Occupational burn-out, fatigue and stress in professional rescuers: a cross-sectional study in Kazakhstan.

OBJECTIVES: To find predictors of burn-out in a cohort of rescuers. DESIGN: Cross-sectional study. SETTING: Republican Rescue Squad (N=105) and Republican Mudslide Rescue Service under the Ministry of Emergency Situations (N=480) in Almaty, Kazakhstan. PARTICIPANTS: In total, we included 268 (80% men, median age 38 (IQR 22) years) rescuers from both organisations. PRIMARY AND SECONDARY OUTCOME MEASURES: We offered a questionnaire to rescuers, which included Maslach Burnout Inventory, quantifying emotional exhaustion (EX), cynicism (CY) and professional efficacy (PE) along with fatigue, stress and health-related quality of life (HRQL) tools. RESULTS: Lower scores of HRQL (Physical Component Score (PCS) beta -0.04 (95% CI -0.06 to -0.02); Mental Component Score beta -0.03 (95% CI -0.05 to -0.01)), higher fatigue (Fatigue Severity Scale (FSS) score beta 0.03 (95% CI 0.03 to 0.04)) and stress (Perceived Stress Score-10 beta 0.04 (95% CI 0.02 to 0.06)) independently predicted greater EX. Lower PCS (beta -0.03 (95% CI -0.06 to -0.01)) and FSS (beta 0.02 (95% CI 0.01 to 0.03)) could predict more CY burn-out. In addition to stress, higher education (beta 0.86 (95% CI 0.40 to 1.32)) was positively associated with lower burn-out severity in PE domain. CONCLUSIONS: Fatigue, stress and HRQL were associated with burn-out in rescuers. Addressing these predictors may help guide further interventions to reduce occupational burn-out.

Social network-based ethical analysis of COVID-19 vaccine supply policy in three Central Asian countries.

BACKGROUND: In the pandemic time, many low- and middle-income countries are experiencing restricted access to COVID-19 vaccines. Access to imported vaccines or ways to produce them locally became the principal source of hope for these countries. But developing a strategy for success in obtaining and allocating vaccines was not easy task. The governments in those countries have faced the difficult decision whether to accept or reject offers of vaccine diplomacy, weighing the price and availability of COVID-19 vaccines against the concerns over their efficacy and safety. We aimed to analyze public opinion regarding the governmental strategies to obtain COVID-19 vaccines in three Central Asian countries, focusing particularly on possible ethical issues. METHODS: We searched for opinions expressed either in Russian or in the respective national languages. We provided data on the debate within three countries, drawn from social media postings and other sources. The opinion data was not restricted by source and time. This allowed collecting a wide range of possible opinions that could be expressed regarding COVID-19 vaccine supply and human participation in the vaccine trial. We recognized ethical issues and possible questions concerning different ethical frameworks. We also considered scientific data and other information, in the process of reasoning. RESULTS: As a result, public views on their respective government policies on COVID-19 vaccine supply ranged from strongly negative to slightly positive. We extracted the most important issues from public debates, for our analysis. The first issue involved trade-offs between quantity, speed, price, freedom, efficacy, and safety in the vaccines. The second set of issues arose in connection with the request to site a randomized trial in one of the countries (Uzbekistan). After considering additional evidence, we weighed individual and public risks against the benefits to make specific judgements concerning every issue. CONCLUSIONS: We believe that our analysis would be a helpful example of solving ethical issues that can arise concerning COVID-19 vaccine supply around the world. The public view can be highly critical, helping to spot such issues. An ignoring this view can lead to major problems, which in turn, can become a serious obstacle for the vaccine coverage and epidemics' control in the countries and regions.

Fractional exhaled NO in a metalworking occupational cohort.

PURPOSE: Secondary metalworking carries exposure to relatively heavy levels of respirable particulate. We investigated the extent to which metalworking is associated with increased exhaled nitric oxide (FeNO), an established inflammatory biomarker. METHODS: We studied 80 metalworking factory employees in Kazakhstan. Informed by industrial hygiene data, we categorized them into three groups: (1) machine operators (41%); (2) welders or assemblers (33%); and (3) all others, including administrative and ancillary staff (26%). Participants completed questionnaires covering occupational history, smoking, home particulate sources, respiratory symptoms, and comorbidities. We measured exhaled carbon monoxide (CO), exhaled fractional nitric oxide (FeNO), and spirometric function. We used mixed-effects modeling to test the associations of occupational group with FeNO, adjusted for covariates. RESULTS: The median age was 51.5 (interquartile range 20.5) years; 7% were women. Occupational group (p < 0.01), daily current cigarette smoking intensity (p < 0.05), and age (p < 0.05), each was statistically associated with FeNO. Welders, or assemblers (Group 2), who had intermediate particulate exposure, manifested significantly higher exhaled FeNO compared to machinists (Group 1, with the highest particulate exposure) and all others (Groups 3, the lowest particulate): adjusted Group 2 mean 44.8 ppb (95% confidence interval (CI) 33.8-55.9) vs. Group 1 24.6 ppb (95% 20.5-28.7) and Group 3, 24.3 ppb (95% CI 17.7-30.9). Secondhand smoking and height were not associated with FeNO. CONCLUSION: In a metalworking industrial cohort, welders/assemblers manifested significantly higher levels of FeNO. This may reflect respiratory tract inflammation associated with airborne exposures specific to this group.

Social network-based ethical analysis of COVID-19 vaccine supply policy in three Central Asian countries.

Background In the pandemic time, many low- and middle-income countries are experiencing restricted access to COVID-19 vaccines. An access to imported vaccines or ways to produce them locally becomes the principal source of hope. But developing a strategy for success in obtaining and allocating vaccines is not easy task. The governments in those countries have faced difficult decision whether to accept or reject offers of vaccine diplomacy, weighing price and availability of COVID-19 vaccines against concerns over their efficacy and safety. Our aim was to analyze public opinion regarding the governmental strategies to obtain COVID-19 vaccines in three Central Asian countries, focusing particularly on possible ethical issues. Methods We searched opinions expressed either in Russian or in the respective national languages. We provided data of the debate within three countries, drawn from social media postings and other sources. The opinion data was not restricted by source and time. This allowed to collect a wide range of possible opinions that could be expressed regarding COVID-19 vaccine supply and public's participation in vaccine trials. We recognized ethical issues and possible questions concerning different ethical frameworks. We also considered additional information or scientific data, in the process of reasoning. Results As a result, public views on their respective government policies on COVID-19 vaccine supply ranged from strongly negative to slightly positive. We extracted most important issues from public debates, for our analysis. The first issue involved trade-offs between quantity, speed, price, freedom, efficacy and safety in the vaccines. The second set of issues arouse in connection with the request to site a randomized trial in one of countries (Uzbekistan). After considering additional evidences, we weighed individual with public risks and benefits to make specific judgements concerning every issue. Conclusions We believe that our analysis would be a helpful example of solving ethical issues that can rise concerning COVID-19 vaccine supply round the world. The public view can be highly critical, helping to spot such issues. An ignoring this view can lead to major problems, which in turn, can become a serious obstacle for the vaccine coverage and epidemics' control in the countries and regions.

Health-related quality of life in a general population sample in Kazakhstan and its sociodemographic and occupational determinants.

BACKGROUND: Health-related quality of life (HRQL) in the general population of Kazakhstan has never been characterized. We constructed this population-based study of the largest city in Kazakhstan, Almaty with the aim to quantitatively assess HRQL and ascertain whether occupation and lifestyle are associated with HRQL in this population. METHODS: In a random sample (N = 1500) of general population in Almaty (median age 49 (interquartile range 28) years, 50% women), we collected data on demographics, socioeconomic status, lifestyle, lifetime occupational history and general HRQL using SF-8 instrument. The association of demographic and occupational predictors with HRQL was tested in multiple regression models. RESULTS: No occupational associations were found for physical component score in the models adjusted for age, sex, income, cigarette and waterpipe smoking, electronic cigarette use, physical activity, alcohol and exposure to secondhand smoke. Ever being a manager (ß - 1.63 (95% confidence interval (CI) - 2.92; - 0.34)), a welder (ß - 5.11 (95% CI - 8.77; - 1.46)) and a secretary (ß - 5.06 (95% CI - 8.56; - 1.56)) for one year or more was associated with poorer mental component score in the models adjusted for age, sex, income, cigarette smoking, physical activity and each other. Age, income and physical activity were independent predictors of both physical and mental components. CONCLUSIONS: Occupational history is associated with HRQL in the general population in Almaty, Kazakhstan, but the mechanism explaining this association should be further elucidated.

Smoking practices in relation to exhaled carbon monoxide in an occupational cohort.

BACKGROUND: Exposure to carbon monoxide (CO) remains a leading occupational hazard in firefighters, but cigarette and waterpipe smoking likely contributes to the other sources of CO in such workers. The aim of this study was to estimate the contribution of self-reported active cigarette smoking, waterpipe use, and potential job-related sources of CO to the level of exhaled CO in firefighters. METHODS: We surveyed the personnel of 18 fire stations (N = 842), median age 28 years, who participated at an annual screening not timed to coincide with recent firefighting. We surveyed smoking and waterpipe history, exposure to secondhand smoke (SHS), use of coal for health and biomass for cooking and time since last exposure to firefighting in the workplace. We measured exhaled CO with an instantaneous reading device (piCO Smokerlyzer). We used multivariable regression models to test the association of time since last smoked cigarette (≤12 h) and waterpipe (≤12 h) and time since last fire (≤6 h) with exhaled CO. RESULTS: In analysis limited to men (93.5% of all surveyed), 42% were daily cigarette; 1% were waterpipe smokers; 94% were exposed to SHS, 29% used coal for heating and 4% used biomass for cooking. The median CO was 4 (interquartile range 3;8) ppm. Age (beta 0.74 per 10 years, p < 0.001), use of biomass fuel for cooking (beta 1.38, p = 0.05), cigarette smoked in the last 12 h (beta 8.22, p < 0.001), waterpipe smoked in the last 12 h (beta 23.10, p < 0.001) were statistically associated with CO, but not time since last fire (≤6 h) (beta 4.12, p = 0.12). There was a significant interaction between older age and firefighting for exhaled CO (p = 0.03). CONCLUSIONS: Cigarette and recent waterpipe smoking are associated with increased exhaled CO in firefighters. Firefighting itself was a less potent contributor to exhaled CO when measured at an annual screening, but an age interaction was manifested.

Plasma cutting and exposure to PM2.5 metal aerosol in metalworking, Almaty, Kazakhstan, 2020.

OBJECTIVES: Little is known regarding the metal working subprocesses that determine exposures in the workplace primarily because their segregation from the main process is rather difficult in real-life occupational settings. The present study aimed to identify the subprocesses in a metalworks plant with high personal exposure to particulate matter (PM2.5) metal aerosol in order to plan future risk reduction interventions. METHODS: A total of eighty 8-hour PM2.5 metal aerosol samples from the breathing zone of four workers in each of four major operations (plasma cutting, machine operating, assembling and welding) were collected in a metalwork plant in Almaty in January to June 2020. Minimal, maximal, time-weighted average PM2.5 metal aerosol mass concentrations were recorded with TSI SidePak AM520 personal aerosol and analysed using analysis of variance (ANOVA) after normalisation. RESULTS: The overall sampling time was 640 hours. Maximal 1 min and geometric mean PM2.5 concentrations were 8.551 and 1.7268 mg/m3 in plasma cutting; 4.844 and 0.9343 mg/m3 in machine operating; 2.993 and 0.6898 mg/m3 in assembling; and 2.848 and 0.4903 mg/m3 in welding. Using a Tukey-Kramer test after a one-way ANOVA, plasma cutting concentrations were significantly higher compared with all other operations (F-ratio 29.6, p<0.001). The fold-range containing 95% of the total variability (R0.95) from all samples was 12.5. CONCLUSIONS: The highest PM2.5 concentrations were found in plasma cutting, potentially elevating the risk of systemic inflammatory effects.

Occupational exposure to particulate matter from air pollution in the outdoor workplaces in Almaty during the cold season.

METHODS: Outdoor security non-smoking guards (N = 12) wore TSI DustTrack AM520 aerosol monitors with a 10-µm impactor for 8 hours of outdoor shift. Ten samples (k = 10) from each worker were obtained for the cold season (November-March) from various locations across Almaty. Total sampling time was 57600 minutes. We compared normalized time-weighted average (TWA) concentrations for 8-hour shifts within and between workers using analysis of variance (ANOVA) and assessed compliance with environmental exposure limit (EEL) (0.060 mg/m3) via exceedance (γ) and probability of overexposure (θ). RESULTS: PM10 TWA ranged from 0.050 to 2.075 mg/m3 with the geometric mean 0.366 and median 0.352 mg/m3. PM10 TWA distribution was left-skewed with large variation. The fold-range of within-person variability, containing 95% of the exposure concentration (wR0.95) was 13, whereas between-person fold-range (bR0.95) was 3. However, between-person variance exceeded the one within with F-ratio 2.797 (p = 0.003) with statistical power 97% at α = 0.05. Only two of 120 samples had TWA below EEL, yielding γ = 0.995 and θ = 1. CONCLUSIONS: Outdoor workers in polluted cities like Almaty are exposed to very high levels of PM10 during the cold season. Urgent action should be taken to regulate such occupational exposure and to raise awareness of workers and employers on hazards associated with it.

Occupational burnout and lifestyle in Kazakhstan cardiologists.

BACKGROUND: No data exist in the published literature on burnout in physicians from Central Asia. The aim of this analysis was to assess burnout prevalence in doctors and nurses of a cardiological hospital in Almaty, Kazakhstan and ascertain whether smoking, alcohol and physical activity may predict job-associated burnout. METHODS: The staff of the City Cardiological Centre of Almaty (N = 259, 82% females) filled in the questionnaire with the questions on demographics, lifestyle, including smoking, alcohol and physical activity, as well as fatigue (using Fatigue Severity Scale (FSS)) and burnout using Maslach Burnout Inventory (MBI) Human Services Survey for Medical Personnel. We compared the scores of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA) between doctors and nurses. RESULTS: We found significant differences in the smoking prevalence, alcohol use and regular physical activity, but no mean scores of burnout between men and women. High DP was prevalent in 52% doctors and 45% nurses, whereas high EE was found in 32 and 26% and PA in 16 and 32%, accordingly. In contrast with EE and DP, PA score was greater in nurses (median 38, interquartile range (IQR) 17) compared to doctors (median 41, IQR 9). Age, sex, work duration, smoking or physical activity could not predict higher burnout, whereas FSS score was associated with higher burnout of all dimensions (p < 0.05), and never-alcohol could predict higher PA burnout (p < 0.05). CONCLUSIONS: In Kazakhstan cardiologists, high prevalence of DP burnout should target specific preventive strategies and the association of alcohol use with PA needs further deeper insight.

Age and work duration do not predict burnout in firefighters.

BACKGROUND: The aim of this study was to ascertain the prevalence of burnout in Kazakhstan firefighters with regard to position and to identify predictors of faster burnout in order to plan future preventive strategies. METHODS: Data on demographics, lifestyle, fatigue (Fatigue Severity Scale (FSS)), SF-8 health-related quality of life (HRQL) and Maslach Burnout Inventory (MBI) emotional exhaustion (EX), cynicism (CY) and professional efficacy (PE) were obtained from 604 (94% men, median age 27 (interquartile range (IQR) 12) years) firefighters from all 18 fire departments of the city of Almaty. Associations between predictors and burnout EX, CY and PE dimensions were tested using multivariate logistic regression analyses. RESULTS: Burnout scores were low in this sample, including EX (0.6; IQR 1.55), CY (1.2; IQR 1.8) and PE (4.8; IQR 2.4). The highest median EX score (1.5 (IQR 2.0)) was in managers as opposed to the lowest in drivers (0.4 (IQR 1.4)), (p < 0.01). The greatest CY difference was between managers (2.1 (IQR 2.2)) and trainees (0.4 (IQR 1.1)) (p < 0.001). Age, work duration, education or fatigue were not associated with EX or CY in adjusted models. Better HRQL predicted lower EX and CY burnout, whereas alcohol never-use and language barrier predicted high CY. Male sex and no university degree predicted high PE burnout. CONCLUSIONS: Firefighting managers are at risk for higher burnout, irrespective of age and work duration, and the targeted intervention to combat burnout should include better uniform, mitigation of language barrier, general health improvement and less alcohol.

Lifetime Occupational History, Respiratory Symptoms and Chronic Obstructive Pulmonary Disease: Results from a Population-Based Study.

Purpose: To ascertain the effect of lifelong occupational history, ambient air pollution, and biochemically verified smoking status on chronic obstructive pulmonary disease (COPD) in a general population of one the largest cities in Central Asia, Almaty. Patients and methods: 1500 adults (median age 49, interquartile range (IQR) 28 years), 50% females, were randomly selected from a registry of enlisted population of a primary care facility in Almaty, Kazakhstan and they filled in the questionnaire on demographics, respiratory symptoms (CAT and mMRC), smoking status, verified by exhaled carbon monoxide, and detailed lifetime occupational history. COPD was defined as postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) below lower limit of normal (LLN) using Belintelmed MAS-2 spirometer (Belarus). Results: 230 (15%) subjects had CAT≥10; 136 (9%) participants had mMRC score ≥2. Greater CAT score was associated with age, smaller income, and less exercise, but not with smoking or living closer to a major road. 26% of the population was ever exposed to vapors, gases, dusts, and fumes (VGDF). In age group 40 years and above (N=1024), COPD was found in 57 participants (prevalence 5.6%), more in men (8.7% vs 3.4%). In the multivariate model adjusted for age, sex, ever-smoking, income, and exercise, any exposure to VGDF increased the odds of COPD (odds ratio (OR) 1.71; 95% confidence interval (CI) 1.03; 2.84), more in the highest exposure category (OR 2.36 (95% CI 1.20; 4.66)). Conclusion: Lifetime exposure to VGDF, found in » of the general population, increased the odds of COPD independent of smoking by 71%.