High levels of indoor fine particulate matter during the cold season in Almaty prompt urgent public health action.

INTRODUCTION: Almaty is the largest city of Kazakhstan with extreme air pollution, mostly in the cold season, but little is known whether staying indoors could lessen the exposure. The aim was to quantitatively characterize indoor fine PM levels and to verify the contribution of ambient pollution to it in a polluted city like Almaty. METHODS: We collected forty-six 24-hour 15-min average samples of the ambient air and a similar number of paired indoor samples (total 92 samples). Predictors of both ambient and indoor PM2.5 mass concentrations in mg/m3, including ambient concentration, precipitation, minimal daily temperature and humidity, along with the indoor/outdoor (I/O) ratio were tested in the adjusted regression models at eight 15-min lags. RESULTS: Ambient air PM2.5 15-min average mass concentrations were highly variable and ranged from 0.001 to 0.694 mg/m3 (geometric mean (GM) 0.090, geometric standard deviation (GSD) 2.285). Snowing was the strongest predictor of lower ambient PM2.5 24-hour mass concentrations (median 0.053 vs 0.135 mg/m3 (p<0.001)). Indoor mean 15-min PM2.5 concentrations ranged from 0.002 to 0.228 mg/m3 (GM 0.034, GSD 2.254). In adjusted models, outdoor PM2.5 concentration explained 0.58 of all variability of the indoor concentration with a 75-min delay (R2 0.67 at lag8 on snowing days). Median I/O ranged from 0.386 (IQR 0.264 to 0.532) at lag0 to 0.442 (IQR 0.339 to 0.584) at lag8. CONCLUSION: During the cold season when fossil fuel is burnt for heating, the population in Almaty is exposed to very high fine PM levels even indoors. Urgent public health action is needed.

Exposure to Respirable Particulate Matter and Its Association with Respiratory Outcomes in Beauty Salon Personnel.

We aimed to assess exposure to respirable particulate matter (PM) of beauty salon personnel, identify its determinants and ascertain the associated respiratory effects. We collected 122 full-day respirable PM samples from 12 beauty salons (floor area ranging from 24 to 550 m3, staff from 4 to 8) in Almaty, Kazakhstan, taking 10 samples from each place using a portable SidePak AM520 monitor. We also assessed lifestyle (smoking, etc.), respiratory symptoms and health-related quality of life (HRQL) of the personnel using questionnaires. Out of 11,831 5-min data points, daily median respirable PM concentrations were highly variable and ranged from 0.013 to 0.666 mg/m3 with 8.5-times difference in the median concentrations between the venue with the highest median (0.29 mg/m3) and the least median (0.034 mg/m3). In a multivariate linear regression modelling, ambient PM2.5 concentration was the strongest predictor of daily median respirable PM concentration (beta 2.12; 95% CI 1.89; 2.39), and R2 of the model was 0.63. We also found a positive association of the median respirable PM with respiratory symptoms and seasonal allergy, but not with HRQL. Short-term respirable PM levels in the beauty salons may be very high, but the median concentrations are mainly determined by the ambient air pollution.

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.

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.

Testosterone and occupational burnout in professional male firefighters.

BACKGROUND: Very little is known about the biologic predictors of the occupational burnout in firefighters. The aim of this study was to characterize testosterone profile of active firefighters and quantify its association with three domains of the occupational burnout. METHODS: We enrolled 100 firefighters (median age 28 (interquartile range (IQR) 9.8) years with 5 (IQR 9) years in service) of three fire departments in Almaty, Kazakhstan. Demographics, smoking status, health-related quality of life (HRQL) and burnout scores of Maslach Burnout Inventory were assessed using a questionnaire, while total blood testosterone was measured in venous blood. Logistic regression models were used to quantify the association of blood testosterone with each burnout domain in the adjusted for confounders models. RESULTS: The median blood testosterone level was 14 (IQR 3.5) nmol/l and was only predicted by age (beta - 0.14, p < 0.01, 79% power). There were no differences in blood testosterone levels between occupational groups (Group 1 (firefighters), 14.6 (IQR 3.4); Group 2 (fire truck drivers), 14.7 (IQR 5.6); Group 3 (shift commanders, division heads, department managers and engineers), 14 (IQR 4.1) nmol/l, Kruskal-Wallis p = 0.32) or departments. Testosterone could not predict EX or CY, but had a negative association with PE score reflecting more burnout (odds ratio 1.18 (95% confidence interval 1.01;1.38)), adjusted for age, mental component of HRQL and education. CONCLUSIONS: Firefighters with higher testosterone may develop burnout in PE earlier, and this should be considered for proper work placement within the rescue system.

Air pollution in the workplace: making shish kebab is an overlooked occupational hazard.

BACKGROUND: Meat grilled with wood charcoal is the most popular meal in Central Asia, but little is known about the grillers' occupational exposure to fine particulate matter (PM) in fumes. OBJECTIVES: The aim of this study was to provide a quantitative analysis of occupational exposure to fine PM in grillers in the workplace. METHODS: We assessed exposure to PM2.5 from barbecue fumes using SidePak AM520 in six popular cafes in Almaty, Kazakhstan. Grillers wore devices for 8 h of work shift for 7 days in each place. Within- and between-place variances of PM2.5 mass concentrations were calculated using analysis of variance, and we also calculated the fold range of the 95% variance within (wR0.95) and between places (bR0.95), as well as exceedance (γ) and the probability of overexposure (θ). RESULTS: Two modes of exposure were identified, including intermittent and continuous. The median of daily geometric mean PM2.5 concentrations was 0.143 (interquartile range (IQR): 0.213) and 0.404 (IQR: 0.243) mg/m3, accordingly. bR0.95 was very large (20.2), but wR0.95 was even greater (47.8), illustrating extremely high fluctuations in PM2.5 concentrations; γ was 0.116, and θ was 0.095. SIGNIFICANCE: Very high occupational exposure to barbecue fumes in grillers is overlooked and likely causes elevated health risks.

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.

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%.

Prevalence of supplement use in recreationally active Kazakhstan university students.

BACKGROUND: Little is known about the supplements use and recreational sport practices in Kazakhstan university students. Therefore, the aim of this study was to ascertain supplements use prevalence and their predictors in this population. METHODS: Cross-sectional survey of both undergraduate and graduate level students was completed in 2017 et al.-Farabi Kazakh National University, the largest higher institution in the country, from almost all Schools. A 45-item questionnaire was used to record physical activity, supplements use, lifestyle attributes (smoking, alcohol, sleep, etc.) and eating habits, and adjusted regression models were used to verify predictors of supplements use. RESULTS: Of the entire sample of 889 students (70% females), 526 (59%) were practicing recreational physical activity (RPA), and walking, jogging and track and field was the most popular activity type (38%). N = 151 (29%) students reported the use of any supplement (31% in men and 27% in women), whereas the most popular supplement type were vitamins. Supplement use was most prevalent in swimmers (55%). Age (odds ratio (OR) 1.19 (95% confidence interval (CI) 1.04-1.37), use of fitness tracker (OR 6.26 (95% CI 3.90-10.03)) and low-fat diet (OR 1.95 (95% CI 1.23-3.10)), but not income predicted supplements use in adjusted models. CONCLUSIONS: With more than half of students exercising regularly, only less than one-third use supplements with a very strong association with fitness tracker use.