Prevention and management of foot problems in diabetes: A summary guidance for daily practice 2015, based on the IWGDF Guidance Documents

In this 'Summary Guidance for Daily Practice', we describe the basic principles of prevention and management of foot problems in persons with diabetes. This summary is based on the International Working Group on the Diabetic Foot (IWGDF) Guidance 2015. There are five key elements that underpin prevention of foot problems: (1) identification of the at-risk foot; (2) regular inspection and examination of the at-risk foot; (3) education of patient, family and healthcare providers; (4) routine wearing of appropriate footwear, and; (5) treatment of pre-ulcerative signs. Healthcare providers should follow a standardized and consistent strategy for evaluating a foot wound, as this will guide further evaluation and therapy. The following items must be addressed: type, cause, site and depth, and signs of infection. There are seven key elements that underpin ulcer treatment: (1) relief of pressure and protection of the ulcer; (2) restoration of skin perfusion; (3) treatment of infection; (4) metabolic control and treatment of co-morbidity; (5) local wound care; (6) education for patient and relatives, and; (7) prevention of recurrence. Finally, successful efforts to prevent and manage foot problems in diabetes depend upon a well-organized team, using a holistic approach in which the ulcer is seen as a sign of multi-organ disease, and integrating the various disciplines involved.

Sankarihautaus vapaussodassa : valkoisten kaatuneiden hautaaminen Suomessa vuonna 1918

Civil War Hero Burials the funerals of the fallen White in Finland in 1918 This study focuses on the burial with honours of fallen White combatants during the Finnish Civil War of 1918, as well as on the reasons underpinning the practice. The main sources of the study included the archives of the White army, the Civil Guard organisation and the Church, as well as the newspapers. The genetic method of history research was used. Both the existing tradition of military burials and the ecclesiastical burial culture influenced the burials of those who fell during the Civil War. The first war hero funerals took place as early as the beginning of February 1918, and the first larger-scale collective funerals were organised in Laihia and Vaasa in the Ostrobothnia province, with the latter attended by the supreme civil and military leaders of White Finland. From early on, these funerals assumed their characteristic features, such as the lion flag a design for the Finnish national flag proposed immediately upon the declaration of the country s independence military parades, lines of honour guards, eulogies, salutes and common war hero graves. As a result of the general offensive begun in mid-March 1918, the numbers of the fallen multiplied, so special organisations were established to handle the burials of the fallen. At the same time, the war hero funerals became more frequent and diffused, and the numbers of the buried grew throughout the country. In early March, the advocates of the republican system of government published their appeal in the newspapers, requesting that collective graves for those who fell in the war prepared in every locality. They motivated their request by stating that it was the funerals in particular that had inspired many men to join the ranks voluntarily in the first place, and that the large collective soldiers graves increased the numbers of those who answered the call and left for the front. The Civil Guard organisation arranged the burials of war heroes. The clergy contributed by officiating the religious service and by clearly aligning themselves with the Whites in their eulogies. The teachings of the Lutheran Church suggest that they found the Whites to be the temporal authority instituted by God, and therefore authorised raising the sword against the Reds. Speaking at the funerals with great pomp and sentimental power, the leaders of the Civil Guard and the exponents of the learned classes instigated their audiences against the Reds. The funeral speeches idealised the war hero s death by recalling military history since the times of ancient Greece. Being of the emblematic colour of the Whites, the white coffin assumed a particular importance connected to ideas of biblical purity and innocence. By the end of May 1918, almost 3,300 Whites were buried in the soldiers graves prepared by the burial organisation in some 400 localities. Only about 200 men remained missing in action or unidentified. The largest common graves accommodated over 60 fallen combatants. Thus, the traditions of the 1918 Civil War directly influenced war hero burial practices, which continued into the Finnish Winter War of 1939.

Pyhä Teresa ja keskiajan mystiikan teoriat

In my dissertation I have studied St Teresa (1515-1582) in the light of medieval mystical theories. I have two main levels in my research: historical and theological. On the historical level I study St Teresa s personal history in the context of her family and the Spanish society. On the theological level I study both St Teresa s mysticism and her religious experience in the light of medieval mysticism. St Teresa wrote a book called Life , which is her narrative autobiography and story about her mystical spiritual formation. She reflected herself through biblical texts interpreting them in the course of the biblical hermeneutics like allegory, typology, tropology and anagogy. In addition to that she read others life stories from her period of time, but reflected herself only slightly through the sociological point of view. She used irony as a means to gain acceptance to her authority and motive to write. Her position has been described as a double bind because of writing at the request of educated men and to the non-educated women as she herself was uneducated. She used irony as a means to achieve valuation to women, to gain negative attributes connected to them and to gain authority to teach them mystical spirituality, the Bible and prayer. In this ironic tendency she was a feminist writer. In order to understand medieval mysticism I have written in the first chapter a review of the main trends in medieval mysticism in connection with the classical emotional theories. Two medieval mystical theories show an important role in St Teresa s mysticism. One is love mysticism and the other is the three partite way of mysticism (purification, illumination and union). The classic-philosophical emotional theories play a role in both patterns. The theory of love mysticism St Teresa interpreted in the traditional way stressing the spiritual meaning of love in connexion with God and neighbors. Love is an emotion, which is bound with other emotions, but all objects of love don t strengthen spiritual love. In the three partite way of mysticism purification means to find biblical values in life and to practice meditative self-knowledge theologically interpreted. In illumination human understanding has to be illuminated by God and united to mystical knowledge from God. St Teresa considered illumination a way to learn things. Illumination has also psychological aspects like recognition of many trials and pains, which come from life on earth. Theologically interpreted in illumination one should die to oneself, let oneself be transformed and renewed by God. I have also written a review of the modern philosophical discussion on personal identity where memory and mental experiences are important creators of personal identity. St Teresa bound medieval mystical teaching together with her personal religious experience. Her personal identity is by its character based on her narrative life story where mental experiences play important role. Previous researchers have labelled St Teresa as an ecstatic person whose experiences produced ecstatic phenomena to the mysticism. These phenomena combined with visions have in one respect made of her a person who has brought physical and visionary tendencies to theology. In spite of that she also represents a modern tendency trying to give words to experiences, which at first seem to be exceptional and extreme and which are easily interpreted as one-sided either physical or sexual or unsaid. In other respect I have stressed the personality of St Teresa that was represented as both strong and weak. The strong personality for her is demonstrated by religious faith and in its practice. The weak personality was for her a natural personal identity. St Teresa saw a unifying aspect in almost all. Firstly, her mysticism was aimed towards union with God and secondly, the unifying aspects and common rules in human relations in community life were central. Union with God is based on the fact that in a soul God is living in its centre, where God is present in the Trinitarian way. The picture of God in ourselves is a mirror but to get to know God better is to recognize his/her presence in us. When the soul recognizes itself as a dwelling place of God, it knows itself as God knows him/herself. There is equality between God and the soul. To be a Christian means to participate in God in his Trinitarian being. The participation to God is a process of divinization that puts a person into transformation, change and renewal. The unitive aspect concludes also knowledge of opposites between experience of community and solitude as well as community and separateness. As a founder of monasteries St Teresa practiced theology of poverty. She renewed the monastic life founding a rule called discalced that stressed ascetic tendencies. Supporters of her work were after the difficulties in the beginning both society and churchly leaders. She wrote about the monasteries including in her description at times seriousness at times humor and irony. Her stories are said to be picaresque histories that contain stories of ordinary laymen and many unexpected occasions. She exercised a kind of Bakhtinian dialogue in her letters. St Teresa stressed the virtues like sacrifice, determination and courage in the monastic life. Most of what she taught of virtues is based on biblical spirituality but there are also psychological tendencies in her writings. The theological pedagogical advice is mixed with psychology, but she herself made no distinction between different aspects in her teaching. To understand St Teresa and her mysticism is to recognize that she mixes her personal religious experience and mysticism, which widens mysticism to religious experience in a new way, although this corresponds also the very definition of mysticism. St Teresa concentrated on mental-spiritual experiences and the aim of her mystical teaching was to produce a human mind well cured like a garden that has God as its gardener.