Browsing by Title

Tutkimuksessa kartoitettiin, millaisia tekijöitä lasten obesiteetin hoidon tuloksellisuuden taustalta löytyy. Aineistona oli HYKS Lastenklinikalla vuosina 2004-2006 käyneitä 0-16-vuotiaita lapsia. Tutkimuksessa oli 237 potilasta, joiden tiedot kerättiin potilasarkistoista. Tuloksista on havaittavissa, että diagnoosin asettaminen yli 10 ikävuoden jälkeen johtaa suurempaan painonnousuun kuin nuoremmissa ikäryhmissä. Sukupuolen suhteen ei saatu merkittäviä eroja. Lapsilla, joilla oli taustalla perussairaus lihavuuden lisäksi, painon kehitys oli jonkin verran noususuuntaisempi. Lääkitys oli tutkittavista 42 %:lla ja heillä hoidon tulokset olivat huonommat. Vanhempien lihavuus ei vaikuttanut merkittävästi hoidon vasteeseen kuten ei myöskään perheen tuki. Normaalit ruokailutottumukset tukivat painon suotuisaa kehitystä, mutta ravitsemusterapialla ei saatu merkittävää etua. Potilaiden jakautumisessa Helsingin alueella erot olivat huomattavia, kun taas hoidon tulokset eivät juurikaan eronneet toisistaan.

Medulloblastoomat ovat yleisimpiä lasten aivokasvaimia. Ne ovat maligneja embryonaalisia tuumoreita, ja saavat alkunsa pikkuaivojen alueelta. Potilaan ennusteeseen vaikuttaa potilaan ikä, metastaasien esiintyminen, jäännöskasvaimen koko sekä kasvainkudoksen histologia. Näiden tekijöiden perusteella potilaat jaetaan korkean riskin ja standardiriskin ryhmiin. Tämän kirjallisuuskatsauksen tarkoituksena oli perehtyä lasten medulloblastoomien hoitoon. Erityisesti selvitettiin sädehoidon ja kemoterapian antamisen periaatteita. Potilaalle annettava hoito määräytyy potilaan riskiryhmän mukaan. Jokaiselta potilaalta pyritään primaarikasvain poistamaan maksimaalisesti leikkauksella. Liitännäishoitoja suunniteltaessa joudutaan tasapainottelemaan käytettävissä olevien hoitomuotojen hyötyjen, ja niistä koituvien haittojen välillä. Nuorella iällä annettu sädehoito voi aiheuttaa vakaviakin neurologisia haittoja. Standardiriskin potilaille annetaan sädehoitoa pienempi annos kuin korkean riskin potilaille. Alle kolmevuotiaat pyritään hoitamaan ilman sädehoitoa pelkän kemoterapian avulla.

The continuum in child language development is a well-known phenomenon. Language skills consist of several different language domains that a child must learn/accomplish to become a fluent language user. Language acquisition is a complex process. It is still partly unknown how the different language domains develop in relation to each other and how they associate to later language skills. The purpose of this Master’s thesis is to find out the longitudinal associations between and predictive value of the mastery of lexicon and language structures of a 3 to 4 year old child and language skills at the age of five. The study aims to look at the connections between a child’s expressive and receptive lexicon and language structures (morphology, syntax and phonology) and later language skills. The sample of this study consisted of 92 children who participated in the LEINIKKI research project. Participants were healthy and typically developing children who acquired Finnish as their first language. The language skills at the age of 3 to 4 were assessed using the LEINIKKI method’s subscales that assess vocabulary, morphology, syntax and phonology and WPPSI-III subscales assessing expressive and receptive lexical skills. At the age of five language skills were assessed again using The Children’s Communication Checklist (CCC-2). The relationships between age 3- to 4-year-old and 5-year-old language proficiency were examined using correlation coefficients and regression models. The results of this study showed that there were several statistically significant and moderately strong correlations between the expressive lexical skills of a 3- to 4-year-old child and the language skills at five measured by both the LEINIKKI method and the WPPSI-III method. The association between toddlers’ receptive lexical skills and language skills at five was not significant. Several statistically significant and moderately strong associations were also found between the mastery of language structures of a 3- to 4-year-old child and the language proficiency at the age of five. The LEINIKKI method’s subscales that assessed morphology and syntax correlated with almost all aspects of language proficiency at the age of five and with the variable measuring overall language proficiency. The LEINIKKI method subscale, which measures speech clarity and sound system, correlated with five-year-old speech clarity and overall language proficiency. Both the lexicon and language structures of the 3- to 4-year-old child significantly explained language proficiency at the age of five years. The best models for explaining later language proficiency included variables of both 3-4-year-old lexicon and language structure variables and explained about 30 % of the language proficiency at the age of five years. Based on the results of this study, attention should be paid to the mastery of both lexicon and grammar in the assessment of a 3- to 4-year-old child's language skills.

Semantic fluency task is often used as part of an assesment to investigate children’s lexical development. Semantic fluency task measures the ability to generate words within a certain category and within a restricted amount of time. In previous studies, children’s semantic fluency skills have increased as the child grows. In addition, word retrieval strategies have been found to enhance word recall in the semantic fluency task with school-aged children and adults. However, there is only little knowledge regarding the use of word retrieval strategies in the semantic fluency task with preschool aged children. So far, in previous studies word retrieval strategies in the task have not been investigated with children under the age of 4. The aim of this study was to examine whether there are differences in 2 to 5 year old children’s performance in the semantic fluency task and whether children’s gender or their parent’s socioeconomic status had an impact on their performance. In addition, the children’s ability of using word retrieval strategies were explored and the relation between the use of word retrieval strategies and the number of correct words were evaluated. The study sample included 79 children. Children completed two semantic fluency tasks guided by their parents in an online questionnaire. During the tasks, the children generated words belonging to the semantic category of animals and clothes within a minute. The performance was evaluated on the basis of the number of correct words, errors and error types. Word retrieval strategies were studied by examining clusters, semantic subcategories and switches between subcategories. The results of this study showed that age had a strong relation to performance on fluency tasks as measured with a number of correct words, clusters, semantic subcategories and switches. The new result was that even 2 year old children could generate correct words for the task and utilize word retrieval strategies in the tasks. The children’s gender or parents’ socioeconomic status had no effect on performance in the semantic fluency tasks. Number of clusters, semantic subcategories and switches had a positive relation to the number of correct words which indicated that successful word retrieval required use of fluency strategies even with preschool aged children. However, due to the lack of previous research data, more research regarding children’s word retrieval strategies is necessary. This study is the first in which the children’s word fluency task was guided by their parents. Clinical practice and further studies could benefit from these results that such a research design would appear to be suitable for assessing children’s semantic fluency.

Cancer är en mycket sällsynt sjukdom hos barn. Leukemi är den vanligaste cancerformen hos barn och den vanligaste leukemin hos barn är ALL (akut lymfatisk leukemi). Kliniska fynd eller avvikelser i blodbilden kan väcka misstanken om leukemi. Vården av leukemi hos barn har gått framåt med storm steg, och i dag är prognosen relativt bra. Leukemi hos barn vårdas i Finland enligt nordiska behandlingsprotokoller. Stamcellstransplantation används vid svår behandlade leukemier, då behandlingsresultatet efter de första behandlingarna varit otillräckligt eller ifall återfall förekommer snabbt efter det första behandlings perioden. Immunförsvaret är nedsatt hos leukemi patienter på grund av själva sjukdomen samt på grund av behandlingarna som används för att vårda sjukdomen. Efter en stamcellstransplantation är patientens immunförsvar svårt nedsatt. Det tar till och med år för immunförsvaret att återhämta sig efter en stamcellstransplantation. Syftet med denna studie var att kartlägga rekonstruktionen av T-lymfocyterna efter stamcellstransplantation, samt vilken inverkan T-lymfocyternas rekonstruktion har på patientens prognos. T-lymfocyternas rekonstruktion uppföljdes med hjälp av blodprov med 1, 3, 6, 9, 12, 18 och 24 månaders mellanrum efter stamcellstransplantationen. Enligt studien rekonstrueras CD8 positiva lymfocyterna snabbare än CD4 positiva lymfocyterna. En långsam rekonstruktion av CD4 positiva lymfocyter korrelerar med en högre mortalitet enligt vår studie.

Aims: Externalizing problem behaviour is common among children which when left untreated can have far-reaching, negative consequences across the lifespan. Parenting has a significant effect on childhood and adolescent development, and one part of which parenting comprises is the parent’s cognitions concerning their parenthood, such as parenting self-efficacy explored in the current study. There has been some research into the associations between externalizing problem behaviour and parenting self-efficacy, but the existing literature contains multiple contradictions and limitations, such as the scarcity of longitudinal designs, research focusing mainly on clinical populations and the tendency to bypass fathers’ experiences. Earlier results on the associations between externalizing problem behaviour and parenting self-efficacy have also been conflicting. The current study explores the associations between externalizing problem behaviour and parenting self-efficacy between the ages 8 and 12. Methods: The used data was from the Finnish population based GLAKU cohort stud. Mothers and fathers of 226 children were asked to assess the children’s externalizing behaviour using the Child Behavior Checklist questionnaire and their sense of parenting self-efficacy using the Parenting Sense of Competence questionnaire when the children were aged 8 and 12. In addition, variables showing change in the assessments on externalizing behaviour and parenting self-efficacy were calculated. The associations between externalizing problem behaviour and parenting self-efficacy were analysed using linear and logistic regression analyses. Results and conclusions: Externalizing behaviour and parenting self-efficacy were significantly associated when the children were aged 8. Higher externalizing behaviour at age 8 was also significantly associated with lower parenting self-efficacy at age 12, and higher parenting self-efficacy at age 8 was significantly associated with lower externalizing behaviour at age 12. Parenting self-efficacy was not significantly associated with change in externalizing behaviour between ages 8 and 12, and higher externalizing behaviour was associated with declining paternal but not maternal parenting self-efficacy. The results of the current study point to a stable association between the two variables during the developmental period between middle childhood and early adolescence. The results also highlight a need to improve the way in which parenting self-efficacy is taken into account during interventions aimed at reducing externalizing problem behaviour among children.

Primaarinen hyperaldosteronismi on sekundaarisen hypertension yleisin syy. Siihen liittyy essentiaalia hypertensiota korkeampi kuolleisuus ja komplikaatioriski. Adrenalektomia on lääkehoitoa tehokkaampi hoitomuoto, mutta se edellyttää preoperatiivisesti huolellista taudin alatyypin määritystä. Tässä suhteessa kultaisena standardina pidettyyn lisämunuaislaskimoiden katetrisaatiotutkimukseen (AVS) liittyy monia metodologisia ongelmia. Uutena mahdollisena menetelmänä on viime vuosina tutkittu vaihtelevin tuloksin 11C-metomidaattipositroniemissiotomografiaa (11C-MTO-PET). Tässä tutkimuksessa analysoimme retrospektiivisesti 44 potilasta, joilta lisämunuainen oli poistettu primaarisen hyperaldosteronismin vuoksi. Kaikille potilaille oli preoperatiivisesti tehty 11C-MTO-PET. Lisäksi 31 potilaalle oli tehty onnistuneesti AVS. Potilaat jaettiin tutkimusta varten kahteen alaryhmään: 36 potilaan konkordanssiryhmään, joilla 11C-MTO-PET:n ja AVS:n tulokset vastasivat toisiaan tai 11C-MTO-PET oli ainoa käytetty menetelmä, sekä 8 potilaan diskordanssiryhmään, joilla menetelmien tulokset olivat keskenään ristiriitaiset ja adrenalektomia tehtiin AVS:n perusteella. Konkordanssiryhmä jaettiin edelleen kahtia sen mukaan, kumman menetelmän perusteella adrenalektomia tehtiin. Näiden ryhmien postoperatiivista paranemista vertailtiin tilastollisessa analyysissa. Konkordanssi- ja diskordanssiryhmien biokemiallisessa ja kliinisessä paranemisessa ei havaittu tilastollisesti merkitsevää eroa. Myöskään konkordanssiryhmän sisällä ei ollut eroa paranemisessa 11C-MTO-PET:n ja AVS:n perusteella leikattujen välillä. Mikäli diskordanssiryhmässä alatyypin määritys olisi tehty 11C-MTO-PET:n perusteella, 6 potilasta olisi jätetty turhaan leikkaushoidon ulkopuolelle ja 2 potilaalta olisi leikattu väärä lisämunuainen. 11C-MTO-PET oli siis virheellinen kaikkiaan 18 %:ssa tapauksista. Vastaavasti AVS oli virheellinen vain 3 %:ssa tapauksista. Tutkimus osoittaa, että 11C-MTO-PET ja AVS johtavat samanlaisiin postoperatiivisiin paranemistuloksiin. Jos menetelmien tulokset ovat kuitenkin keskenään ristiriitaiset, vaikuttaisi AVS luotettavammalta alatyypin määrityksessä.

Tausta ja tarkoitus: Laugier-Hunziker syndrooma on harvinainen, vuonna 1970 tunnistettu benigni tila, johon liittyy suun limakalvoilla ja huulilla esiintyviä pigmenttileesioita. Laugier- Hunziker syndroomaan liittyvät pigmentaatiomuutokset kehittyvät spontaanisti aikuisiässä etiologian ollessa tuntematon. Potilailla tavataan usein mys pitkittäisiä leesioita pääasiassa sormien-, mutta myös varpaankynsien alueella. Harvoissa tapauksissa pigmenttileesioita on tavattu myös muualla kehossa. Laugier-Hunziker syndrooman diagnoosiin päästään poissulkemalla muut mahdolliset vaihtoehdot, jotka aiheuttavat multippeleita suun limakalvon pigmenttimuutoksia. Tutkielman tavoitteena on tuoda tieto kirjallisuudesta Laugier-Hunziker syndroomasta, sillä se on yhä tuntematon monille hammaslääkäreille. Materiaalit ja menetelmät: Tutkimusaineistona käytettiin Pubmed-tietokannasta systemaattisesti haettuja englanninkielisiä artikkeleita hakusanalla Laugier-Hunziker. Mukaan otettiin syndroomaa koskevat tutkimukset ja potilastapausselostukset, joissa pigmenttimuutoksia esiintyi suun tai huulien alueella. Tulokset: Hakutulokseksi saatiin 98 artikkelia, joista 44 täytti mukaanottokriteerit. Artikkelit oli julkaistu vuosina 1986 - 2020. Kaksi artikkeleista oli tutkimuksia, yksi käsitteli geenitestiä ja muut olivat potilastapausselostuksia. Yhteensä artikkeleissa kuvattiin 93 Laugier-Hunziker diagnoosin saanutta potilasta. Naisten osuus oli 81 % ja miesten 19 %. Potilaiden keski-ikä oli 45,9 vuotta (vaihteluväli 8 - 80 v). Suumuutoksista yleisin esiintymispaikka olivat huulet, joista 78 %:lla näitä oli sekä huulen puna-alueella että limakalvoilla. Ikenillä muutoksia oli 23 %:lla ja kielessä 23 %:lla. Kaksi tutkimusta oli tutkinut näiden pigmenttimuutosten hoitoa laserilla, joista 81 %:lla muutokset hävisivät jo yhden käsittelykerran jälkeen. Johtopäätökset: Kirjallisuutta ja erityisesti tutkimusta Laugier-Hunziker syndroomasta on vähän ja se koostuu pääosin potilastapausselostuksista. Raportoitujen tapausten perusteella syndroomaa esiintyy kaiken ikäisillä ja naisilla enemmän kuin miehillä. Tyyppipaikka oli huulet. Hoitoa nämä pigmenttimuutokset tarvitsevat vain esteettisistä syistä ja laserhoito vaikutti kahdessa ensimmäisessä aiheen tutkimuksessa toimivan tässä tehokkaasti.

The aim of the study. The importance of emotional intelligence in the 21st century has grown considerably, when it comes to the world of work, and has created an emergence of research literature around the topic in the past decades. Especially, when talking about leadership, there is an increasing emphasis on emotional, communication and interpersonal skills that are needed for leaders to navigate in the ever-changing work environment and to tackle different, multidimensional challenges. The current world situation and changes in it has also placed new demands on both employees and managers as well as probably permanently altered the way we do work and have understood it previously. Today, leadership ability is often studied through competences, as they provide an easily understandable and measurable approach to a demanding and complex subject. The purpose of this study was to explore the extent to which emotional intelligence and its different scales are associated with leadership competences and differentiate the most relevant applications these findings have in real life. The impact of gender and job level was also examined. Methods. The data consisted of 482 individuals who took part in competence assessments, as part of recruitment processes, conducted by a private talent management consultancy between 2020 and 2023. Their emotional intelligence was assessed by the EIP3 questionnaire, which measures the overall emotional intelligence and additionally, the 16 subscales of emotional intelligence. Furthermore, the respondents also completed the PAPI3+ questionnaire, which was used to assess their ability in three different leadership competences: ’Coaching and developing’, ’Motivating and engaging’, and ’Resilience’. The relationship between emotional intelligence, gender and job level, and the three leadership competences was examined using regression models. Results. The results of the study showed a statistically significant association between emotional intelligence and leadership competence. When looking at each of the three leadership competences, statistically significant associations were found across a number of different emotional intelligence subscales, indicating that emotional intelligence is indeed an important key factor underlying leadership ability. Conclusions. The findings in this study highlights emotional intelligence as a crucial factor when predicting leadership performance and competence. Future research efforts should focus on understanding this connection in more depth and studying the effect of emotional intelligence on other leadership competences as well.

Aims Studies on the efficacy of NF training of ADHD patients have given ambiguous results because most randomly controlled trials (RCTs) have sought to establish its effect in the entire ADD/ADHD-population, treating it as a uniform group. This study addresses whether those who do and do not learn to self-regulate based on NF training differ in terms of ADHD related outcomes and whether the two groups could be identified in advance. Secondly, the study asks whether ’learning’ to succeed in NF training exercises is a sufficient or necessary condition for the effects of NF training on ADHD symptoms. Methods By studying existing data from 23 patients with ages between 25 and 57 and who were trained in the CENT project, the learners and non-learners were first identified by a regression model. The two groups were subsequently compared in terms of several background variables as well as behavioral and self-reported ADHD related outcomes. Moreover, the learning processes in the two groups were analysed by using continuous time structural equations modeling (CTSEM). Results One of the most important predictors of NF learning appeared to be low score in the dissociative experiences scale (DES) and high score in the behavioral inhibition scale (BIS). At the same time, NF learning was enhanced by elevated scores on the generalised anxiety disorder scale (GAD). However, the behavioral effects were mixed among the ‘learners’ and ‘non-learners’, with some positive and some negative effects visible in both groups. Conclusions The study concludes that patients’ ability to learn to self-regulate according to NF data does not appear to be a necessary nor sufficient condition for positive ADHD-related outcomes. This supports the conclusion that the effects of NF training are not solely based on operant conditioning but that the learning processes involved in NF training are more complex. The study suggests that more research should be done regarding the specific role of DES, with possible reference to different neurological mechanisms associated with different classes of symptoms (e.g. inattention and hyperactivity), and possibly explaining the mixed results of RCTs.