Neuvolaikäisen lapsen vanhemmille annettava rokotusohjaus

Laurea-ammattikorkeakoulu Tiivistelmä Hyvinkää Sosiaali,- terveys,- ja liikunta-ala Hoitotyön koulutusohjelma Lahti Laura ja Räikkönen Elisa Neuvolaikäisen lapsen vanhemmille annettava rokotusohjaus Vuosi 2011 Sivumäärä 62 Tässä työssä käsitellään kansallista rokotusohjelmaa ja siihen liittyvää neuvolaikäisten lasten vanhempien ohjausta. Kansallinen rokotusohjelma on uudistunut viime vuosien aikana ja siihen on lisätty uusia rokotteita. Esimerkiksi vuonna 2010 on rokotusohjelmaan lisätty kaikille lapsille annettava pneumokokkirokote. Rokotusohjelman muutosten vuoksi, siihen liittyvä ohjauksen tarve on lisääntynyt. Vanhemmat kaipaavat yhä tarkempaa tietoa rokotuksista ja niiden tarpeellisuudesta. Opinnäytetyön tarkoituksena oli laatia vanhempia varten kirjallisuuskatsaukseen perustuva esite lasten rokotteilla ehkäistävistä infektiotaudeista ja rokotusohjelman mukaisista rokotuksista. Lisäksi esite toimii terveydenhoitajan työvälineenä, kun hän ohjaa perheitä. Opinnäytetyö oli osa Lapsen ja nuoren hyvä arki 2008–2011 –hanketta. Työ toteutettiin yhteistyössä Hyvinkään kaupungin neuvoloissa työskentelevien terveydenhoitajien kanssa. Työn menetelmänä on käytetty systemaattista kirjallisuuskatsausta. Kirjallisuuskatsaus perustuu pääosin Terveyden ja hyvinvoinnin laitoksen (THL) Rokottajan käsikirjan Internet -versioon 2010. Internet -version käyttö on mahdollistanut rokotteista saatavilla olevan, uusimman tiedon hankkimisen. Lisäksi tässä työssä on käytetty Ovid-, ja Laurus-tietokantoja tiedon hankkimiseen. Esitteen teksti perustuu kirjallisuuskatsauksen avulla saatuihin tietoihin. Sen sisältö koottiin teoriaosuuden pohjalta ja siihen poimittiin oleellisimmat asiat rokotteilla ehkäistävistä infektiotaudeista, rokotteista ja rokottamisesta. Lisäksi tarkoituksena on antaa lasten vanhemmille hyödyllistä tietoa, jota he tarvitsevat tehdessään lasta koskevia rokotuspäätöksiä ja hoitaessaan rokotteen saanutta lastaan. Esite toimii terveydenhoitajien apuvälineenä neuvoloissa ja myös muiden terveysalan ammattilaisten antaman ohjauksen tukena. Se mahdollistaa keskustelun syntymistä ja toivomme sen herättävän vanhemmissa kysymyksiä terveydenhoitajalle. Se voidaan antaa jo lasta odottavalle perheelle, jotta perhe voi keskustella rokotuksiin liittyvistä asioista jo raskausaikana. Tilaaja on arvioinut esitteen tekstiä ja antanut siitä tekijöille palautetta. Tällä tavoin tilaaja on arvioinut myös sen käyttökelpoisuutta käytännön työssä. Lisäksi esitettä ovat lukeneet ja arvioineet useat vanhemmat, joilla on neuvolaikäisiä lapsia. Vanhemmat ovat todenneet esitteen selkeäksi ja hyödylliseksi itselleen, lisäksi he ovat antaneet kehitysehdotuksia. Esite on luovutettu Hyvinkään kaupungille InDesign –ohjelmalla taitettuna versiona ja tässä työssä se on liitteenä Word-tiedostona. Asiasanat: rokottaminen, neuvolaikäinen lapsi, kansallinen rokotusohjelma, tartuntataudit, ohjausLaurea University of Applied Sciences Abstract Hyvinkää Health Care, Social Services and Sport Degree Programme in Nursing Laura Lahti ja Elisa Räikkönen Guidance of vaccination to parents who have under 7-year-old children Year 2011 Pages 62 In this thesis the national vaccination program and parents guidance considering childrens´ vaccinations are discussed. National vaccination program has been renewed during past years and new vaccinations have been added in it. For example, the pneumococcus vaccine which is given to all children, was added into the program in 2010. Because the vaccination program has changed parents need more specific information about vaccines and why they are necessary. The purpose of this thesis was to compile a brochure for childrens´ parents. In this brochure there is information about infectious diseases that can be prevented by vaccines given to children and information about vaccines included in the national vaccination program. The brochure is a good aid for public health nurses when they advise parents. The thesis was part of the project Lapsen ja nuoren hyvä arki 2008-2011. The study was conducted in co-operation with Hyvinkää´s public health nurses working in child health clinics. The method used was literature review. This literature review was primaly based on the Internet version of the Vaccinator´s handbook compiled by Terveyden ja hyvinvoinnin laitos. Using this Internet version made it possible to get the latest information about vaccines. Laurus and Ovid databases were also used as sources of information. The brochure was compiled from the information in literature review. Essential facts related to vaccines, infectious diseases and vaccination were included in it. The purpose of the brochure is to give to the parents useful information that they need, for example, when they make decisions considering their childrens´ vaccinations. The brochure works as a tool for public health nurses in child health clinics and as an aid for other health care professionals when they guide people. The brochure makes it possible for parents to discuss vaccination and ask questions from public health nurse if needed. It can be given to families who are expecting a baby because it is important that the parents have discussed vaccination before the child is born. The partner in cooperation has evaluated the usability of the brochure for practical purposes and has given feedback of it. The brochure has also been read by numerous parents who have children under seven. Parents have also evaluated the content and usefulness of it and they have discovered the brochure to be clear and useful. The brochure has been given to the city of Hyvinkää as a version in InDesign program and it is an attachment at the end of this thesis as a word file. Keywords: vaccination, a child aged 0-6 years, national vaccination program, infectious diseases, guidanc

Tulevaisuudentutkimus osana muotoiluprosessia

Tämä pro gradu -työ sisältää sekä tieteellisen (A -osa), että taiteellisen (B -osa) osan. Taiteellisessa osassa olen toteuttanut Urbaanista joutomaasta kaupunkikeitaaksi - muotoiluprojektin, jonka lopputuloksena on kolme Rovaniemen keskustan kortteli 9:än sijoittuvaa liiketoimintakonseptia. Taiteellisen osan muotoiluprojekti toimii tieteellisen osan case-tapauksena. Tieteellisessä osassa tutkin tulevaisuudentutkimuksen vaikutuksia muotoiluprosessissa. Lähestyn aihetta tapaustutkimuksen kautta, jonka casena toimii työn taiteellinen osa. Tutkimus on luonteeltaan laadullinen ja sen menetelmänä on teoriaohjaava sisällönanalyysi. Aineiston hankinnan menetelmänä on ollut autoetnografia. Tutkimus liikkuu muotoilun ja tulevaisuudentutkimuksen kentällä näyttämönään rakennettu kaupunkiympäristö. Tutkimuksessani halusin selvittää, tarjoaako tulevaisuudentutkimuksen hyödyntäminen muotoiluprosessissa lisäarvoa tai tuotko se prosessiin jotain uutta. Tulevaisuudentutkimuksen laajalta menetelmien kentältä käyttööni valikoitui tulevaisuuspyörä (the futures wheel). Tulevaisuuspyörien rakentamisessa hyödynsin valmiita trendilistauksia ja heikkoja signaaleja. Muotoilu on tulevaisuuteen tähtäävää toimintaa. Tulevaisuudentutkimuksen avulla tuotettu tulevaisuustieto herättelee uusia ajatuksia ja auttaa tuottamaan uusia ideoita. Käyttämällä tulevaisuudentutkimuksen menetelmiä osana muotoiluprosessia voidaan saavuttaa tietoa, jonka avulla ideoita ja niiden potentiaalisuutta voidaan arvioida. Muotoiluprosessiin ja sen kohteeseen liittyvät tulevaisuuskuvat toimivat myös kommunikaation välineenä, kun keskustellaan tuotteista ja tuotemahdollisuuksista, joita ei vielä ole olemassaacceptedVersio

The interplay between objective and subjective ethno-cultural diversity in predicting intergroup relations

This nation-wide probability sample survey study among Finnish majority group members (N = 335) focused on the interactive effects of objective and subjective ethno-cultural diversity on three indicators of intergroup relations: outgroup attitudes, perceived group and personal discrimination, and outgroup trust. Complementing previous research that has mostly examined a linear relationship between cultural diversity and intergroup relations, special attention was given to moderate diversity contexts, which are claimed to pose different challenges to intergroup dynamics than high- and low-diversity contexts. It was hypothesised that majority group members who live in contexts characterised by moderate levels of objective diversity but subjectively perceive high levels of diversity will report more negative outgroup attitudes, lower levels of outgroup trust and higher levels of discrimination, as compared to those living in low- or high-diversity contexts. The hypothesis was confirmed for perceived group discrimination and outgroup trust. The results highlight the need to acknowledge possible non-linear relationships between diversity and intergroup relations.Peer reviewe

The majority influence on interminority attitudes : The secondary transfer effect of positive and negative contact

Among minority members, positive contact with the majority was previously found to improve not only the attitudes towards the majority but also the attitudes towards minority outgroups (the secondary transfer effect; STE). However, the role of negative intergroup contact and ingroups' social status in a receiving society in the development of the STE have not been yet examined. Therefore, in the present study we investigated the association between positive and negative contact with the national majority group (Finns) and mutual attitudes among high-status Estonian (n = 171) and low-status Russian (n = 180) immigrants in Finland. Two mediators of the STE were tested: attitudes toward the majority (attitude generalisation) and collective self-esteem (diagonal hostility). While positive and negative STEs emerging via attitude generalisation were expected to occur among both immigrant groups, the mediating effect of collective self-esteem was assumed only for members of the low-status group. Among members of both groups, the relationship between positive contact with majority members and attitudes towards the other immigrant group was positive and indirect, and occurred through more favourable attitudes towards majority members. The same mechanism was followed by negative contact, where the indirect effect was mediated by less positive attitudes towards Finns. As predicted, collective self-esteem mediated the effects of positive and negative contact with majority members on attitudes towards the other minority only among low-status Russian immigrants. The results call for the acknowledgement of different mechanisms underlying the development of the STE among minority groups enjoying different social status in host society.Peer reviewe

Acculturation and Identity

Peer reviewe

From Cultural Discordance to Support for Collective Action : The Roles of Anxiety, Trust and Group Status

Support for collective action, an initial step in challenging social inequalities, can have important implications for intergroup relations in contemporary plural societies. The present study, conducted among majority Finns (n=274) and Russian immigrants in Finland (n=228), investigated the relationship between perceived cultural discordance (i.e., disagreement between majority and minority groups about the importance of cultural maintenance for minority members) and support for collective action benefiting the minority. Specifically, it was expected that the association between cultural discordance and collective action would be at least partially mediated by intergroup anxiety and outgroup trust, and that both the direct and indirect effects of cultural discordance would depend on group status (i.e., majority vs. minority). The results showed that among majority group members, the association was negative and mediated by high intergroup anxiety and low outgroup trust, whereas among minority group members the association was positive and mediated by only low outgroup trust.Peer reviewe

Effect of Vitamin D3Supplementation in the First 2 Years of Life on Psychiatric Symptoms at Ages 6 to 8 Years : A Randomized Clinical Trial

Importance: Vitamin D is associated with neurodevelopment, but causality, critical windows, and potentials for modification remain unknown. Objective: To determine the impact of high-dose (1200 IU) vs standard-dose (400 IU) vitamin D3supplementation during the first 2 years on psychiatric symptoms at ages 6 to 8 years and whether the impact is different in children with lower vs higher maternal vitamin D3levels; lower vs higher levels were defined as 25-hydroxyvitamin D (25[OH]D) less than 30 ng/mL vs 30 ng/mL or greater. Design, Setting, and Participants: This study was a long-term follow-up of the double-blind randomized clinical trial (RCT) Vitamin D Intervention in Infants (VIDI) conducted at a single center in Helsinki, Finland, at 60 degrees north latitude. Recruitment for VIDI took place in 2013 to 2014. Follow-up data for secondary data analysis were collected 2020 to 2021. VIDI originally included 987 term-born infants; 546 of these individuals participated in the follow-up at ages 6 to 8 years, among whom 346 individuals had data on parent-reported psychiatric symptoms. Data were analyzed from June 2022 to March 2023. Interventions: There were 169 infants randomized to receive 400-IU and 177 infants randomized to receive 1200-IU oral vitamin D3supplementation daily from ages 2 weeks to 24 months. Main Outcomes and Measures: Primary outcomes were internalizing, externalizing, and total problems scores, with clinically significant problems defined as T scores of 64 or greater in the Child Behavior Checklist questionnaire. Results: Among 346 participants (164 females [47.4%]; mean [SD] age, 7.1 [0.4] years), the vitamin D3dose was 400 IU for 169 participants and 1200 IU for 177 participants. Clinically significant internalizing problems occurred in 10 participants in the 1200-IU group (5.6% prevalence) compared with 20 participants (11.8%) in the 400-IU group (odds ratio, 0.40; 95% CI, 0.17-0.94; P =.04) after adjustment for sex, birth season, maternal depressive symptoms at birth, and parental single status at follow-up. In a post hoc subgroup analysis, 48 children in the 400-IU group with maternal 25(OH)D concentrations less than 30 ng/mL had higher internalizing problems scores compared with children in the 1200-IU group, including 44 children with maternal 25(OH)D concentrations below 30 ng/mL (adjusted mean difference, 0.49; 95% CI, 0.09-0.89; P =.02) and 91 children with maternal concentrations above 30 ng/mL (adjusted mean difference, 0.37; 95% CI, 0.03-0.72; P =.04). Groups did not differ in externalizing or total problems. Conclusions and Relevance: This randomized clinical trial found that higher-than-standard vitamin D3supplementation in the first 2 years decreased risk of internalizing problems at ages 6 to 8 years. Trial Registration: ClinicalTrials.gov Identifiers: NCT01723852 (VIDI) and NCT04302987 (VIDI2).Peer reviewe

Genome-wide analyses identify a role for SLC17A4 and AADAT in thyroid hormone regulation.

Thyroid dysfunction is an important public health problem, which affects 10% of the general population and increases the risk of cardiovascular morbidity and mortality. Many aspects of thyroid hormone regulation have only partly been elucidated, including its transport, metabolism, and genetic determinants. Here we report a large meta-analysis of genome-wide association studies for thyroid function and dysfunction, testing 8 million genetic variants in up to 72,167 individuals. One-hundred-and-nine independent genetic variants are associated with these traits. A genetic risk score, calculated to assess their combined effects on clinical end points, shows significant associations with increased risk of both overt (Graves' disease) and subclinical thyroid disease, as well as clinical complications. By functional follow-up on selected signals, we identify a novel thyroid hormone transporter (SLC17A4) and a metabolizing enzyme (AADAT). Together, these results provide new knowledge about thyroid hormone physiology and disease, opening new possibilities for therapeutic targets

Shared genetic risk between eating disorder- and substance-use-related phenotypes:Evidence from genome-wide association studies

First published: 16 February 202