Occupational exposure to fine particulate matter in the reinforced concrete production and its association with respiratory symptoms and lung function.

BACKGROUND: Reinforced concrete production is widespread, but little is known about the occupational exposure to fine particulate matter (PM) in such workplaces, including from metalworking and concrete processing. Therefore, the aim was to characterize exposure to fine PM in the typical workplaces of the whole production cycle and to quantify the risk of respiratory symptoms and lung function in a cohort of reinforced concrete parts production industry. METHODS: At a reinforced concrete parts producing facility in Almaty, we collected 50 personal PM2.5 samples from the main exposure sites and the measured mass concentrations using gravimetric method. Workers also completed questionnaires on a detailed working history, respiratory symptoms (chronic obstructive pulmonary disease (COPD) Assessment Tool (CAT)), followed by spirometry. The association of cumulative dose with CAT score and forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) was tested with multiple regression. RESULTS: The highest PM2.5 concentrations were found in the concrete-mixing unit (median 1180 µg/m3), followed by metalworking (510 µg/m3), armature workshop (375 µg/m3) and molding site (245 µg/m3), different from the concentrations in the office (29.5 µg/m3), Kruskall-Wallis p < 0.001. Cumulative PM2.5 dose, mg/m3-year (beta 0.10 (95% confidence interval (CI) 0.05; 0.15)) was strongly associated with CAT score, whereas production with FEV1/FVC (beta -4.96 (-8.31; -1.61)), independent of smoking and chronic bronchitis and sex. CONCLUSIONS: Mixing concrete and metalworks pose the greatest risk for worker's health in the reinforced concrete production from the inhalational exposure to aerosol, adversely affecting respiratory health.

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.

Asthma control in Kazakhstan: need for urgent action.

BACKGROUND: Asthma control, patients' awareness level and adherence to treatment in Kazakhstan have never been studied. The aim of this study was to verify the prevalence of controlled, poorly controlled and uncontrolled asthma in a large sample of three largest cities of Kazakhstan. METHODS: We recruited 600 (median age 54 (interquartile range (IQR) 22) years, 64% females) patients with diagnosis confirmed earlier in the outpatient facilities in Almaty, Astana and Shymkent in 2020-2021. We offered a structured questionnaire on asthma control and risk factors as of GINA and performed spirometry. We report the prevalence of asthma control, knowledge and skills and pharmacological treatment with 95% confidence interval (CI) and the association of selected predictors with asthma control. RESULTS: With the median of 9 (IQR 13) years of diagnosis, 40% of patients had comorbid COPD and 42% had allergic rhinitis, whereas 32% lived with pets. Asthma was well-controlled in only 12.3% (95% CI 9.7-15.0), partly controlled in 29.8% (95% CI 26.2-33.5) and uncontrolled in 57.8% (95% CI 53.9-61.8) patients. ACQ-5 score (range 0-5.8, median 2) equaled 0.2 (IQR 0.85) in well-controlled asthma patients, 1.4 (IQR 1) in partly controlled and 2.8 (IQR 1.4) in uncontrolled asthma patients. Knowledge and skills levels were very low. Only 54% were on inhaled corticosteroids (52.2% of them used budesonide/formoterol and 39.5% used fluticasone/salmeterol). 39% used steroids per os or parenterally within a period of 12 months (51% of patients with uncontrolled asthma). CONCLUSION: Asthma control, knowledge and skills levels of asthma patients in the largest cities of Kazakhstan remain unacceptably low, whereas pharmacological treatment is far from optimal. Urgent action should be taken to support doctors' training, and we call to launch a national asthma program to coordinate asthma care in Kazakhstan.

Exposure to respirable dust among workers fabricating aluminium trihydroxide-containing synthetic countertops.

The aim of this study is to characterize personal exposure of workers to respirable particulate matter (PM) generated in cutting and other fabrication activities when fabricating acryl polymer/aluminium trihydroxide synthetic countertops. We collected 29 personal full-day samples of respirable PM from three workers in a small private workshop. We tested differences between- and within-worker variances of mass concentrations using the Kruskall-Wallis test. We used segmented regression to test the means and medians 15-min interval concentrations changes over time and to identify a breakpoint. Respirable PM concentrations ranged nearly 100-fold, from 0.280 to 25.4 mg/m3 with a median of 2.0 mg/m3 (1-min concentrations from 13,920 data points). There were no statistical difference in daily median or geometric mean concentrations among workers, whereas the concentrations were significantly higher on days with three versus two workers present. The 15-min median concentrations (n = 974 measures) increased until 2.35 h (beta 0.177; p < 0.05), representing a 0.70 mg increase in exposure per hour. This was followed by a plateau in concentrations. The high levels of respirable PM we observed among workers fabricating aluminium trihydroxide-containing synthetic countertops highlight an unmet early prevention need.

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.

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.

Medico-social effectiveness of biological monitoring of iodine deficiency status (IDS) among women of reproductive age in Kazakhstan.

INTRODUCTION: Iodine deficiency is one of the most important public health problems in the world. It mostly affects pregnant women and children. The lack of iodine leads to an increase in the numbers of perinatal mortality and mental retardation. MATERIAL AND METHODS: In 2012-2014, a survey was carried out of 2,342 women, of whom 2284 were analyzed for salt to measure the content of iodine, and 2,242 women of reproductive age had their urine samples analyzed by the cerium-arsenite method based on the Sandell-Kolthoff reaction. Determination of the medical and social effectiveness of biological monitoring of IDS was carried out in 3 stages. RESULTS: The study revealed that in the eastern Kazakhstan region the relative risk (RR) of overall prevalence of iodine deficiency among women was 1.1 times higher (95% ID: 0.35-3.61; Z statistic = 0.192) among household respondents (≤15mkg/kg). In the Pavlodar region, the RR of the prevalence of total iodine deficiency is 0.5 times higher in households where the salt was not sufficiently iodized. In the Zhambyl region the RR of the iodine deficiency prevalence was about twice as high due to insufficient iodized salt. CONCLUSIONS: The introduction of biological monitoring of IDS among women, especially pregnant women, may positively affect the detection of the risk limits for the birth of infants with reduced mental abilities or other diseases during pregnancy, using timely targeted preventive measures to exclude factors that affect the spread of IDS.

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%.