Ystävä sä lapsien : Lasten virret ja hengelliset laulut suomenkielisissä kokoelmissa 1824-1938 ja niiden vaikutus vuoden 1938 virsikirjaan

Ystävä sä lapsien. Collections of Finnish language children s hymns and spiritual songs from 1824─1938 and their influence on the Hymnal 1938. The Hymnal has been the common song book of Lutheran parishes since the 1500s. In the beginning, the congregations sang the hymns from memory led by the choir or the church musician. The fundamentals of Christian faith are taught through the hymns, both in church and in family devotions. The Hymnal was the only song book of the church in Finland until the end of the 1800s. This study attempts to clarify when and by who were spiritual songs and hymns for children written in Finland. Research materials used were all the books I could find (approximately 200), whose headings were for pupils and young children in the home and school circles. The method of study is historical and analytical. In the first chapter, it is explained that children s literature in Finland differentiated from other literature at the end of the 1700s. Eric Juvelius published a small prayer book in 1781 with the prayer Gud, som hafver barnen kär / Jumala joka Lapsia rakasta. From that, after many Finnish translations, the first verse of the hymn Ystävä sä lapsien took shape. The second chapter considers singing instruction in the folk school from the beginning of the 1860s. Textbooks, including songbooks, were produced for the pupils. Some of the first pioneers in producing these materials were the teachers P.J. Hannikainen, Sofie Lithenius, Mikael Nyberg, Anton Rikström and Aksel Törnudd, as well as Hilja Haahti, Immi Hellén and Alli Nissinen, who were all teachers gifted in writing poetry. Several new spiritual songs appeared in the folk school songbooks. Hymns were sung often, especially in connection with church year celebrations. Children s songs in Christian education are discussed in the third chapter. The Lutheran Evangelical Association of Finland recognized children already in its early song collections. The illustrative teaching methods in the folk school influenced the Sunday school activities and especially the Sunday school hymns. Hymns introduced as exclusively for children and pupils which appear in the Hymnal from 1886 and the supplement to the 1923 Hymnal are explored in the fourth and fifth chapters. The study shows that the renewal of church life at the beginning of the 1900s also resulted in an increase of the number of spiritual songs for children. This is also seen in the diverse choice of songs in the supplementary materials from 1923. The final chapter deals with the School and Childhood section of the 1938 Hymnal. The Hymnal committee did not think that the already well known folk school and Sunday school songs received enough attention in the Hymnal. Those songs were, among others, Kautta tyynen, vienon yön, Oi, katsopa lintua oksalla puun, Olen Luojani pikku varpunen, Rakas Isä taivahan ja Tuolla keinuu pieni pursi. Heikki Klemetti, Ilmari Krohn, Armas Maasalo and Aarni Voipio influenced the opinion that the spiritual songs still were not suitable to be sung in church. Hymns for children and pupils were brought into the same line as the entire Hymnal. The same hymn tunes, which were mainly old ones, were used as common settings for numerous hymn texts. No special type of melody emerged for the children s hymns. It was still notable that hymns for children and pupils were collected at all. In addition, the Hymnal committee marked those verses suggested for singing in both the folk school and Sunday school with an asterisk (*) throughout the entire Hymnal.

Treatment of illicit opioid and γ-hydroxybutyrate overdose by Helsinki emergency medical services

Aims: To examine the characteristics, incidence, treatment and outcome of presumed opioid, γ-hydroxybutyrate (GHB) and γ-butyrolactone (GBL) overdoses involving users of illicit drugs in Helsinki. GHB/GBL were included in this study, despite not being opioids, due to the relative ease with which they can cause potentially fatal respiratory depression. The incidence and time interval of recurrent opioid toxicity after prehospital administration of naloxone, an opioid antagonist, was studied in presumed heroin overdose patients. Naloxone has been reported to have many adverse effects and the effects of naloxone administered during an opioid overdose on the cardiovascular system and catecholamine levels in piglets were studied. Materials and methods: Patients included in these published retrospective studies were from the following time periods: Study I: 1995-2002, II: 1997-2000, III: 1995-2000, V: 2006-2007. Presumed opioid overdose patients were examined in studies I, II and III. GHB/GBL overdoses among injecting drug users was examined in study V. Recurrent opioid toxicity after prehospital naloxone administration in heroin overdose patients was examined in study III. The effects of naloxone (80 μg/kg i.v.) on the cardiovascular system and catecholamine levels administered during morphine overdose (8mg/kg i.v.) and under propofol anesthesia with spontaneous breathing were studied in eight piglets (IV). In this thesis, previously unpublished data on the incidence of opioid overdose between 2001-2007 and comparison of the characteristics of buprenorphine and heroin overdose patients encountered in 1995-2005 are also included. Results: Helsinki Emergency Medical Service (EMS) ambulances were dispatched annually to 34,153- 45,118 calls from 1995 to 2007. Of them, 7-8% were coded as intoxications or overdoses. During this time, 436 patients were treated by the EMS for presumed opioid overdose. The peak incidence of opioid overdoses was in the year 2000 (113 cases), after which they declined to 6-26 cases annually. The annual incidence of buprenorphine related overdoses increased from 4 (4% of opioid overdoses) in the year 2000 to 8 (30% of opioid overdoses) in 2007. The annual number of GHB related overdose patients treated by Helsinki EMS increased from 21 to 73 between 2004-2007. There appeared to be a peak in the incidence of both GHB/GBL and opioid related overdoses on Saturdays. Characteristics of opioid overdose patients The median age of opioid overdose patients was 28 years (22;33, 25- and 75-percentiles), and 84% were male. Buprenorphine overdose patients had more polydrug, such as alcohol and/or benzodiazepines, use in comparison with heroin overdose patients, 70% versus 33%, respectively. Severe respiratory depression was reported less often with buprenorphine overdoses compared to heroin overdoses, in 67.0% versus 85.4%, respectively. Outcome of heroin overdose patients with cardiac arrest Ninety four patients suffered cardiac arrest due to acute drug poisoning/overdose and were thus considered for resuscitation. Resuscitation was attempted in 72 cases. Cardiac arrest was caused by heroin overdose for 19 patients of which three (16%) were discharged alive. Other agents also induced cardiac arrest in 53 patients, of which six (11%) were discharged alive. The arrest was either EMS witnessed or occurring after the emergency call for all survivors of heroin induced cardiac arrest. Characteristics of GHB/GBL overdose patients The records of 100 GHB/GBL related overdose patients from 2006-2007 were retrieved. The median age of GHB/GBL overdose patients encountered on weekend nights was 24 years (22;27, 25- and 75-percentiles) and 49% were male. Polydrug use was reported in 62-80% of the cases. Thirty nine patients were encountered on Friday-Saturday or Saturday-Sunday night between 11 pm-6 am. The remaining sixty one patients were outside this time frame. There was a statistically significant difference between these two groups in history of chronic injecting drug use (33% vs. 59%, respectively, p=0.012). Recurrent heroin toxicity after prehospital naloxone administration Study III included 145 presumed heroin overdose patients. After prehospital care, 84 patients refused further care and were not transported to an Emergency Department (ED). Seventy one (85%) of them were administered naloxone by the EMS. During a 12-h follow up period, none of these patients developed severe recurrent opioid toxicity. The remaining 61 patients were transported to an ED. Prior to transportation, 52 (85%) patients were administered naloxone by the EMS. Fifteen of them were administered naloxone also in the ED and recurrent opioid toxicity was evident either on arrival at the ED or shortly thereafter. Prehospital naloxone was administered either intravenously, intramuscularly (i.m.) or subcutaneously (s.c.). There was a tendency for more frequent recurrent heroin toxicity among the patients with only intravenous administration of prehospital naloxone (13/36) compared with the patients with intramuscular or subcutaneous prehospital naloxone (2/16), p=0.106. The effects of naloxone on the cardiovascular system and catecholamine levels in piglets The administration of morphine to piglets resulted in an obvious respiratory depression, which was reversed by naloxone. Two severely hypoxemic piglets developed cardiac arrest after naloxone administration. In the other six animals, the administration of naloxone did not provoke arrhythmias, cardiac ischemia or visible evidence of pulmonary edema. There was a statistically significant (p=0.012) increase in norepinephrine levels after morphine administration and before naloxone administration: from 1.9 (1.3-2.3) ng/ml at baseline, to 31.7 (8.3-83.0) ng/ml (median, 25 and 75 percentiles parentheses) after morphine administration. After the administration of naloxone, the catecholamine levels continued to increase in only one of the animals. Conclusions: The incidence of buprenorphine related overdoses increased during the study period, but was still lower in comparison to those involving heroin. Injecting drug users have also started to use GHB/GBL. While recreational drug users use GHB/GBL during weekend nights, a GHB/GBL overdose patient encounter during weekdays has a more probable history of injecting drug use. Patients with cardiac arrest after heroin overdose have a poor prognosis. It appears to be safe to leave heroin overdose patients on scene after prehospital treatment with naloxone. Although no statistically significant difference was observed, it seems prudent to administer part of the total naloxone dose s.c. or i.m. to reduce the risk of recurrent respiratory depression. If transported to an ED, an observation period of one to two hours after the last naloxone dose seems adequate. The treating physician must be vigilant, however, due to the high prevalence of polydrug use and high morbidity after non fatal heroin overdose. Furthermore, care should be taken regarding possible chronic disorders and drug rehabilitation should be addressed. In the experimental animal study, two animals developed cardiac arrest after receiving naloxone while in hypoxemia and bradycardia. Further studies are required to assess the effect of naloxone during opioid-induced hypercapnia and hypoxemia in animals addicted to opioids.