Strategies to enhance the biological nitrogen removal of high-strength ammonium and low C/N landfill leachate with the SBR process.

The treatment of high ammonium-nitrogen concentration landfill leachate has become an increasing problem because of the requirements to reduce nutrient emissions. A laboratory-scale sequential batch reactor (SBR) was operated and tested in order to optimize the operational strategies of a cost-saving method to enhance the removal of ammonium-nitrogen from a real landfill leachate. Two sequence schemes were tested, one with long non-aerated/aerated sequences and another with short sequences. The air supply levels with low to intermediate dissolved oxygen (DO) and external carbon addition were altered. With both schemes a high ammonium reduction (> 99%) and a reasonable total nitrogen (TN) reduction (around 60%) could be achieved with strong carbon limitation (BOD7/N = 1.1). Chemical oxygen demand (COD) removal was lower with longer sequences. Denitrification via nitrite seemed to be an important part of TN removal, controlled with the low DO. With increasing nitrite accumulation COD/N removed decreased in both schemes indicating clearly a more efficient use of COD. The scheme with short sequences indicated advantages to save the air supply preventing nitrite oxidation under low air supply conditions and better TN and COD removal efficiencies. The results show that an applicable operational strategy can be found resulting in a reasonable pre-treatment option in landfills, requiring less carbon and aeration energy.

Cost-saving biological nitrogen removal from strong ammonia landfill leachate.

The aim of the study was to develop an improved management mode in Ämmässuo landfill (Finland) for leachate ammonium-nitrogen removal, to minimize the leachate management costs and secure compliance with the uptrend requirements of regulations for on-site leachate management. With a single sequential batch simulation reactor, the minimum C/N ratio was detected as 1.7 (adjusted by external carbon addition), to achieve the acceptable removal efficiency of 99, 62 and 74% in NH( 4)-N, total nitrogen and chemical oxygen demand, respectively. Both total nitrogen removal and efficiency of carbon use were correlated with an increasing NO(-) (2) /NO(-) (x) ratio indicating higher performance with denitrification via nitrite. It was estimated that the leachate management cost could be reduced by 28 to 38%.

Smoking cessation, decline in pulmonary function and total mortality: a 30 year follow up study among the Finnish cohorts of the Seven Countries Study.

BACKGROUND: Permanent smoking cessation reduces loss of pulmonary function. Less is known in the long term about individuals who give up smoking temporarily or quitters with lower initial pulmonary function. Little is known also about the relationship between decline in pulmonary function and mortality. We examined these aspects and the association between smoking, decline in pulmonary function, and mortality. METHODS: Two middle aged male Finnish cohorts of the Seven Countries Study and their re-examinations on five occasions during a 30 year period of follow up were analysed. RESULTS: During the first 15 years (n=1007) adjusted decline in forced expiratory volume in 0.75 seconds (FEV(0.75)) was 46.4 ml/year in never smokers, 49.3 ml/year in past smokers, 55.5 ml/year in permanent quitters, 55.5 ml/year in intermittent quitters, and 66.0 ml/year in continuous smokers (p<0.001 for trend). Quitters across the entire range of baseline FEV(0.75) had a slower decline in FEV(0.75) than continuous smokers. Among both continuing smokers and never smokers, non-survivors had a significantly (p<0.001) more rapid decline in FEV(0.75) than survivors. The adjusted relative hazard for total mortality was 1.73 (95% confidence interval (CI) 1.41 to 2.11) and 1.24 (95% CI 1.02 to 1.52) in the lowest and middle tertiles of decline in FEV(0.75). Never smokers, past smokers, and quitters had significantly lower total mortality than continuous smokers, partly because of their slower decline in FEV(0.75). CONCLUSION: These results highlight the positive effect of smoking cessation, even intermittent cessation, on decline in pulmonary function. Accelerated decline in pulmonary function was found to be a risk factor for total mortality. The beneficial effect of smoking cessation on mortality may partly be mediated through a reduced decline in pulmonary function.

Nurses' competence in advising and supporting clients to cease smoking: a survey among Finnish nurses.

The article describes the results of a survey of Finnish nurses (n = 882). The purpose of the study was to describe how nurses' education, working experience and their own smoking habits relate to their self-reported competence in advising and supporting clients to cease smoking. Nurses evaluated their skills fairly highly, but did not believe that advice alone was helpful to clients who wished to cease smoking. Nurses had minimal knowledge of smoking substitutes. Lower general education, a fairly short time from graduation and a history of smoking were positively related to nurses' competence to guide clients. Nurses who smoked daily were found to have better skills in giving advice and support than their non-smoking colleagues. The results have implications for the design of smoking cessation programmes. More education and guidance is required for nurses, so that they can develop their understanding and a positive view as to the effectiveness of smoking cessation programmes.

Work stress, smoking habits and competence in supporting clients to cease smoking--a survey among Finnish nurses.

This paper describes results of a survey of Finnish nurses (n=882), their views of themselves as employees, their experiences of work stress and their competence to guide clients in smoking cessation. Nurses' skills to guide clients were fairly good but they had a lack of knowledge of smoking cessation centers and nicotine substitutions. The more positive the nurses' views were of themselves as employees, and the less they had experienced work stress related to their clients, the better they evaluated their skills and knowledge to guide clients to cease smoking. The results can be used to develop nurse education by providing a stronger knowledge base of smoking cessation. Nurses' view of themselves as employees could be strengthened by providing them with positive feedback from colleagues and managers.

Pulmonary function, smoking cessation and 30 year mortality in middle aged Finnish men.

BACKGROUND: Although it is well known that impaired pulmonary function is a strong predictor of mortality and that smoking decreases pulmonary function, little is known about the long term effect of smoking cessation on mortality at different levels of pulmonary function. We have studied the impact of smoking cessation on mortality over the entire range of baseline pulmonary function. METHODS: The study subjects consisted of men aged 40-59 at entry who were the Finnish participants in the Seven Countries Study during 1959-89. RESULTS: In all the participants (n = 1582) impaired forced expiratory volume in 0.75 seconds (FEV(0.75)) was significantly associated with increased all cause mortality. When those who gave up smoking during the follow up period were compared with continuous smokers (n = 860) all cause mortality was found to be decreased among those who quit. The relative adjusted hazard (HR) was 0.71 (95% confidence interval 0.50 to 1.00). The median survival time in those who stopped smoking compared with those who continued to smoke from 1969 onwards was 7.65, 7.59, and 6.30 years longer in the lowest, middle and highest tertiles of adjusted FEV(0.75) distribution, respectively. In those who gave up smoking, mortality from cardiovascular causes was significantly lower (HR 0.60 (95% CI 0.37 to 0.98)). CONCLUSIONS: These findings suggest that smokers across the entire range of pulmonary function may increase their expectation of lifespan by giving up smoking.

Factors associated with early dropout from adolescent psychiatric outpatient treatment.

OBJECTIVE: To examine background factors, psychopathology, and psychosocial impairment among adolescents complying with or dropping out early from outpatient psychiatric treatment. METHOD: Family background, psychiatric history, and other data were collected prospectively on 143 male and 154 female outpatients aged 12 to 22 years. DSM-II-R psychiatric diagnoses were assessed at the end of treatment. RESULTS: Fifty-three adolescents (17.8%) attended 1 or 2 treatment appointments, and 33 of them (11.1% of 297) then dropped out; 50.5% of the total attended 3 to 13, and 31.6% attended 14 or more appointments. Low parental socioeconomic status was more common among the early dropouts than the other patient groups (88%, 69%, 63%, respectively). The early dropouts had had more problems with the law than the adolescents attending 14 or more appointments (18%, 6%), but less suicidal behavior (24%, 56%, respectively). Among the early dropouts, mood disorders were less common (21%, 49%), especially major depression (0%, 20%), and substance abuse was more common (9%, 0%) than among patients attending 14 or more appointments. CONCLUSIONS: Low parental socioeconomic status, not having mood disorder, not having psychotropic medication, and having substance abuse were associated with early dropout of adolescents from outpatient psychiatric treatment.

Relationships between family dynamics of Finnish child-rearing families, factors causing strain and received support.

The aim of this study was to determine the relationships between family dynamics, the factors causing strain on child-rearing parents and the support available to families from public health nurses. Family dynamics was defined as the family's unique way of functioning and was conceptualized by means of six different dimensions. Questionnaires were sent to 118 families, and of these 85 mothers and 79 fathers participated in the study. According to the findings the majority of parents involved in bringing up children aged 3-4 years assessed their families to be well-functioning. There was a correlation between a low level of factors causing strain on the family and a positive evaluation of family dynamics based on the various dimensions. According to the mothers the support, i.e. emotional, appraisal and instrumental support, received from public health nurses, along with a small number of strain-causing factors on the partner relationship, correlated well with their positive assessments of the mutuality and flexibility of their families.

Participation of expectant mothers in decision making in maternity care: results of a population-based survey.

The purpose of the study was to acquire knowledge of the opportunities that expectant mothers had to participate in decision making regarding their care in maternity clinics during their last pregnancy. The study is a part of a larger national survey 'Family planning services in Finland' carried out by the National Research and Development Centre for Welfare and Health. The rationale for the study were the known benefits of participation in one's care and its emphasis in health policy documents. The subjects were a random sample of women aged between 18 and 44. The response rate was 73% (n = 1289). The data were gathered by a mailed questionnaire and analysed statistically. According to the results mothers had fairly good opportunities to participate in decision making. However, there were statistically significant differences in opportunities between the women. The mothers who were most satisfied were aged 25-29 years, lived in a permanent relationship, had 12 years of basic education and had three children. Opportunities to participate in care have improved from the 1970s to the 1990s. The results have many implications for the development of nursing practice in maternity clinics and the deepening of the knowledge base in nursing education. The study, being the first national survey on this topic, also gives suggestions for further studies.

Disability pensions in severely disturbed in-patient adolescents. Twenty-year prospective study.

BACKGROUND: Knowledge of working capacity from adolescence until adulthood among severely disturbed in-patients is scarce. METHOD: In a follow-up study of 61 adolescent in-patients, we studied associations between being on a disability pension 20 years after hospitalisation, and the patients' psychopathology and treatment-related factors during the hospitalisation and seven-year follow-up. RESULTS: Of the former in-patients, 27% had not been on a disability pension, 20% had short-term pension periods, and 53% were pensioned. Subjects whose overall psychosocial functioning had improved and who had not utilised in-patient services until the seven-year follow-up, had a better prognosis in terms of working capacity. Half of the subjects who had not been on pension during the follow-up had received a diagnosis of conduct disorder at discharge, and half of those pensioned had a psychotic disorder. CONCLUSIONS: The patients' level of psychosocial functioning and capability to work in young adulthood were associated with long-term prognosis in terms of working capacity. Adolescence seems to be the critical time for intensive psychiatric care combined with vocational rehabilitation programmes.

[Critical thinking among nurses during unit-based quality assurance projects]. / Sairaanhoitajien kriittinen ajattelu hoitotyön laadunvarmistuksessa.

The purposes of this study were to describe the objectives and levels of critical thinking among nurses during unit-based quality assurance projects and the meaning of the participation for their own development and nursing practice. The data were collected by interviewing ten nurses who had taken part in the quality assurance projects. The themes used in interviews were created on the basis of two open questions answered by 28 nurses. The data were analysed by using qualitative content analysis and applying the levels of reflective thinking developed by Mezirow (1981), Goodman (1984) and Järvinen (1990). The first level of critical thinking was defined as technical thinking, the second level as reflective thinking and the third level as critical reflection. The results showed that nurses reflected the structural factors of the quality assurance on the technical level. When reflecting their own quality assurance processes (process factors) nurses used their critical thinking on all levels. Very few nurses considered the outcome factors of the quality assurance, but when they focused their thinking on the outcomes the reflection reached all levels. The nurses reflected the meaning of the quality assurance projects on all three levels. According to the nurses, the quality assurance enhanced their professional abilities as well as motivation in work and self-esteem. The quality assurance projects also clarified the principles guiding nursing practice. Interaction between nurses, patients and colleagues became more open.

Psychosocial functioning in adolescent psychiatric patients: a prospective study on changes in psychosocial functioning among severely and moderately impaired adolescent out-patients.

Changes in psychosocial functioning during out-patient treatment among 73 adolescent male and 100 female subjects, aged 12 to 19 years, were studied. The mean number of total treatment sessions was 15 sessions among the severely impaired and 14 sessions among the moderately impaired patients. The level of psychosocial functioning improved among the severely impaired (Global Assessment Scale (GAS) at treatment entry 3.9 vs. 4.7 at the last session, 95% CI, -1.085 to -0.577) and the moderately impaired patients (GAS 5.5 vs. 6.0, 95% CI, -0.682 to -0.355). The improvement was highly dependent on the psychiatric diagnosis. The level of psychosocial impairment improved in about two-thirds of subjects with adjustment and non-comorbid mood disorders, in about one-third of those with non-comorbid personality disorders, and in about a quarter of those with disruptive disorders. Careful diagnostic evaluation and assessment of psychosocial functioning are essential elements in the development of adolescent psychiatric services.

Characteristics of out-patient adolescents with suicidal tendencies.

Suicidal adolescent out-patients were compared with non-suicidal subjects with respect to background factors, psychopathology and treatment received. Data for suicidal ideation, suicide attempts, psychiatric diagnoses (DSM-III-R) and other patient-related factors were collected prospectively during treatment of 122 male and 138 female out-patients aged 12-22 years. In total, 42% of subjects displayed suicidal tendencies, and 18% had attempted suicide. According to polychotomous regression, mood disorder, previous psychiatric treatment and low level of psychosocial functioning at treatment entry were associated with suicide attempts and with suicidal ideation for both sexes. Suicidal patients were more often receiving psychotropic medication and had more total appointments (mean number 15 vs. 9) than non-suicidal patients. Suicidal and non-suicidal patients kept their scheduled appointments to the same extent (66% vs. 65%). Treatments which meet the needs of disordered suicidal adolescents need to be developed.

Excess mortality among former adolescent male out-patients.

Mortality among 156 males and 122 females referred to an out-patient adolescent psychiatric clinic in a Finnish town between 1984 and 1989 was examined. During the follow-up (mean duration 6 years; range 0-6.3 years for the deceased, 0.6-10.3 years for the survivors), 16 male subjects but no females had died. Among those who had died, the mode of death was suicide in 11 cases. The mortality for any cause for males was 10.3% and that for suicide was 7.1%. All male victims had similar high levels of individual and familial disturbances. Current suicidal ideation and suicide attempts, poor psychosocial functioning and a recommendation for psychiatric hospital treatment during the index treatment were associated with male mortality/suicidality. A high risk for mortality for several years after psychiatric treatment was found. It is concluded that, in clinical settings, perceived current suicidal tendencies should be assessed carefully.

Cocaine increases circulating levels of atrial natriuretic peptide and pro atrial natriuretic peptide N-terminal fragment in conscious rats.

We examined the effects of intravenously administered cocaine (1 and 3 mg/kg) on haemodynamics (mean arterial pressure, heart rate and right atrial pressure), plasma immunoreactive atrial natriuretic peptide (immunoreactive ANP) and immunoreactive N-terminal peptide of proANP (immunoreactive N-terminal ANP) in conscious, chronically cannulated Sprague-Dawley rats. The direct effect of cocaine (10(-6)-10(-4) M) was also studied in primary cultures of neonatal rat cardiac ventricular myocytes. Intravenous injection of 1 mg/kg or 3 mg/kg of cocaine caused an immediate peak rise in mean arterial pressure (1 mg/kg: 44 +/- 3 mm Hg, n = 8; 3 mg/kg 49 +/- 2 mm Hg, n = 12), which was followed by a dose-dependent sustained pressor response. The right atrial pressure rose simultaneously and 10-20 s later heart rate decreased. Plasma immunoreactive ANP levels increased significantly (1 mg/kg: 56 +/- 10 pmol/1; n=8; 3 mg/kg: 130 +/- 54; n = 12) and also immunoreactive N-terminal ANP levels rose significantly 2 min after the injection of the higher cocaine dose (230 +/- 27 pmol/l, n = 12). Significant correlations between plasma immunoreactive ANP levels and all haemodynamic variables were found, especially between mean arterial pressure and plasma immunoreactive ANP levels (r = 0.86, P < 0.001). In neonatal rat ventricular myocyte cultures, the highest concentration of cocaine (10(-4) M) reduced ANP release into the incubation medium (-41 +/- 14%, n = 5) but the reduction was not statistically significant. Our results show that cocaine dose dependently increases ANP and N-terminal ANP secretion into the circulation in conscious rats and that this increase is mediated by haemodynamic changes. Thus, plasma ANP and N-terminal ANP levels could be used as markers for acute cocaine-induced cardiac toxicity.

Project plan for studies on suicide, attempted suicide, and suicide prevention.

Completed and attempted suicide are major public health problems in most western countries. The importance of suicidal behavior as a health problem, particularly among adolescents and young adults, has been emphasized by the European Union, the WHO (Europe), as well as the Finnish authorities. Due to the exceptionally high suicide mortality, suicide prevention has been one of the main targets of Finnish health policy since the late 1980s. However, to develop feasible strategies for suicide prevention, better knowledge of the phenomenon of self-destruction is necessary. The Department of Mental Health of the National Public Health Institute has been actively involved in suicide research and the development of suicide strategies both in Finland and western Europe since 1986. The success is based on a long tradition of suicide research in Finland, the representative and reliable suicide data, a highly motivated research group, and also the necessary economic support by both the National Public Health Institute and the Finnish Academy. This article outlines our groups research plan for the next few years.

Nursing quality assurance in Finland.

Explicit quality assurance efforts in nursing in Finland began over 15 years ago. Nurses have taken the lead for initiating projects and standards, better abilities and awareness of the nature and variations of quality, and the factors associated with it. The Finnish Federation of Nurses (FFN) has been a facilitator, having organized five-day training courses and a support network to set off activities by local associations.