lapsiperheiden tarpeisiin puuttuva näkökulma. Varhaisen tuen työn kehittämistä suuntaa muun muassa toimintaympäristön muutokset. Tutkimuksessa on alueellisen yhteisösosiaalityön perustasta johdettu neljä varhaisen tuen yhteisöllistä kehittämisen strategiaa, joissa yhdistyvät toiminnan yleinen tavoite, varhaisen tuen elementit ja työmuodot. Strategiat ovat edistävän ja ehkäisevän toiminnan, yhteisöä lähellä olevien palveluiden, toimijoiden jaetun vastuun ja sosiaalisten verkostojen vahvistamisen -strategiat

Radiographic scoring systems for psoriatic arthritis are insufficient for psoriatic arthritis mutilans : results from the Nordic PAM Study

Background Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis (PsA). Purpose To describe the radiological features in PAM and explore whether existing scoring systems for radiological damage in psoriatic arthritis are applicable for PAM. Material and Methods Radiographs were scored according to the modified Sharp-van der Heijde (mSvdH) and the Psoriatic Arthritis Ratingen Score (PARS) systems for PsA. Results At inclusion, 55 PAM patients (49% women, mean age 58 +/- 12 years) had conventional radiographs of both hands and feet. A total of 869 PAM joints were detected and 193 joints with ankylosis. The mean total mSvdH score was 213.7 +/- 137.8 (41% of maximum) with a higher score for hands than for feet: 136.6 +/- 90.1 vs. 79.1 +/- 60.9. However, the total score was relatively higher in the feet than in the hands when compared to the highest possible scoring (47% vs. 38% of max). The mean total PARS score was 126.3 +/- 79.6 (35% of max). Scoring for joint destruction was higher than for proliferation (22% vs. 11% of max). Strong correlation was found between mSvdH and PARS (r(2) = 0.913). A significant correlation was found between scoring and duration of arthritis and the Health Assessment Questionnaire. History of smoking, BMI, and gender did not influence the scoring values. Conclusions The two scoring systems studied may not be ideal to indicate progression of PAM in advanced disease since they reach ceiling effects rather early. Therefore, reporting early signs suggestive of PAM, e.g. signs of pencil-in-cup deformities or osteolysis, is crucial. This would reveal the presence of PAM and might lead to improved treatment in order to minimize joint damage.Peer reviewe

Comorbidities in a Cohort of 66 Patients With Psoriatic Arthritis Mutilans-Results From the Nordic PAM Study

Objective: Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis due to excessive bone erosion causing joint destruction and decreased functional capacity. The aim of this study was to investigate the prevalence of comorbidities among patients with PAM and the association between comorbidities and joint involvement. Methods: A total of 66 patients aged >= 18 years from the Nordic countries with past or present psoriasis along with at least one mutilated joint were included in the present study. Results: The median number of comorbid conditions per patient was 1 [interquartile range (IQR) 0-2] and 16.7% reported three or more comorbidities. The most frequent comorbidity was hypertension (36.4%). The median number of mutilated joints per patient was 3 (IQR 1-8.3; range 1-38). Conclusion: Two thirds of the patients with PAM reported comorbid conditions and the most frequent was hypertension which affected more than a third of the patients. However, this study was unable to detect any association between comorbidities and the severity of PAM.Peer reviewe

Radiographic progression in PsA Personal non-commercial use only

ABSTRACT. Objective. To describe early radiographic findings in patients from the Swedish psoriatic arthritis (SwePsA) registry, progression of destruction, correlations with clinical disease variables, and predictors of destruction. Methods. Hand and foot radiographs were available for 72 of 197 SwePsA patients followed for 5 years. Clinical data were collected according to the SwePsA protocol. Results. Disease characteristics and clinical improvement were similar in men and women. Radiographic abnormalities were more pronounced in men. Total Wassenberg radiographic score at baseline was 0 in 45% of men and 51% of women. One man and one woman had a score > 10. At 5 years, total score was 0 in 14% of men and 40% of women (p = 0.018); 17% of men and 7% of women had scores > 10. Mean total scores for men and women had increased. Baseline erythrocyte sedimentation rate was associated with baseline total radiographic score. In men, swollen joint count was positively, and in women tender joint count negatively, correlated to total radiographic score. After 5 years, only male scores, mainly hand scores, significantly correlated with 28-joint Disease Activity Score and Disease Activity Index for Psoriatic Arthritis scores, swollen joint count, and dactylitis. Achieving remission or minimal disease activity after 5 years protected against structural damage, mainly in men. Conclusion. Radiographic progression in early PsA was generally slow but substantial. Male sex appears to be a risk factor for early radiographic damage while the presence of baseline radiographic damage and dactylitis developing during followup seem to predict further destruction. Hand and foot radiograph scoring cannot be substituted with clinical signs. (J Rheumatol First Release October 15 2015; doi:10.3899/jrheum.150165

Ehdotus kansallisesti haitallisten vieraslajien hallintasuunnitelmaksi

Vieraslajit ovat ihmisen avustamina uusille alueille tahattomasti tai tarkoituksella levinneitä lajeja. Vieraslajia pidetään haitallisena, jos lajin on todettu uhkaavan tai haittaavan luonnon monimuotoisuutta. FIN-HAVI -hankkeessa selvitettiin 26 kansallisesti haitallisen vieraslajin/lajiryhmän esiintymistä ja niistä aiheutuvia haittoja Suomessa, sekä koottiin suositukset tarvittavista hallintatoimenpiteistä. Tavoitteena oli kohdentaa haitallisten vieraslajien torjunta kiireellisimpiin ja tärkeimpiin kohteisiin. Hankkeen tulokset ja toimenpidesuositukset muodostavat ehdotuksen kansallisesti haitallisten vieraslajien hallintasuunnitelmalle. Lajit jakautuivat neljään ryhmään: 1) Vakiintuneet lajit – välittömät torjunta-toimenpiteet, 2) Suomessa tavatut lemmikit – valistus maahantuontikiellosta, kasvattamiskiellosta ja ympäristöön päästämiskiellosta 3) Suomessa satunnaisesti tavatut lajit – yksilöiden poistaminen tavattaessa, 4) Pienen leviämisriskin lajit – levinneisyyden seuranta ja valistus. Ensimmäiseen ryhmään kuuluville yleisemmille lajeille (kurtturuusu, komealupiini, japanintatar, sahalinintatar, tarhatatar, kanadanvesirutto, minkki, espanjansiruetana) on esitetty tarkemmat tiedot levinneisyydestä sekä lajikohtaiset priorisoidut hallintatoimenpiteet. Tiedotus vieraslajien riskeistä, rajoituksista ja niiden perusteluista on tärkein yleinen hallintatoimenpide.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa (tietokayttoon.fi). Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Multiple receptor tyrosine kinases are expressed in adult rat retinal ganglion cells as revealed by single-cell degenerate primer polymerase chain reaction

BACKGROUND: To achieve a better understanding of the repertoire of receptor tyrosine kinases (RTKs) in adult retinal ganglion cells (RGCs) we performed polymerase chain reaction (PCR), using degenerate primers directed towards conserved sequences in the tyrosine kinase domain, on cDNA from isolated single RGCs univocally identified by retrograde tracing from the superior colliculi.RESULTS: All the PCR-amplified fragments of the expected sizes were sequenced, and 25% of them contained a tyrosine kinase domain. These were: Axl, Csf-1R, Eph A4, Pdgfrbeta, Ptk7, Ret, Ros, Sky, TrkB, TrkC, Vegfr-2, and Vegfr-3. Non-RTK sequences were Jak1 and 2. Retinal expression of Axl, Csf-1R, Pdgfrbeta, Ret, Sky, TrkB, TrkC, Vegfr-2, and Vegfr-3, as well as Jak1 and 2, was confirmed by PCR on total retina cDNA. Immunodetection of Csf-1R, Pdgfralpha/beta, Ret, Sky, TrkB, and Vegfr-2 on retrogradely traced retinas demonstrated that they were expressed by RGCs. Co-localization of Vegfr-2 and Csf-1R, of Vegfr-2 and TrkB, and of Csf-1R and Ret in retrogradely labelled RGCs was shown. The effect of optic nerve transection on the mRNA level of Pdgfrbeta, Csf-1R, Vegfr-2, Sky, and Axl, and of the Axl ligands Gas6 and ProteinS, was analysed. These analyses show transection-induced changes in Axl and ProteinS mRNA levels.CONCLUSIONS: The repertoire of RTKs expressed by RGCs is more extensive than previously anticipated. Several of the receptors found in this study, including Pdgfrbeta, Csf-1R, Vegfr-2, Sky, and Axl, and their ligands, have not previously been primarily associated with retinal ganglion cells

Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations.

OBJECTIVE We aimed to compile evidence for the efficacy and safety of therapeutic options for the peripheral arthritis domain of psoriatic arthritis (PsA) for the revised 2021 Group in Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations. METHODS A working group consisting of clinicians and patient research partners was convened. We reviewed the evidence from new randomized controlled trials (RCTs) for PsA treatment from February 19, 2013, to August 28, 2020. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-informed approach to derive evidence for the classes of therapeutic options for 3 patient groups: (1) naïve to treatment, (2) inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and (3) inadequate response to biologic DMARDs (bDMARDs). Recommendations were derived through consensus meetings. RESULTS The evidence review included 69 RCTs. We derived GRADE evidence for each class of therapeutic options and achieved consensus for the recommendations. For patients naïve to treatment, the working group strongly recommends csDMARDs (methotrexate, sulfasalazine, leflunomide) and phosphodiesterase 4 inhibitors, and emphasizes regular assessment and early escalation to achieve treatment target. bDMARDs (tumor necrosis factor inhibitors [TNFi], interleukin 17 inhibitors [IL-17i], IL-12/23i, IL-23i) and Janus kinase inhibitors (JAKi) are also strongly recommended. For patients with inadequate response to csDMARDs, we strongly recommend TNFi, IL-17i, IL-12/23i, IL-23i, and JAKi. For those who had prior experience with bDMARDs, we strongly recommend a second TNFi, IL-17i, IL-23i, and JAKi. The evidence supporting nonpharmacological interventions was very low. An expert panel conditionally recommends adequate physical activity, smoking cessation, and diet to control weight gain. CONCLUSION Evidence supporting optimal therapy for the peripheral arthritis domain of PsA was compiled for the revised 2021 GRAPPA treatment recommendations