الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Workers at aluminum production industry are exposed to various occupational hazardous factors such as fumes and gases (mainly hydrogen fluoride), mineral dusts, coal tar pitch volatiles, electromagnetic fields, heat and others which have serious hazardous effects on their health (4).
No known useful biological function was identified for aluminum. It has been noted that toxic effects of aluminum on living organisms have become clear only recently even though the element is present in small amounts in mammalian tissues. Aluminum is now being implicated as interfering with a variety of cellular and metabolic processes in the nervous system and in other tissues(5).
It is known that not only asthma but a much wider range of lung diseases may be caused by occupational factors in aluminum production: chronic bronchitis (CB), chronic obstructive pulmonary disease (COPD), alveolitis, pneumosclerosis, pneumoconiosis, oncological respiratory diseases(7).
The present study was an analytical cross-sectional study conducted in the aluminum company of Egypt present in Naga Hammadi; district at Qena governorate aimed to detect respiratory disorders and associated risk factors among workers in primary aluminum industry.
Data was collected from the workers under the study by semi structured questionnaires through an interview done by the researcher herself. The data was collected by the questionnaire include: Personal data, detailed occupational history of the present occupation, data about chronic respiratory symptoms and acute work-related symptoms on exposure to work environment and data about symptoms of other systems.
Measurement of blood pressure and ECG were done to the studied workers, spirometry was carried out for them at their work site,postero-anterior chest x-ray film at deep inspiration was taken for each studied subject in addition to some laboratory investigations include the following(CBC, liver enzymes, blood urea, serum creatinine and CRP).
from the study we revealed that:
The aluminum exposed workers significantly more suffering of chronic respiratory symptoms as well as acute-work related symptoms than partially and non exposed.
The occurrence of chronic respiratory symptoms and acute work-related symptoms were higher among aluminum exposed workers with duration of exposure more than 25 years, those who were smokers, those who were from rural areas and low educated.
There was significantly higher occurrence of asthma among exposed participants (8.1%) especially those from rural areas compared to partially exposed(3.3%) and non exposed ones (1.2%) with p value 0.04*.
The study showed that there was no statistical significant difference as regard the occurrence of COPD in the studied groups but the difference was statistically significant among the exposed workers in relation to smoking.
The history of occurrence of allergic rhinitis was significantly higher among exposed ( 7.3%) compared to partially exposed (5%) and non exposed (0%) groups(p=0.04*).
The mean values of spirometric measurements regarding FVC%, FEV1%, FEV1/FVC and PEF25-75% were significantly lower among exposed participants (84.15±15.02, 88.77±17.65, 106.15±14.73 and 81.34±29.10, respectively) compared to partially exposed(89.30±17.83, 94.15±19.34, 111.53±15.14and 86.22±29.40, respectively) and non exposed ones(93.35±12.58,99.16±13.31,112.78±11.36 and 92.59±26.01, respectively) (p values; 0.001*,0.001*, 0.001* and 0.008*, respectively). Also there was more reduction of these ventilatory functions with increasing duration of exposure.
The total WBCs*10*3 count, platelets count and RDW% significantly higher in exposed group (7.56±2.46,225.15±67.89 and 12.69±1.27, respectively) compared to partially exposed(6.20±2.23, 212.53±51.51 and 12.07±0.10, respectively) and non exposed groups(6.04±1.25, 202.00±46.39 and 11.52±0.58, respectively)(p values; 0.001*, 0.01*, and 0.001*, respectively).
The positive CRP was significantly more frequently occurred in exposed group (27.7%) compared to partially exposed (6.7% ) and non exposed ones (3.8%) with p value 0.001*.
Interpretation of chest x-rays revealed that reticular, reticulonodular infiltrations and pleural thickenings were significantly more predominant in exposed workers compared to partially exposed and non exposed workers, also diaphragmatic hump was significantly more frequently occurred in chest x-rays of exposed workers , these x-rays findings were higher amongworkers whose exposure more than 25 years. As regards the radiological findings according to ILO classification, our study showed that occurrence s (denoting asbestosis)and p (denoting silicosis) opacities were significantly higher among exposed compared to partially exposed group. This study is the first study that detects asbestosis among primary aluminum industry laborers.
We stated this fact after interpretation of x-rays and finding in spite that asbestos fibers is not a component of bauxite but it is present in this industry as an insulator e.g. lining many tools and vessels to prevent dissipation of heat and to protect the metallic walls of these tools and vessels as in ladles, storage rooms and molds. Also asbestos fibers are present in ropes hanging ladles, seals of vessels, gloves, boots etc... In handling these equipments containing asbestos fibers and repairing them, workers are exposed to asbestos fibers and there hazards.
The mean urea and creatinine level were significantly higher in exposed (32.40±14.22 and 1.28±0.81, respectively ) compared to partially exposed(27.24±4.49 and 1.11±0.13, respectively ) and non exposed participants(26.94±4.39 and 0.98±0.14, respectively ) (p= 0.001* for both urea and creatinine).
The mean systolic and diastolic Bp were significantly higher among exposed participants (122.02±13.96 and81.92±9.17, respectively) compared to partially exposed (116.67±17.72and 76.17±10.75, respectively) and non exposed (117.25±11.14and 77.50±8.04, respectively)with p= 0.003* for systolic Bp and p= 0.001* for diastolic Bp.
The history of occurrence of dental falling was significantly higher among exposed (51.9%) compared to partially exposed (18.3%) and non exposed (3.8%) groups (p=0.001*).It also showed that occurrence of bleeding per gum significantly higher among exposed group (16.9%) compared to partially exposed (5%) and non exposed (2.5%) ones (p=0.001*).
The highly predictive of major risk factors that may predispose to occurrence of abnormalities in chest x-rays in the studied exposed and partially exposed participants, were in order: positive family history of allergy (odds ratio= 5.66), smoking (odds ratio= 2.45), pattern of exposure (odds ratio= 2.12) and duration of exposure (odds ratio= 1.045).
So we recommend that:
Pre-placement examination should be done for all new workers and those having chronic respiratory diseases and family history of allergy should be informed that they are at higher risk.
Measures should be taken to decrease duration of working hoursof exposure / day to be less than 8 hours / day.
Replacing the asbestos, as an insulator, by other material not harmful or at least less harmful is a fundamental demand.
Periodic medical examination should be done for exposed workers including: physical, spirometric, and radiological chest examinations to pick up and removal of the affected workers from further exposure withsuitable managementof them.
CRP and platelets count may be used in periodic medical examination as an additional measure to allow more complete and relevant assessment of affection of workers by asthmatic attacks and also CBCs may be used for early detection of anemia and changes in leucocytic counts.
Health and safety education of workers by explaining the health hazards to which they are exposed, early symptoms of these hazards and the importance of the proper use of protective measures.
Using PPE requires hazard awareness and training on how to use. Employees must be aware if the equipment isn’t used properly, hazards will occur. To reduce the possibility of health hazards, equipment must be efficient,properly fitted, and maintained in a clean and serviceable condition.
Workers working in hot environment should be instructed to increase fluid intake and salts in their food to prevent renal disorders and heat strokes.
Prohibition or at least restriction of smoking is very important to minimize its synergistic effects on the respiratory system.
Kidney functions should be done periodically especially for workers in pot rooms and those who manufacturing or repairing the electrodes.
Continuous engineering improvements, which involve enclosement of dusty process to reduce the resulting chemical emissions as well as proper ventilation of the workplace through efficient local,exhaust ventilation system. Periodic testing for the ventilation systems to assure that they are perfect and periodic air analysis should be carried out for measuring the particulates and gaseous concentrations to be with the standard measurement