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Objectives Few studies have focused on the association between childhood and young adulthood cancers and cancer screening attendance. Our aim was to assess the effect of cancer diagnosed before the age of 30 years on first-time cervical screening attendance. Methods Using the nation-wide and population-based Finnish Cancer Registry and the Mass Screening Registry, we identified 4,491 cancer patients born between years 1961 and 1988 and diagnosed with cancer before age 30 and alive at the time of first cervical cancer screening invitation at age 25 or 30 years. Attendance probability to screening was compared between individuals with and without a prior cancer diagnosis. Results Compared to women with no previous cancer (attendance probability of 58% in study period), difference in attendance to first-time screening invitation was observed among women with previous cervical cancer (24%), other malignant gynaecologic cancer (43%) and borderline ovarian tumours (48%). Attendance among women with other previous cancer types did not differ from women with no previous cancer. Differences in the attendance probability of cancer survivors and cancer free individuals also varied between catchment areas. Conclusions The low cervical cancer screening attendance among survivors of previous gynecologic cancers and borderline ovarian tumors calls for further exploration on the reasons. As attendance probability differed among survivors of gynecological and other types of cancer significantly only if the invitation came <5 years after the cancer diagnosis, one likely explanation is ongoing oncologic follow-up. Regional differences underline the importance of national guidelines.

Vaccine uptake has been low for some vaccines in the Pietarsaari region in Finland. Among health care workers vaccine uptake has been low for the influenza vaccine. This qualitative study intends to answer questions about what kind of attitudes and thoughts health care workers have towards vaccination and which factors affect the attitudes. This study consists of 23 semi-structured interviews and three focus-group interviews with health care workers in the Pietarsaari region. The interviews were conducted in June-July 2017 and were analyzed with qualitative content analysis. The general attitude towards vaccination is positive amongst the health care workers. Vaccines are seen as fundamental protection against diseases and are an important part of health prevention. Many informants trust the authorities and research conducted about vaccines. Yet some informants are hesitant about certain vaccines. Vaccines, which are called unnecessary or risky, varies between the informants. Reasons for refusing vaccines are preference of natural immunity, negative experiences of vaccination, for example adverse effects, or the attitude that ”we can ́t vaccinate against everything”. Furthermore, the concerns about vaccines have increased since 2009, when the swine flu vaccination was associated with severe adverse effects. Health care workers also oppose the compulsory vaccination of the influenza vaccine.

Tutkielma on kirjallisuuskatsaus, jonka tavoitteena on löytää oikeanlaisia tapoja kohdata hammashoidon lapsipotilaita, joilla on autismikirjon häiriö tai ADHD (Attention Deficit Hyperactivity Disorder) eli aktiivisuuden ja tarkkaavuuden häiriö. Tutkielmassa pyritään selvittämään, miten lapsen kehityksellinen neuropsykiatrinen häiriö kannattaa ottaa huomioon hammashoidossa, miten ADHD- tai autismikirjon lapsen kanssa toimitaan mahdollisimman oikealla tavalla toimenpiteitä suorittaessa ja miten lasta tuetaan hoidon aikana.Tavoitteena on parantaa lasten kokemusta ja helpottaa hammaslääkärien työskentelyä erityislapsipotilaiden kanssa. ADHD ja autismikirjon häiriöt ovat molemmat kehityksellisiä neuropsykiatrisia häiriöitä. Näiden taustalla on neurobiologinen häiriö, joka aiheuttaa psykiatrisia oireita. ADHD- tai autismikirjon lapsen erityistarpeet on tärkeää ottaa huomioon hammashoidossa. Näin vältytään turhilta ongelmilta ja hoito etenee mahdollisimman sujuvasti. Erilaisia vuorovaikutusmenetelmiä on mahdollista käyttää helpottamaan toimenpiteitä. Lapsilla, joilla on ADHD tai autismikirjon häiriö esiintyy enemmän käytöspulmia ja stressiä hammashoidossa, kuin normaalisti kehittyvillä lapsilla. Hammashoidon tukena voidaan käyttää kerro-näytä-tee-menetelmää tai kuvia hammashoitotilanteesta. Lisäksi kehut ja palkinnot sekä ulkoisten ärsykkeiden minimointi helpottavat vuorovaikutusta näiden lasten kanssa. Lapsilla, joilla on ADHD tai autismikirjon häiriö saattaa olla kohonnut kariesriski ja huonompi suuhygienia kuin tavallisesti kehittyvillä lapsilla. Hoitotilannetta tukee hammaslääkärin hyvä tietotaso ADHD:sta ja autismikirjon häiriöstä sekä lapsen erityistarpeista. Vuorovaikutus ADHD- ja autismikirjon potilaan kanssa hammashoidossa on prosessi, jossa tarvitaan hoitohenkilökunnalta vuorovaikutustaitoja ja kykyä kohdata jokainen lapsi yksilönä.

Objectives. Autism spectrum disorder (ASD) is a neurobiological developmental disorder that involves challenges in social interaction and restricted/repetitive behaviors. Since generalization and maintenance of acquired skills is essential in the rehabilitation of ASD, it is important to integrate interventions into the home environment by parental guidance. There has been some research on the rehabilitation of children with ASD in Finland, but no research has been conducted on the guidance of parents from the perspective of speech therapist. The purpose of this study is to find out the views of parental guidance from speech therapists who rehabilitate children with ASD. Interviews with speech therapists will clarify the ways in which parents of children with ASD are guided through speech therapy and the challenges and contributing factors in parental guidance. Methods.The research method was a semi-structured interview. Five speech pathologists with experience in the rehabilitation of ASD were interviewed. The interviews were recorded and transcribed. The data was analyzed by content analysis. Results and conclusion. Parental guidance of children with ASD was divided into information sharing, interaction & discussion and direct guidance. The challenges were parental strain, parent attitude and in some cases multiculturalism. Contributing factors appeared in training practices and home conditions. Challenges and benefits were influenced by the individuality of families. Speech therapists hoped for more opportunities to arrange separate parental guidance sessions so that they would be able to discuss deeper about the methods and family situation without the child’s presence. Speech therapists considered parental guidance important in the rehabilitation of children with ASD because, with the guidance of parents it helped to increase skills in everyday life and guaranteed training intensity. As parental strain was identified as a challenge in this study, it would be important to explore how they could be more effectively supported during rehabilitation. In addition, it could be explored whether separate parental guidance sessions should be increased or whether the number of parental guidance sessions has been adapted through the development of new working practices.

Autism spectrum disorder (ASD) is a condition that affects social interaction, communication and behavior. Since effective communication and interaction is a prerequisite for learning, the use of augmentative and alternative communication (AAC) methods has been considered necessary in study environments. The education professionals' perspectives and attitudes towards the use of AAC methods have been linked to the extent to which they support the development of communication skills of their pupils using communication aids. The purpose of this study is to describe the experiences of autism classroom teachers and classroom assistants in the use of AAC methods. This topic is examined based on the benefits and challenges that autism education professionals associate with the use of communication aids, the number of factors contributing to the successful use of the AAC methods as well as the development of the students' communication skills. In this study nine education professionals who worked in autism education classrooms and school's afternoon activities in Helsinki were interviewed. The interviews were conducted as semi-structured individual interviews, which discussed the use of AAC methods for students with ASD. The interviews were recorded, transcribed and analyzed by using inductive thematic analysis approach. Finally, the themes of each research question were compared with each other. Based on the results of this study, AAC methods are particularly useful not only for communication between students and education professionals, but also for the students' ability to express themselves, to develop better social skills and to become more independent in their everyday lives. The challenges of using AAC methods related to usability factors, students' developmental abnormalities, education professionals' practices and various resource issues. Professional co-operation, motivation, favorable usability factors of the AAC methods, and factors related to the activities and roles of education professionals were seen to influence the successful use of the AAC methods and to improve the students' communication skills. In addition, the interviewees strongly emphasized the importance of students' spontaneous communication and speech development in the motivation and work satisfaction of education professionals. The autism classroom teachers' and classroom assistants' experiences in the use of AAC methods emphasize the importance of training and multiprofessional co-operation in support of the use of communication aids and development of students' communication skills. Based on the results of this study, the speech therapists' counseling activities can be regarded as significant for the development and maintenance of the education professionals' AAC skills and for constituting positive attitudes related to the use of AAC methods. This study highlights the importance of further research focusing particularly on more specific identification of challenges related to the use of AAC methods in autism classroom education.

Aim: Oral infections up-regulate a number of systemic inflammatory reactions that, in turn, play a role in the development of systemic diseases. We investigated the association between oral health and autoimmune diseases in a cohort of Swedish adults. Hypothesis was that poor oral health associates with incidence of autoimmune diseases. Materials and Methods: Overall 1676 subjects aged 30–40 years old from Stockholm County (Sweden) participated in this study in 1985. Subjects were randomly selected from the registry file of Stockholm region and were followed-up for 30 years. Their hospital and open health care admissions (World Health Organization ICD 9 and 10 codes) were recorded from the Swedish national health registers. The association between the diagnosed autoimmune disease and the oral health variables were statistically analyzed. Results: In all, 50 patients with autoimmune diagnoses were detected from the data. Plaque index was significantly higher in the autoimmune disease group (≥median 35 (70%) vs. under median 872 (54%), p = 0.030). No statistical difference was found in gingival index, calculus index, missing teeth, periodontal pockets, smoking or snuff use between patients with and without autoimmune disease. Conclusions: Our study hypothesis was partly confirmed. The result showed that subjects with a higher plaque index, marker of poor oral hygiene, were more likely to develop autoimmune diseases in 30 years.

Iän myötä ajaminen saattaa vaikeutua kognitiivisten, sensoristen ja motoristen taitojen heiketessä. Useimmissa Euroopan maissa on siksi käytössä autonkuljettajien ikäkausitarkastukset, joiden ajatuksena on seuloa liikenteestä pois kaikkein suurimman onnettomuusriskin omaavat kuljettajat. Tutkimukset ovat kuitenkin kyseenalaistaneet tarkastusten aikana suoritettavien testien tehon. Tutkielman tavoitteena oli selvittää, vähentävätkö autonkuljettajien ikäkausitarkastukset liikenneonnettomuuksia, sekä arvioida iäkkäiden mahdollisesti korkeampaan onnettomuusriskiin vaikuttavia tekijöitä. Tätä varten tehtiin laaja kirjallisuuskatsaus ja vertailtiin kahdentoista Euroopan maan liikennekuolemia vuosilta 2019–21, samalla huomioiden, mikäli kyseisissä maissa on käytössä ikäkausitarkastukset vai ei. Lisäksi perehdyttiin myös mahdollisiin ikäkausitarkastuksista aiheutuviin haittoihin, liikenneonnettomuustilastojen tulkintaan liittyviin harhoihin, sekä niistä aiheutuviin suoriin ja epäsuoriin kustannuksiin. Tulosten perusteella voidaan todeta, ettei autonkuljettajien ikäkausitarkastuksilla vaikuta olevan liikenneonnettomuuksia merkittävästi vähentävää vaikutusta ja että tietyissä tapauksissa ne ovat saattaneet johtaa iäkkäiden suojaamattomien tienkäyttäjien (pyöräilijät, kävelijät, moottoripyöräilijät) liikennekuolemien merkitsevään kasvuun. Muutamassa tutkimuksessa ajokortin uusiminen paikan päällä (esimerkiksi tieliikenneviranomaisen luona) ja näöntarkastukset olivat yhteydessä iäkkäiden vähäisempiin auto-onnettomuuksiin. Yhdessäkään tutkimuksessa ei kuitenkaan osoitettu, että lääkärintarkastuksilla olisi iäkkäiden liikenneonnettomuuksia vähentävää vaikutusta. Ikäkausitarkastusten arvioitiin maksavan Suomen veronmaksajille noin 6 000 000 euroa vuodessa, minkä lisäksi on huomioitava rajalliset lääkäriresurssit. Näistä syistä johtuen ainakaan lääkärien suorittamat autonkuljettajien ikäkausitarkastukset eivät ole perusteltuja.

Inflammatoriska tarmsjukdomar (IBD = inflammatory bowel disease) är en grupp kroniska, återkommande inflammatoriska sjukdomar vars uppkomstmekanism ännu är till stor del okänd. Gemensamt för sjukdomarna är en kronisk inflammation i mag-tarmkanalen, men även olika extraintestinala manifestationer är vanliga hos dessa patienter. Även om behandlingen av IBD har blivit betydligt effektivare under de senaste 20 åren är sjukdomsbilden för patienter med IBD ofta fluktuerande och en del drabbas av ett svårt skov som kräver sjukhusvård någon gång under sin sjukdomstid. I avhandlingen studerades retrospektivt vård och endoskopier av patienter med IBD som blivit inlagda på Mejlans sjukhus på grund av ett skov under åren 2021–2022. Patienternas symtom, vård, medicinering, bruk av antibiotika och infektioner analyserades närmare. Tidigare studier har visat att IBD patienter med Clostridioides difficile infektion (CDI) har en större risk att utveckla en svårare sjukdomsbild och att incidensen av CDI är dessutom högre hos IBD-patienter. Studien visade att läkarna är medvetna om CDI risken och att CDI således utesluts genom laboratorieundersökning av så gott som alla patienter med ett svårt skov. Endast en av studiens patienter hade en CDI. Vidare analyserades endoskopiernas omfång, fynd och möjliga komplikationer. Hos studiens patienter uppstod inte några komplikationer i samband med endoskopierna även om en del av endoskopierna avbröts i förtid pga smärta hos patienten. Detta visar att trots att man bedömt att endoskopi är nödvändigt för utvärdering av sjukdomsbeloppet, agerar läkarna enligt patientens symtom för att undvika komplikationer.

Avomahahoito on kirurginen hoitokeino, jossa faskia jätetään sulkematta laparostomian jälkeen ja vatsaontelo suojataan tilapäisellä sulku menetelmällä. Avomahahoito on haastavaa ja sen käyttö on perusteltua vatsanalueen kirurgisissa hätätilanteissa, joissa vatsaontelon sisäinen paine uhkaa kohota tai on jo koholla. Vatsaontelon avaaminen laskee sen sisäistä painetta ja suojaa vatsaontelon elimiä vatsaontelon ylipaineoireyhtymältä. Avomahahoito on myös tarpeen, mikäli laparotomian jälkeen vatsaontelon sulku ei ole mahdollista esimerkiksi kudospuutoksen tai -turvotuksen takia. Hoitoon liittyy korkea kuolleisuus sekä komplikaatioriski. Tyypillinen komplikaatio on laparostomia-arpeen myöhemmin kehittyvä arpityrä tai suunniteltu tyrä, joka syntyy, kun avomahahoidon päätteeksi ei ole mahdollista sulkea faskiaa vaan vatsaontelo suljetaan omalla iholla tai ihosiirteellä. Tässä tutkimuksessa tarkasteltiin retrospektiivisesti potilasasiakirjoista vuosina 2014-2017 Helsingin yliopistollisessa keskussairaalassa hoidettuja avomahapotilaita ja kartoitettiin vatsanpeitteen tyrän syntymistä hoidon komplikaationa. Tyräpotilaiden terveystiedot sekä hoitojakson kulkuun liittyvät keskeiset tiedot kerättiin, ja niiden perusteella analysoitiin näiden potilaiden erityispiirteet ja hoitokeinot sekä ongelmat. Edelleen selvitettiin onnistuiko tyrän korjaaminen myöhemmässä vaiheessa sekä kuvattiin käytetyt leikkausmenetelmät. Lopuksi saatuja tuloksia verrattiin aihetta käsitteleviin tutkimuksiin. Tutkimuksen hoitojaksosta selvinneistä 124 potilaasta 20:lla todettiin tyrä avomahahoidon komplikaationa. Tyräilmaantuvuus oli 16,1%. Tapauksista 10 (50%) oli suunniteltuja tyriä ja 10 (50%) myöhemmin syntyneitä arpityriä. Tyrän korjausleikkaus tehtiin 50% potilaista. Avomahahoidon kesto oli keskimäärin 15,6 vrk ja käytetyin tilapäisen sulun menetelmä oli vatsaontelon sulku verkkoavusteisin alipainesidoksin, jota oli käytetty yhtenä menetelmänä kaikilla 20 potilaalla. Tyrien ilmaantuvuus osoittautui muihin tutkimuksiin verrattuna melko matalaksi, jota luultavasti selittää tämän tutkimuksen lyhyempi leikkauksen jälkeinen seuranta-aika.

Aim. Compared to spoken conversations, achieving mutual understanding may be more at risk when one or more participants use aided communication. An aided communicator may take a passive role in conversations and may not have adequate strategies to repair conversational breakdowns when they occur. The aim of this study was to describe how an aided communicator may attempt to solve the problems he encounters in conversations with his speaking communication partners. Aided communicator’s repair strategies, causes of breakdowns and partners’ influence on repair phenomena were studied. This study may help professionals to acknowledge the threats that compromise achieving mutual understanding in aided conversations and recognize some of the strategies in overcoming potential communication disrupts. Method. Within the framework of data driven qualitative analysis this case study examined videotaped conversations, where an 11-year-old boy using communication book communicated with his mom, teacher and peer. The data was originally videotaped as a part of the international research project Becoming an Aided Communicator. Data driven analysis was considered as an appropriate method for studying a topic with limited previous research. Results and conclusion. Almost all of the aided communicator’s repairs were self-initiated self-repairs and the rest were other-initiated self-repairs. The former occurred mostly as responses to the partner’s misinterpretations and operational difficulties while the latter followed requests for clarifications. Aided communicator repaired by repeating or modifying his utterances or by adding new elements to the original utterance. For repairs he utilized nonverbal modalities: gaze, gestures and actions. In some exchanges, he changed modality. Reasons for the misinterpretations and requests for clarifications emerged from the linguistic limitations of the graphic communication system and partner’s difficulty in understanding the aided communicator’s nonverbal communicative acts. Operational challenges seemed to be related to partner’s experience with using communication aids that affected the fluency of communication. Partners’ varying familiarity with aided communication seemed to affect the need to repair and the effectivity of repair. In addition, the shared competence of the dyad influenced achieving mutual understanding. For the best results of support and guidance, speech and language therapists should emphasize finding out the communicator’s individual strategies in repair as well as effective practices to use a communication book. This could be implemented by video-based observations.