Post–lumbar puncture headache is a frequent clinical problem. Needle design is expected to reduce post–puncture headache. In this study, we compared two different lumbar puncture needle designs in diagnostic lumbar puncture and analysed post–dural puncture headache (PDPH) and social and economical harm associated with the diagnostic lumbar puncture procedure. This prospective, controlled study consisted of 80 consecutive adult patients requiring elective diagnostic lumbar puncture due to various neurological symptoms. Lumbar puncture was completed either with Spinocan ® 22 G sharp bevel needle or Whitacre ® 22G pencil point needle. Patients were asked about previous headache symptoms and pain provoked by puncture. One week after the lumbar puncture all patients were interviewed by telephone and occurrence and type of headache, headache intensity, medication and frequency of impairment in activities of daily living were asked. Need for epidural blood patch was also recorded. Thirty–three of 78 (42%) patients experienced headache after diagnostic lumbar puncture and in 26 (33%) the headache could be classified as PDPH. There were no statistically significant differences between needle types in the frequency of common headache, PDPH, puncture pain intensity, need for epidural blood patch or sick leave. Also, there were no other complications except local back pain or headache. In this study, the needle design did not affect the frequency of PDPH. Also, PDPH was common, occurring in 33% cases and caused a considerable amount of disturbance in daily activities. Seeking help for this condition was insufficient and only part of these PDPH patients were treated with epidural blood patch.

Artikkelissa tarkastellaan nuorten mielenterveyskuntoutujien erilaisia koulutuspolkuja, koulutusuran ongelmakohtia sekä mielenterveyden ongelmien asettamia haasteita nuorten toimijuudelle. Tutkimusaineisto koostuu nuorten mielenterveyskuntoutujien (n=28) elämänkulkuhaastatteluista, joiden perusteella heidät luokiteltiin viiteen koulutuspolkutyyppiin. Haastatteluja analysoitiin toimijuuden viitekehyksessä, joka mahdollistaa koulutusuralla tapahtuneiden yksilöllisten tapahtumien paikantamisen ja niiden merkityksen tarkastelun osana yksilön elämänkulkua. Koulutuspolkutyyppien heterogeenisyydestä huolimatta nuorten koulutusuralla oli usein samankaltaisia ongelmakohtia, joista keskeisimmät liittyivät muun muassa opinnäytetyön tekemiseen, koulukiusaamiseen, joustamattomiin opetusjärjestelyihin, psykiatrisen diagnoosin saamiseen ja sairaalahoitojaksoista johtuviin poissaoloihin. Analyysi havainnollistaa, kuinka sosiaalisen tuen ja taloudellisten resurssien puute asettavat rajoituksia ja ehtoja yksilön toimijuudelle. Haastattelut tuovat esiin myös sen, että opinnoissaan hyvin pärjäävien nuorten mielenterveysoireilu, kuten masennus tai ahdistus, saattaa usein jäädä huomaamatta ja avun saaminen viivästyä. Nuorten ongelmiin on syytä suhtautua vakavasti riippumatta siitä, kuinka hyvin he täyttävät koulun institutionaaliset odotukset. Oikea-aikainen keskusteluapu voi vahvistaa nuorten toimijuutta ja näin edesauttaa yhteiskuntaan kiinnittymistä. Asiasanat: elämänkulku, koulutuspolku, mielenterveysongelmat, sosiaalinen tuki, toimijuus *** Agency of mental health rehabilitees at critical turning points in educational trajectoriesTaina Heinonen & Markku VanttajaThe Finnish Journal of Youth Research(Nuorisotutkimus) Vol 41 (2), 55–72 The study examines critical turning points in the educational trajectories of young people with a history of mental health problems, and the challenges that these problems pose for their agency. The data consist of 28 life story interviews with young mental health rehabilitees. The life stories were categorized into five subgroups that typify the findings. The interviews were analyzed through the lens of agency, which enables locating individual events in a person’s educational career and examining their meaning as a part of an individual’s life course. Despite the heterogeneity of the subgroups, the educational careers of young people often revealed similar problems, the most significant of which were related to doing a thesis, being bullied at school, inflexible teaching arrangements, receiving a psychiatric diagnosis, and absences from school due to periods of hospitalization. The analysis illustrates how a lack of social support and financial resources strongly determines the terms and opportunities of agency. The interviews also show that mental health symptoms, such as depression or anxiety, among young people who have done well in their studies may often go unnoticed and help may be delayed. Whenever young people bring up experiences of mental distress, it is essential to pay attention regardless of how well they meet the school’s institutional expectations. Well-timed support discussions can strengthen young people’s agency and promote integration into society.Keywords: life course, educational trajectory, mental health problems, social support, agency