Etiopathogenetic programs aimed at preventing in children risk-associated diseases caused by exposure to adverse components in emissions from a large non-ferrous metallurgic production

Introduction. Non-ferrous metallurgy holds a specific place among various productions that create potential health risks due to environmental pollution. Total emissions from the branch enterprises into ambient air reach three million tons (aluminum, fluorine, nickel, manganese, benzo(a)pyrene, sulfur dioxide and trioxide, hydrocarbon, etc.) per year, which accounts for 18% of the total emissions from all stationary sources. Implementation of etiopathogenetic prevention programs is a promising trend in preventing in children actual diseases associated with poor quality of the environment.

The aim of this study was to develop and substantiate technologies aimed at reducing incidence in children of risk-associated pathologies caused by exposure to emissions from a large non-ferrous metallurgic enterprise as well as assess their effectiveness.

Materials and methods. We examined five hundred forty two children lived in close proximity to a large non-ferrous metallurgic enterprise and 149 children who lived on a reference territory. Both groups were comparable in terms of age, sex, lifestyle, and socioeconomic position. The examination program included general clinical, functional, laboratory, chemical-analytical and statistical research methods, mathematical modelling, and assessment of technology effectiveness.

Results. Fluorine, aluminum, manganese, chromium and nickel compounds as well as benzo(a)pyrene were identified in ambient air on the observation territory, their levels reaching 1.20–10.96 of average annual MPL; ambient air on the reference territory conformed to safety standards. Blood levels of these chemicals, which are 1.4–5.0 times higher than the reference level, raise prevalence of diseases of respiratory, nervous, musculoskeletal, and endocrine systems and blood by 1.6–3.1 times. Pathomorphosis and pathology prevalence are determined by serous-catarrhal and immune-dependent inflammation with damage to airway epithelium and thyrocytes, deceleration of endochondral ossification and bone remodelling, impaired neuromediator synthesis and inhibited synaptic transmission, hemopoiesis suppression; impaired iron and iodine metabolism, imbalance in immune-competent cell sub-populations, specific sensitization and redox imbalance induced by chemical exposures.

Limitations. The study was performed in 4–7 years children lived in an area influenced by a large non-ferrous metallurgic enterprise.

Conclusion. Implementation of etiopathogenetic prevention programs decreases frequency of relapses by 3.8 times; prevents a growth in incidence rates; increases the number of children in health groups I and II (practically healthy and without any chronic diseases) by 17–39%; promotes recovery of functional and metabolic activity of critical organs and systems in 68–98% cases. It reduces costs associated with medication provision for children with risk-associated pathology by 34–60% and by 50–75% for children with high and medium risks. Another significant result 2.6–3.3 times shorter duration of temporary disability due to taking care of a sick child with a risk-associated disease; this period decreases 2.6–3.3 times in case of children with high and medium risks. Economic efficiency of these technologies amounts to 6.5 rubles per 1 spent ruble.

Compliance with ethical standards. The study was approved by the Local Ethics Committee of the Federal Scientific Center for Medical and Preventive Health Risk Management Technologies of the Federal Service for Supervision in Protection of the Rights of Consumer and Man Wellbeing (the meeting report No. 12 dated December 18, 2020) and conducted in full conformity with the conventional principles stated in the WMA Declaration of Helsinki (2013 edition).

Contributions:
Zaitseva N.V. — the study concept and design, editing the text;
Ustinova О.Yu. — the study design, data analysis, and editing the text;
Zemlyanova М.А. — the study design, data analysis, and editing the text;
Goryaev D.V. — the study design, data analysis, and editing the text;
Valina S.L. — data collection and analysis, writing the text;
Shtina I.Е. — data collection and analysis, writing the text;
Nosov А.Е. — data collection and analysis;
Kobyakova О.А. — data collection and analysis.
All the authors have approved the final version of the article and bear full responsibility for the integrity of all its parts.

Conflict of interest. The authors declare no conflict of interest.

Acknowledgement. The study had no sponsorship.

Received: August 12, 2024 / Revised: October 10, 2024 / Accepted: December 3, 2024 / Published: January 31, 2025