Restorative treatment practices and dentist-related factors

This study aimed at elucidating real-life aspects of restorative treatment practices. In addition, dentists' views and perceptions of and variation in restorative treatment practices with respect to dentist-related factors were evaluated. Reasons for placement and replacement of restoration, material selection, posterior restoration longevity, and the use of local anesthesia were assessed on two cross-sectional data sets. Data from the Helsinki Public Dental Service (PDS) included details on 3057 restorations performed by dentists (n=134) during routine clinical work in 2001. The other PDS data from Vantaa were based on 205 patient records of young adults containing information on 1969 restorations investigated retrospectively from 1994-1996 backwards; 51 dentists performed the restorations. In addition, dentists’ self-reported use of local anesthesia and estimates of restoration longevity were investigated by means of a nationwide questionnaire sent to 592 general dental practitioners selected by systematic sampling from the membership list of the Finnish Dental Association in 2004. All data sets included some background information on dentists such as gender, year of birth or graduation, and working sector. In PDS in 2001, primary caries was the reason for placement of restoration more often among patients aged under 19 years than among older patients (p<0.001). Among patients over 36 years of age, replacements represented the majority. Regarding dentist-related factors, replacements of restorations were made by younger dentists more frequently than by older dentists (p<0.001). In PDS in 1994-1996, the replacement rate of posterior restorations was greater among female dentists than among male dentists (p=0.01), especially for amalgams (p=0.008). The mean age of replaced posterior restoration among young adults was 8.9 (SD 5.2) years for amalgam and 2.4 (SD 1.4) years for tooth-colored restorations, the actual replacement rate for all existing posterior restorations being 7% in PDS in 1994-1996. Of all restorative materials used, a clear majority (69%) were composites in PDS in 2001. Local anesthesia was used in 48% of cases and more frequently for older patients (55%) than for patients aged under 13 years (35%) (p<0.001). Younger dentists more often used local anesthesia for primary restoration than did the older dentists (p<0.001), especially for primary teeth (p=0.005). Working sector had an impact on dentists’ self-reported use of local anesthesia and estimates of restoration longevity; public sector dentists reported using local anesthesia more frequently than private sector dentists for Class II (p=0.04) and for Class III restorations (p=0.01). Private sector dentists gave longer estimates of posterior composite longevity than public sector dentists (p=0.001). In conclusion, restorative treatment practices seem to vary according to patient age and also dentist-related factors. Replacements of restorations are common for adults. For children, clear underuse of local anesthesia prevails.

Examination of Genetic Components Affecting Human Obesity-Related Quantitative Traits

Obesity increases the risk for several conditions, including type 2 diabetes mellitus, cardiovascular disease, hypertension, osteoarthirits and certain types of cancer. Twin- and family studies have shown that there is a major genetic component in the determination of body mass. In recent years several technological and scientific advance have been made in obesity research. For instance, novel replicated loci have been revealed by a number of genome wide association studies. This thesis aimed to investigate the association of genetic factors and obesity-related quantitative traits. The first study investigated the role of the lactase gene in anthropometric traits. We genetically defined lactose persistence by genotyping 31 720 individuals of European descent. We found that lactase persistence was significantly correlated with weight and body mass index but not with height. In the second study we performed the largest whole genome linkage scan for body mass index to date. The sample consisted of 4401 twin families and 10 535 individuals from six European countries. We found supporting evidence for two loci (3q29 and 7q36). We observed that the heritability estimate increased substantially when additional family members were removed from the analyses, which suggests reduced environmental variance in the twin sample. In the third study we assessed metabonomic, transcriptomic and genomic variation in a Finnish population cohort of 518 individuals. We formed gene expression networks to portray pathways and showed that a set of highly correlated genes of an inflammatory pathway associated with 80 serum metabolites (of 134 quantified measures). Strong association was found, for example, with several lipoprotein subclasses. We inferred causality by using genetic variation as anchors. The expression of the network genes was found to be dependent on the circulatory metabolite concentrations.

Kelan järjestämän kuntoutuksen kohdentuminen ja vaikutukset työkykyyn kunnallisilla työpaikoilla

Tutkimuksessa selvitettiin Kansaneläkelaitoksen (Kelan) järjestämän kuuden yleisimmän työssä käyvälle väestölle tarkoitetun kuntoutusmuodon kohdentumista kuntatyöntekijöille (n = 67 106 henkilöä). Lisäksi selvitettiin Kelan järjestämän tuki- ja liikuntaelinkuntoutuksen ja ASLAKkurssien vaikutuksia työkykyyn sekä verrattiin kahta fibromyalgiaa sairastaville tarkoitettua kuntoutusmuotoa. Muuttujatiedot kerättiin työnantajien omista ja kansallisista rekistereistä. Naiset olivat Kelan järjestämässä kuntoutuksessa yliedustettuina ja määräaikaisessa työsuhteessa työskentelevät aliedustettuina. Selkäkipukuntoutukseen osallistuneiden ja työnantajien palveluksessa seurannan loppuun saakka olleiden vuosittaiset hyvin pitkät sairauspoissaolot vähenivät kolmen kuntoutuksen jälkeisen vuoden ajaksi. Niskakipukuntoutukseen osallistuneilla ei todettu tätä muutosta. ASLAK-kuntoutukseen osallistuneiden sairauspoissaolopäivät ja hyvin pitkät sairauspoissaolokerrat vähenivät kuntoutusvuonna ja kolmena sen jälkeisenä vuonna samalle tasolle kuin kuntoutukseen osallistumattomilla kaltaistetuilla verrokeilla. Työkyvyttömyyseläkkeen riski oli kuntoutujilla neljän kuntoutuksen jälkeisen vuoden aikana verrokkeja pienempi. Fibromyalgiaa sairastavien kahden kuntoutusmuodon (fibromyalgiakurssi ja epäspesifinen tules-kuntoutus) vertailussa ei kuntoutuksen vaikutuksissa työkykykyyn todettu eroa. Kelan järjestämän kuntoutuksen sisällössä tarvitaan kriittistä arviointia, tutkimusta ja kehitystyötä, jotta yhteiskunnan odotus vaikuttavuudesta toteutuu.

Luottamus koulussa : Tutkimus yhdeksännen luokan oppilaiden luottamus- ja epäluottamuskertomuksista ja niiden merkityksestä oppilaiden kouluarjessa

The aim of this study is to explore trust at school and its meaning for 9th grade students. The intent is to investigate students views about trust and mistrust in school relationships. Three research questions are posed: 1) what meanings do students give to their experiences of trust and mistrust at school and how do they evaluate connection of these experiences to their well-being and enjoyment in the classroom? 2) what and how important, is the teacher s role according to the students writings, and 3) what might the different pedagogical and administrative structures of schools reveal about trust and mistrust in a particular school culture? The data consists of 134 writings of 9th grade students (secondary school) from three schools in one of the biggest cities in Finland. The schools differ from others in terms of their pedagogical or structural backgrounds. The study is restricted to the micro-level of, disposition of Educational Sociology, focusing on trust in schools relationships. The theoretical framework of the study is trust, as a part of social capital; however trust is also approached from the sociological, the psychological and philosophical perspective. The methodological approach is narrative research concerning school practice . Analysis of narrative consist mostly content analysis, but also some elements of holistic-content reading, thematic reading and categorical content. The analysis found three main themes: 1) individual stories of trust, 2) the teachers role in making trust possible in the classroom, and 3) school as a community of trust. According to the study trust at school (1) is a complex phenomenon consisting of people s ability to work together and to recognize the demands that different situations present. Trust at school is often taken for granted. In the students experiences trust is strongly connected to friendship, and the teacher s ability to connect with students. Students experiences of mistrust stem from bulling, school violence, lack of respect as well as teachers lacking basic professional behavior. School relationships are important for some students as source of enjoyment, but some feel that it is difficult to evaluate the connection between trust and enjoyment. The study found that students trust of teachers (2) is linked to the teacher s professional role as a teacher, a caring human being open to dialogue. In other words, the students describe teachers abilities to create a sense of trust in terms of three expectations: the teacher was better, the same or worse than expected. Better than expected, means the teacher engender a high degree of trust and has excellent communication skills. Same as expected means the teacher comes across as familiar and secure, while lower than expected means the teacher creates no trust and has poor communication skills. Finally, it was shown that trust at school (3) should not only exist between some individuals, but between (all) members of the school community. In other words, according to the study there is some evidence that trust is strongly committed to school culture. Further, trust seems to depend on (school-) cultural background, values, beliefs, expectations, norms as well as staff behaviour. The basic elements of an optimum level of trust at school are favourable school structure and pedagogical background; however, good relationships between teachers and students as well as high professional skills are also needed. Trust at school is built by good communication, working together and getting to know each other.

Painehaavapotilaille tehtyjen hoitointerventioiden määrä ja tulokset HYKS:n plastiikkakirurgian klinikassa

Keräsimme ICD-10 koodilla L89 HYKS:n plastiikkakirurgian klinikassa hoidetuista 401:stä potilaasta hoitotiedot vuosilta 2000-2008. Plastiikkakirurgiseen leikkaukseen ja hoidon arvioon päätyneiden potilaiden keski-ikä oli 60,3 (18-97v.). Painehaavan riskitekijät selvitettiin. Yksittäisistä riskitekijöistä yleisimpiä olivat paraplegia ( n=77; 17% ) ja diabetes/ASO tauti ( n=53; 12 % ). Yhteensä painehaavaleikkauksia tehtiin 347 , joista revisioleikkauksia 108 ja varsinaisia sulkuleikkauksia oli 239. Keskimäärin potilaat tarvitsivat 1.7 operaatiota. Leikatuista painehaavoista gradus III- haavoja oli 35,1% ; n= 84 ja gradus IV 25,5% ; n= 61, pinta-ala haavoilla oli keskimäärin 30,5 cm2. Istuinkyhmyjen ja sacrumin painehaavat olivat potilasaineistossamme yleisiä (20% ja 27% operoiduista painehaavoista). Gradus III haavoja leikattiin keskimäärin 1,6 kertaa ja gradus IV haavoja keskimäärin 2,0 kertaa. Postoperatiivisia poliklinikkakäyntejä tarvittiin keskimäärin 2,3, gradus III painehaavapotilailla 2,0 ja gradus IV potilailla 2,6 käyntiä. Leikkausmenetelmistä eri kielekerekonstruktiot olivat selkeästi eniten käytetty leikkausmenetelmä painehaavaleikkauksissa: 58 % rekonstruktioleikkauksista suoritettiin käyttäen jonkinlaista iho- lihaskielekettä. (134 sanaa)

The Nature and Change of Bonds in Industrial Business Relationships

A focus on cooperative industrial business relationships has become increasingly important in studies of industrial relationships. If the relationships between companies are strong it is usually a sign that companies will cooperate for a longer time and that may affect companies’ competitive and financial strength positively. As a result the bonds between companies become more important. This is due to the fact that bonds are building blocks of relationships and thus affect the stability in the cooperation between companies. Bond strength affect relationship strength. A framework regarding how bonds develop and change in an industrial business relationship has been developed in the study. Episodes affect the bonds in the relationship strengthening or weakening the bonds in the relationship or preserving status quo. Routine or critical episodes may lead to the strengthening or weakening of bonds as well as the preservation of status quo. The method used for analyzing bond strength trying to grasp the nature and change of bonds was invented by systematically following the elements of the definitions of bonds. A system with tables was drawn up in order to find out if the bond was weak, of medium strength or strong. Bonds are important regulators of industrial business relationships. By influencing the bonds one may have possibilities to strengthen or weaken the business relationship. Strengthen the business relationship in order to increase business and revenue and weaken the relationship in order to terminate business where the revenue is low or where there may be other problems in the relationship. By measuring the strength of different bonds it can be possible to strengthen weak bonds in order to strengthen the relationship. By using bond management it is possible to strategically strengthen or weaken the bonds between the cooperating companies in order to strengthen the cooperation and tie the customer or supplier to the company or weaken the cooperation in order to terminate the relationship. The instrument for the management of bonds is to use the created bond audit in order to know which bonds resources should be focused on in order to increase or decrease their strength.

Information Sharing in Banking: A Collusive Device?

We show that information sharing among banks may serve as a collusive device. An informational sharing agreement is an a-priori commitment to reduce informational asymmetries between banks in future lending. Hence, information sharing tends to increase the intensity of competition in future periods and, thus, reduces the value of informational rents in current competition. We contribute to the existing literature by emphasizing that a reduction in informational rents will also reduce the intensity of competition in the current period, thereby reducing competitive pressure in current credit markets. We provide a large class of economic environments, where a ban on information sharing would be strictly welfare-enhancing.

Simplified Treatment of Childhood Acute Bone and Joint Infections

Acute childhood osteomyelitis (OM), septic arthritis (SA), and their combination osteomyelitis with adjacent septic arthritis (OM+SA), are treated with long courses of antimicrobials and immediate surgery. We conducted a prospective multi-center randomized trial among Finnish children at age 3 months to 15 years in 1983-2005. According to the two-by-two factorial study design, children with OM or OM+SA received 20 or 30 days of antimicrobials, whereas those with SA were treated for 10 or 30 days. In addition, the whole series was randomized to be treated with clindamycin or a first-generation cephalosporin. Cases were included only if the causative agent was isolated. The treatment was instituted intravenously, but only for the first 2-4 days. Percutaneous aspiration was done to obtain a representative sample for bacteriology, but all other surgical intervention was kept at a minimum. A total of 265 patients fulfilled our strict inclusion criteria and were analyzed; 106 children had OM, 134 SA, and 25 OM+SA. In the OM group, one child in the long and one child in the short-term treatment group developed sequelae. One child with SA twice developed a late re-infection of the same joint, but the causative agents differed. Regarding surgery, diagnostic arthrocentesis or corticotomy was the only surgical procedure performed in most cases. Routine arthrotomy was not required even in hip arthritis. Serum C-reactive protein (CRP) proved to be a reliable laboratory index in the diagnosis and monitoring of osteoarticular infections. The recovery rate was similar regardless of whether clindamycin or a first-generation cephalosporin was used. We conclude that a course of 20 days of these well-absorbing antimicrobials is sufficient for OM or OM+SA, and 10 days for SA in most cases beyond the neonatal age. A short intravenous phase of only 2-5 days often suffices. CRP gives valuable information in monitoring the course of illness. Besides diagnostic aspiration, surgery should be reserved for selected cases.

Branding: The Past, Present, and Future: A Study of the Evolution and Future of Branding

Branding, as any other concept, has evolved over time: from the days when sheep of one herd started to be branded to distinguish them from another herd to the current era when everything, from water and flowers to clothes and food, is branded. Throughout these times, there have been numerous theories to describe and understand the underlying nuances. This paper finds the relationships in previous literature and reveals how these theories see branding from various perspectives and how they can be integrated to form a coherent view. It is also discussed how branding and society affect each other. Based on the knowledge of how branding theories have been developed as dependent variables of each other and the society, we are able to form a better understanding of the past, the present, and the future of branding.

Onttojen puiden lahopuukovakuoriaiset — kolmen pyydystyypin vertailu

Vanhat ja ontot puut ovat tärkeä elinympäristö monelle lahopuusta riippuvaiselle eliölajille. Onttoihin puihin on erikoistunut suuri määrä myös vaarantuneita ja harvinaisia hyönteislajeja, jotka elävät puun onkalon seinämillä tai onkalon pohjalle kerääntyvässä orgaanisessa aineksessa, ns. mulmissa. Tutkimuksen tavoitteena oli selvittää, mikä kolmesta pyydystyypistä (ikkuna-, vuoka- ja kuoppapyydys) soveltuu parhaiten onttojen puiden lahopuukovakuoriaisten pyyntiin. Lisäksi tavoitteena oli kartoittaa hyönteisnäytteiden ensimmäiseen laboratoriokäsittelyyn vaadittua aikaa. Tutkimuksessa oli mukana vanhoja rungostaan onttoutuneita lehmuksia, tammia ja vaahteroita pääkaupunkiseudun puisto- ja kartanoalueilta. Puiden onkaloiden sisään aseteltiin ikkuna-, vuoka- ja kuoppapyydyksiä, kaksi kutakin tyyppiä ja ne tyhjennettiin kolmen viikon välein touko-heinäkuussa 2006. Pyydyksiä oli siis yhteensä 90 per pyyntijakso. Kun näytteistä eroteltiin halutut hyönteislahkot (mukaanlukien kovakuoriaiset) niiden käsittelyyn käytetty aika kirjattiin ylös. Aineistosta tunnistettiin yhteensä 3825 kovakuoriaisyksilöä ja 212 lajia, joista lahopuusta riippuvaisia oli yhteensä 3398 yksilöä ja 121 lajia. Ikkunapyydyksissä esiintyi yhteensä 1639 yksilöä ja 140 lajia, vuokapyydyksissä 1506 yksilöä ja 134 lajia, kuoppapyydyksissä 680 yksilöä ja 111 lajia. Näytteiden käsittelyaikojen keskiarvot olivat 48,3 minuuttia ikkunapyydykselle, 65,5 minuuttia vuokapyydykselle ja 34,1 kuoppapyydykselle. Lajistokoostumuksen huomioiva ?-diversiteetti erosi huomattavasti pyydysten välillä, se oli 36,5 % ikkuna- ja vuokapyydysten välillä, 13,1 % ikkuna- ja kuoppapyydysten välillä ja 14,2 % vuoka- ja kuoppapyydysten välillä. Ikkuna- ja vuokapyydysten välillä ei havaittu tilastollisesti merkitsevää eroa saproksyylilajien (p<0,05), -yksilöiden (p<0,05) tai käsittelyaikojen (p<0,05) keskiarvoissa. Ikkuna- ja vuokapyydyksillä saatiin keskimäärin selvästi enemmän saproksyylilajeja ja –yksilöitä kuoppapyydykseen verrattuna. Kuoppapyydyksellä saatiin kokonaisyksilömäärään verrattuna suhteellisesti vähemmän saproksyylejä (59 %) kuin ikkuna- (69 %) ja vuokapyydyksillä (71 %). Ikkunapyydykset olivat tehokkain pyydystyyppi vertailtaessa pyydysten keräämää saproksyyliyksilömäärää suhteessa aineiston käsittelyn vaatimaan aikaan. Tehokkuus (yksilöä minuutissa) ikkunapyydykselle oli 0,74, vuokapyydykselle 0,43 ja kuoppapyydykselle 0,21. Ikkunapyydyksiä ei ole aikaisemmin käytetty puun onkalon sisällä hyönteisiä pyydettäessä vaan ne ovat aikaisemmissa tutkimuksissa roikkuneet onkalon ulkopuolella. Ikkunapyydykset kuitenkin toimivat erinomaisesti myös onkaloiden sisällä. Ikkuna- sekä vuokapyydys toimivatkin selkeästi paremmin lahopuukovakuoriaisten pyynnissä verrattuna kuoppapyydykseen, jonka poisjättäminen olisi kuitenkin tuottanut huomattavasti lajiköyhemmän aineiston. Mahdollisimman monimuotoisen onttojen puiden lahopuukovakuoriaislajiston keräämiseksi tulisi käyttää ikkuna- tai vuokapyydyksiä yhdessä kuoppapyydysten kanssa.

Denitrification in the River Estuaries of the Northern Baltic Sea

Estuaries have been suggested to have an important role in reducing the nitrogen load transported to the sea. We measured denitrification rates in six estuaries of the northern Baltic Sea. Four of them were river mouths in the Bothnian Bay (northern Gulf of Bothnia), and two were estuary bays, one in the Archipelago Sea (southern Gulf of Bothnia) and the other in the Gulf of Finland. Denitrification rates in the four river mouths varied between 330 and 905 mu mol N m(-2) d(-1). The estuary bays at the Archipelago Sea and the Gulf of Bothnia had denitrification rates from 90 mu mol N m(-2) d(-1) to 910 mu mol N m(-2) d(-1) and from 230 mu mol N m(-2) d(-1) to 320 mu mol N m(-2) d(-1), respectively. Denitrification removed 3.6-9.0% of the total nitrogen loading in the river mouths and in the estuary bay in the Gulf of Finland, where the residence times were short. In the estuary bay with a long residence time, in the Archipelago Sea, up to 4.5% of nitrate loading and 19% of nitrogen loading were removed before entering the sea. According to our results, the sediments of the fast-flowing rivers and them estuary areas with short residence times have a limited capacity to reduce the nitrogen load to the Baltic Sea.