PhD Proposal Of

Assessment of Air Pollution association with hypertension for Cement Plants Workers

By:

Mr. Ahmed Omer Abo Shoga

Master of Environmental Sciences

(Environmental Health)

Palestine, Gaza Strip

Phone: 00972599056375

Email:

Feb.2016

CONTENT
1 / LIST OF ABBREVIATIONS
2 / ABSTRACT
3 / INTRODUCTION
4 / BACKGROUND
4.1 DISEASE OUTCOMES
4.1.1 HYPERTENSION
4.2 ENVIRONMENTAL RISK FACTORS
4.2.1 NOISE POLLUTION
4.2.2 PARTICULATE MATTER POLLUTION
5 / STATEMENT OF THE PROBLEM
6 / AIM AND OBJECTIVES
7 / RESEARCH QUESTIONS
8 / PROPOSED METHODOLOGY
8.1 INTRODUCTION
8.2 DATA COLLECTION
8.3 INSTRUMENTS
8.4 TECHNIQUES
8.5 EQUIPMENT
8.6 INCLUSION AND EXCLUSION CRITERIA FOR CASES
8.7 INCLUSION AND EXCLUSION CRITERIA FOR CONTROLS
8.8 STATESTICAL ANALYSIS
9 / PROPOSED FLOW CHART
10 / REFERENCES

1.List of Abbreviations:

MEANING / ABBR ABBR.
Particulate matter with aerodynamic diameter of 10 μm or less. / PM10
Blood Pressure. / BP
The Institution of Occupational Safety and Health / IIOSH
Environment Protection Agency. / EPA
Particulate Matters. / PM
Pulse Rate. / PR
Software Package used for Statistical Analysis. / SPSS
World Health Organization. / WHO

2.Abstract

Environmental risk factors contribute as critical role in cardiovascular effects. Cardiovascular diseases is a main cause of death.1 It is also estimated to be the most important reason for loss of disability- adjusted life years worldwide.2 The most common cardiovascular disorders are hypertension, coronary heart disease, and cerebrovascular disease.3 After a century of increasing cardiovascular death rates in nearly all countries, mortality has decreased in many countries, largely due to preventive measures, focusing on Air quality.

Despite various support for links between air quality and cardiovascular disease, there are still gaps in the knowledge that make the scientific evidence uncertain and prone to criticism.

The study will design to be a case-control study, which is very useful to investigate and display the associations between air quality and Hypertension for cement plants workers in Gaza Strip.

In case-control study the researcher will start with a group of subjects who have already experienced a problem of concern (cardiovascular cases), and then selects a second group of people who have not (cardiovascular free/controls), then both groups are compared for history of exposures.

The main aim of this research is to investigate and display the association between air quality and Hypertension for cement plants workers in Gaza Strip- Palestine. The environmental risk factors of air quality which will be studied include Particulate matter, and Noise pollution.

The specific objectives is to explore a possible association between Particulate matter exposure and the occurrence of hypertension, to investigate an association between exposure to Noise pollution and the occurrence of hypertension, to measure the Particulate matter concentrations in all cement plants (Downwind reading, Upwind reading and Contribution by the unit), to measure the noise level in work area for all cement plants and to test the hypothesis that the protective cloths materials is associated with a decreased risk of hypertension.

This study will prove and demonstrate significance of the relationship between exposure to air quality risk factors (Particulate matter and Noise pollution) and the occurrence of hypertension to reject and revocation of all the criticisms which guided to the relationship between the mentioned variables.

3.Introduction

Numerous environmental risk factors can cause or contribute to heart disease. According to the American Heart Association, while a person's risk of heart disease from environmental factors is lower than other known cardiovascular risk factors, such as obesity and hypertension. But pollution is a critical environmental risk factor and need risk factor management, because it's a significant public health problem due to the large number of people exposed and the length of exposure.

Environmental risk factors suggested to be of importance for cardiovascular disease include environmental tobacco smoke (ETS). 4-5 ambient air pollution,6-8 noise exposure,9-14 and the chemical composition of drinking water.15 Furthermore, also other environmental exposures, such as lead and polyaromatic hydrocarbons,16,17,18 and meteorological factors like temperature 20-24 and rainfall have been discussed in relation to cardiovascular disease. Yet, despite some research on the association between environmental exposures and cardiovascular disease, many questions still remain regarding which environmental agents play a role and the nature of their pathophysiological mechanisms. The increasing interest for environmental factors in the etiology of coronary heart disease is manifested by a new emerging research field of environmental cardiology.23

4.Background

4.1 Disease outcomes

The major cardiovascular disease which will be included in this thesis are hypertension. Hypertension is one of the most important risk factors for coronary heart disease, and together with myocardial infarction and stroke the most common of the cardiovascular diagnoses.3

4.1.1 Hypertension

Hypertension refers to a clinical diagnosis of persistently increased blood pressure that may be harmful to the cardiovascular system. High blood pressure has deleterious effects on the coronary, renal, and cerebral arteries, and causes an increased work load on the heart.3

The blood pressure varies widely from individual to individual and within one individual at different times.29 It changes with physical activity, stress, age, and many other circumstances of the individual.3 Blood pressure is highest when the heart beats to push blood out into the arteries (i.e. systolic pressure), and lowest when the heart relaxes to fill with blood again (i.e. diastolic pressure). Blood pressure is measured in millimeters of mercury (mm Hg) and if a person's systolic pressure is 120 and diastolic pressure is 80, it is expressed as 120/80 mm Hg.

4.2 Environmental Risk factors (Air Quality)

The present study will focus on the main factors related to hypertension discussed in the literature of relevance for environmental risk management and public health prevention. These include noise pollution exposure, here represented by cement plants machines noise, and Particulate matter air pollution.

Studies of associations between disease and the ambient environment may be hampered by lower levels and contrast in exposure, but are of great public health importance due to the large number of people that are unwillingly exposed to factors like air pollution and noise in their work.

4.2.1 Noise pollution

WHO has set up guidelines for noise arranged according to specific environments and critical health effects.28 To protect most people from being seriously annoyed by noise at daytime it is recommended that the noise level should not exceed 55 dBA at balconies, terraces, and outdoor living areas. To avoid sleep disturbance, indoor guideline values for bedrooms are 30 dBA for continuous noise and 45 dBA for single sound events at night.

The burden of injuries and diseases caused by workers' exposure to excessive noise is heavily perceived by the Israeli economy, public health and OSH communities. This is why IIOSH feels obliged to take an initiative and call on the employers, OSH professionals and all relevant stakeholders to do their utmost in order to preserve the workers' hearing and to minimize the noise harm.

4.2.2 Particulate Matter Pollution

"Particulate matter," also known as particle pollution or Particulate matter, is a complex mixture of extremely small particles and liquid droplets. Particle pollution is made up of a number of components, including acids (such as nitrates and sulfates), organic chemicals, metals, and soil or dust particles .27

Particulate matter is an environmental factor that can cause or contribute to heart disease. According to a 2010 scientific statement on air pollution and heart disease by the AHA published in the journal "Circulation," there exists a causal relationship between particulate matter exposure and cardiovascular morbidity and mortality, and particulate matter is a modifiable environmental factor that contributes to heart disease.

  1. Statement of The Problem

Despite various support for links between these environmental factors and cardiovascular disease, there are still gaps in the knowledge that make the scientific evidence uncertain and prone to criticism.

Compared to other risk factors, the association between environmental factors and cardiovascular disease has been studied less extensively, resulting in uncertainty as to which role the environment plays in the causation of cardiovascular disease.25

This study aims to investigatea significance of the relationship between exposure to some environmental risk factors (Noise pollution and Particulate matter) and the occurrence of hypertension, By focusing on the people who work in the most polluted Particulate matter and noise areas,The results and outcomes will play an active role in a rejection and revocation of all the criticisms which guided to the relationship between the mentioned variables.

6.Aim and Objectives

The main aim of this research is to investigate associations between the environment and cardiovascular diseases for cement plants workers in Gaza Strip - Palestine, focusing on hypertension. The environmental factors studied include Particulate matter, and Noise pollution.

6.1. The specific Objectives are to:

1)Examinethe association between Particulate Matter (PM) exposure to the occurrence of hypertension.

2)Investigate an association between exposure to Noise pollution and the occurrence of hypertension.

3)Measure the Particulate matter concentrations in all cement plants (Downwind reading, Upwind reading and Contribution by the unit).

4)Measure the noise level in work area for all cement plants.

5)Test the hypothesis that the protective cloths materials is associated with a decreased risk of hypertension.

6.2. Research Questions:

1)Is there a significance relationship between Particulate matter exposure and the occurrence of hypertension?

2)Is there any significance between Noise pollution exposure and the occurrence of hypertension.

3)Is the concentration of Particulate matter higher than accepted level and can lead to Hypertesnsion?

4)Is the level of noise higher than accepted level and can lead to Hypertesnsion ?

5)Is the hypothesis that the protective cloths materials is associated with a decreased risk of hypertension accurate?

7.Materials and Methods

The study will design to be a case-control study, which is very useful to investigate the possible environmental risk factors of cardiovascular diseases in Gaza Strip.

In case-control study the researcher will starts with a group of subjects who have already experienced a problem of concern (cardiovascular cases), and then selects a second group of people who have not (cardiovascular free/controls), then both groups are compared for history of exposures.

7.1 Data Collection

In the interview, the researcher will use the structured face to face questionnaire. Great care will take to ensure the confidentiality; the researcher will give the participant enough time to answer the questions and encouraged them to be open in answering.

Particulate matterconcentrations monitoring will be conducted using two sets of particulate matter samplers, one placed at the upwind location and the other on the downwind direction during the work time. The difference between downwind and upwind concentration gives the concentration actually contributed by virtue of operation of the cement plant.

Noise level monitoring during work for all cements plants in Gaza strip. Noise level monitoring will be conducted using noise level detector, which will be placed in the area of cement plants workers during the work time.

7.2 Techniques :

The researcher will use the following techniques and equipment:

7.2.1 Field Techniques .

7.2.1.1 Particulate Matter Concentration Measuring

The researcher will measure the concentration of Particulate matter during work for all cements plants in Gaza strip. Particulate matter concentrations monitoring will be conducted using two sets of particulate matter samplers, one placed at the upwind location and the other on the downwind direction during the work time.

The downwind particulate matter sampler was located at appropriate locations covering emission from all the sources of particulate matter generation. So two results (upwind and downwind) will be documented for each plant.

The upwind side particulate matter is so located that it gives the background concentration, which is due to the particulate matter from other sources i.e. mounds of crushed stones, mixing cement with gravel machines and brick manufacturing machines.

The downwind side particulate matter sampler measures Particulate matter emission from the cement plant under the study as well as the other sources .

The difference between downwind and upwind concentration gives the concentration actually contributed by virtue of operation of the cement plant.

(Downwind reading) -(Upwind reading) = (Contribution by the unit).

7.2.1.2 Noise level Measuring

The researcher will measure the noise level during work for all cements plants in Gaza strip. Noise level monitoring will be conducted using noise level detector, which will be placed in the area of cement plants workers during the work time.

7.2.2 Laboratory Equipment .

7.2.2.1 Particulate matter measuring device:

The Model HAL-HPC300 handheld optical particle counter used to measure the concentration of Particulate matter in the air, its utilizes the laser technology for single particle detection.

7.2.2.2 Noise Measuring device (Digital Sound Level Meter (Pulsar Model 14)):

The Model 14 is the ideal solution for users needing a low cost, accurate measurement instrument for those applications where aDigital Sound Level Meterwould be useful but a high specification meter would be too expensive.

7.3 Instruments:

Every person included in the study will be submitted to the following procedures:

7.3.1 Questionnaire :

Each worker will fill out the questionnaire with the researcher, It will include Personal, Detailed occupational history, Life style and Smoking, Past history of hypertension, heart diseases, Blood pressure and pulse rate values that will be measured for each individual pre and post work day.

7.3.2 Vital signs

Vital signs might provide surveillance for changes in their condition, recognizing early clinical deterioration and protection from harm or errors.24

Blood pressure (BP) refers to the pressure exerted by blood against the arterial wall. It is influenced by cardiac output, peripheral vascular resistance, blood volume and viscosity and vessel wall elasticity .25

Pulse is defined as the palpable rhythmic expansion of an artery produced by the increased volume of blood pushed into the vessel by the contraction and relaxation of the heart. 26

For these reasons, the researcher will measure blood pressure and pulse rate for all individuals who will be participated in the study.

7.4 Inclusions and Exclusion criteria .

7.4.1 For cases

  1. Inclusions criteria:

Included people are People who work in Gaza Strip Cements plants for five years or more and have cardiovascular symptoms after working in cement. .

  1. Exclusion criteria:

Excluded people are People who do not work in Gaza Strip Cements plants for five years or more and have cardiovascular symptoms before working in cement .

7.4.1 For control

  1. Inclusions criteria:

Included people are People who work in Gaza Strip, do not exposure to environmental risk factors and haven’t cardiovascular symptoms.

  1. Exclusion criteria:

Excluded people are People who do not works in Gaza Strip, and Exposed to environmental risk factors and have cardiovascular symptoms.

7.5 Ethical Considerations

The study will carry out in accordance with the directions of the Institutional Review Board for Ethics in Human's Medical Studies (The Helsinki Committee). An informed consent will attach to each questionnaire obtained from each participant in the study. The researcher will explain the aim and the objectives of the study to all the participants, and the inclusion in the study was optional and confidential. Neither name nor personal data had been published. Official letters has been sent to the Palestinian Ministry of Health and Environment Authority to obtain the request approval for the study.

7.6 Statistical Analysis

The researcher will use the Statistical Package for Social Sciences version 15 (SPSS) for data coding, entry and analysis. Simple distribution and frequencies of the study variables, the cross tabulation, and normal chi square will be applied. P value will be calculated for the ordinal level measures (P< 0.05), variables that are statistically significant by chi square test will be analyzed using odds ratio and 95% confidence interval.

  1. PROPOSED FLOW CHART
  1. REFERENCES:
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