Occupa ional Medicine 2016;66:241–246
Ad ance Access publica ion 8 Decembe 2015 doi:10.1093/occmed/kq 197
© The Au ho 2015. Published by Ox o d Uni e si y P ess on behal o he Socie y o Occupa ional Medicine.
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Cause-speci ic mo ali y in Finnish e och omium
and s ainless s eel p oduc ion wo ke s
M.Hu inen1 and E.Pukkala2,3
1Ou okumpu Oyj, PO Box 140, FI-02201 Espoo, Finland, 2Finnish Cance Regis y, Ins i u e o S a is ical and Epidemiological
Cance Resea ch, Unioninka u 22, FI-00130 Helsinki, Finland, 3School o Heal h Sciences, Uni e si y o Tampe e, FI-33014
Tampe e, Finland.
Co espondence o: M.Hu inen, Ou okumpu Oyj, PO Box 140, FI-02201 Espoo, Finland. Tel:+358 9 4212450; e-mail:
[email p o ec ed]
Backg ound Al hough s ainless s eel has been p oduced o mo e han a hund ed yea s, exposu e- ela ed mo al-
i y da a o p oduc ion wo ke s a e limi ed.
Aims To desc ibe cause-speci ic mo ali y in Finnish e och omium and s ainless s eel wo ke s.
Me hods We s udied Finnish s ainless s eel p oduc ion chain wo ke s employed be ween 1967 and 2004,
om ch omi e mining o cold olling o s ainless s eel, di ided in o sub-coho s by p oduc ion uni s
wi h speci ic exposu e pa e ns. We ob ained causes o dea h o he yea s 1971–2012 om S a is ics
Finland. We calcula ed s anda dized mo ali y a ios (SMRs) as a ios o obse ed and expec ed
numbe s o dea hs based on popula ion mo ali y a es o he same egion.
Resul s Among 8088 wo ke s s udied, o e all mo ali y was signi ican ly dec eased (SMR 0.77; 95% con i-
dence in e al [CI] 0.70–0.84), la gely due o low mo ali y om diseases o he ci cula o y sys em
(SMR 0.71; 95% CI 0.61–0.81). In ch omi e mine, s ainless s eel mel ing shop and me allu gical
labo a o y wo ke s, he SMR o ci cula o y disease was below 0.4 (SMR 0.33; 95% CI 0.07–0.95,
SMR 0.22; 95% CI 0.05–0.65 and SMR 0.16; 95% CI 0.00–0.90, espec i ely). Mo ali y om
acciden s (SMR 0.84; 95% CI 0.67–1.04) and suicides (SMR 0.72; 95% CI 0.56–0.91) was also
lowe han in he e e ence popula ion.
Conclusions Wo king in he Finnish e och omium and s ainless s eel indus y appea s no o be associa ed wi h
inc eased mo ali y.
Key wo ds Cause-speci ic mo ali y; e och omium; Finland; hexa alen ch omium; molybdenum; nickel;
occupa ional exposu e; s ainless s eel; i alen ch omium.
In oduc ion
The Finnish e och omium and s ainless s eel p oduc-
ion chain is unique. All uni s a e in he same geog aphic
a ea and owned by he same company ( he only p oduce
o s ainless s eel in Finland). Va ious me allu gical spe-
cies o ch omium a e encoun e ed in wo kplace ai a
di e en s ages o p oduc ion, om ch omi e o e mining
o cold olling o s ainlesss eel.
Mos wo ke s who joined he company in he 1960s,
70s and 80s belonged o he i s gene a ion o p o es-
sionals in mining and me allu gical p oduc ion. The
annual u no e a e o wo ke s was abou 2–4% so i is
possible o ollow he same sub-coho s wo king in he
same depa men s o e  ime.
No ad e se long- e m espi a o y heal h e ec s ha e
been obse ed in p e ious s udies o Finnish e och o-
mium and s ainless s eel p oduc ion [1,2]. O e all can-
ce incidence was no ele a ed and lung cance isk was
dec eased by abou 20% [3]. Ea lie s udies o e och o-
mium and s ainless s eel indus y wo ke s [4–8] ha e no
ound signi ican ly ele a ed mo ali y bu hese s udies
we e ela i ely small. In a Swedish s udy [8], he e was a
signi ican inc ease in mo ali y caused by acciden s and
iolence in sho - e m wo ke s.
In e och omium and s ainless s eel p oduc ion, ine
and ul a ine pa icles may be gene a ed in he smel -
ing and mel ing p ocesses and emi ed om diesel-pow-
e ed ehicles. Long- e m exposu e o ine pa icula e
ai pollu ion is associa ed wi h ca dio ascula mo ali y
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242 OCCUPATIONAL MEDICINE
p obably due o pulmona y and sys emic in lamma ion
and accele a ed a he oscle osis [9–11].
Acco ding o ea lie exposu e s udies a Ou okumpu
To nio Wo ks ( he Finnish s ainless s eel p oduc ion
company), he median pe sonal wo kplace ai concen-
a ion o C 6+ in he e och omium smel e was below
he de ec ion limi o he me hod (0.5µg/m3, maximum
2.4 µg/m3) [12]. In an analysis using a ield emission
scanning elec on mic oscope, he ae osols om he e -
och omium smel e we e obse ed o con ain agglome -
a es o pa icles wi h a diame e o <1µm. Ch omium
seemed o be dissol ed in a silica ma ix. The pa icles
encoun e ed in he s ainless s eel mel ing shop we e p e-
dominan ly me al alloys. No pu e ch omium o nickel
pa icles we e obse ed [13]. In an analysis using scan-
ning elec on mic oscopy (SEM), ene gy-dispe si e X- ay
spec oscopy (EDS) and X- ay di ac ion, he composi-
ion o he me al pa icles gene a ed om he mel ing
p ocess and eleased o he ambien ai was obse ed o
esemble s ainless s eel [14]. In a con inuous ou doo ai
quali y moni o ing p og amme wi hin he indus ial a ea
o Ou okumpu To nio Wo ks, he mean concen a ion o
ch omium in he espi able pa icles (PM10) was 181 ng/
m3. The espec i e igu e o nickel was 77 ng/m3 [15].
The aim o his s udy was o assess cause-speci ic mo -
ali y in Finnish e och omium and s ainless s eel wo ke s
employed since he beginning o p oduc ion in 1967, wi h
special e e ence o ci cula o y and espi a o y diseases.
Me hods
We s udied e e yone employed a he Kemi mine and
To nio p oduc ion uni s o Ou okumpu G oup (called
To nio Wo ks) be ween 1967 and 2004, who had no
died o emig a ed be o e 1971. We iden i ied he coho
om he company’s employmen eco ds. All Finnish
esiden s ha e had unique pe sonal iden i y codes (PICs)
since 1967, which enable eliable au oma ic eco d link-
age. Th ough an ex ensi e sea ch o popula ion egis e s,
we aced co ec PICs, possible emig a ion da e and
i al s a us o all bu nine (0.1%) o he wo ke s, lea ing
a coho o 8088 (Table1).
We ob ained causes o dea h o 1971–2012 om
S a is ics Finland. The longi udinal cause o dea h eg-
is e o S a is ics Finland has 53 causes o dea h ca ego-
ies. I s a ed in 1971, and he la es yea a ailable o
ou s udy was 2012. De e mina ion o cause o dea h is
based on medical o o ensic e idence, which p o ides
g ounds o dea h ce i ica ion. Fo ensic de e mina ion
may be necessa y i dea h is no due o illness, i i is acci-
den al o iolen o is caused by a ea men p ocedu e o
occupa ional disease.
We ob ained causes o dea h om i s employmen o
1 Janua y 1971, whiche e was la e , o emig a ion, dea h
o 31 Decembe 2012, whiche e was i s . We u he
di ided he da a by ime elapsed since i s employmen
and analysed hem by p oduc ion depa men (Table1),
om he da e when a pe son had wo ked o 5yea s in
a depa men .
We coun ed obse ed dea hs and pe son-yea s a isk,
by 5-yea age g oups, sepa a ely o males and emales, and
o se en 6-yea calenda pe iods be ween 1971 and 2012.
We calcula ed expec ed numbe s o dea hs and speci ic
causes o dea h by mul iplying pe son-yea s in each s a-
um by he co esponding a e age mo ali y and cause-spe-
ci ic mo ali y in he popula ion o he a ea o he Regional
Table1. Numbe o pe sons (n) a To nio Wo ks, and pe son-yea s a ollow-up du ing 1971–2012, by wo k depa men , age and
gende
Men Women To al
nPe son-yea s nPe son-yea s nPe son-yea s
To al 6293 158 642 1795 41 118 8088 199 760
Agea
<30 5305 42 471 1516 14 065 6821 56 537
30–44 878 67 439 228 16 183 1106 83 622
45–59 106 37 901 51 8261 157 46 162
60–74 410 035 – 2216 4 12 250
75+ – 796 – 393 – 1188
Depa men (a leas 5yea s o employmen )
Ch omi e mine 116 2914 6 200 122 3114
Fe och omium plan 274 6917 5 124 279 7041
S ainless s eel mel ing shop 404 7088 7 126 411 7214
Ho olling mill 132 2091 6 76 138 2166
Cold olling mill 849 15 689 89 1838 938 17 527
Main enance and se ices 557 14 416 169 3823 726 18 238
Me allu gical labo a o y 111 2579 54 1175 165 3754
O ice 172 3808 202 4893 374 8702
aAge in n columns de ined in he beginning o ollow-up.
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M. HUVINEN AND E.PUKKALA: MORTALITY IN FINNISH FERROCHROMIUM AND STAINLESS STEEL WORKERS 243
S a e Adminis a i e Agency o No he n Finland. As
To nio Wo ks is a he no he nmos end o he Bal ic Sea
on he Swedish bo de , we assumed ha selec ed e e ence
a es ep esen ed ypical mo ali y le els in ha egion.
To calcula e s anda dized mo ali y a ios (SMRs) o
b oade age anges, we added up age-speci ic obse ed
numbe s o dea hs and di ided by he sum o expec ed
numbe s o espec i e age ca ego ies. To calcula e 95% con-
idence in e als (CIs) o he SMRs, we assumed ha he
numbe o obse ed dea hs ollowed a Poisson dis ibu ion.
This s udy ecei ed e hical app o al om he Na ional
Ins i u e o Heal h and Wel a e (THL/1010/5.05.00/2012).
Resul s
We ollowed up 6293 men (158 642 pe son-yea s) and
1795 women (41 118 pe son-yea s) in he coho (Table1).
Mean indi idual ollow-up was 24.7yea s. We obse ed 451
dea hs caused by diseases. The expec ed numbe was 586.4
and he SMR was 0.77 (95% CI 0.70–0.84) (Table 2).
O e all mo ali y, mo ali y om diseases o he ci cula o y
sys em, and in pa icula om ischaemic hea disease, was
signi ican ly dec eased (Table2). The SMR o all malig-
nan neoplasms combined was 0.88 (95% CI 0.73–1.03)
and o lung cance 0.80 (95% CI 0.55–1.12) (Table2). In
hose who had wo ked in he same depa men o >5yea s,
he SMR o lung cance was 0.60 (95% CI 0.33–1.01)
(Table3). In depa men -speci ic analyses, he e we e sig-
ni ican dec eases in ci cula o y disease mo ali y in ch o-
mi e mine wo ke s, in he s ainless s eel mel ing shop, in he
me allu gical labo a o y and in he o ices (Table3). The
SMR o acciden s was 0.84 (95% CI 0.67–1.0) and o
suicides 0.72 (95% CI 0.56–0.91) (Table4).
The e we e no signi ican di e ences be ween he
SMRs acco ding o age, pe iod o sex. Fo example,
he SMR o all diseases among male and emale
employees combined was 0.53 (95% CI 0.39–0.70) in
he 30–44 age g oup, 0.77 (95% CI 0.65–0.88) aged
45–59, 0.89 (95% CI 0.76–1.02) aged 60–74 and 0.74
(95 % CI 0.56–0.96) aged ≥75. The SMR among male
employees was 0.79 (95% CI 0.71–0.86) o all dis-
eases, 0.64 (95% CI 0.53–0.77) o ischaemic hea
diseases and 0.69 (95% CI 0.52–0.91) o suicides.
The espec i e a ios o emale employees we e 0.63
(95% CI 0.45–0.84), 0.68 (95% CI 0.31–1.29) and
0.74 (95% CI 0.15–2.15).
Discussion
We ound signi ican dec eases in o e all mo ali y, and
in pa icula in mo ali y om ci cula o y diseases, acci-
den s and suicides.
Table2. Obse ed (Obs) and expec ed (Exp) numbe s o dea hs and SMRs wi h 95% CIs among wo ke s a To nio Wo ks du ing
1971–2012, by disease
Causes o dea h Obs Exp SMR 95% CI
All diseases 451 586.4 0.77 0.70–0.84***
Malignan neoplasms 133 152.0 0.88 0.73–1.03
Malignan neoplasm o s omach 7 10.0 0.70 0.28–1.44
Malignan neoplasm o colon 5 7.7 0.65 0.21–1.52
P ima y malignan neoplasm o li e 3 5.3 0.57 0.12–1.66
Malignan neoplasm o panc eas 12 12.5 0.96 0.50–1.67
Malignan neoplasm o la ynx, achea and lung 33 41.2 0.80 0.55–1.12
Malignan neoplasm o b eas 1 5.2 0.19 0.00–1.08
Malignan neoplasm o p os a e 10 7.9 1.27 0.61–2.33
Malignan neoplasm o lymphoid/haema opoie ic issue 20 15.0 1.33 0.81–2.05
O he malignan neoplasms 24 23.2 1.03 0.66–1.53
Endoc ine, nu i ional and me abolic diseases 5 11.5 0.44 0.14–1.01
Diabe es melli us 5 9.7 0.52 0.17–1.20
Demen ia, Alzheime ’s disease 10 12.5 0.80 0.38–1.46
O he diseases o he ne ous sys em 7 14.1 0.50 0.20–1.02
Diseases o he ci cula o y sys em 188 264.3 0.71 0.61–0.81***
Ischaemic hea disease 111 171.4 0.65 0.53–0.77***
O he hea diseases 19 31.1 0.61 0.37–0.95*
Ce eb o ascula diseases 42 41.7 1.01 0.73–1.36
O he diseases o he ci cula o y sys em 16 20.0 0.80 0.46–1.30
Diseases o he espi a o y sys em 20 28.1 0.71 0.43–1.09
Pneumonia 4 10.2 0.39 0.11–1.00
B onchi is, emphysema 12 13.0 0.92 0.48–1.61
O he diseases excluding demen ia and alcohol- ela ed diseases 3 5.6 0.54 0.11–1.56
Alcohol- ela ed diseases and acciden al poisoning by alcohol 62 70.9 0.87 0.67–1.12
Included a e diseases and causes o dea h wi h Exp >5.
*P<0.05; ***P<0.001.
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244 OCCUPATIONAL MEDICINE
S eng hs o ou s udy include he use o non-selec ed
na ional egis e s wi h good da a accu acy and co e age,
long ollow-up ime and comple e in o ma ion on causes
o dea h [16]. Howe e , in o ma ion on co ac o s was
no sys ema ically a ailable.
We used he mo ali y a es o he popula ion o
No he n Finland as he main e e ence because mo -
ali y a es a y geog aphically. Mo ali y also a ies
acco ding o socio-economic posi ion. The majo i y o
he wo ke s in he depa men s a To nio Wo ks belong
o he ca ego y o skilled blue-colla wo ke s who in
he gene al popula ion ha e an a e age o sligh ly
ele a ed o e all mo ali y [17]. I we had been able
o adjus ou SMRs o social class, he o e all SMR
and mos o he cause-speci ic SMRs would ha e been
e enlowe .
A No wegian s udy o e och omium wo ke s ound
an SMR o 0.81 [7] bu a Swedish s udy o 1876 men
wo king in e och omium p oduc ion and ollowed
om 1951 o 1975 ound an SMR o 0.99 [8]. In h ee
s udies in he F ench s ainless s eel indus y, he o al
SMRs we e 0.82 (95% CI 0.69–0.97), 1.04 (95% CI
0.95–1.14) and 0.91 (95% CI 0.84–0.98) [4–6]. The
Swedish s udy epo ed an SMR o ci cula o y dis-
eases o 1.04 (95% CI 0.90–1.20) [8]. In he F ench
s udies, he SMRs o ci cula o y diseases we e 1.04
(95% CI 0.73–1.44), 0.87 (95% CI 0.70–1.06) and
0.90 (95% CI 0.77–1.04) [4–6]. The Swedish s udy
ound an SMR o espi a o y diseases o 0.76 (95%
CI 0.76–1.23) [8]. In he F ench s ainless s eel indus-
y coho s, he SMRs we e 0.15 (95% CI 0.00–0.86),
0.88 (95% CI 0.51–1.40) and 0.89 (0.57–1.09) [4–6].
In he Swedish s udy, he SMR o dea hs due o acci-
den s, poisoning, suicides and iolence was 1.3 (95%
CI 1.0–1.8) [8]. In he F ench s ainless s eel indus-
y s udies, he SMRs o acciden s and iolence we e
close o 1.0 [4,5].
Ou esul s o cance mo ali y e lec he obse -
a ions o cance incidence o he same coho pub-
lished and discussed be o e [3]. Since he numbe s o
Table3. Obse ed (Obs) and expec ed (Exp) numbe o dea hs (all diseases, ci cula o y diseases, espi a o y diseases and lung cance )
and SMRs wi h 95% CIs du ing 1971–2012 among wo ke s a To nio Wo ks wi h employmen mo e han 5yea s, by depa men
Depa men All diseases Ci cula o y diseases Respi a o y diseases Lung cance
Obs Exp SMR 95% CI Obs Exp SMR 95% CI Obs Exp SMR 95% CI Obs Exp SMR 95% CI
Ch omi e mine 12 19.3 0.62 0.32–1.08 3 9.1 0.33 0.07–0.95*– 1.0 0.00 0.00–3.65 1 1.6 0.61 0.02–3.41
Fe och omium plan 30 44.4 0.68 0.46–0.96*15 21.4 0.70 0.39–1.15 2 2.5 0.80 0.10–2.90 3 3.8 0.80 0.16–2.33
S ainless s eel mel ing
shop
18 29.5 0.61 0.36–0.96*3 13.4 0.22 0.05–0.65** 3 1.4 2.19 0.45–6.39 2 2.3 0.85 0.10–3.08
Ho olling mill 3 6.2 0.48 0.10–1.40 1 2.6 0.38 0.01–2.12 – 0.2 0.00 0.00–16.3 1 0.4 2.35 0.06–13.1
Cold olling mill 42 61.2 0.69 0.49–0.92*20 26.6 0.75 0.46–1.15 1 2.7 0.37 0.01–2.04 2 4.5 0.44 0.05–1.60
Main enance and
se ices
100 128.6 0.78 0.63–0.93** 49 61.3 0.80 0.59–1.05 8 7.2 1.12 0.48–2.19 6 9.9 0.61 0.22–1.32
Me allu gical
labo a o y
7 14.3 0.49 0.20–1.00 1 6.1 0.16 0.00–0.90*– 0.6 0.00 0.00–5.75 1 1.0 0.97 0.02–5.40
O ice 14 36.7 0.38 0.21–0.63*** 7 15.7 0.45 0.18–0.91*– 1.9 0.00 0.00–1.94 – 2.8 0.00 0.00–1.34
Any depa men 208 305.0 0.68 0.59–0.77*** 86 140.3 0.61 0.49–0.75*** 13 15.6 0.83 0.44–1.42 14 23.2 0.60 0.33–1.01
*P<0.05; **P<0.01; ***P<0.001.
Table4. Obse ed (Obs) and expec ed (Exp) numbe s o acciden al and iolen dea hs and SMRs wi h 95% CIs among wo ke s a
To nio Wo ks du ing 1971–2012, by ype o acciden
Type o acciden o iolence Obs Exp SMR 95% CI
All acciden s, excluding acciden al poisoning by alcohol 83 98.7 0.84 0.67–1.04
T a ic acciden s 20 22.0 0.91 0.56–1.40
Wa e anspo acciden s 6 8.4 0.72 0.26–1.56
Acciden al alls 22 17.7 1.24 0.78–1.87
D owning 4 8.1 0.49 0.13–1.25
Acciden al poisoning (non-alcohol) 13 18.9 0.69 0.37–1.17
O he acciden s and la e e ec s o acciden al inju ies 13 20.8 0.63 0.33–1.07
Suicides 69 95.6 0.72 0.56–0.91**
Assaul 4 9.0 0.44 0.12–1.13
E en o unde e mined in en 10 8.0 1.25 0.60–2.30
To al 166 211.6 0.78 0.67–0.90***
Included a e diseases and causes o dea h wi h Exp >5.
**P<0.01; ***P<0.001.
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M. HUVINEN AND E.PUKKALA: MORTALITY IN FINNISH FERROCHROMIUM AND STAINLESS STEEL WORKERS 245
cance dea hs a e smalle han numbe s o inciden
cance s and he accu acy o incidence in o ma ion,
om he Finnish Cance Regis y, is highe han can
be ob ained om dea h-ce i ica e-based mo ali y
s a is ics, we do no discuss he cance -speci ic SMRs
he e.
Smoking is he mos impo an con ounde and has
no been con olled o in mos s udies. I may lead o
a bias in a di e en di ec ion, depending on whe he
smoking in he coho is lowe o highe han in he
e e ence popula ion. Smoking habi s o a ep esen a-
i e sample o he employees o he To nio Wo ks we e
documen ed in connec ion wi h wo iden ical c oss-
sec ional espi a o y heal h s udies in 1993 and 1998
[2]. The p e alence o smoking in male employees in
1993 a ied om 28% in he e och omium smel e
and s ainless s eel mel ing shop o 58% in he ch o-
mi e mine and in 1998 om 27% in he e och omium
smel e and he s ainless s eel mel ing shop o 43%
in he cold olling mill. The p e alence o smoking in
men in he p o ince o Lapland in No he n Finland
in 1990–2005 a ied om 20% in he highes educa-
ional class o 42% in he lowes one [18]. Hence, he
con ounding due o smoking in ou s udy appea s o be
small and he smoking igu es a he poin owa ds a
nega i e con ounding.
SMRs obse ed in s udies om di e en e och o-
mium indus y coho s may a y due o di e ences in
indus ial p ocesses and exposu e le els. Fo ins ance,
he e och omium elec ic a c u naces in No way
we e ei he open o semi-closed u naces, while he
Finnish u naces a e ully closed ones wi h educing
condi ions wi hin he u nace. The p oduc ion ech-
nology has been de eloped con inuously and bes
a ailable echnology u ilized. The d i ing o ces ha e
been no only occupa ional hygiene and sa e y, bu
also p oduc i i y, ene gy e iciency and en i onmen al
impac , all o which ha e bene i ed om ac i e de el-
opmen . This echnological ea u e explains why he
exposu e le els o C 6+ we e subs an ially highe in he
No wegian coho s ( a ia ion 13–8000µg/m3) han in
he Finnish one (median below 0.5µg/m3 and maxi-
mum 2.4µg/m3).
I is common o mo ali y o be low o some yea s
a e i s employmen (heal hy wo ke e ec ) bu in his
coho he SMRs emained low h oughou ollow-up.
The heal h o all employees a To nio Wo ks was moni-
o ed egula ly by he company’s own on-si e occupa-
ional heal h uni , which besides p e en i e se ices
also p o ided ea men o common acu e and ch onic
diseases and illnesses. This, in addi ion o selec ion o
employees wi h ela i ely heal hy li es yle, may ha e con-
ibu ed o dec eased disease mo ali y among wo ke s
in he coho .
Gene al sa e y awa eness a To nio Wo ks has been
aised by equen ly o ganized sa e y campaigns.
Occupa ional sa e y has been a op p io i y in he com-
pany’s ope a ions o decades.
Keypoin s
•Mo ali y om espi a o y and ci cula o y dis-
eases in Finnish e och omium and s ainless s eel
indus y wo ke s was no inc eased as migh ha e
been expec ed on he basis o ea lie publica ions.
•We ound no inc ease in mo ali y om o he dis-
eases o acciden s and iolence.
•The occupa ional exposu es o wo king condi-
ions in he Finnish e och omium and s ainless
s eel indus y appea no o be associa ed wi h
inc eased mo ali y om any cause o dea h.
Funding
This esea ch ecei ed no speci ic g an om any unding
agency in he public, comme cial o no - o -p o i sec o s.
Acknowledgemen s
We hank Aki Kane o, A mi Te ho and Rii a E as i o hei
g ea inpu in collec ing he s udy coho .
Con lic s o in e es
M.H.has been employed by he Ou okumpu g oup since 1975.
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