Landscape history improves detection of marginal habitats on semi-natural grasslands.

Semi-natural grassland habitats have markedly declined from their historical coverage, thus causing substantial losses for agricultural biodiversity and establishing a consequent need to spot the remaining habitat patches. These patches are generally remnants of once larger habitat areas, formed by uninterrupted and low-intensity management for centuries, but then later being isolated and fragmented into smaller pieces. In the light of this development, past landscape phases have a crucial role for the present existence of semi-natural grasslands. The importance of historical factors has been indicated in many studies but evaluation of their added value, or actual site-specific effects compared to observations of only the present landscape characteristics, is not generally provided. As data related to the past is often difficult to obtain, tedious to process and challenging to interpret, assessment of its advantages and related effects - or consequences of potential exclusion - would be needed. In this study, we used maximum entropy approach to model the distribution of Fumewort (Corydalis solida) which in the study area is a good indicator of valuable semi-natural habitats. We constructed three different models - one based on only the contemporary environment with expected indicators of habitat stability, one solely on the historical landscape phases and long-term dynamics, and one combining variables from the past and the present. Predictions of the three models were validated and compared with each other, followed by an analysis indicating the similarity of model results with known Fumewort occurrences. Our results indicate that present landscapes may provide workable surrogates to delineate larger core habitats, but utilization of historical data markedly improves the detection of small outlying patches. These conclusions emphasize the importance of previous landscape phases particularly in detecting marginal semi-natural grassland habitats, existing in contemporarily suboptimal conditions and being prone to disappear if no further actions are taken.

Activities of daily living, social functioning and their determinants in persons with psychotic disorder.

OBJECTIVE: The determinants of everyday functioning in persons with psychotic disorder have not been widely studied in community dwelling samples. Our aim was to investigate limitations in everyday functioning among subjects with psychotic disorders in a population-based study. METHOD: Everyday functioning was assessed in a nationally representative sample of 7112 persons aged 30+ using interviewer observations and self-reports, while verbal fluency and memory were also measured. Diagnostic assessment of DSM-IV psychotic disorders was based on SCID interview and case-note data. Lifetime-ever diagnoses of psychotic disorder were classified into schizophrenia (n=61), other non-affective psychotic disorders (ONAP) (n=79) and affective psychoses (n=45). RESULT: Non-affective psychotic disorder was significantly associated with limitations in everyday functioning, as well as with deficits in verbal fluency and memory. Negative symptoms, depression, age, gender, verbal memory deficits, and reduced visual acuity were predictors of limitations in everyday functioning even after controlling for sociodemographic factors and chronic medical conditions, and difficulties in social functioning were also related to expressive speech problems. CONCLUSION: Persons with schizophrenia and ONAP have significantly more problems in everyday functioning than the general population. One significant predictor of problems was reduced visual acuity, which at least in some situations could be easily corrected.

School-based tobacco-control programming and student smoking behaviour.

The study examined the association of a school-based tobacco-control program with students' smoking behaviour over time using three cross-sectional, provincial census datasets (grade 10 students in 1999, grade 11 students in 2000, grade 12 students in 2001). Data were collected from all secondary schools in Prince Edward Island (Canada) using the Tobacco module of the School Health Action, Planning and Evaluation System (SHAPES). The proportion of regular smokers increased from grade 10 (22.3%) to grade 12 (27.8%, chi(2) = 10.35, df = 1, p < 0.001). Being exposed to different school-based tobacco programs and policies in grades 10 and 11 was not associated with the smoking behaviour of grade 12 students. The strongest predictors of smoking behaviour were having friends or close family members who smoke. This preliminary evidence suggests that programs and policies associated with banning smoking and enforcing smoking restrictions at school may be insufficient unless they also address the influence of smoking peers and family members and link to comprehensive programming within the broader context of other community and policy level interventions.

A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: evaluating a provincial tobacco control strategy.

This paper examined how smoking policies and programs are associated with smoking behavior among Grade 10 students (n = 4709) between 1999 and 2001. Data from the Tobacco Module from the School Health Action Planning and Evaluation System were examined using multilevel logistic regression analyses. We identified that (i) attending a school with smoking prevention programs only was associated with a substantial risk of occasional smoking among students with two or more close smoking friends and (ii) attending a school with both smoking prevention programs and policies was associated with substantial risk of occasional smoking among students who did not believe there were clear smoking rules present. Students attending schools where year of enrollment in high school starts in Grade 9 were more likely to be regular and occasional smokers. Each 1% increase in Grade 12 smoking rates increased the odds that a Grade 10 student was an occasional smoker. It appears that grade of enrollment, senior student smoking behavior, close friend's smoking behavior and clear rules about smoking at school can impact school-based tobacco control programming. These preliminary study findings suggest the need for further research targeting occasional smoking behavior and the transition stage into high school.

Cardiopulmonary resuscitation skills in nurses and nursing students.

The purpose of this study is to describe the basic cardiac life-support (BLS) skills of nurses and nursing students in southern Finland and Hungary, and to assess the influence of resuscitation teaching and other group characteristics on performance. The data for the study were collected in the spring and autumn of 1997. The study group consisted of 75 nurses from Helsinki University Central Hospital's medical outcome unit, 188 final term students in four nursing institutes in Uusimaa county and 35 final term students in a Hungarian institute of nursing. A total of 298 people (34 men and 264 women) participated in the study. Background information was collected using a structured questionnaire devised specifically for this study. Resuscitation skills were measured using the Skillmeter Anne manikin. The manikin was placed supine during the test. After completing the questionnaire, every participant attempted resuscitation on the manikin - which was supplied with a printer - for 4 min. The results were printed out and attached to the questionnaires. The data were analysed using two-way frequency tables and logistic regression. Statistical differences were calculated using the chi(2)-test. The results showed that 53% of the participants had studied resuscitation during the last 6 months, but 7% had never participated in resuscitation teaching. Before testing, 55% of the participants estimated that their resuscitation skills were good. The results showed that 36% first assessed the patient's response, 67% opened the airway but only 3% determined pulselessness before starting to resuscitate. Twenty-one percent of the participants compressed correctly for at least half of the test and 33% ventilated correctly at least half of the time. Logistic regression showed that the best predictors for good response assessment skills went to those who were nursing students who had studied resuscitation skills sometime during the previous 6 months. The best predictor of the skill to open the airway was a positive attitude towards personal cardiopulmonary resuscitation (CPR) skills, i.e. self-confidence. The predictor for adequate skills in artificial ventilation was that they belonged in the group of nursing students who had benefited from recent resuscitation training (<6 months). In conclusion, the skills of the participants of the study can not be considered adequate in terms of an adequate and prompt assessment of the need for resuscitation, and a 50% success rate in artificial ventilation and chest compression.

Patient participation in bedside reporting on surgical wards.

Increasingly nowadays, patients have an opportunity to take part in nurses' reporting sessions via bedside reporting. The aim of this study was to compare nurses' and patients' opinions of the purpose of bedside reports, patient participation in bedside reporting sessions, and factors that promote or prevent their participation. Data were collected by a questionnaire survey of nurses (N = 118) and patients (N = 74). A response rate of 81% was achieved in both groups. Additionally, 76 bedside reporting sessions were observed. According to patients, the main reasons for not participating were tiredness, difficulties in formulating questions, lack of encouragement, difficulties with the language used, nurses concentrating more on their papers than on them, and the reporting sessions were too short. Nurses reported that patients took a more active part in reporting sessions than patients themselves thought. The average time spent on each patient's report was three minutes.

Maternal predictors of perinatal mortality: the role of birthweight.

BACKGROUND: Many maternal characteristics increase the risk for perinatal death. To locate potential sites for intervention, it is important to identify these risk factors and examine how much of the excess mortality is explained by infants' low birthweight. METHODS: Data on all newborns in Finland born between 1991 and 1993 (N = 199,291, of which 1461 were perinatal deaths) were obtained from the Medical Birth Register. Logistic regression analysis was used to adjust for background variables, both including and excluding infants' birthweight. The percentage reduction in odds ratios after adjustment for infants' birthweight was used to estimate the contribution of infants' low birthweight to the excess mortality. RESULTS: After adjusting confounding factors, increased risk for perinatal death was found for eight maternal characteristics. In the following the increased risk is given as odds ratios and the proportions of the excess mortality explained by infants' low birthweight are in parentheses: in-vitro fertilization 4.12 (> 100%); earlier stillbirth 3.43 (87%); higher maternal age, from 1.21 to 3.08 (38-99%); maternal diabetes 2.87 (50%); lower socioeconomic status, from 1.30 to 1.70 (27-44%); smoking during pregnancy 1.45 (> 100%); single mother 1.44 (50%); first birth 1.36 (75%). CONCLUSIONS: Excess mortality due to maternal risk factors occurred mainly through their tendency to cause low birthweight. However, the excess mortality associated with low socioeconomic status, single motherhood, and diabetes was mediated by other mechanisms in addition to low birthweight.

[Guidance for breast cancer patients in the surgical ward and in the outpatient department]. / Rintasyöpäpotilaan ohjaus yliopistollisen keskussairaalan kirurgisella vuodeosastolla ja poliklinikalla.

The purpose of this study was to examine the perceptions of breast cancer patients, who had undergone a breast operation. The study focused on patients' perceptions of the length of hospital stay and the sources and contents of information given to them. Patients also evaluated how they could participate in the decision making concerning the choice of operation. Data were collected by questionnaires given to 100 patients at one hospital. The questionnaires were returned circa 2 weeks later when the patients visited the hospital for follow up examinations. Of the sample, 71% responded to the questionnaire. All patients had undergone an operation, either resection of the breast, ablation of the breast, or immediate reconstruction of the breast. The results were presented in frequencies and percentages. The average time spent by patients in surgical ward was 3, 5 days for resection and ablation and 11 days for reconstruction. Most patients (86%) considered, that the hospital stay was sufficiently long. The patients felt that the information they received had met their needs quite well. They were well-informed about operation, illness in general, exercises of arms and anesthesia. They got less information about future treatments (hormonal treatment, chemotherapy, x-ray and reconstruction of the breast). The greatest need for further information was about future treatments. Most patients (72%) considered that they had coped well at home; even drainage had not caused much trouble. Patients had received most information from surgeons, nurses and written sources. Two-thirds (66%) of the patients reported, that they could participate in decision making concerning the choice of operation.

[Use of Faces Scale in children's self-assessment of pain]. / Kasvoasteikon käyttö lapsen kivun itsearviointimenetelmänä.

In this study 3-8 year old children's pain assessment and management after tonsillectomies were evaluated on two otological wards. The sample consisted of 80 children, 40 from both wards and the response rate was 92%. The groups were compared with each other: on one ward nurses used the Faces Scale in children's self assessment of pain while the other was a comparative ward. The data were collected using measurements: 1. background of children, 2. intensity of children's pain after the operation observed by their parents, 3. parents' satisfaction with children's assessment and management of pain, 4. children's self assessment of pain with the Faces Scale and 5. documentation of children's pain management. The data were analysed by cross-tabulations, mean-values, t-test, Pearson's correlation and content analysis. 40% of children had severe or intolerable pain after the operation observed by their parents. Children's self assessment of pain and parents' observations correlated highly (r = .74, p < .05). Children had less pain (the difference was statistically significant) on the ward, where the Faces Scale was used in pain assessment. The parents were also more satisfied with their children's pain assessment and management on this ward. However, there were differences in pain management practices between there two wards. Nurses need more education to be able to assess and manage children's pain adequately.

Analysis of EDTA and DTPA.

In this paper, analytical techniques for the determination of ethylenediaminetetraacetic acid (EDTA) and diethylenetriaminepentaacetic acid (DTPA) are reviewed. These compounds, especially EDTA, are used as metal chelating agents in several industries. As they are likely to be poorly degraded in waste water treatment plants, significant amounts of EDTA and DTPA are released into natural waters. The overview consists of comparing chromatographic, electrochemical, spectrophotometric, titrimetric and atomic absorption methods and their applicability to the determination of EDTA and DTPA in different matrices.

Comprehensive drug screening in blood for detecting abused drugs or drugs potentially hazardous for traffic safety.

A comprehensive drug screening procedure for detecting drugs in the blood samples of car drivers suspected of driving under the influence of drugs, is presented. Amphetamines, cannabinoids, opioids, cocaine and benzodiazepines were screened by an immunological EMIT ETS system after acetone precipitation. Gas chromatographic methods were used to screen and quantitate basic, neutral and acidic drugs. The free amino groups of basic drugs were derivatized with heptafluorobutyric anhydride. Analysis was performed by a dual channel gas chromatograph combined with a nitrogen phosphorus and an electron capture detector. Phenyltrimethylammonium hydroxide was used as a methylathing agent for acidic substances before analysis with a gas chromatograph connected to a nitrogen phosphorus detector. A gas chromatograph/mass spectrometry was used as a common confirmation method. Tetrahydrocannabinol was quantitated after bis(trimethylsilyl)trifluoroacetamide derivatization, opiates after pentafluoropropionic anhydride derivatization and benzoylecgonine after pentafluoropropionic anhydride and pentafluoropropanol derivatization. Excluding benzodiazepines, which were confirmed with a gas chromatograph connected to a nitrogen phosphorus and an electron capture detector, the other basic drugs as well as the acidic drugs were confirmed after the same derivatization procedures as in the screening methods. Alcohols were quantitated in triplicate by gas chromatography using three different kinds of columns. Although urine is the most important specimen for screening abused drugs, it has only limited use in forensic toxicology. The described system is most useful for analyzing a wide range of substances, including illicit drugs, benzodiazepines, barbiturates, antidepressants and phenothiazenes in forensic samples when urine is not available.

Falls among institutionalized elderly--a prospective study in four institutions in Finland.

We analyzed prospectively the incidence, the intrinsic and extrinsic factors and the consequences of falls during a 7-month period in 4 institutions in Finland in 1993. A total of 370 falls among 160 patients were recorded. Of the fallers 56% fell once and 44% more than once (range 2-24). The mean fall rate in men was higher than that in women (p < 0.01). Fallen men were younger but less ambulatory than women. Of the falls 95% occurred without eyewitness and 27% during the night shift; 30% (114/370) resulted in an injury and 7% (11/160) of the fallers suffered a fracture.

Analysis of aldehydes and ketones from beer as O-(2,3,4,5,6-pentafluorobenzyl)hydroxylamine derivatives.

O-(2,3,4,5,6-pentafluorobenzyl)Hydroxylamine (PFBOA) was used as a derivatization reagent for carbonyl compounds in beer. Derivatization was carried out in aqueous solution without extraction or concentration of the sample. The effects of antifoam agent, reaction time and pH on the reaction efficiency were studied. Antifoam RD, a silicone polymer-based antifoam reagent, was the best antifoaming agent since it did not cause interferences. Reaction time studies showed that the yield of aldehydes increased up to 12 hr and then decreased slightly. The yield of 3-hydroxybutanone, a test compound for ketones, increased throughout the 48 hr test period. The natural pH of beer (ca. 4.5) was favourable for the determination of carbonyl compounds as PFBOA derivatives. Higher pH values caused yield losses and some compounds, such as butanedione, 2,3-pentanedione and 5-hydroxymethyl-2-furfural, could not be measured at all in neutral or basic conditions. Carbonyl compounds were identified by GC-MS, using three different ionization techniques, electron impact ionization, chemical ionization, and negative chemical ionization. The formation of the protonated molecules by ammonia chemical ionization and formation of the negative molecular ions and [M - HF](-.) ions by negative chemical ionization permitted reliable identification of the various carbonyl compounds studied. Sixteen carbonyl compounds from the 32 standard compounds were identified in beer and 11 of the most significant were quantitated using GC-ECD. Reproducibility of quantitation for beer samples was good, the relative standard deviations varied between 2.7 and 6.7 %. The estimated detection limits of the PFBOA derivatives of the carbonyl compounds in beer varied in the range of 0.01-1 microg/dm(3).

Leadership for motivation in health care.

For primary health care to achieve its potential the providers have to be strongly motivated. Supportive leadership can play a significant part in bringing this about. A study in Finnish health centres showed that leadership functions, such as the encouragement of doctors and nurses, were particularly important in helping staff to feel that they were doing worthwhile jobs.

Unnecessary visits to health centres as perceived by the staff.

The aim of this study was to assess the present situation concerning unnecessary visits to health centres as perceived by the primary health care staff. Associations of this perception with the internal work motivators were analysed. Data consisted of the personnel of four health centres located in various parts of Finland. A pretested questionnaire was employed with a response rate of 87%. The number of responders was 644, comprising 24 administrative staff, 146 general practitioners, 383 nursing staff, and 91 office staff. An estimate of the number of unnecessary visits (%) was obtained using a scale from 0 to 50%. Estimates less than 20% were regarded in the analyses as acceptable by the authors. The methods of analysis included cross tabulations and logistic regression. The theoretical framework for this research was a modification of the work motivation model by Hackman and Oldham. 41% of responders felt that at least 20% of patient visits could be characterized as unnecessary (49% of doctors, 37% of nursing staff). The health centres also differed from each other. The longer the doctors had worked in their present health centre, the less they regarded the visits as unnecessary. Among those doctors who had worked in the health centre less than four years, 63% indicated that 20% or more of all visits to doctors were unnecessary. There was no similar trend with nurses. With the doctors, the most important risk factors among the internal motivators for perceiving the proportions of unnecessary visits high were the lack of work significance and lack of task identity whereas with the nursing staff the important risk factors appeared to be the perceived lack of skill variety of the work and lack of task identity. The study suggests the need for specific postgraduate training for doctors who intend to work permanently in primary health care.

Health centre efficiency. First results of an organizational analysis of four Finnish health centres.

First results are given on the opinions and perceptions of the health centre personnel (including administrative staff, doctors, nursing and office personnel) concerning their work at four health centres, which represent different types of organization with respect to urbanrural axis, geographical location, and size of base population. Data were collected using a pretested questionnaire. The number of completed forms was 710, of which 702 were included in the final analysis. The response rate was 95%. The results indicated that doctors and administrative staff considered their work mentally more stressful than the other groups. According to the doctors, important adverse factors in their work were 1) the forced pace of work and 2) the perceived haste and tight schedule. The findings also suggest that, at least in those health centres studied, communication between various professional groups was insufficient. Likewise, the transfer of information between the various functional units was problematic. These findings may indicate difficulties in the planning, organization, and coordination of the work. Therefore the attention should be focused especially on the management of health centre organizations.

Factors influencing the patient-provider relationship.

This article analyzes some of the central elements of the patient-provider relationship i.e. continuity of care, communication, compliance, and the various elements of the consultation itself. This analysis is based on the review of relevant literature. The same principles apply to this relationship regardless of the provider category. When aiming at good care the recognition of the real need of care and the sharing of information with the patient in a proper and effective way are important. These skills belong to the professional competence of the provider. Continuity of care is the element facilitating the forming of a good patient-provider relationship. The importance of the patient-provider consultation is very great. The immediate, intermediate and long term outcomes of the consultation have been studied by several researchers. The immediate outcomes such as the patient satisfaction strongly influence the intermediate outcomes and also the long term outcomes all-though the intermediate (i.e. compliance) and long term (i.e. change in health status) is also strongly influenced by the patient's sociocultural environment. On the other hand, the patient's health understanding can be much enhanced through skillful communication by the provider during the consultation in a good patient-provider relationship. This, again, connects the elements of consultation very tightly with the success or failure of the care process and the patient's future use of health services.