Cervical headgear in Class II division 1 correction in children : Academic Dissertation

Class II division 1 malocclusion occurs in 3.5 to 13 percent of 7 12 year-old children. It is the most common reason for orthodontic treatment in Finland. Correction is most commonly performed using headgear treatment. The aim of this study was to investigate the effects of cervical headgear treatment on dentition, facial skeletal and soft tissue growth, and upper airway structure, in children. 65 schoolchildren, 36 boys and 29 girls were studied. At the onset of treatment a mean age was 9.3 (range 6.6 12.4) years. All the children were consequently referred to an orthodontist because of Class II division 1 malocclusion. The included children had protrusive maxilla and an overjet of more than 2mm (3 to 11 mm). The children were treated with a Kloehn-type cervical headgear as the only appliance until Class I first molar relationships were achieved. The essential features of the headgear were cervical strong pulling forces, a long upward bent outer bow, and an expanded inner bow. Dental casts and lateral and posteroanterior cephalograms were taken before and after the treatment. The results were compared to a historical, cross-sectional Finnish cohort or to historical, age- and sex-matched normal Class I controls. The Class I first molar relationships were achieved in all the treated children. The mean treatment time was 1.7 (range 0.3-3.1) years. Phase 2 treatments were needed in 52% of the children, most often because of excess overjet or overbite. The treatment decreased maxillary protrusion by inhibiting alveolar forward growth, while the rest of the maxilla and mandible followed normal growth. The palate rotated anteriorly downward. The expansion of the inner bow of the headgear induced widening of the maxilla, nasal cavity, and the upper and lower dental arches. Class II malocclusion was associated with narrower oro- and hypopharyngeal space than in the Class I normal controls. The treatment increased the retropalatal airway space, while the rest of the airway remained unaffected. The facial profile improved esthetically, while the facial convexity decreased. Facial soft tissues masked the facial skeletal convexity, and the soft tissue changes were smaller than skeletal changes. In conclusion, the headgear treatment with the expanded inner bow may be used as an easy and simple method for Class II correction in growing children.

Peripheral facial palsy : Grading, Etiology, and Melkersson-Rosenthal Syndrome

The objective of this study was to assess the utility of two subjective facial grading systems, to evaluate the etiologic role of human herpesviruses in peripheral facial palsy (FP), and to explore characteristics of Melkersson-Rosenthal syndrome (MRS). Intrarater repeatability and interrater agreement were assessed for Sunnybrook (SFGS) and House-Brackmann facial grading systems (H-B FGS). Eight video-recorded FP patients were graded in two sittings by 26 doctors. Repeatability for SFGS was from good to excellent and agreement between doctors from moderate to excellent by intraclass correlation coefficient and coefficient of repeatability. For H-B FGS, repeatability was from fair to good and agreement from poor to fair by agreement percentage and kappa coefficients. Because SFGS was at least as good in repeatability as H-B FGS and showed more reliable results in agreement between doctors, we encourage the use of SFGS over H-B FGS. Etiologic role of human herpesviruses in peripheral FP was studied by searching DNA of herpes simplex virus (HSV) -1 and -2, varicella-zoster virus (VZV), human herpesvirus (HHV) -6A, -6B, and -7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) by PCR/microarray methods in cerebrospinal fluid (CSF) of 33 peripheral FP patients and 36 controls. Three patients and five controls had HHV-6 or -7 DNA in CSF. No DNA of HSV-1 or -2, VZV, EBV, or CMV was found. Detecting HHV-7 and dual HHV-6A and -6B DNA in CSF of FP patients is intriguing, but does not allow etiologic conclusions as such. These DNA findings in association with FP and the other diseases that they accompanied require further exploration. MRS is classically defined as a triad of recurrent labial or oro-facial edema, recurrent peripheral FP, and plicated tongue. All three signs are present in the minority of patients. Edema-dominated forms are more common in the literature, while MRS with FP has received little attention. The etiology and true incidence of MRS are unknown. Characteristics of MRS were evaluated at the Departments of Otorhinolaryngology and Dermatology focusing on patients with FP. There were 35 MRS patients, 20 with FP and they were mailed a questionnaire (17 answered) and were clinically examined (14 patients). At the Department of Otorhinolaryngology, every MRS patient had FP and half had the triad form of MRS. Two patients, whose tissue biopsies were taken during an acute edema episode, revealed nonnecrotizing granulomatous findings typical for MRS, the other without persisting edema and with symptoms for less than a year. A peripheral blood DNA was searched for gene mutations leading to UNC-93B protein deficiency predisposing to HSV-1 infections; no gene mutations were found. Edema in most MRS FP patients did not dominate the clinical picture, and no progression of the disease was observed, contrary to existing knowledge. At the Department of Dermatology, two patients had triad MRS and 15 had monosymptomatic granulomatous cheilitis with frequent or persistent edema and typical MRS tissue histology. The clinical picture of MRS varied according to the department where the patient was treated. More studies from otorhinolaryngology departments and on patients with FP would clarify the actual incidence and clinical picture of the syndrome.

Global processes, local strategies : migration of educated Dominicans.

The aim of this thesis is to examine migration of educated Dominicans in light of global processes. Current global developments have resulted in increasingly global movements of people, yet people tend to come from certain places in large numbers rather than others. At the same time, international migration is increasingly selective, which shows in the disproportional number of educated migrants. This study discovers individual and societal motivations that explain why young educated Dominicans decide to migrate and return. The theoretical framework of this thesis underlines that migration is a dynamic process rooted in other global developments. Migratory movements should be seen as a result of interacting macro- and microstructures, which are linked by a number of intermediate mechanisms, meso-structures. The way individuals perceive opportunity structures concretises the way global developments mediate to the micro-level. The case of the Dominican Republic shows that there is a diversity of local responses to the world system, as Dominicans have produced their own unique historical responses to global changes. The thesis explains that Dominican migration is importantly conditioned by socioeconomic and educational background. Migration is more accessible for the educated middle class, because of the availability of better resources. Educated migrants also seem less likely to rely on networks to organize their migrations. The role of networks in migration differs by socioeconomic background on the one hand, and by the specific connections each individual has to current and previous migrants on the other hand. The personal and cultural values of the migrant are also pivotal. The central argument of this thesis is that a veritable culture of migration has evolved in the Dominican Republic. The actual economic, political and social circumstances have led many Dominicans to believe that there are better opportunities elsewhere. The globalisation of certain expectations on the one hand, and the development of the specifically Dominican feeling of ‘externalism’ on the other, have for their part given rise to the Dominican culture of migration. The study also suggests that the current Dominican development model encourages migration. Besides global structures, local structures are found to ve pivotal in determining how global processes are materialised in a specific place. The research for this thesis was conducted by using qualitative methodology. The focus of this thesis was on thematic interviews that reveal the subject’s point of view and give a fuller understanding of migration and mobility of the educated. The data was mainly collected during a field research phase in Santo Domingo, the Dominican Republic in December 2009 and January 2010. The principal material consists of ten thematic interviews held with educated Dominican current or former migrants. Four expert interviews, relevant empirical data, theoretical literature and newspaper articles were also comprehensively used.

Moralpanik eller förnuftslogik - i Jokela-fallets diskursiva efterdyningar

I denna pro gradu avhandling undersöker jag Jokela-fallets diskursiva efterdyningar utgående från ett moralpanikperspektiv. Syftet är att se huruvida reaktionerna på och förklaringarna till skolmassakern i Jokela kan anses präglas av moralpanik, samt vilka andra förklaringsmodeller som präglade den omfattande Jokela-debatten. Avhandling grundar sig på en kvalitativ diskursanalys av förklaringsmodellerna så som de presenterades i opinionstexter och insändare i Helsingin Sanomat hösten 2007. Jag analyserar hur den medierade Jokela-debatten utvecklades och formade perceptionerna om skolskjutningar, ungdomar och det finländska samhällstillståndet i stort. Jokela-fallet väckte starka reaktioner och rädsla. Man försökte förstå och förklara orsakerna till skottdramat. Flera olika förklaringsmodeller presenterades i medierna; en oro över ungdomens mentala hälsa och mobbning, webbens och populärkulturens farliga inflytande, det hårdnade samhällsklimatet och en försvagad välfärd, också den bristfälliga vapenlagstiftningen kritiserades. Den gemensamma nämnaren var att Jokela-fallet uppfattades som en indikator på hela samhällets tillstånd där en gemensam värdegrund och moral håller på att erodera. Mitt teoretiska perspektiv grundar sig främst på moralpanikteorier av Stanley Cohen och Chas Critcher som jag kopplar ihop med Ulrich Becks teori om risksamhället och Emile Durkheims anomiteori. Det här speglar jag mot bland annat Hille Koskelas forskning om rädslans kultur och trygghetssamhället, samt jämför med amerikansk forskning om skolskjutningar. Jokela-debatten formades främst av två dominerande diskurser: a) en rationaliseringsdiskurs som kännetecknas av att man försöker förklara Jokela-fallet genom förnuftsmässiga och logiska resonemang genom att peka på olika samhällsaspekter, b) en risk- och kontrolldiskurs som kännetecknas av moralpaniktendenser främst i form av oro över ungdomar, internet och försvagade samhällsnormer, samt krav på ökad social kontroll och reglering för att säkra trygghet och ordning i samhället. Jokela-fallet var inte ett klassiskt moralpanikfall, men fyllde många av kriterierna för moralpanik. Jokela-debatten uttryckte en rädslans kultur som genomsyrar dagens risksamhälle och som legitimerar ökad riskhantering och social kontroll, som försvar mot de hot och problem som samhället kollektivt upplever. Det ställdes krav på mera social kontroll och reglering på grund av upplevda hot mot samhällets normer och en försvagad moral, vilket är ett uttryck för moralpanik. Jokela-fallets diskursiva efterdyningar visar att tryggheten har blivit ett moraliskt imperativ. Trygghet har blivit något vi förutsätts eftersträva och som vi är färdiga att betala ett allt högre pris för, både mätt i pengar och i frihet.

Samarbete genom lagstiftning. Samarbetsförfarandets organisation, procedur och innehåll

Samarbetslagen är en omstridd lag. Innan lagen trädde i kraft i början av år 1979 fanns på arbetstagarsidan förhoppningar om att skapa en lag om reell företagsdemokrati medan man från arbetsgivarhåll var rädd att personalen skulle få ett alltför stort inflytande på beslutsfattandet. En oro fanns också att medbestämmandet skulle byråkratisera beslutsfattandet inom företagen. I dag anser många arbetstagare att samarbetsförfarandet endast används vid massuppsägningar, nedskärningar och rationaliseringar men i övrigt glömts bort. Samarbetsförfarandet och regleringen av det är en viktig och aktuell fråga, eftersom samarbetsförfarandet utgör det forum i samarbetet mellan arbetsgivare och personal där nedskärningar och massuppsägningar diskuteras. Avhandlingens syfte är att analysera hur samarbetsförfarandet fungerar utifrån samarbetslagen. Målet är att granska samarbetsförfarandet ur ett perspektiv där samarbetsförfarandet ses som en potentiell möjlighet och ett verktyg till framgångsrik företagsverksamhet och personalledarskap. I analysen utgår författaren från samarbetslagens 1 §. Syftet med samarbetsförfarandet är att utveckla företagets verksamhet och arbetsförhållanden, att effektivera samarbetet mellan arbetsgivare och personal samt personalens interna samverkan. Samarbetsförfarandet skall utöka personalens möjligheter att påverka behandlingen av ärenden som gäller deras arbete och arbetsplats i enlighet med lagen. Enligt samarbetsförfarandet skall arbetsgivaren rådgöra med arbetstagarna och deras företrädare om de viktigaste ärendena som påverkar personalens ställning och arbetsförhållande innan besluten fattas. Avhandlingen granskar hur lagen tillämpas i dag och hur lagstiftningen kan utvecklas för att effektivera samarbetet i framtiden.

Global Processes, Local Strategies : migration of educated Dominicans.

The aim of this thesis is to examine migration of educated Dominicans in light of global processes. Current global developments have resulted in increasingly global movements of people, yet people tend to come from certain places in large numbers rather than others. At the same time, international migration is increasingly selective, which shows in the disproportional number of educated migrants. This study discovers individual and societal motivations that explain why young educated Dominicans decide to migrate and return. The theoretical framework of this thesis underlines that migration is a dynamic process rooted in other global developments. Migratory movements should be seen as a result of interacting macro- and microstructures, which are linked by a number of intermediate mechanisms, meso-structures. The way individuals perceive opportunity structures concretises the way global developments mediate to the micro-level. The case of the Dominican Republic shows that there is a diversity of local responses to the world system, as Dominicans have produced their own unique historical responses to global changes. The thesis explains that Dominican migration is importantly conditioned by socioeconomic and educational background. Migration is more accessible for the educated middle class, because of the availability of better resources. Educated migrants also seem less likely to rely on networks to organize their migrations. The role of networks in migration differs by socioeconomic background on the one hand, and by the specific connections each individual has to current and previous migrants on the other hand. The personal and cultural values of the migrant are also pivotal. The central argument of this thesis is that a veritable culture of migration has evolved in the Dominican Republic. The actual economic, political and social circumstances have led many Dominicans to believe that there are better opportunities elsewhere. The globalisation of certain expectations on the one hand, and the development of the specifically Dominican feeling of ‘externalism’ on the other, have for their part given rise to the Dominican culture of migration. The study also suggests that the current Dominican development model encourages migration. Besides global structures, local structures are found to ve pivotal in determining how global processes are materialised in a specific place. The research for this thesis was conducted by using qualitative methodology. The focus of this thesis was on thematic interviews that reveal the subject’s point of view and give a fuller understanding of migration and mobility of the educated. The data was mainly collected during a field research phase in Santo Domingo, the Dominican Republic in December 2009 and January 2010. The principal material consists of ten thematic interviews held with educated Dominican current or former migrants. Four expert interviews, relevant empirical data, theoretical literature and newspaper articles were also comprehensively used.