IN DUBIO PRO NATURA? A Philosophical Analysis of the Precautionary Principle in Environmental and Health Risk Governance

In this book, I apply a philosophical approach to study the precautionary principle in environmental (and health) risk decision-making. The principle says that unacceptable environmental and health risks should be anticipated, and they ought to be forestalled before the damage comes to fruition even if scientific understanding of the risks is inadequate. The study consists of introductory chapters, summary and seven original publications which aim at explicating the principle, critically analysing the debate on the principle, and constructing a basis for the well-founded use of the principle. Papers I-V present the main thesis of this research. In the two last papers, the discussion is widened to new directions. The starting question is how well the currently embraced precautionary principle stands up to critical philosophical scrutiny. The approach employed is analytical: mainly conceptual, argumentative and ethical. The study draws upon Anglo-American style philosophy on the one hand, and upon sources of law as well as concrete cases and decision-making practices at the European Union level and in its member countries on the other. The framework is environmental (and health) risk governance, including the related law and policy. The main thesis of this study is that the debate on the precautionary principle needs to be shifted from the question of whether the principle (or its weak or strong interpretation) is well-grounded in general to questions about the theoretical plausibility and ethical and socio-political justifiability of specific understandings of the principle. The real picture of the precautionary principle is more complex than that found (i.e. presumed) in much of the current academic, political and public debate surrounding it. While certain presumptions and interpretations of the principle are found to be sound, others are theoretically flawed or include serious practical problems. The analysis discloses conceptual and ethical presumptions and elementary understandings of the precautionary principle, critically assesses current practices invoked in the name of the precautionary principle and public participation, and seeks to build bridges between precaution, engagement and philosophical ethics. Hence, it is intended to provide a sound basis upon which subsequent academic scrutiny can build.

The effectiveness of vocationally oriented multidisciplinary rehabilitation (ASLAK®) amongst public sector employees

In Finland, vocationally oriented medical rehabilitation (ASLAK®) is a common preventive rehabilitation measure with the primary goal of preserving and improving work ability. The ASLAK® programme has been used for almost 30 years, although limited data exist on its effectiveness. The aims of this study were to determine whether the increased risk of work disability predicts the participants’ likelihood to be granted ASLAK® rehabilitation and to assess the effectiveness of the programme in decreasing the risk of work disability and modifying health-risk behaviours. This study is a part of the on-going Finnish Public Sector Study conducted by the Finnish Institute of Occupational Health. Data on 53 416 employees (81% women) were gathered from employers’ records, national health registers and repeated survey responses. During the 5-year follow-up, increased levels of the risk factors for work disability did not predict participation in the rehabilitation programme. During the 2.8-year followup (range 0.04–5.0 years), the risk of long-term work disability (sick leave >90 days or retirement) overall or, more specifically, due to musculoskeletal or mental diseases did not differ between the rehabilitants who participated in ASLAK® in 1997–2005 and their propensity score matched controls. There was no evidence of ASLAK® being effective in changing participants’ health-risk behaviours or in improving perceived general or mental health. The results suggest that potential participant recognition, mainly taking place in occupational health care, may fail to identify those with a higher risk of work disability. No evidence on the effectiveness of the programme was found in the study cohort when measured by the selected indicators.

Prionitautien eläintauti- ja elintarvikeriski

Summary: Animal and veterinary public health risk of prion diseases

Lihantuotannossa käytettävien kasvunedistäjien käyttö ja mahdolliset terveysvaikutukset ihmisissä

Summary: The use of growth promoters in meat production and their potential health effects for human

Organofosforiyhdisteille (TBEP ja TEHP) altistuminen työpaikoilla

Työssä mitattiin työilman TBEP- ja TEHP-pitoisuuksia siivousalalla (3 kohdetta) ja muovituoteteollisuudessa (2 kohdetta). Pitoisuutta ilmassa verrattiin työntekijöidenbiomonitorointinäytteistä analysoitujen 2-butoksietikkahapon (2-BAA) ja 2-etyyliheksaanihapon (2-EHA) pitoisuuteen. Tavoitteena oli biomonitoroin-timenetelmän soveltuvuuden selvittäminen altistumisen arvioinnissa sekä tarvittavien lisäsuojaus- ja torjunta-tarpeiden selvittäminen. Biomonitorointia sekoittavien tekijöiden (2-butoksietanoli ja 2-etyyli-1-heksanoli) pitoisuus mitattiin työntekijöidenhengitysilmasta kerätystä VOC-näytteestä. OVS-keräimiin kerätyt TBEP- ja TEHP-näytteet uutettiin ultraäänellä sopivalla liuottimella ja analysoitiin kaasukromatografisesti (GC). VOC-näytteet kerättiin Tenax GR ¿adsorbenttiin, irrotettiin keräimestä termodesorptiolla ja analysoitiin GC:lla. Biomonitorointinäytteiden (virtsa) 2-BAA- ja 2-EHA -pitoisuus analysoitiin myös GC:lla. Lattianvahauksen aikana siivoojien hengitysilmasta mitatuissa TBEP-näytteissä pitoisuudet vaihtelivat välillä 70 - 860 ng/m3 sekä VOC-näytteistä 88 %:sta löytyi2-butoksietanolia, jonka pitoisuus vaihteli välillä 3 - 1800 µg/m3. Virtsan 2-BAA:n pitoisuudet vaihtelivat välillä <0,3 - 26 mmol/mol kreatiniinia ollen korkeimmillaan 43 % toimenpiderajasta. Raskaana olevien toimenpideraja ylitettiin 30 % näytteistä. Muovituotetehtaissa TEHP-pitoisuus työntekijöiden hengitysilmassa oli alle määritysrajan (eli < 1 - < 3 ng/m3). Muovituotetehtaissa kerätyistä VOC-näytteistä 16 %:sta löydettiin 2-etyyli-1-heksanolia, jonka pitoisuus vaihteli välillä 90 - 100 µg/m3. Virtsan 2-EHA-pitoisuudet olivat välillä <0,1 - 0,2 mmol/mol kreatiniinia. Tulosten perusteella siivoojat altistuvat TBEP:lle ja 2-butoksietanolille lattianvahauksen yhteydessä, muttaaltistuminen ei ilman pitoisuuksien ja biomonitoroinnin tulosten mukaan aiheutaterveyshaittaa ainakaan yhden mahdollisen metaboliitin 2-BAA:n kautta. Pois lukien raskaana olevat työntekijät, joille 2-butoksietanolia sisältävän vahanpoistotuotteen käsitteleminen aiheuttaa mahdollista terveyshaittaa. Käytetyillä biomonitorointimenetelmillä ei voitu osoittaa altistumista tapahtuneen mitatuilla TBEP:n ja TEHP:n pitoi-suustasoilla. Metaboliareittien varmistamisen jälkeen on mahdollista tutkia toimivampaa menetelmää altistumisen arviointiin biomonitoroinnin avulla. Työntekijöiden suojautuminen niin muovituotetehtaissa kuin siivoustyössäkin mitattujen yhdisteiden osalta oli pääosin riittävää. Ainoastaan raskaana olevien työntekijöiden, jotka siivoustyössään altistuvat 2-butoksietanolille, suojaukseen tulisi kiinnittää huomiota.

Interactions between Polyunsaturated Fatty Acids and Probiotics

The prevalence of inflammatory based diseases has increased in industrialized countries over the last decades. For allergic diseases, two primary hypotheses have been proposed to explain this phenomenon, namely the hygiene and dietary evolution based hypothesis. Particularly, the reduced early exposure to microbes and an increase in the amount of polyunsaturated fatty acids (especially n-6 PUFA) in the diet have been discussed. Often, these two factors have been studied independently, even though both factors have been shown to possess potential health benefits and their mode of action to share similar mechanisms. The hypothesis of the present study was that demonstrate that PUFA and probiotics are not separate entities as such but do interact with each other. In the present study, we investigated whether maternal diet and atopic status influence the PUFA composition of breast milk and serum fatty acids of infants, and whether the fatty acid absorption and utilization of infant formula fatty acids is affected by supplementation of infant formula with probiotic bacteria (Lactobacillus GG and Bifidobacterium lactis Bb-12). Moreover, we investigated the mechanisms by which different PUFA influence the physicochemical and functional properties of probiotics as well as functionality of epithelial cells in vitro. We demonstrated a carry-over effect of dietary fatty acids from maternal diet via breast milk into infants’ serum lipid fatty acids. Our data confirmed the previously shown allergy –related PUFA level imbalances, though it did not fully support the impaired desaturation and elongation capacity hypothesis. We also showed that PUFA incorporation into phospholipids of infants was influenced by probiotics in infant formula in a strain dependent manner. Especially,Bifidobacterium lactis Bb-12 in infant formula promoted the utilization of n-3 PUFA. Mechanistically, we demonstrated that probiotics (Lactobacillus GG, Lactobacillus casei Shirota and Lactobacillus bulgaricus) did incorporate and interconvert exogenous free PUFA in the growth medium into bacterial fatty acids strain and PUFA dependently. In general, high concentrations of free PUFA inhibited the growth and mucus adhesion of probiotics, whereas low concentrations of specific long chain PUFA were found to promote the growth and mucus adhesion of Lactobacillus casei Shirota. These effects were paralleled with only minor alterations in hydrophobicity and electron donor – electron acceptor properties of lactobacilli. Furthermore, free PUFA were also demonstrated to alter the adhesion capacity of the intestinal epithelial cells; n-6 PUFA tended to inhibit the Caco-2 adhesion of probiotics, whereas n-3 PUFA had either no or minor effects or even promote the bacterial adhesion (especially Lactobacillus casei Shirota) to PUFA treated Caco-2 cells. The results of this study demonstrate the close and bilateral interactions between dietary PUFA and probiotics. Probiotics were shown to influence the absorption and utilization of dietary PUFA, whereas PUFA were shown to alter the functional properties of both probiotics and mucosal epithelia. These findings suggest that a more thorough understanding of interactions between PUFA and intestinal microbiota is a prerequisite, when the beneficial effects of new functional foods containing probiotics are designed and planned for human intervention studies.

Terveyskorttiprojektin kustannusvaikuttavuuden arviointi

Tämän kandidaatintyön lähtökohtana oli selvittää Helsingin kaupungin Terveysasemaosaston Terveyskorttiprojektin aikana toteutetun pilotin taloudellisuutta ja vaikuttavuutta rinnakkaispalveluna. Kirjallisuuskatsauksen tavoitteena oli selvittää millaisilla metodeilla kustannusvaikuttavuutta voidaan analysoida terveydenhuollossa. Lisäksi tavoitteena oli selvittää kyseisen projektin kustannusten suhdetta palvelun vaikuttavuuteen, eli muutoksiin asiakkaiden terveystottumuksissa. Keskeisimpiä kustannusvaikuttavuuden arviointimenetelmiä terveydenhuollossa ovat kustannusten minimointianalyysi (KMA), kustannus-hyötyanalyysi (KHA), kustannus-vaikuttavuusanalyysi (KVA) ja kustannus-utiliteettianalyysi (KUA). Käytännön päätöksenteon analyyttinen mallintaminen empirian- ja näyttöön perustuvan tiedon pohjalta osoittautui kirjallisuuskatsauksessa myös päteväksi tavaksi arvioida palveluiden vaikuttavuutta. Terveyskorttiprojektin suurimmat kustannussäästöt, verrattuna perinteiseen vastaanotto-malliin, muodostuivat verkkopalvelun seulontavaiheessa. Terveyden edistämisen osa-alueisiin painonhallinta, liikunta ja ravitsemus palvelu soveltui hyvin. Palvelun käytettävyyden kehittämishaasteiksi muodostuivat tulosten perusteella tekniset ongelmat, vuoro-vaikutuksen puute ja asiakkaan oman motivaation löytyminen.

Ampumaratojen kunnostustarpeen selvittäminen

Suomessa arvioidaan olevan kaikkiaan 2000 - 2500 ampumarataa joista aktiivisessa käytössä on noin 1000 kpl. Useimmat ulkoradat on perustettu paljon ennen nykyisten ympäristölakien voimaantuloa. Tästä syystä ammunnan ympäristövaikutukset melua lukuun ottamatta, eivät varmaan ole olleet tarkasteltavien asioiden listan kärjessä ampumaratoja suunniteltaessa. Sopivan maa alueen saatavuus sopivalla paikalla rakennuskustannusten minimoimiseksi on täytynyt olla yksi tärkeimmistä kriteereistä. Joissakin tapauksissa tämä valitettavasti on johtanut siihen, että ratojen paikoiksi on valittu sellaisia, mitä tämän päivän tietämyksellä ei suositeltaisi, kuten esimerkiksi pohjaveden muodostumisalueet. Ampumaratojen, etenkin haulikkoratojen, on todettu aiheuttaneen paikallisesti varsin laajaa maaperän pilaantumista. Toiminnan jatkuessa, runsaasti raskasmetalleja kertyy maahan ja taustapenkkoihin josta se rapautuu ja kulkeutuu alueelta pohjavesiin. Pohjaveden mukana haitta-aineet saattavat kulkeutua vedenpuhdistamoihin muodostaen riskiä paikallisasukkaiden terveydelle sekä jossain määrin alueen kasvillisuudelle ja faunalle. Vuoden 2007 valtioneuvoston PIMA-asetus muutti joitakin ohje-arvoja, joten näitä uusia arvoja on otettavaa huomioon niin riskiarvioinnissa kuin alueen käyttömahdollisuuksien kannalta tulevaisuudessa. Asetuksen voimaantulo edellyttää tapauskohtaisten riskiarviointien tekemistä ampumarata-alueiden kunnostuksen yhteydessä jolloin saavutetaan mahdollisemman tehokasta hyöty-kustannustasoa. Tutkimuksen tarkoituksena on kartoittaa uuden asetuksen mukaisesti ampumaratojen muodostamaa riskiä sekä rajata kunnostettavat alueet ja valita sopivammat kunnostusvaihtoehdot. Esimerkkitapauksina käytetään Kokkolan kaupungin alueella sijaitsevaa ampumarata-aluetta.

Geochemistry and water quality of Lake Qarun, Egypt

Water geochemistry is a very important tool for studying the water quality in a given area. Geology and climate are the major natural factors controlling the chemistry of most natural waters. Anthropogenic impacts are the secondary sources of contamination in natural waters. This study presents the first integrative approach to the geochemistry and water quality of surface waters and Lake Qarun in the Fayoum catchment, Egypt. Moreover, geochemical modeling of Lake Qarun was firstly presented. The Nile River is the main source of water to the Fayoum watershed. To investigate the quality and geochemistry of this water, water samples from irrigation canals, drains and Lake Qarun were collected during the period 2010‒2013 from the whole Fayoum drainage basin to address the major processes and factors governing the evolution of water chemistry in the investigation area. About 34 physicochemical quality parameters, including major ions, oxygen isotopes, trace elements, nutrients and microbiological parameters were investigated in the water samples. Multivariable statistical analysis was used to interpret the interrelationship between the different studied parameters. Geochemical modeling of Lake Qarun was carried out using Hardie and Eugster’s evolutionary model and a model simulated by PHREEQC software. The crystallization sequence during evaporation of Lake Qarun brine was also studied using a Jänecke phase diagram involving the system Na‒K‒Mg‒ Cl‒SO4‒H2O. The results show that the chemistry of surface water in the Fayoum catchment evolves from Ca- Mg-HCO3 at the head waters to Ca‒Mg‒Cl‒SO4 and eventually to Na‒Cl downstream and at Lake Qarun. The main processes behind the high levels of Na, SO4 and Cl in downstream waters and in Lake Qarun are dissolution of evaporites from Fayoum soils followed by evapoconcentration. This was confirmed by binary plots between the different ions, Piper plot, Gibb’s plot and δ18O results. The modeled data proved that Lake Qarun brine evolves from drainage waters via an evaporation‒crystallization process. Through the precipitation of calcite and gypsum, the solution should reach the final composition "Na–Mg–SO4–Cl". As simulated by PHREEQC, further evaporation of lake brine can drive halite to precipitate in the final stages of evaporation. Significantly, the crystallization sequence during evaporation of the lake brine at the concentration ponds of the Egyptian Salts and Minerals Company (EMISAL) reflected the findings from both Hardie and Eugster’s evolutionary model and the PHREEQC simulated model. After crystallization of halite at the EMISAL ponds, the crystallization sequence during evaporation of the residual brine (bittern) was investigated using a Jänecke phase diagram at 35 °C. This diagram was more useful than PHREEQC for predicting the evaporation path especially in the case of this highly concentrated brine (bittern). The predicted crystallization path using a Jänecke phase diagram at 35 °C showed that halite, hexahydrite, kainite and kieserite should appear during bittern evaporation. Yet the actual crystallized mineral salts were only halite and hexahydrite. The absence of kainite was due to its metastability while the absence of kieserite was due to opposed relative humidity. The presence of a specific MgSO4.nH2O phase in ancient evaporite deposits can be used as a paleoclimatic indicator. Evaluation of surface water quality for agricultural purposes shows that some irrigation waters and all drainage waters have high salinities and therefore cannot be used for irrigation. Waters from irrigation canals used as a drinking water supply show higher concentrations of Al and suffer from high levels of total coliform (TC), fecal coliform (FC) and fecal streptococcus (FS). These waters cannot be used for drinking or agricultural purposes without treatment, because of their high health risk. Therefore it is crucial that environmental protection agencies and the media increase public awareness of this issue, especially in rural areas.