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The eye lens exposure among 16 technicians in two nuclear medicine departments at university hospitals in Finland was investigated by measuring the operational quantity Hp(3) using EYE-D dosemeters. For all workers, the annual mean Hp(3) was estimated to be 1.1 mSv (max. 3.9 mSv). The relation between Hp(3) to routinely monitored personal dose equivalent Hp(10) was clearly correlated. Considering individual dose measurement periods (2–4 weeks), the Hp(3)/Hp(10) ratio was 0.7 (Pearson’s coefficient r = 0.90, p 0.1 mSv vs.

Since the 1980s, the pulp and paper industry in Finland has resulted in the accumulation of fibres in lake sediments. One such site in Lake Näsijärvi contains approximately 1.5 million m3 sedimented fibres. In this study, the methane production potential of the sedimented fibres (on average 13% total solids (TS)) was determined in batch assays. Furthermore, the methane production from solid (on average 20% TS) and liquid fractions of sedimented fibres after solid-liquid separation was studied. The sedimented fibres resulted in fast methane production and high methane yields of 250 ± 80 L CH4/kg volatile solids (VS). The main part (ca. 90%) of the methane potential was obtained from the solid fraction of the sedimented fibres. In addition, the VS removal from the total and solid sedimented fibres was high, 61–65% and 63–78%, respectively. The liquid fraction also contained a large amount of organics (on average 8.8 g COD/L), treatment of which also has to be considered. The estimations of the methane production potentials in the case area showed potential up to 40 million m3 of methane from sedimented fibres. acceptedVersion

Introduction Timely, complete and accurate patient data is needed in care decisions along the continuum of care. To access patient data from other organizations, there are three types of regional health information exchange systems (RHIS) in use In Finland. Some regions use multiple RHISs while others do not have a RHIS available. The recently introduced National Patient Data Repository (Kanta) is increasingly used for health information exchange (HIE). Objectives The purpose of this study was to assess usage of paper, RHISs and Kanta by context in 2017; evolution of paper use over the years; and predictors of paper use in 2017 among Finnish physicians for HIE system development. Methods Data from national electronic health record (EHR) usage and user experience surveys were taken from 2010 (prior to ePrescription system implementation), 2014 (prior to implementation of Kanta) and 2017 (Kanta was in full use in the public sector and in large private organizations). The web-based surveys were targeted to all physicians engaged in clinical work in Finland. Results Kanta was the most frequently used means of HIE in 2017. Paper use had reduced significantly from 2010 to 2014. The trend continued in 2017. Still, up to half of the physicians reported using paper daily or weekly in 2017. There were great variations in paper use by healthcare sector, available RHIS type and EHR system used. In multivariable analysis (with all other variables constant), predictors of more frequent use of paper than electronic means for HIE were: private sector or hospital, access to Master Patient Index RHIS (type 1), multiple RHIS (type 4) or no RHIS (type 5), two particular EHR systems, older age, less experience, operative, psychiatric or diagnostic specialties, and male gender. Conclusions Usability of HIE systems including EHRs as access points to HIE need to be improved to facilitate usage of electronic HIE. Usage ensures more timely and complete patient data for safe, coordinated care. Specialty-specific needs and requirements call for more user participation in HIE design. Especially older professionals need training to better exploit HIS for HIE.

Background The responsiveness and the intertester reliability of the Finnish Canine Stifle Index (FCSI) were tested, and a cut-off between compromised and severely compromised performance level was set. Methods Three groups of dogs were used, 29 with any stifle dysfunction (STIF), 17 with other musculoskeletal disease except stifle (OTHER) and 11 controls (CTRL). All dogs were tested with the FCSI by the same physiotherapist at three occasions, at baseline, at six weeks and 10 weeks, and once also by another physiotherapist. Results Dogs in the STIF group demonstrated significantly higher (P

This study aimed at developing a quantitative testing battery for dogs' stifle functionality, as, unlike in human medicine, currently none is available in the veterinary field. Forty-three dogs with surgically treated unilateral cranial cruciate ligament rupture and 21 dogs with no known musculoskeletal problems were included. Eight previously studied tests: compensation in sitting and lying positions, symmetry of thrust in hindlimbs when rising from lying and sitting, static weight bearing, stifle flexion and extension and muscle mass symmetry, were summed into the Finnish Canine Stifle Index (FCSI). Sensitivities and specificities of the dichotomised FCSI score were calculated against orthopaedic examination, radiological and force platform analysis and a conclusive assessment (combination of previous). One-way analysis of variance (ANOVA)was used to evaluate FCSI score differences between the groups. Cronbach's alpha for internal consistency was calculated. The range of the index score was 0-263, with a proposed cut-off value of 60 between 'adequate' and 'compromised' functional performance. In comparison to the conclusive assessment, the sensitivity and specificity of the FCSI were 90 per cent and 90.5 per cent, respectively. Cronbach's alpha for internal reliability of the FCSI score was 0.727. An estimate of the surgically treated and control dogs' FCSI scores were 105 (95 per cent CI 93 to 116) and 20 (95 per cent CI 4 to 37), respectively. The difference between the groups was significant (P

Background: No established method for digitizing and digital measuring of paper electrocardiograms (ECG) exists. We describe a paper ECG digitizing and digital measuring process, and report comparability to manual measurements. Methods: A paper ECG was recorded from 7203 health survey participants in 1978-1980. With specific software, the ECGs were digitized (ECG Trace Tool), and measured digitally (EASE). A sub-sample of 100 ECGs was selected for manual measurements. Results: The measurement methods showed good agreement. The mean global (EASE)-(manual) differences were 1.4 ms (95% CI 0.5-2.2) for PR interval, 1.0 ms (95% CI 1.5 [-0.5]) for QRS duration, and 11.6 ms (95% CI 10.5-12.7) for QT interval. The mean inter-method amplitude differences of RampV5, RampV6, SampV1, TampII and TampV5 ranged from 0.03 mV to 0.01 mV. Conclusions: The presented paper-to-digital conversion and digital measurement process is an accurate and reliable method, enabling efficient storing and analysis of paper ECGs. (C) 2017 Elsevier Inc. All rights reserved.

Objectives To estimate the internal consistency, test–retest reliability and comparability of paper and computer versions of the Finnish version of the Tampa Scale of Kinesiophobia (TSK-FIN) among patients with chronic pain. In addition, patients’ personal experiences of completing both versions of the TSK-FIN and preferences between these two methods of data collection were studied. Design Test–retest reliability study. Paper and computer versions of the TSK-FIN were completed twice on two consecutive days. Participants The sample comprised 94 consecutive patients with chronic musculoskeletal pain participating in a pain management or individual rehabilitation programme. The group rehabilitation design consisted of physical and functional exercises, evaluation of the social situation, psychological assessment of pain-related stress factors, and personal pain management training in order to regain overall function and mitigate the inconvenience of pain and fear-avoidance behaviour. Results The mean TSK-FIN score was 37.1 [standard deviation (SD) 8.1] for the computer version and 35.3 (SD 7.9) for the paper version. The mean difference between the two versions was 1.9 (95% confidence interval 0.8 to 2.9). Test–retest reliability was 0.89 for the paper version and 0.88 for the computer version. Internal consistency was considered to be good for both versions. The intraclass correlation coefficient for comparability was 0.77 (95% confidence interval 0.66 to 0.85), indicating substantial reliability between the two methods. Conclusion Both versions of the TSK-FIN demonstrated substantial intertest reliability, good test–retest reliability, good internal consistency and acceptable limits of agreement, suggesting their suitability for clinical use. However, subjects tended to score higher when using the computer version. As such, in an ideal situation, data should be collected in a similar manner throughout the course of rehabilitation or clinical research.

The aim of the study was to assess occupational exposure to bisphenol A in Finland. Five companies took part in the research project: two paint factories (liquid and powder paints), a composite product factory, a thermal paper factory, and a tractor factory. Exposure was assessed by measuring total bisphenol A excretion (free and conjugated) from urine samples, and its concentrations in the air. The results revealed the specific work tasks in two of five companies in which significant occupational exposure to bisphenol A may occur. In the manufacturing of liquid paint hardener, urine samples collected after the working day showed bisphenol A levels of up to 100-170 µg l-1. Workers in thermal paper manufacturing were also exposed to bisphenol A, especially those working in the manufacture of coating material and operating coating machines. Median concentrations of the post-shift urine samples of coating machine workers were in the range of 130-250 µg l-1. The highest bisphenol A concentrations were in the range of 1000-1500 µg l-1. Recommendations for more effective personal protection resulted in decreased exposure, particularly among coating machine operators. In the rest of the companies, urinary bisphenol A levels were typically in the range of those of the general population. Bisphenol A concentrations in air samples were typically low (

Increased ethoxyresorufin-O-deethylase (EROD) activity is a sensitive biomarker of exposure to the chemicals which activate the aryl hydrocarbon receptor (AhR) and induce the cytochrome P450 system, such as many polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs). Pulp bleaching was one of the main sources of PCDDs and PCDFs until elemental chlorine free (ECF) and total chlorine free bleaching processes since 1990s have remarkably decreased but not completely eliminate discharges of these chemicals. In addition, historically contaminated sediments may act as a source of these persistent contaminants. In this study, the contamination history and recovery of a watercourse heavily loaded by the chemical wood industry were studied by analyzing PCDDs, PCDFs and PCBs from vertical sediment samples and by measuring hepatic EROD activity from rainbow trout intraperitoneally dosed with the sediment extracts. No PCDDs or PCDFs were found above the chromatographic limit of detection from the study area and only small amounts of PCB congeners 101, 138, 153, and 180 were present. No increased EROD activity was observed in fish indicating the absence of any AhR-activating compounds in the surface sediment, to about 15 cm depth, representing about the last 20 years when kraft pulping and ECF bleaching with activated wastewater treatment have been used. It can be concluded that nowadays organochlorines and other AhR-ligands do not harm the previously heavily polluted watercourse.

Several Finish wallpapers from the 18th and 19th century were analysed by using Raman spectroscopy assisted with EDXRF instrumentation, in an attempt of determine the pigments used in their manufacture process as well as of trying to date some of the samples through pigment composition. All pigments present in samples were determined and surprisingly the unusual and strange iron (III) chromate yellow pigment was found. Besides, unusual mixtures were found to obtain fashionable colours, especially in blue and green areas, where more than one blue pigments were mixed with green and yellow pigments. Blue verditer, ultramarine blue, Prussian blue, chrome yellow, calcite, lead white, red and yellow iron oxide, gypsum and carbon black were identified. The presence of the risky and poisonous emerald green must be highlighted. The results were compared with those found in other wallpapers from Spain and France.

A number of high molecular weight (HMW) lignin derivatives possessing varied chemical properties were screened for their biological effects in order to obtain more information on the possible structural features of HMW lignin-related effects. The studied compounds were both commercial and in-house extracted lignin derivatives. Bioassays used include reverse electron transport (RET), Vibrio fischeri, Daphnia magna , and juvenile rainbow trout ( Oncorhynchus mykiss) hepatocytes. The studied lignin derivatives inhibited the in vitro systems and luminescence of V. fischeri bacteria to some extent–daphnids were not affected. It seems that, at least in the RET assay, certain pH-dependent functional groups in lignin may be of importance regarding the biological effects.

A five-stage sequential extraction procedure was used to determine the distribution of 11 metals (Cd, Cr, Cu, Mo, Pb, Zn, As, Co, V, Ni, Ba), and sulphur (S) in bottom ash and in fly ash from a fluidized bed co-combustion (i.e. wood and peat) boiler of Stora Enso Oyj Oulu Mill at Oulu, Northern Finland, into the following fractions: (1) water-soluble fraction (H2O); (2) exchangeable fraction (CH3COOH); (3) easily reduced fraction (NH2OH—HCl); (4) oxidizable fraction (H2O2 + CH3COONH 4); and (5) residual fraction (HF + HNO3 + HCl). Although metals were extractable in all fractions, the highest concentrations of most of the metals occurred in the residual fraction. From the environmental point of view, this fraction is the non-mobile fraction and is potentially the least harmful. The Ca concentrations of 29.3 g kg—1 (dry weight) in bottom ash and of 68.5 g kg— 1 (dry weight) in fly ash were correspondingly approximately 18 and 43 times higher than the average value of 1.6 g kg— 1 (dry weight) in arable land in Central Finland. The ashes were strongly alkaline pH (∼ 12) and had a liming effects of 9.3% (bottom ash) and 13% (fly ash) expressed as Ca equivalents (dry weight). The elevated Ca concentrations indicate that the ashes are potential agents for soil remediation and for improving soil fertility. The pH and liming effect values indicate that the ashes also have a pH buffering capacity. From the environmental point of view, it is notable that the heavy metal concentrations in both types of ash were lower than the Finnish criteria for ash utilization.

Conjugated resin acids (RAs) in fish bile are considered a sensitive chemical indicator of exposure to pulp and paper mill effluent, and were used in this study to monitor the post-spill situation of a lake area (Southern Lake Saimaa) contaminated by black liquor discharged from a mill in June 2003. From the exposure perspective of populations of wild roach and perch, which were studied for their bile RAs at four time periods (July 2003, September 2003, May 2004, July 2004), the exceptional event passed in 2 months or less. Perch had lower concentration of RAs in bile than roach in all sampling areas and all times. Besides the current emissions present in the water column, part of the exposure status of the roach population to RAs seemed to derive from historically contaminated sediments. In order to test this hypothesis, a laboratory experiment with perch and roach, along with three teleosts (rainbow trout, brown trout and whitefish), was conducted. The species were simultaneously exposed for 7 days to RAs (23 microg/l). We calculated a perch/roach-ratio to investigate the difference in origin of exposure between perch and roach populations in the wild and in the laboratory. One year after the spill, the perch/roach-ratio of bile RAs was 0.25 (CV 25%) at 1 km from the mill. This is in contrast to that found under the sole waterborne conditions (0.44; CV 24%), supporting the idea that sediments serve as an additional source of RAs in roach. Additionally, bioconcentration factor log BCF(bile(RA)) was calculated to assess hepatobiliary performance and the capacity to excrete RAs in fish.

Objectives: To assess the relation between exposure to carbonless copy paper (CCP), paper dust, and fumes from photocopiers and printers (FPP), and the occurrence of sick building syndrome (SBS)-related symptoms, chronic respiratory symptoms and respiratory infections. Methods: A population-based cross-sectional study with a random sample of 1016 adults, 21–63 years old, living in Pirkanmaa District in South Finland was conducted. This study focused on 342 office workers classified as professionals, clerks or administrative personnel according to their current occupation by the International Standard Classification of Occupations-88. They answered a questionnaire about personal information, health, smoking, occupation, and exposures in the work environment and at home. Results: In logistic regression analyses adjusting for age, sex and a set of other confounders, all three exposures were related to a significantly increased risk of general symptoms (headache and fatigue). Exposure to paper dust and to FPP was associated with upper respiratory and skin symptoms, breathlessness, tonsillitis and middle ear infections. Exposure to CCP increased the risk of eye symptoms, chronic bronchitis and breathlessness. It was also associated with increased occurrence of sinus and middle ear infections and diarrhoea. A dose–response relations was observed between the number of exposures and occurrence of headache. The risk of tonsillitis and sinus infections also increased with increasing number of exposures. All chronic respiratory symptoms, apart from cough, were increased in the highest exposure category (including all three exposures). Conclusions: This study provides new evidence that exposure to paper dust and to FPP is related to the risk of SBS symptoms, breathlessness and upper respiratory infections. It strengthens the evidence that exposure to CCP increases the risk of eye symptoms, general symptoms, chronic respiratory symptoms and some respiratory infections. Reduction of these exposures could improve the health of office workers.

Background: The role of admission blood glucose level on the prognosis of patients with intracerebral haemorrhage has not been elucidated. Objective: To examine this association on the basis of an epidemiologically representative patient material. Methods: 249 500 people living in the catchment area of the Central Hospital of Central Finland. The diagnosis of ICH was established if verified by cranial computed tomography (CT) or autopsy. Results: Of the 416 patients who fulfilled the diagnostic criteria, 30 died before admission and 386 were admitted to the Central Hospital. All 329 patients (290 nondiabetics and 39 diabetics) with both admission blood glucose and cranial CT data were included in the study. The mean blood glucose level was 10.6 mmol/l for nondiabetics who died on the day of onset, 8.6 mmol/l for those dying during days 1 to 28, and 6.8 mmol/l for the 28 day survivors. The corresponding figures for diabetics were 13.9 mmol/l, 12.5 mmol/l, and 9.3 mmol/l. In both nondiabetics and diabetics, patients who died had significantly higher mean glucose than the 28 day survivors (p

The global recession has forced the Finnish forest industry to carry out major restructuring activities. Employees have faced different kinds of restructuring, mainly aimed at reducing staff and production. Many studies have shown the negative consequences of restructuring on employee well-being by using negative, ill-health indicators. Our aim is to examine the extent to which change appraisal influences both the negative and positive aspects of work-related well-being among employees who continue working in the organization after the restructuring process. We also examine the role of different actors (top management, immediate supervisor, employees themselves) in how the change is appraised. The study investigated blue-collar employees working in the Finnish forest industry during a period of extensive transition (2008–2009). All six participating factories underwent restructuring between baseline and the follow-up survey (n=369). After adjustment for gender, age and baseline well-being, negative change appraisal increased the risk of experiencing more stress and less work enjoyment. Negative change appraisals thus also damaged the positive, motivational aspects of employee well-being. The results showed the importance of offering employees the opportunity to participate in the planning of changes related to their work as regards positive change appraisal.

Bisphenol A (BPA) has one of the highest production volumes of all chemicals worldwide. It has been widely studied because of its endocrine modulating activity. In addition to dietary intake, absorption of BPA via the skin from handling thermal papers is believed to be a relevant route of exposure. We studied BPA exposure via thermal paper receipts in simulation experiments performed by three volunteers, and examined urinary excretion of BPA. We also evaluated background BPA excretion among the Finnish working-age population. The geometric mean BPA excretion among non-occupationally exposed working-age Finns (n=121) was 2.6 μg/l, the range being 0.8-18.9 μg/l. The 95th percentile of the non-occupationally exposed people was 8 μg/l, and this was set as the reference limit for the non-occupationally exposed population. In the first simulation experiment, which was conducted under conditions representing the most likely exposure, i.e., the work of a cashier in a supermarket, BPA excretion remained below the reference limit in all participants. In the second simulation experiment, with more intensive, short-time handling of thermal paper (three times 5 min), urinary excretion also remained at or below background levels (highest value being 10.3 μg/l). The calculated maximum BPA excretion per day after handling thermal paper was less than 0.2 μg/kg of body weight, suggesting a total daily intake over 25 times lower than the European Food Safety Authority's (EFSA's) proposal for a temporary tolerable daily intake (temporary TDI) (5 μg/kg/day).

Caged common lake mussels (Anodonta piscinalis) have been used in the monitoring of organochlorine compounds in pulp and paper mill recipient watercourses of Finland annually from 1984 to 1998. Statistically significant decreasing trends of chlorophenols and chloroguaiacols originating from chlorobleaching were observed in all recipients in parallel with the decreasing discharges from the mills. Metabolites of chlorophenols, chloroanisoles and chloroveratroles had no or slightly increasing trends. Elevated PCB concentrations were measured in four watercourses. In two areas, PCBs were found to be significantly increasing, in two other cases they showed no trend. A mill producing recycled paper was apparently responsible for an increase of PCBs and DDE in recipient watercourses. Overall decreases were observed for other chlorohydrocarbons except for DDT. Material flows of chlorohydrocarbons were positively correlated with waterflows (Q) in some cases.

The authors assessed the health effects of emission reduction of malodorous sulfur compounds in a prospective cohort study with a controlled natural experiment. A total of 810 subjects (83%) participated in the follow up: 316 from the severely polluted, 306 from the moderately polluted, and 188 from the nonpolluted communities. In the severely polluted community, the annual ambient air concentration of total reduced sulfur compounds decreased from 11 microg/m3 to 6 microg/m3. Compared with the nonpolluted community, the relative decrease in acute respiratory infections, adjusted for a change in smoking habits, was 0.53 episodes/person-year (95% confidence interval = 0.22, 0.83) in the severely polluted community and 0.36 episodes/person-year (95% confidence interval = 0.06, 0.66) in the moderately polluted community. In addition, the frequency of nasal symptoms (p = .004) and cough (p = .037) decreased significantly. The results are consistent with the hypothesis that exposure to malodorous sulfur compounds increases the risk of acute respiratory infections and symptoms of the respiratory tract.

Juvenile whitefish (Coregonus lavaretus L. s.l.) were exposed by caging in the field to diluted effluents from three operating pulp, paper, and paperboard mills in Southern Lake Saimaa, Finland. The expression of the vitellogenin gene, used as a biomarker of estrogenic contamination of effluents, was measured using a Northern blotting method. Increased mRNA levels, the most specific and reliable evidence for estrogen receptor-mediated actions in vivo, were found in fish caged in the vicinity of one of three mills studied. This mill was found to discharge wood-derived compounds, such as sterols and resin acids, into Lake Saimaa in amounts considerably exceeding those from the other two mills. The increased vitellogenin gene expression suggests that the effluent is a source of estrogenic contaminants.

High molecular mass fractions of lignin and humic compounds in sediments and waters downstream of a pulp mill were characterized applying pyrolysis-gas chromatography-mass spectrometry. The results were compared to those obtained using reversed phase HPLC on the cupric oxide oxidation products. The chromatographic data of both pyrolysis and cupric oxide oxidation were also subjected to the principal component analysis (PCA). The sediment samples and fractions obtained by ultrafiltration of river water samples were freeze dried prior to characterization. The sediment samples were also extracted using 2 M sodium hydroxide solution. The extracts were ultrafiltrated, freeze dried and compared to the freeze dried original sediments using the procedures mentioned above. The amounts of HMMs obtained from the sediments ranged from 62 mg to 97 mg per one gram of sediment. Gel permeation chromatography was applied to samples obtained from sediments by extraction with tetrahydrofuran. The weight average molecular weights of these fractions were in the range of 1500–2300 amu.

Physiological and biochemical biomarker responses were studied in juvenile whitefish (Coregonus lavaretus L. s.l.) exposed experimentally to effluent from the forest industry. The large study area (609 km2), Southern Lake Saimaa, in Southeast Finland, receives 330,000 m3 d-1 of biologically and 55,000 m3 d-1 of chemically treated effluents, discharged from two integrated elementary chlorine free (ECF) bleached kraft pulp and paper mills, from one ECF pulp mill, and from one mill producing unbleached pulp and cardboard. The assessment of exposure to effluent discharged from the mills was based on lake water chlorophenolics (CPs) and resin acids (RAs) measured in samples collected from the 22 experimental sites along the area. Despite the low levels of effluent constituents in the lake, they were still accumulated in detectable levels in fish bile, indicating an exposure to the bioactive compounds of effluents. In comparison to the reference area, a two- to four-fold increase in ethoxyresorufin O-deethylase (EROD) activity was observed in whitefish exposed in the vicinity (1-6 km) of all the mills. However, cytochrome P450 1A1 (CYP1A1) gene expression was increased in only one of the receiving areas, indicating higher sensitivity of the EROD activity in the present study. There were no statistically significant correlations between EROD activity and the ambient water concentrations of the CPs, the RAs, or effluent dilution expressed by water sodium concentration. Neither bile chlorophenolics nor bile resin acids showed a significant correlation with EROD. No significant changes in circulating reproductive steroids, 17beta-estradiol and testosterone, in juvenile whitefish were observed. The vitellogenin gene was expressed in the vicinity of the pulp mill discharging the most wood-derived compounds, i.e. resin acids and wood-sterols, including beta-sitosterol. No differences were observed in plasma immunoglobulin M, glucose, or lactate concentrations between the effluent sources.

We assessed the role of long-term exposure to ambient air malodorous sulfur compounds released from pulp mills as a determinant of eye and respiratory symptoms and headache in children. Adverse health effects of environmental exposure to these compounds in children have not been reported previously. The parents of 134 children living in a severely polluted (n = 42), moderately polluted (n = 62) and rural nonpolluted (n = 30) community responded to a cross-sectional questionnaire. The response rate was 83%. The adjusted odds ratios (OR) for symptoms experienced during the previous 4 weeks and 12 months in the severely versus nonpolluted community were estimated in logistic regression analysis controlling for age and gender. The risk of nasal symptoms (4 weeks OR 1.40, 95% CI 0.59-3.31; 12 months OR 2.47, 95% CI 0.93-6.53), cough (4 weeks OR 1.83, 95% CI 0.75-4.45; 12 months OR 2.28, 95% CI 0.95-5.47), eye symptoms (12 months OR 1.15, 95% CI 0.43-3.05), and headache (12 months OR 1.77, 95% CI 0.69-4.54) was considerably increased in the severely polluted community, although not quite reaching statistical significance. The results suggest that exposure to malodorous sulfur compounds may affect the health of children.

Field experiments were conducted in early summer 2004 by caging brown trout (Salmo trutta m. lacustris) in Southern Lake Saimaa (SE Finland) for 10 days. Cages were positioned into two depths at four distances (5 to 17 km) from the pulp and paper mill; one set with direct contact to the sediment and other locating at the three meters' depth from the water surface. Resin acids were measured from sediment, water, and fish bile. Possible toxicities were investigated by measuring liver EROD-activity, HSP70-protein, and gene expression profiles by microarray. The concentration of resin acids in the sediment showed clear gradient along the distance from the mill, and their concentrations in water ranged approximately from one to 30 microg L(-1). In the trout bile, concentrations were higher near the surface than on the bottom, indicating the role of current releases as sources of resin acids. When compared to trout held upstream from the effluent source, no differences were found in liver EROD nor HSP70 in bottom cages. However, near surface, a slight but statistically significant increase in EROD and HSP70 was found. Altogether 145 genes were found to be differentially regulated at downstream sites when compared 10 km upstream from the mill. The numbers of genes at each site varied from 5 to 45 without consistent differences between bottom and surface cages. Overall, neither expression profiles nor composition of the transcription signatures made possible to conclude an overt toxicity in exposed brown trout.

The Bothnian Bay at Kemi, which is the northernmost basin of the Gulf of Bothnia in the Baltic Sea, is affected by effluents from point sources such as pulp and paper mills and municipal sewage plant. During the period 1988–2008, the accumulated values of effluent volume, BOD7, CODCr, Tot-P, Tot-N, TSS and AOX from these point sources fell considerably as follows: 1) effluent volume by 24%, BOD7 by 92%, CODCr by 74%, Tot-P by 79%, Tot-N by 38%, TSS by 76% and AOX by 93%. The decrease in the effluent loadings is due to the introduction of Best Available Techniques (BAT) for the production processes and wastewater treatment at the pulp and paper mills. According to the long-term monitoring program that has been carried out every third year between 1997–2009, the decreasing trend in EOX—concentrations in the top 2 cm of the bottom sediment reflects the decrease in organochlorine discharges (AOX) from the mills. In 1997, the EOX concentrations in bottom sediment varied between 3–70 μg of Cl g−1 (dry weight), and in 2009 between 1.2–31 μg of Cl g−1 (dry weight).

The paper mills in South Karelia, the southeast part of Finland, are responsible for releasing a substantial amount of malodorous sulfur compounds such as hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and methyl sulfides [(CH3)2S and (CH3)2S2], into ambient air. In the most polluted residential area the annual mean concentrations of hydrogen sulfide and methyl mercaptan are estimated to be 8 and 2 to 5 micrograms/m3 and the highest daily average concentration 100 and 50 micrograms/m3. The annual mean and highest daily concentrations of sulfur dioxide (SO2) are very low. We studied the effects of malodorous sulfur compounds on eye, nasal and respiratory symptoms, and headache in adults. A cross-sectional self-administered questionnaire was distributed in February 1987 and responded to by 488 adults living in a severely (n = 198), a moderately (n = 204), and a nonpolluted community (n = 86). This included questions about occurrence of the symptoms of interest during the previous 4 wk and 12 months and individual, behavioral, and other environmental determinants of the symptoms. The response rate was 83%. The odds ratios (OR) for symptoms experienced often or constantly in severely versus nonpolluted and moderately versus nonpolluted communities were estimated in logistic regression analysis controlling potential confounders. The odds ratios for eye (moderate exposure OR 11.70, Cl95% 2.33 to 58.65; severe exposure OR 11.78, Cl95% 2.35 to 59.09) and nasal symptoms (OR 2.01, Cl95% 0.97 to 4.15; OR 2.19, Cl95% 1.06 to 4.55) and cough (OR 1.89, Cl95% 0.61 to 5.86; OR 3.06, Cl95% 1.02 to 9.29) during the previous 12 months were increased, with a dose-response pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

From the utilization point of view, it is notable that the total element concentrations in the precipitated calcium carbonate (PCC) waste were significantly lower than the maximal allowable heavy metal concentrations for fertilizers used in agriculture and in forestry, set on the basis of the EU and Finnish legislation. The easily soluble Ca concentration of 168.5 g kg −1 (d.w.) in PCC waste was 105 times higher than the typical value of 1.6 g kg −1 (d.w.) in the coarse mineral soil in Finland indicates that the PCC waste is a potential agent for soil remediation and for improving soil fertility if it is used as fertilizer. According to a five-stage sequential extraction procedure, the highest concentrations of most of the elements occurred either in HF + HNO 3 + HCl or H 2 O 2 + CH 3 COONH 4 fraction. This means that the major part of the elements retained in the PCC waste are not easy to extract (leach) under conditions normally found in nature. This is beneficial since, if inorganic materials and by-products are utilized in earth construction, the content of harmful compounds must be low and the harmful components must be tightly bound to the matrix.

This work presents the current waste management system at the pulp and paper mill complex of Stora Enso Oyj Veitsiluoto Mills at Kemi, Northern Finland. This paper covers examples of case studies carried out at the mill and describes how the wastes and by-products are utilized as a neutralizing agent for acidic wastewaters (i.e., green liquor dregs from the causticizing process), as a hardener in filling mine cavities (i.e., ash from the fluidized bed boiler), as a landscaping agent (i.e., ash as well as the fibre clay from chemical wastewater treatment plant), as a hydraulic barrier material for landfills (i.e., fibre clay), and as a soil enrichment agent (i.e., calcium carbonate from the precipitated calcium carbonate plant). In addition, the wood waste from the wood-handling plant, sawmill, packaging pallet plant and from the groundwood mill, as well as the biosludge from the biological wastewater treatment plant, are all incinerated in the fluidized bed boiler for energy production. Due to effective utilization of the solid wastes generated at the mills, the annual amount of waste to be disposed of in the landfill has decreased between 1994 and 2004 from 42,990 to 6083 tonn (expressed as wet weight). The paper also gives an overview of the relevant European Union legislation on the forest industry and on waste management, as well as of the pulping process and of the generation of major solid wastes in the pulp and paper mills.

Objective: To compare the secular trends and geographical differences in the incidence of relapsing-remitting (RRMS) and primary progressive multiple sclerosis (PPMS) in Finland, and to draw inferences about aetiological differences between the two forms of the disease. Methods: New multiple sclerosis cases in southern Uusimaa and the western districts Vaasa and Seinajoki of Finland in 1979–1993 were verified from hospital records and classified into RRMS and PPMS. Patients met the Poser criteria for definite multiple sclerosis or otherwise satisfied the criteria for PPMS. Disease course was categorised by the same neurologist. Crude and age adjusted incidence in 1979–1993 was estimated. Results: During 1979–1993 the age adjusted incidence was 5.1 per 100 000 person-years in Uusimaa, 5.2 in Vaasa, and 11.6 in Seinajoki. The rates in Uusimaa remained stable, while a decrease occurred in Vaasa and an increase in Seinajoki. Between 1979–86 and 1987–93 the incidence of PPMS increased in Seinajoki from 2.6 to 3.7 per 105 and decreased in Vaasa from 1.9 to 0.2 per 105; the trends were similar for RRMS. Conclusions: There are significant differences in secular trends for multiple sclerosis incidence in Finland by geographical area, but these are similar for PPMS and RRMS. The recent changes point to locally acting environmental factors. The parallel incidence trends for RRMS and PPMS suggest similar environmental triggers for the two clinical presentations of multiple sclerosis.

The lack of landfill capacity, forthcoming EU waste disposal and landfill management legislation and the use of non-renewable and energy intensive natural resources for the end-treatment of old landfills increase pressures to develop new landfill management methods. This paper considers a method for the end-management of old landfills in Finland, which is based on the utilization of forest and paper industry waste flows, wastes from paper recycling (de-inking) and wastes from forest industry energy production. Fibre clay wastes from paper mills, de-inking sludges from de-inking of recovered waste paper and incineration ash from forest industry power plants serve to substitute the use of natural clay for the building of landfill structures for closed landfills. Arguably, this method is preferable to existing practices of natural clay use for landfill building, because it (1) substitutes non-renewable natural clay, (2) consumes less energy and generates less CO2 emissions than the use of natural clay, and (3) eliminates considerable amounts of wastes from paper production, paper consumption and from forest industry energy production. Some difficulties in the application of the method are considered and the waste flow utilization is incorporated into a local forest industry recycling network.

Extensive environmental effects of the forest industry led to implementation of activated sludge treatment of effluents in the 1980s. Although the existence of chlorinated compounds in the effluents has decreased, a discussion about the possible environmental effects of elemental-chlorine-free (ECF) and total-chlorine-free (TCF) bleached pulp mill effluents has arisen, and chronic effects on aquatic organisms have still been found. Recently, studies have mainly focussed on wood extractives and their role in the effects of effluents. Resin acids and unsaturated fatty acids are found to be toxic, and plant sterols are reported to have adverse endocrine effects on water organisms already at low concentrations. In this study, Finnish wastewater treatment plants of an ECF kraft pulp mill, a paper mill, and an integrated TCF kraft pulp and paper mill were sampled in order to ascertain how wastewater treatment plants, and especially activated sludge treatments, remove wood extractives. Concentrations of extractives in discharged wastewaters varied between 0.4 and 11 g/t kraft or mechanical pulp, and the concentrations decreased over 95% during the treatment processes. Of the wood extractives, 1.1-64% were adsorbed to biosludge and 35-99% were degraded or transformed to other forms during the activated sludge treatment. A major part of these compounds were discharged in particles (74-99%). The removal of extractives was efficient even in the effluent treatment plant, which was highly loaded during the sampling period.

The fish community in sublittoral and profundal waters, at stony shores, and densities of vendace larvae were studied in the southern Lake Saimaa, Finland. The objective was to investigate the possible recovery of fish populations after modernizations at the pulp and paper mills discharging into the lake. Sublittoral and profundal waters were studied by gill net trial fishings, stony shores by electrofishing, and vendace larvae by beach seine. The research area was divided in a polluted (0.5–4.0% effluent), an intermediate (0.1–0.5%) and a ‘clean’ reference area. The fish community in sublittoral and profundal waters in the lake was dominated (>60%) by perch and roach. Relative abundance of fish was highest in the polluted area, and lowest in the reference area. The number of species caught was similar among areas. The abundance of bleak and ruffe was highest in the polluted area, while the abundance of vendace and whitefish was highest in the intermediate and reference area. The fish fauna of stony shores in the lake was dominated by bullhead, stone loach and minnow, densities were lowest at polluted shores and highest in the intermediate area. Minnow, apparently a more sensitive species to pulp mill effluents, were not caught at the most polluted shores. The catch of vendace larvae was similar among areas, larvae were also caught in the vicinity of the mills. Compared with before the modernization at the mills, the relative abundance of perch in the polluted area was increased, ruffe decreased, while populations of whitefish and vendace showed signs of recovery. These changes may be explained by the reduced nutrient load and toxicicity of pulp mill effluents. At present, the fish community in the polluted area can be considered typical for a moderate eutrophication.

Lipophilic organic compounds originating from kraft pulping and papermaking were identified by straight gas chromatography/mass spectrometry (GC/MS) analyses. Samples analyzed included a primary clarifier effluent (PE) and a secondary clarifier effluent (SE) from the activated sludge treatment plant of a Finnish ECF-bleached (Elementally Chlorine Free) kraft pulp and paper mill. Liquid-liquid extraction composition of PE was compared with solid phase extraction (SPE) and dialysis of a semipermeable membrane device (SPMD) exposed to PE. Dichloromethane extracts of particulate material isolated from PE, sludges from both the primary and secondary clarifier, a sediment collected in the vicinity of the mill and whitefish subacutely exposed to the secondary treatment effluent were also investigated. Typical pulp mill-related compounds such as terpenes, terpenoids and aromatic compounds were identified in PE whereas these were non-detectable in SE. For example, thunbergene, thunbergol, squalene, longifolene and derivatives of abietic acid were observed in PE. Alkylated polycyclic aromatics were major compounds identified in the sediment sample with retene (C4-alkyl phenanthrene) as a predominant component.

An investigation was made of cytochrome P4501A (CYP1A) induction, determined by the activity of EROD (7-ethoxyresorufin O-deethylase), and formation of benzo[a]pyrene-diolepoxide-DNA (BPDE-DNA) adducts, measured by synchronous fluorescence spectrophotometry, in liver microsomes of perch (Perca fluviatilis), bream (Abramis brama), and roach (Rutilus rutilus). Fish were collected from the southern part of Lake Saimaa (Finland), an area polluted by effluents from the pulp and paper industry. In addition, two conjugation enzymes (UDP-glucuronosyltransferase and glutathione S-transferase) were determined. Overall, when compared to an upstream reference, EROD activity was higher in fish at waters downstream of the mill sewer. In bream EROD activity was threefold and in roach twofold. The changes in conjugation enzymes were not clearly related to the pollution gradient. The formation of BPDE-DNA adducts by liver microsomes was in correlation to both the pollution gradient and the EROD activity. This implies that CYP1A enzymes may play an important role in carcinogen activation in natural fish populations and that the formation capacity of DNA adducts may be a useful indicator when evaluating the potential toxicity of industrial water pollution.

Exposure to very low levels of ambient-air malodorous sulfur compounds and their effect on eye irritation, respiratory-tract symptoms, and central nervous system symptoms in adults were assessed. A cross-sectional self-administered questionnaire (response rate = 77%) was distributed during March and April 1992 to adults (n = 336) who lived in a neighborhood that contained a pulp mill and in a nonpolluted reference community (n = 380). In the exposed community, the measured annual mean concentrations of total reduced sulfur compounds and sulfur dioxide measured in two stations were 2 to 3 micrograms/m3 and 1 micrograms/m3, respectively. In the reference community, the annual mean concentration of sulfur dioxide was 1 micrograms/m3. The residents of the community near the pulp mill reported an excess of cough, respiratory infections, and headache during the previous 4 wk, as well as during the preceding 12 mo. The relative risk for headache was increased significantly in the exposed community, compared with the reference area: the adjusted odds ratio (aOR) was 1.83 (95% confidence interval [95% CI] = 1.06-3.15] during the previous 4 wk and 1.70 (95% CI = 1.05-2.73) during the preceding 12 mo. The relative risk for cough was also increased during the preceding 12 mo (aOR = 1.64, 95% CI = 1.01-2.64). These results indicated that adverse health effects of malodorous sulfur compounds occur at lower concentrations than reported previously.

We evaluated the acute health effects of a strong emission of malodorous sulfur compounds released from a pulp mill in South Karelia, Finland. The 24-hour ambient air concentrations of hydrogen sulfide for the two emission days were 35 and 43 micrograms/m3 (maximum 4-hour 135 micrograms/m3). A questionnaire was distributed after the high exposure and later after a low exposure period to 29 households with 75 subjects living in the nearby community. During the high exposure, 63% of the respondents reported experience of at least one symptom compared to 26% during the reference period. Every third participant reported difficulties in breathing. In the 45 subjects responding to both questionnaires more eye, respiratory and neuropsychological symptoms occurred during the exposure compared to the reference period. The strong malodorous emission from a pulp mill caused an alarming amount of adverse effects in the exposed population.

The results of various epidemiological research indicate that workers in the pulp and paper industry have an increased risk of developing and dying of malignant cancer with a specific location. The paper discusses recent studies in the area. The findings point to an increased risk of stomach cancer in workers occupationally exposed to pulp produced in the sulfite process. Workers making paper and cardboard are especially at risk for lung cancer. Some researchers signal a higher risk of lymphatic system cancer and stoma cancer. On the basis of existing data on exposure in the pulp and paper industry, it is impossible to determine the exact effects of exposure to a given compound or chemical. Assessment of exposure at particular work areas and analysis of data using the job exposure matrix is necessary. This should provide more information about cancerogenic compounds in the pulp and paper industry.

The risk of cancer of 152 male workers exposed to organic chlorine compounds formed during chlorine pulp bleaching was assessed in a retrospective cohort study. The men had worked continuously for at least one year in selected job categories between 1 January 1945 and 31 December 1961. The cohort was followed for death and cancer incidence until 31 December 1987 with the use of the data of the National Population Register and the Finnish Cancer Registry. There were 12 observed cancers against 8.1 expected [standardized incidence ratio (SIR) 1.5, 95% confidence interval (95% CI) 0.8-2.6]. Among the stock preparation workers (N = 53), a significantly elevated risk of lung cancer was found (6 observed, 1.0 expected, SIR 6.3, 95% CI 2.3-14) that was especially prominent after a latency (time since first employment) of at least 15 years and in the age group of 35 to 59 years. Although all of the cases involved smokers, a part of the increased incidence may be associated with the workplace exposure to organic chlorinated compounds.

The possible confounding caused by smoking was studied in connection with a mortality and cancer incidence study of 3,520 workers in the pulp and paper industry. A group 1,290 sawmill workers was used for comparison in addition to the expected numbers based on national statistics. A total of 801 questionnaires was sent to a representative sample of the workers, 537 to people still alive and 264 to the next-of-kin of decedents. The reply percentage was 86.6 for the former and 80.9 for the latter. The prevalence of smoking was determined for 1956 and 1981. The proportions of moderate and heavy smokers were assessed for 1981, and smoking indices were calculated for each occupational group. The estimated rate ratios for lung cancer in relation to smoking categories and the corresponding smoking-adjusted standardized incidence ratios were calculated for 1981, and they were compared with the observed standardized incidence ratios for lung cancer. The smoking habits could not explain the observed excess of lung cancer, nor the increased mortality from coronary heart disease found among the pulp and paper workers. Postal questionnaires may be a feasible tool for assessing smoking habits in retrospective cohort studies.

The cancer incidence of 3,545 workers in the Finnish pulp and paper industry was assessed in a retrospective cohort study. The cohort included workers with continuous employment of at least one year between 1 January 1945 and 31 December 1961 and was followed until 31 December 1980. Six subcohorts were formed (sulfite mill, sulfate mill, paper mill, board mill, maintenance department, and power plant). Separate analyses were made for the 2,597 workers hired after 1 January 1945. The smoking habits were surveyed. Among the men, 196 cases of primary cancer were detected versus 203.8 expected [standardized incidence ratio (SIR) 96, 95% confidence interval (95% CI) 82-114], and there were 47 cancer cases among the women versus 57.9 expected (SIR 91, 95% CI 60-108). Lung cancer occurred in 78 men (62.6 expected, SIR 125, 95% CI 98-155), and the excess was the most prominent for the male board mill workers (40 observed, 81.1 expected, SIR 222, 95% CI 158-302), particularly after 20 year's latency (25 observed, 7.8 expected, SIR 323, 95% CI 209-476). Analogous excesses of lung cancer occurred among the men (especially the male board mill workers) who began work after 1 January 1945. The findings were not explained by smoking habits.

We investigated survival of Klebsiella pneumoniae in freshwater, by determining bacterial densities at eight temperatures between 0 and 20 degrees C at various distances from the discharge area in a lake receiving bacteria mainly from a paper mill. An mFC-inositol-carbenicillin-agar medium was used for Klebsiella enumeration by the membrane filter method. About 90% of the bacteria forming typical colonies on this medium were identified as Klebsiella species. About 10% of the bacteria were false positive, and, an equal percentage were false negative. Semilogarithmic plots of bacterial densities as a function of distance were found to be linear, with slopes depending on water temperature. The average velocity of the flow was estimated from the travel-of-bacterial-density minima caused by production stops. Regression equations were calculated for the dependence of death rate on temperature alone and on both temperature and discharge. The temperature coefficient (Q10) of the death rate was estimated to be 2.1 +/- 0.4. The decimal reduction time (T90) of K. pneumoniae at 0 degrees C was calculated to be about 24 days, and that at 20 degrees C was slightly over 5 days. The regression model was verified by independent observations. Factors affecting the reliability of the estimates were evaluated.

An 8-year follow-up of workers exposed for at least 5 years to carbon disulfide showed an excess of deaths due to coronary heart disease in reference to a comparison cohort. However, after effective preventive measures, e.g., leaving only 19% of the original group exposed and reducing the level of exposure to less than 10 ppm, had been undertaken after the 5th year of follow-up, coronary mortality decreased and no excess mortality during the last 3 years of follow-up occurred. These results, although only suggestive -- due to the small number of deaths and the short time of follow-up after the intervention -- seem promising from the point of view of improving the prognosis of workers who have already accumulated an excess risk for coronary death.

Mortality among workers in the Finnish pulp and paper industry was evaluated in a retrospective cohort study of 3520 workers who had been employed continuously for at least one year between 1945 and 1961. Six subcohorts were formed according to six work areas: sulphite, sulphate, paper, and board mills, maintenance department, and power plant. National mortality rates were used for comparison. The mortality of a cohort of 1290 sawmill workers was also studied in order to have a socially, geographically, and occupationally similar group without the exposures typical of the pulp and paper industry for comparison. Smoking habits were surveyed. Mortality was followed up until 31 December 1981. Overall mortality for the entire cohort did not differ from that expected (1044 obs, 1029.4 exp, SMR 101), but there was an excess of deaths from diseases of the circulatory system among the men (489 obs, 404.9 exp, SMR 121). This was due to the excess of deaths from ischaemic heart disease found among the men at the sulphite, sulphate, and paper mills, maintenance department, and power plant, but not at the sawmill. The existing smoking data did not explain this finding and it may therefore be associated with occupational exposures.