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Now showing items 61-80 of 28489
• (Helsingin yliopisto, 2016)
Anthropogenic land use has caused detrimental impacts especially on forest ecosystems, and native forested landscapes have been lost and fragmented worldwide. Forest-dwelling animals are generally susceptible to habitat loss and fragmentation because of their strict habitat requirements and dependency on forests for food, nest sites and movements. Consequently, forest specialists, such as arboreal squirrels and gliding mammals, provide a worthy group of model species in order to assess the influence of landscape modification. The Siberian flying squirrel (Pteromys volans) is an arboreal rodent inhabiting spruce-dominated mature forests and due to destruction of its most suitable breeding habitat, the population has been decreasing in Finland. In my thesis, I investigate the effects of landscape modification on the occurrence, space use and survival of this species at multiple spatial scales. The occurrence probability of flying squirrel increased with a proportion of suitable movement forests on a 400-m-scale and was negatively associated with the isolation of occupied sites in a partly urban study area. However, no negative effects of urban habitat types were found, which indicates that the species is not disturbed by urbanization. It was found that regional environmental authorities were unaware of the presence of flying squirrel in most cases of forest harvesting in southern Finland. Despite occupied sites were delineated according to given guidelines, many of these sites became deserted after forest harvesting. This shows that the legal habitat protection of flying squirrel is ineffective and to improve this conservation practice, larger forested areas should be maintained around inhabited sites. The presence of urban habitats on movement routes increased movement distance and speed whereas urban habitats within home-range impeded only male movements. Structural forested connections had varying effects on nest-site switching and their importance remained unclear, which points out that defining and maintaining a species-specific connectivity is challenging in human-modified landscapes. Regional variation in flying squirrel survival was most likely caused by differences in predation pressure, predator community and landscape composition. Male mortality increased with a proportion of low-quality habitats in the surrounding landscape, whereas fine-scale habitat composition of the most used areas did not show any survival impacts. Natal dispersal distances of juveniles did not increase their mortality. Results of this thesis indicate that the effects of landscape modification on forest-dwelling animals are varying, sex-specific and depend on the scale. As landscape modification can also affect species indirectly, it is important to investigate the costs and risks of animal movements in human-modified environments.
• (Helsingin yliopisto, 2016)
Aims – To perform a detailed evaluation of the bowel functional outcomes of anorectal malformations (ARMs) after standardized treatment and systematic follow-up in relation to matched controls. To study the bowel habits of a large cohort of individuals from the general population to obtain a baseline for comparison to patients. Methods – A single-institution, cross-sectional study of all patients treated between 1983-2006 for anterior anus (AA, conservative or anal dilatations), perineal fistula (PF) males (anoplasty and/or dilatations) vestibular fistula (VF) or PF females (anterior sagittal anorectoplasty - ASARP) rectourethral fistula (RUF; posterior sagittal anorectoplasty – PSARP). Patients with significant cognitive impairment, total sacral agenesis/caudal regression syndrome, Currarino syndrome, or meningomyelocele were excluded. Participants answered a detailed questionnaire on bowel function by post. Parents of children <16 years assisted in responses. Case details were obtained from records. Patients were matched by age and gender to 3 individuals from the general population who had answered identical questionnaires. Ethical approval was obtained. Results – Our study of 594 individuals from the general population identified that minor aberrations in bowel function, especially soiling prevail in healthy individuals in an age-dependent manner. A total of 159 patients (72%; median age 12.5 (4-29) years) participated in the study on outcomes for ARMs (79 females: 45 AA and 34 VF/PF and 80 males: 46 PF/low ARM and 34 RUF males (35% bulbar, 53% prostatic, 12% bladder neck fistula). Fecal control in AA females and low ARM males was not significantly different from controls in the long-term (p=NS). In VF/PF in females, 68% of patients attained a functional outcome comparable to controls and 85% were socially continent (vs 100% of controls; p<0.001) Among RUF males, 76% of patients were social continent (vs 95% of controls; p<0.002). Despite some improvement in symptoms with increasing age, both soiling and fecal accidents among patients with VF/PF (65% and 24% respectively) and RUF (59% and 37% respectively) remained significantly higher than in controls in the long-term (18-26% for soiling and 4-6% for fecal accidents; p≤0.006 vs patients).The median BFS, the proportion with voluntary bowel movements and total continence decreased with increasing level of fistula in RUF. Constipation was an important sequel in all types of ARMs, affecting 31-44% of patients vs 2-13% of controls (p≤0.003 vs patients). Social restrictions affected a 15-36% of patients with severe ARMs (vs ≤5% of controls; p≤0.01). Conclusions - Our results support the appropriateness of sagittal repair methods for the treatment of VF/PF in females and RUF, and minor perineal procedures for mild ARMs. Patients with mild ARMs can generally be expected to develop bowel functional outcomes comparable to matched peers. In females with VF/PF and males with RUF, problems with fecal control persist at higher levels than controls into adulthood. However, the majority can be expected to achieve social continence with appropriate aftercare and effective management of constipation.
• (Helsingin yliopisto, 2016)
The present cross-sectional study investigates the reciprocity of ethnic relations in Finland and the role this reciprocity plays in the development of an inclusive integration context characterised by positive intergroup attitudes, and support for multiculturalism and for the minority groups collective action. The theoretical framework builds on the social identity theory, the theory of acculturation and contact hypothesis. Identity- and contact-related predictors of the inclusive integration context are examined among Finns and among Russian and Estonian immigrants. First, this study sheds more light on intergroup attitudes in the context of immigration. High national identification of Finns and Russian immigrants elicited stronger psychological ownership of Finland. However, while strong ownership made the attitudes of Finns towards Russian immigrants more negative, among the Russian immigrants ownership was linked to more positive attitudes towards Finns. Positive contact with Finns elicited more positive attitudes towards this group, which in turn were linked to more favourable mutual attitudes among Estonian and Russian immigrants. The same association, but with a negative valence, was true for negative contact. Moreover, positive contact with Finns was linked to higher, and negative contact to lower, public collective self-esteem among low-status Russian immigrants but not among high-status Estonian immigrants; higher and lower public collective self-esteem was, in turn, respectively linked to more positive and more negative attitudes towards Estonian immigrants. Second, ethnic identification of Russian immigrants fostered support for multiculturalism only when ethnic superiority of the ingroup was not perceived. Third, among Finns the perception of Russian immigrants preserving more of their culture than Finns would prefer, elicited stronger anxiety and lowered trust, these factors both in turn being related to lower support for collective action of Russian immigrants. When Russian immigrants perceived that they were not allowed by Finns to preserve as much of their culture as they wished, outgroup trust declined and strengthened support for the ingroup s collective action. This study shows that the inclusive integration context does not develop in a social vacuum and provides strong evidence on the importance of the reciprocity of multidimensional intergroup relations in diverse societies.
• (Helsingin yliopisto, 2016)
Many existing and emerging microbial infectious diseases are caused by environmentally growing opportunist pathogens. These pathogens are, contrary to obligatory pathogens, able to survive and replicate in the outside-host environment as free-living microbes that use within-host growth as an alternative replication strategy. This disease class has eco-evolutionary implications in natural populations and causes a serious health and economical threat to humans, our food production and to wildlife. Because of the ability of environmentally growing opportunists to survive and replicate independently of hosts, these diseases are hard to eradicate with conventional methods. The conditions that favor or disfavor environmental opportunism are still poorly understood. Better understanding of the dynamics of these diseases is needed in order to develop proper control methods against them. In this thesis I have developed novel epidemiological models to describe the disease dynamics of environmentally growing pathogens. These models modify the traditional Susceptible-Infected host (SI-model) framework by combining it to the outside-host community of an environmentally growing pathogen. I have considered how the environmental growth of the pathogens and the antagonistic ecological interactions these pathogens face in the outside-host environment, such as competition, predation and parasitism, affect the disease dynamics, invasion of novel pathogens and biological control of environmentally growing infectious diseases. The analyses show that the disease dynamics of environmentally growing pathogens differ from obligatory pathogens. Importantly, ability to grow in the outside-host environment promotes disease outbreaks and can lead to the extinction of the host, which is untypical in the case of obligatory pathogens. Antagonistic interactions the pathogen faces in the outside-host environment can on the other hand limit disease outbreaks and prevent extinction of the hosts that would otherwise occur due to the disease. I conclude that the eradication can be accomplished 1) by increasing the outside-host competition, 2) through predation of pathogens, or 3) through viral infections in pathogens.
• (2016)
Tutkielmassa määritän triviaalin solmun ja $p,q$-torussolmun ryhmät eli niiden komplementin perusryhmät. Solmu on ympyrän upotus kolmiulotteiseen avaruuteen. Yksinkertaisinta solmua kutsutaan triviaaliksi solmuksi. Torussolmuksi $K_{p,q}$ kutsutaan solmua, joka kiertyy kiinteän toruksen ympärille $p$ kertaa pitkittäiseen suuntaan ja $q$ kertaa poikittaiseen suuntaan. Eräs solmuteorian keskeisistä kysymyksistä on, milloin kaksi solmua ovat keskenään ekvivalentteja. Invariantit ovat osittaisia vastauksia tähän kysymykseen: ne ovat solmujen funktioita, jotka saavat saman arvon ekvivalenteilla solmuilla. Invariantit voidaan jaotella kombinatorisiin eli solmukaavioihin perustuviin sekä topologisiin invariantteihin. Topologisista invarianteista tärkeimpiä on solmun ryhmä. Esittelen tutkimuksessani ensin homotopian perusominaisuuksia ja perusryhmän käsitteen. Erityisesti kerron, miten selvitetään avaruuden deformaatioretraktin ja tuloavaruuden perusryhmä. Seuraavaksi osoitan, että ympyrän perusryhmä on ääretön syklinen ryhmä. Käyn myös läpi tutkielmassa tarvittavaa algebran käsitteistöä, erityisesti sen, miten ryhmän esityksen voi määrittää vapaan ryhmän, virittäjien ja relaattoreiden avulla. Tutkielman ensimmäinen päätulos on polkuyhtenäisten avaruuksien perusryhmiä koskeva van Kampenin lause, jonka avulla voidaan määritellä avaruuden $U \cup V$ perusryhmä, kun avaruudet $U$, $V$ ja $U \cap V$ ovat polkuyhtenäisiä ja epätyhjiä ja näiden avaruuksien perusryhmät tunnetaan. Tämän jälkeen tutkin solmujen ryhmiä. Ensin osoitan, että triviaalin solmun ryhmä on ääretön syklinen ryhmä, ja sen jälkeen määritän ympyrän perusryhmän ja van Kampenin lauseen avulla, että torussolmun $K_{p,q}$ ryhmän eräs esitys on $\langle a,b | a^p = b^q \rangle$. Lopuksi pohdin yleisesti solmun ryhmän käyttöä invarianttina.
• (2016)
The demand for mobile services is increasing constantly and mobile network operators need to significantly upgrade their networks to respond to the demand. The increasing complexity of the networks makes it impossible for a human operator to manage them optimally. Currently the network management operations are automated using a pre-defined logic. The future goal is to introduce cognitive network management functions which can adapt to changes in the network context and handle uncertainty in network data. This thesis discusses using Markov Logic Networks for cognitive management of mobile networks. The method allows uncertain and partial information and makes it possible to consolidate knowledge from multiple sources into a single, compact, representation. The model can be used to infer configuration changes in network parameters and the model parameters can be learned from data. We test the method in a simulated LTE network and examine the results in terms of improvements in network performance and computational cost.
• (Helsingin yliopisto, 2016)
Olga Pussinen's study "Functionally limited Russian language: Contact varieties, variations in language consciousness and diverse communication types" reviews the phenomenon of functional limitations of the Russian language (FLRL). The author defines the bilingualism within an everyday communication system that comprises two types of languages: functionally dominant and functionally limited. The work represents a complex analysis of Russian language functional limitations inside Russia (in Mordovia) and outside of it (in the Russian-speaking diaspora of Finland). The research describes the different types of the acquisition of FLRL and different levels of their existence and usage: lexis-grammatical, cognitive-psychological and socio-pragmatic. The author analyses the findings with the data collected from the interviews and from free associative experiments. Part 1, The Transformation of FLRL linguistic levels , consists of the chapters Language used at home . Russian language as the second mother tongue: The strategy of its functioning in the Russian-speaking diaspora in Finland ; Features of the language situation and the Russian language in Mordovia ; and Key features defining the pronunciation of Russian vowels by Erzyan bilinguals . Part 2, The Transformation of the FLRL cognitive level: The balance and dynamics of a bilingual thesaurus , consists of the chapters Formation of an associative-verbal network in bilingualism (based on interaction materials between the Russian and Finnish languages) and The specificity of language consciousness formation for Russian-Finnish bilingual students . Part 3, The transformation of FLRL communicative-pragmatic usage , consists of the chapters Changes in etiquette communication in the Russian-speaking diaspora in Finland ; The types of communication failures occurring when Russian language is functionally not the first ; and The ratio of functionally dominant and functionally limited languages in a bilingual speech system .
• (Helsingin yliopisto, 2016)
This dissertation studies classical questions in the field of geometric analysis in the context of metric spaces. The dissertation is comprised of three research articles. The first is on the connection of quasiconformal maps and the quasihyperbolic metric. The remaining two concern notions of homotopy classes of Sobolev type maps between metric spaces, comparison with the manifold case, and the existence of minimizers of a p-energy in these homotopy classes. The unifying theme of all three articles is analysis on metric spaces. That is, all three papers deal with questions concerning maps between metric spaces. The particular type of metric spaces involved is generally referred to as PI-spaces. PI-spaces satisfy conditions allowing one to extend a large part of classical first order calculus, such as the theory of Sobolev maps and, á posteriori, differentiability of Lipschitz functions.
• (Helsingin yliopisto, 2016)
Endometriosis is a common gynecological disease affecting women in their best reproductive years. Deep infiltrating form of the disease, rectovaginal endometriosis (RVE), causes pain via mechanisms that are partly unknown. In symptomatic patients not responding to hormonal therapies, surgery is needed. Surgical treatment of RVE is challenging, and may require bowel resection. Currently, a laparoscopic approach is used in most RVE operations, bowel resections included. Recurrence rates following surgery vary between 5-30%. This study was undertaken in order to acquire information on the long-term outcome of surgery for RVE, in particular factors affecting recurrence. Altogether 60 patients operated upon in 2002-2004 had a follow-up visit in our clinic, on average four years after the original operation. Symptom recurrence was evaluated by using symptom diaries. In addition, we studied charts on 164 patients who had undergone bowel resection in 2004-2012. The laparoscopic approach to bowel resection was of special interest, with emphasis on collecting information on complications. Increased innervation in endometriotic tissue may contribute to endometriosis-associated pain generation. We used immunohistochemistry to study the density of nerve fibers, and the effect of hormonal therapies on their density, in 45 samples obtained during RVE surgery. Our results showed that even though clinical recurrence developed in 35% of cases, symptom recurrence was rare. Bowel resection was protective as regards recurrence, as were all the forms of hormone and surgical therapy that resulted in amenorrhea. Laparoscopy offers a safe route for performing RVE surgery, and should be the primary approach even as regards colorectal resection in cases of RVE. We found that the rate of complications did not depend on the type of surgery (laparoscopy vs. laparotomy) but was more related to the experience of the surgeon. Excessive innervation was identified in the RVE specimens. This innervation may be one of the explanations for the severe pain that these patients experience. The density of nerve fibers was reduced among those patients who were using either combined oral contraceptives or progestins. In conclusion, bowel resection may protect women from recurrences in cases of colorectal involvement. Following operative treatment for RVE, hormonal therapies aimed at amenorrhea should be administered to all women in order to protect them from symptom recurrence. Recurrent symptomatic disease, however, is very uncommon, and most patients greatly benefit from surgical treatment of RVE.
• (Helsingin yliopisto, 2016)
The interaction of auxin and cytokinin signalling regulates primary root procambial patterning, xylem cell fate and differentiation in Arabidopsis thaliana. Plants contribute to the Earth s atmosphere by binding carbon dioxide and releasing oxygen. Trees produce biomass, which is a renewable source of energy. The Arabidopsis root vasculature is a good model system for studying biomass formation, as it contains the same cell types that are also found in trees: xylem, phloem and intervening pluripotent procambial cells. In Arabidopsis thaliana roots, these cells arise from stem cells within the root meristem. The wild type root radial pattern is bisymmetric, and the regulation of xylem formation is controlled by phytohormones, especially auxin and cytokinin. Our findings show that the vascular pattern is set by a symmetry-breaking event during embryogenesis and is initiated by auxin accumulation and signalling at the cotyledon initials. As the embryo grows, the high auxin signalling promotes the expression of AHP6. Upregulation of AHP6 in specific cells leads to inhibition of cytokinin signalling and might be a key factor in symmetry breakage. Mutants with altered cotyledon numbers or altered cotyledon anatomy fail to establish the bisymmetric pattern and often show altered root symmetry. In growing roots, the bisymmetric pattern is actively reinforced by polar auxin transport and long distance cytokinin transport/translocation from the apical parts of the plant. Cytokinin movement via the phloem and unloading at the root apical meristem promotes cytokinin signalling in the procambial cells in the proximal meristem. Both cytokinin and auxin are required during root procambial patterning, and the interaction of these two phytohormones is mutually inhibitory. According to our model (described in the first part of this thesis), auxin signalling is critical for protoxylem identity formation. In turn, the results from the procambial re-patterning experiments (second part of this thesis) show that cytokinin is the key hormone in promoting cell proliferation in the proximal meristem. Epistasis experiments illustrate that a fine balance between these two hormones affects the fate of all vascular cells. We are beginning to understand the complexity and interdependencies of signalling pathway interactions during proximal meristem vascular patterning, yet the temporal aspect is still largely unexplored. In the last part of this thesis, I discuss the role ROS signalling might have in stele patterning and temporal regulation of programmed cell death. While our published GRI-MC9-PRK5 module might not be directly linked to primary root proximal meristem procambial patterning, one cannot exclude the possibility that it might be required in the final stages of protoxylem differentiation or that a similar signalling mechanism could regulate initial stele patterning and meristem growth dynamics. This thesis describes the auxin-cytokinin interaction in vascular initial patterning and the mechanism by which the hormonal signalling domains are maintained in the proximal meristem. The unpublished data demonstrate how procambial cells can be manipulated to generate new tissues by affecting the homeostasis of auxin and cytokinin signalling. The last part of the thesis describes a cell death signalling module and speculates that it (or similar module) might be involved with primary root meristem maturation.
• (Helsingin yliopisto, 2016)
Neurons have distinctive polar morphology with distinctive subcellular features comprising of cell soma, axons and dendrites. Primary objective of this study was to develop a novel microfluidic device for spatial isolation of axons from the somatodendritic compartment of cultured hippocampal neurons. A new method was developed for asymmetrical genetic manipulation improving specificity in studies of how individual proteins affect axonal morphology, presynaptic development and function. Subsequently, the microfluidic culture system was used to study the signaling events involved in synaptogenesis, focusing on the roles of kainate type of glutamate receptors (KARs). Functional studies have shown that KARs are present in axons and may regulate presynaptic function. However, the molecular composition and detailed subcellular localization of axonal KARs as well as their roles in presynaptic differentiation are largely unknown. The results show that axonal KARs promote early stages of synaptogenesis. Expression of low (GluK1-3) and high affinity (GluK4-5) KAR subunits promoted filopodiogenesis function at the isolated axons. In addition, axonal low affinity subunits enhanced clustering of synaptic vesicles and transmission efficacy at nascent glutamatergic synapses, an effect which was associated with widening of presynaptic active zone. High affinity KAR subunits had no effect on synaptic vesicle clustering, nor presynaptic transmission efficacy. However their heteromerization with low affinity subunits completely prevented the synapse promoting effects and instead lead to strong inhibition of presynaptic transmission efficacy. The presynaptic effects of GluK1-3 on synaptic vesicle clustering involved both PKA and PKC pathways. GluK1 expression was developmentally regulated in neonatal and juvenile hippocampus and heteromeric combination of GluK1c with high affinity subunits suppressed glutamatergic synaptic transmission. KARs are linked to various neurological and neuropsychiatric disorders. Our observations and previous findings strongly suggest that KARs are involved in morphological maturation of neurons and in refinement of neuronal circuitry in the brain. The present results provide novel insights into the involvement of different types of KAR subunits in synaptic development and morphological differentiation. Hence, they are potential therapeutic targets in various developmentally originating neurological disorders.
• (Helsingin yliopisto, 2016)
From Enlighteners to Professionals. Finnish Journalists Long Road from 1771 to 1921 The From Enlighteners to Professionals research presents a new interpretation of the professionalization process of the Finnish journalists from the 19th century to the beginning of the 20th century. According to the research, the journalist occupation was professionalised much earlier than has been presented in previous studies. This interpretation of Finnish journalists professionalization is based on exploring professional co-operation, the structural changes of the profession and the development of journalistic culture. The evaluation is made in the economic, political and social contexts. The important part of the research is a socio-economic examination of Finnish journalism between 1771 and 1921. The development of newspaper work into a profession began in Finland in the second half of the 19th century. The professionalization process followed in the footsteps of Nordic colleagues, especially Swedish journalists. The research focuses on the changes in the social position of journalists and the different defensive strategies the profession used to improve its position. The most effective strategy to improve the occupation s social status was the foundation of professional organisations. The Finnish journalists organized six national congresses between 1876-1900 and founded their first professional organisation, the Finnish Association of Journalists. Between 1905 and 1920, professional co-operation developed into political journalist associations and in 1921 the journalists established a national trade association, the Union of Journalists in Finland. Participating in journalists international co-operation was also an important part of the Finnish journalists professionalization process. The number of Finnish journalists increased rapidly from the second half of the 19th century. There were over 2,000 people who worked at Finnish newspapers as journalists or contributors between 1771 and 1921. The increase in the number of professional journalists escalated the professionalization and affected the organisation of professional co-operation. The relationship between journalists and political parties was very close in Finland at the beginning of the 20th century. This connection was highly accepted and political commitment was not considered an obstacle to execute the public duty of journalists. Keywords: journalists, journalistic profession, professionalization, journalist organisation, journalism, Finnish Association of Journalists, Union of Journalists in Finland, International Union of Press Associations.
• (Helsingin yliopisto, 2016)
Accurate and up-to-date information concerning vegetation characteristics is needed for decision-making from individual-tree-level management activities to the strategic planning of forest resources. Outdated information may lead to unbeneficial or even wrong decisions, at least when it comes to the timing of management activities. Airborne laser scanning (ALS) has so far been successfully used for applications involving detailed vegetation mapping because of its capability to simultaneously produce accurate information on vegetation and ground surfaces. The aim of this dissertation was to develop methods for characterizing vegetation and its changes in varying environments. A method called multisource single-tree inventory (MS-STI) was developed in substudy I to update urban tree attributes. In MS-STI stem map was produced with terrestrial laser scanning (TLS) and by combining the stem map with predictors derived from ALS data it was possible to obtain improved estimates of diameter-at-breast height but also to produce new attributes such as height and crown size. Boat-based mobile laser scanning (MLS) data were employed in substudy II to map riverbank vegetation and identify changes. The overall classification accuracy of 73% was obtained, which is similar to accuracies found in other studies. With multi-temporal MLS data sets changes in vegetation were mapped year to year. In substudy III, open access ALS data were combined with multisource national forest inventory (NFI) data to investigate the drivers associated to wind damage. The special interest was in ALS-based predictors to map areas with wind disturbance and apply logistic regression to produce a continuous probability surface of wind predisposition to identify areas most likely to experience wind damage. The results demonstrated that a combination of ALS and multisource NFI in the modelling approach increased the prediction accuracy from 76% to 81%. The dissertation showed the capability of ALS and MLS for characterizing vegetation and mapping changes in varying environments. The developed applications could increase and expand the utilization of multi-temporal 3D data sets as well as increase data value. The results of this dissertation can be utilized in producing more accurate, diverse, and up-to-date information for decision-making related to natural resources.
• (Helsingin yliopisto, 2016)
This study evaluated the dental general anaesthesia (DGA) process in Helsinki Public Dental Service (PDS). The aims were to describe the characteristics of the DGA patients, the parents descriptions of their children s previous dental care, to assess the dental care that precedes DGA, the reasons for having to resort to DGA, the treatments performed under DGA, and the long-term outcome of DGA. Three groups of DGA patients comprised the data. Study group 1 included all generally healthy (GH) patients aged 0 16 years treated under DGA in 2001 (n=102). Study group 2 included all GH patients aged 0 13 years treated under DGA in 2004 (n=199), and the study group 3 included all patients including those that were not GH treated under DGA in 2010 (n=349). The data were obtained from patient documents and from a questionnaire given to the parents of children treated under DGA in 2001. The three study groups were restricted to include 0 13-year-old GH patients for longitudinal comparisons. Most of the DGA patients in the Helsinki PDS were GH children in 2010. A comparison of the 0 5-year-old GH DGA children showed that the proportion of immigrants increased from 30% in 2004 to 51% in 2010. Conscious sedation had been used for more than half of the patients before DGA. Parents reported in 2001 that the first difficulties in the child s dental care were noticed when the child was younger than 3 years of age for 39% of that study group, and dental fear followed by pain were the most important reasons for previous unsuccessful dental care. The most frequent reasons for the referrals in 2004 and 2010 for DGA were extreme uncooperation, extreme dental fear and need for extensive treatments. The reason of avoidance of dental fear was introduced in 2010. Restorations, followed by tooth extractions, dominated the treatment-mix performed under DGA. The treatment need was extensive, even more for immigrants than for non-immigrants. The GH 0 13-year-olds that were treated under DGA in 2004 were followed-up for a mean of 47.6 (13.7 SD) months. The first visit of the patients to their home dental clinic after DGA generally occurred on a far later date than that recommended. The mean time elapsed to the first operative treatment need was 18.5 (14.1 SD) months. More than half (53%) of patients expressed dental fear and 54% were uncooperative during the follow-up. Familiarization in order to control dental fear was given to only 13% of the patients. Emergency treatment was given to 52% of the patients and 65% missed at least one appointment. DGA could probably be avoided for GH children. However, this requires earlier intervention. Special attention is needed with immigrant families. DGA is an essential part of the PDS care, even if there are some aspects of the DGA process that need more considerations and improvements.
• (2016)