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1. Human sex ratio at birth at the population level has been suggested to vary according to exogenous stressors such as wars, ambient temperature, ecological disasters and economic crises, but their relative effects on birth sex ratio have not been investigated. It also remains unclear whether such associations represent environmental forcing or adaptive parental response, as parents may produce the sex that has better survival prospects and fitness in a given environmental challenge. 2. We examined the simultaneous role of wars, famine, ambient temperature, economic development and total mortality rate on the annual variation of offspring birth sex ratio and whether this variation, in turn, was related to sex-specific infant mortality rate in Finland during 1865-2003. 3. Our findings show an increased excess of male births during the World War II and during warm years. Instead, economic development, famine, short-lasting Finnish civil war and total mortality rate were not related to birth sex ratio. Moreover, we found no association between annual birth sex ratio and sex-biased infant mortality rate among the concurrent cohort. 4. Our results propose that some exogenous challenges like ambient temperature and war can skew human birth sex ratio and that these deviations likely represent environmental forcing rather than adaptive parental response to such challenges.

This study compared surgical patients' (n = 874) and perioperative nurses' (n = 143) perceptions of the quality of perioperative nursing care. The data were collected with a structured questionnaire in five hospital operating departments in Finland. The questionnaire items were divided into five main categories (staff characteristics, nursing activities, preconditions, progress of nursing process and environment); some of these categories were further divided into subcategories. Overall, patients tended to give significantly higher (P

The quality of perioperative care: development of a tool for the perceptions of patients Aim of the study. To find out how surgical hospital patients (n=874) perceived the quality of perioperative care they received in an operating department and in the recovery room. Background. Patients’ perceptions of the perioperative care have not been included systematically in the improvement of the care. Accordingly, there is no standardized, valid, and reliable instrument or system in common use that we could use for the evaluation. The nursing care in operating departments has an important role in modern health care, and therefore more research concerning perioperative care quality is needed urgently and the development of the measurement tool is urgent. Method. The data were collected using a structured questionnaire in five operating departments in southern Finland during 1998. Results. Physical activities (such as pain management and temperature maintenance) were rated as excellent, as were staff characteristics and the physical and social environment. The most critical comments were made with regard to supporting patient initiative, encouragement and educational activities. Patients stated they would have liked more information and it was felt that they should have been encouraged to ask more questions about unclear matters. Some of the patients said they had only very limited influence over their own care. The patients were very pleased with their care in the recovery room. There were only minor differences between the views of patients from different departments. Conclusions. Overall the quality of care was considered extremely good, but comparisons of different quality categories did reveal some problems. Although it has already proved to be a useful tool, the questionnaire needs to be developed and tested further.

The metabolic and clinical responses to intravenously administered atropine + meperidine (pethidine), glycopyrrolate + meperidine, diazepam and placebo were examined in 76 healthy children. After atropine + meperidine and glycopyrrolate + meperidine administration, a significant antisialogogue effect, tachycardia and elevation in systolic blood pressure were observed. Diazepam decreased oxygen consumption (VO 2 ) whereas atropine + meperidine increased both VO 2 and energy expenditure (EE). The maximal effect of diazepam on VO 2 was found 10 min after drug administration (mean difference from baseline -10.0%) and maximal effect of atropine+meperidine on VO 2 and EE after 5 min (mean difference from baseline +6.0% and +3.3%, respectively). It is concluded that intravenous administration of meperidine with atropine or glycopyrrolate is followed by profound anticholinergic effects and such combinations do not appear to be suitable for clinical purposes. Although statistically significant, the alterations in VO 2 and EE after diazepam and atropine+meperidine premedication can be considered clinically insignificant because they were of short duration and the measured changes represented only a fraction of fluctuation seen in normal values.

Background In Finland, a national programme for COPD prevention and treatment was developed in 1998. The main goals of the programme were to diagnose COPD as early as possible and to encourage people to quit smoking. The role of primary health care was emphasized in the programme. Our aim was to investigate the use of spirometry and recording of smoking habits of COPD patients in primary health care before and during the COPD programme. Methods We compared patients with respiratory symptoms or diseases visiting primary health care during 1997 (before programme) and 2002 (during programme). Patients with respiratory symptoms were divided into two groups: COPD patients and "others". Patient records were thoroughly investigated and data retrieved from them. Results There was a significant increase in the whole study group from 8.0% to 38.9% in the use of spirometry (p < 0.001). This increase was significant both in the COPD group (from 32.0% to 79.6%, p < 0.001) and "others" (from 5.6% to 32.8%, p < 0.001). Written information on smoking habits in patient records increased from 16.6% of all patients in 1997 to 53.2% in 2002 (p < 0.001), and in COPD group from 45.0% to 84.3% (p < 0.001). Conclusions We observed a significant increase in the use of spirometry and knowledge of smoking habits in COPD patients, which may be a result of the Finnish national COPD programme.

Maternal sensitivity behavior, mother's experienced difficulties, experienced social support, and the amount of infant's crying, fussing and contented behavior were studied when the infants were 3 and 12 months of age. Fifty-seven Finnish low-risk mothers' sensitivity behavior was assessed by the Parent-Child Early Relational Assessment method. Infant's crying behavior was assessed by the Baby's Day Record and by the Crying Patterns Questionnaire. The Social Support Questionnaires (SSQ 1 and 2) were used to evaluate mother's experienced difficulties and support. The infants of More Sensitive (MS) mothers were more contented than those with Less Sensitive (LS) mothers. The MS mothers experienced fewer difficulties with their infants and experienced more support from their best friend and their husband than LS mothers. In addition, some gender differences were found concerning infant behavior.

The migration of inflammatory cells into a wound and their subsequent changes during wound healing are essential for the complex processes of tissue repair to occur. The aim of this work was to investigate the number of wound leukocytes during early wound healing at different time periods in children. Wound cells of 184 children aged 0-15 years, operated on for a benign disease in the lower abdominal region, were harvested with the Cellstick(R) device. The device was removed from the wound at 3, 6, or 24 hours after surgery and differential cell counts were performed. The cellular patterns were significantly influenced by the age of the patient and by the duration of the surgery. The proportions of neutrophils, lymphocytes, and monocytes changed significantly from 3-24 hours. Our results suggest that there is a distinct time-related change in the pattern of inflammatory cells in the early phase of wound healing in children. This pattern is affected by the age of the child and by the duration of the surgery.

Interleukin-6 and matrix metalloproteinase-9 concentrations in the wound fluid and their associations to cellular changes were determined in early wound healing. Wound healing of 75 children who underwent elective operations was studied with the Cellstick(R) device, which was inserted into the wound at the end of the operation and removed 3 or 24 hours post-wounding. Differential counts of the wound cells and interleukin-6 and matrix metalloproteinase-9 concentrations in the wound fluid were analyzed. Interleukin-6 and the matrix metalloproteinase-9 concentrations increased in parallel (r = 0.81). The proportion of wound neutrophils increased (p < 0.0001) and lymphocytes decreased (p < 0. 0001) between the observation times. The number of wound neutrophils had a strong correlation with both interleukin-6 (adjusted R2 = 0.41, p < 0.0001) and matrix metalloproteinase-9 concentrations (adjusted R2 = 0.37, p < 0.0001). The extracellular matrix degradation process of the early wound healing seems to be closely linked to the inflammatory response. Both of these measured markers are associated significantly with the neutrophil proportion in the wound.

Summary: A major role has been proposed for group II phospholipase A2 in the pathogenesis of local and generalised inflammatory reactions. Elevated catalytic activity and mass concentrations of this enzyme have been found in serum and tissue samples of the colon in patients with active ulcerative colitis. The cellular source(s) of group II phospholipase Az in the blood circulation is (are) unknown. In the current prospective study, we investigated the mass concentration of group II phospholipase AI and the catalytic activity concentration of phospholipase AI in serial serum samples of 15 consecutive patients who underwent a standard panproctocolectomy operation for severe ulcerative colitis. Both the catalytic activity concentrations of phospholipase A2 and the mass concentrations of group II phospholipase AI increased rapidly in serum samples to maximum values on the first postoperative day and then decreased (p = 0.002 and p < 0.001, respectively) in patients who recovered uneventfully. Three patients had postoperative complications that further increased the enzyme concentrations at the time of respective complications. The pattern of group II phospholipase Az mass concentration profiles was similar to the profiles of C-reactive protein. The results show that the removal of the large bowel does not eliminate the potential to secrete group II phospholipase AZ into the blood circulation in these patients. Secretion of group II phospholipase A2 into the circulation after surgery seems to be a normal host response to a major abdominal operation and postoperative complications. Consequently, we conclude that the large bowel is not an important source of group II phospholipase AZ in sera of patients with ulcerative colitis. The results also support the assumptions that the catalytic activity of phospholipase A2 in serum is attributable to group II phospholipase A2 and that this enzyme is an acute phase protein.