Contemporary Methods for Evaluating the Health Impact of Chrysotile-Asbestos on Workers: Scoping Review

Zhengisbek Zharylkassyn 1, Yertay Otarov 2, Olga Grebeneva 3, Alexey Alexeyev 3, Zhanbol Sabirov 3, Aigul Zharylkassynova 4, Marat Kalishev 1, Darkhan Abitayev 1, Karina Nukeshtayeva 1 *
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1 School of Public Health, Karaganda Medical University, Karaganda, Kazakhstan
2 Director, National Centre for Occupational Health and Diseases, Karaganda, Kazakhstan
3 Research Sanitary and Hygienic Laboratory, National Centre for Occupational Health and Diseases, Karaganda, Kazakhstan
4 Obstetrics and Laboratory Diagnostics department, Karaganda Regional Higher Nursing College, Karaganda, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 22, Issue 5, pp. 93-104. https://doi.org/10.23950/jcmk/16881
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Author Contributions: Conceptualization, Zh. Zh., Ye. O.; methodology, K. N., M. K. and O. G.; validation, A. A., Zh. S.; formal analysis, D. A.; investigation, K. N., Zh. Zh. and A. A.; resources, O. G.; data curation, A. Zh.; writing – original draft preparation, A. Zh., Zh. Zh. and K. N.; writing – review and editing, Ye. O. and D. A.; visualization, K. N.; supervision, Zh. Zh.; project administration, A. A.; funding acquisition – not applicable. All authors have read and agreed to the published version of the manuscript.

ABSTRACT

Analysis of literature data on delayed effects (remote consequences) of exposure to mineral fibers on the body, including chrysotile asbestos, to study the mechanisms by which mineral fibers cause adverse effects in both animals and humans, is a hot topic of interdisciplinary research, many aspects of which are yet to be clarified. The conducted review of scientific literature allowed us to establish a list of pathological conditions in humans and animals that develop later after cessation of contact with various mineral fibers, including chrysotile asbestos. Such conditions (diseases) include pleural mesothelioma, lung cancer, asbestosis, pneumofibrosis, pulmonary emphysema, chronic dust bronchitis, etc. According to literary data, it has been established that workers at enterprises with high occupational dust risks, especially older and elderly people, may develop dust pathology after dismissal, which should be considered as delayed effects of exposure to unfavorable factors. Such production requires more careful attention, study and in-depth analysis of morbidity with temporary loss of ability to work, the results of periodic professional examinations for a quantitative assessment of the magnitude of health risks in various professional groups, the use of modern epidemiological, ecological-hygienic and clinical-diagnostic studies to prevent the development of diseases, premature mortality aimed at increasing the life expectancy of people in industrial regions of the country and after the end of work.
Keywords: mining industry, extraction and enrichment of mineral fibers, chrysotile asbestos production, asbestos cement materials, chrysotile asbestos-containing dust.

CITATION

Zharylkassyn Z, Otarov Y, Grebeneva O, Alexeyev A, Sabirov Z, Zharylkassynova A, et al. Contemporary Methods for Evaluating the Health Impact of Chrysotile-Asbestos on Workers: Scoping Review. J CLIN MED KAZ. 2025;22(5):93-104. https://doi.org/10.23950/jcmk/16881

REFERENCES

  • Methodological guidelines No. 95/235 of the Ministry of Health and Medical Industry of the Russian Federation letter No. 11–6/15 dated 15.03.1996.
  • Silicosis and Silicate Diseases Committee. Diseases associated with exposure to silica and non-fibrous silicate materials. Arch Pathol Lab Med. 1988; 112: 673–720.
  • Lenshin AV, Ilyin AV, Maltseva TA, Kraynov SA. Radiation diagnostics of non-industrial (household) asbestosis of the chest organs in different generations of the same family [in russian]. Bulletin. 2015; 58: 96–107.
  • Kosarev VV, Babanov SA. Occupational diseases: Textbook [in Russian]. University textbook: INFRA-M. 2011: 252.
  • Otarov Y, Zharylkassyn Z, Shaibek A, Mukasheva M, Sabirov Z, Alexeyev A, Izdenov A, Ismailov C, Tilemissov M, Dossybayeva G, Zhaketayeva N, Shaikhattarova U. Cytological Analysis of Upper Respiratory Tract Epithelial Cells in Chrysotile Asbestos Factory Workers. Life. 2025; 15 (3): 353. https://doi.org/10.3390/life15030353.
  • Izmerov NF Professional pathology. National guidelines [in Russian]. Moscow. 2011: 784.
  • Begin R. Asbestos–related diseases. Occupational Lung Disorders. Eur Resp Monogr: CE Mapp. 1999: 158–78. https://doi.org/10.3389/fonc.2023.1172496.
  • Litvyakov AM, Shchupakova AN. Occupational diseases: a course of lectures [in Russian]. Vitebsk: VSMU Publishing House. 2011: 223.
  • Mapa M. S. T., Koralege R. S. H. Silicosis and Asbestosis // Medical Geology: En route to One Health. Wiley. 2023: 83–94.
  • Babanov SA, Averina OM. Dust lung diseases: features of diagnosis and treatment. Pharmateka. 2011; 18: 21–27.
  • Doll R. Other asbestos-related neoplasms. In Asbestos-related Malignancy. Florida: Strotton Inc. 1987: 81–96.
  • Lightfoot Jr RW. Churg-Strauss syndrome and polyarteritis nodosa. Curr Opin Rheumatol. 1991; 3(1): 3-7. https://doi.org/10.1097/00002281-199102000-00002.
  • Becklake MR, Case BW. Fiber burden and asbestos-related lung disease: determinants of dose-response relationships. Am J Respir Crit Care Med. 1994; 150(6): 1488-92. https://doi.org/10.1164/ajrccm.150.6.7952604.
  • Federal clinical guidelines. "Occupational chronic obstructive pulmonary disease". Available online: http://www.niimt.ru/doc/fedclinrekhobl.pdf [Accessed 11 March 2025].
  • Bushueva TV, Roslaya NA. Risk factors for the development of community-acquired pneumonia in workers of the main professions in the production of chrysotile asbestos [in Russian]. Med.truda i prom.ekologiya. 2019; 59(2): 113–116. https://doi.org/10.31089/1026–9428-2019-59-2-113-116.
  • Chimutso T. C. Occupational exposure to dust and associated respiratory symptoms among quarry mine workers, Roodepoort, Johannesburg, South Africa. – University of Johannesburg (South Africa), 2023.
  • Kovalevsky EV. Asbestos and other fibrous materials used in industry: their application, impact on humans and some data on biological action. Collection of reports and speeches of the international seminar "Asbestos". 2004: 3–32.
  • Finley BL, Pierce JS, Phelka AD. Evaluation of tremolite asbestos exposures associated with the use of commercial products. Critical Reviews in Toxicology. 2012; 42(2): 119–146. https://doi.org/10.3109/10408444.2011.636028.
  • Lacourt A, Lebailly P, Guha N. Pleural Mesothelioma and Occupational Asbestos Exposure: Continued Evidence From Independent Case–Control Studies With Updated Estimates. Occupational and Environmental Medicine. 2023; 80(1): 60-67. https://doi.org/10.1164/rccm.201210-1911OC.
  • Liddell FDK, Miller K. Mineral Fibers and Health. Boca Raton, FL: CRC Press. 1991: 400.
  • Baur X, Frank AL. Ongoing downplaying of the carcinogenicity of chrysotile asbestos by vested interests. Journal of Occupational Medicine and Toxicology. 2021; 16(1): 6. https://doi.org/10.1186/s12995-021-00295-2.
  • Jarabek AM, Asgharian B, Miller FJ. Dosimetric adjustments for interspecies extrapolation of inhaled poorly soluble particles (PSP). Inhalation Toxicology. 2005; 17(7-8): 317-334. https://doi.org/10.1080/08958370590929394.
  • Bernstein D, Castranova V, Donaldson K. Testing of fibrous particles: short-term assays and strategies. Inhalation Toxicology. 2005; 17(10): 497–537. https://doi.org/10.1080/08958370591001121.
  • Meisenkothen C, Backes C, Meyer-Lindenberg A. Asbestos Fiber Burden and Mesothelioma. International Journal of Radiation Oncology, Biology, Physics. 2023; 108(1): 83-94.
  • Bernstein D. The health effects of short fiber chrysotile and amphibole asbestos. Crit Rev Toxicol. 2022; 52(2): 89-112. https://doi.org/10.1080/10408444.2022.2056430.
  • Gelzleichter TR, Bermudez E, Vangum JB. Comparison of pulmonary and pleural of rats and hamsters to inhaled refractory ceramic fibers. Toxicol Scienses. 1999; 49: 93–101.
  • Asbestos: Selected Cancers Washington (DC): National Academies Press (US). Institute of Medicine (US) Committee on Asbestos: Selected Health Effects. 2006. https://doi.org/10.17226/11665.
  • Donaldson K, Tran CL. An Introduction to the Short-term Toxicology of Respirable Industrial Fibres. Mutat Res. 2004; 3(553): 5–9. https://doi.org/10.1016/j.mrfmmm.2004.06.011.
  • Searl A, Buchanan D, Cullen RT. Biopersistence and durability of nine mineral fibre types in rat lungs over 12 months. Ann Occup Hyg. 1999; 43(3): 143–53.
  • Timerbulatova GA, Dunaev AP, Dimiev DM. Comparative characteristics of various fibrous materials in in vitro experiments [in Russian]. Kazan Medical Journal. 2021; 102(4): 501-509. https://doi.org/10.17816/kmj2021-501.
  • Visona SD, Capella S, Bodini S. Evaluation of deposition and clearance of asbestos (detected by SEM-EDS) in lungs of deceased subjects environmentally and/or occupationally exposed in Broni (Pavia, Northern Italy). Front Public Health. 2021; 20(9): 678040. https://doi.org/10.3389/fpubh.2021.678040.
  • Bernstein D, Dunnigan J, Hesterberg T. Health risk of chrysotile revisited. Crit Rev Toxic. 2013; 43(2): 154–83. https://doi.org/10.3109/10408444.2012.756454.
  • Schüz J, Kovalevskiy E, Olsson A. Cancer mortality in chrysotile miners and millers, Russian Federation: main results (Asbest Chrysotile Cohort-Study). J Natl Cancer Inst. 2024; 116(6): 866–875. https://doi.org/10.1093/jnci/djad262.
  • Padmore T, Stark C, Turkevich LA, Champion JA. Quantitative analysis of the role of fiber length on phagocytosis and inflammatory response by alveolar macrophages. Biochim Biophys Acta Gen Subj. 2017; 1861(2): 58–67. https://doi.org/10.1016/j.bbagen.2016.09.031.
  • Seung-Hyun Park. Types and health hazards of fibrous materials used as asbestos substitutes. Saf Health Work. 2018; 9(3): 360–364. https://doi.org/10.1016/j.shaw.2018.05.001.
  • Marinaccio A, Binazzi A, Marzio DD. Pleural Mesothelioma in Italy: Trends and Geography of Mortality and Incidence. American Journal of Industrial Medicine. 2022; 65(9): 817–825.
  • Oddone E, Gennaro V, Vigotti MA. Pleural Mesothelioma Mortality Among Asbestos-Exposed Workers With Pleural Plaques. Journal of Occupational and Environmental Medicine. 2022; 64(5): 344–350.
  • Pira E, Pelucchi C, Piolatto PG. First Employment in Asbestos Plants and Risk of Pleural Mesothelioma: A Case—Control Study in North-Western Italy. Occupational and Environmental Medicine. 2022; 79(7): 549–553.
  • Visona SD, Capella S, Bodini S. Inorganic fiber lung burden in subjects with occupational and/or anthropogenic environmental asbestos exposure in Broni (Pavia, Northern Italy): an SEM-EDS study on autoptic samples. Int J Environ Res Public Health. 2021; 18(4): 2053. https://doi.org/10.3390/ijerph18042053.
  • Weiderpass E, Zahm SH, Halperin WE. Cancer Mortality Among Workers Exposed to Chrysotile Asbestos in Italy: A Historical Cohort Study. American Journal of Epidemiology. 2023; 175(10): 1043–1050.
  • Gualtieri AF, Pollastri S, Gandolfi NB, Gualtieri ML. In Vitro Acellular Dissolution of Mineral Fibres: A Comparative Study. Sci Rep. 2018; 8(1): 7071. https://doi.org/10.1038/s41598-018-25531-4.
  • Kashansky SV. Pleural mesothelioma: a systematic review of the works of Russian-speaking authors. XVIII National Congress on Respiratory Diseases: collection of works, Yekaterinburg [in Russian]. 2008; 151: 64.
  • Cheperel A. Expert group of the French-speaking society of lung disease (SPLF). Recommendations of the French-speaking society of lung disease for the management of malignant pleural mesothelioma [in Russian]. Pulmonology. 2007; 6: 12–22.
  • Bani-Hani KE. Malignant peritoneal mesothelioma. Oncol. 2005; 91(1): 17–25. https://doi.org/10.1002/jso.20266.
  • Yablonsky PC. Malignant mesothelioma of the pleura [in Russian]. Practical oncology.2006; 7(3): 179–188.
  • Shoikhet YaN. Pleural diseases [in Russian]. Respiratory medicine. 2007; 2: 464–483.
  • Nepomnyashchaya EM. Malignant mesotheliomas of the pleura. Pulmonology. 2001; 4: 65–68.
  • Lange S, Walsh D. Radiological diagnostics of diseases of the chest organs: a guide. 2010: 432.
  • Maskell N, Millar E. Handbook of respiratory medicine. 2013: 610.
  • Gutich EA. Epidemiological features of malignant mesothelioma in the Republic of Belarus. Bulletin of the National Academy of Sciences of Belarus. Series of Medical Sciences. 2021; 18(3): 315–326.
  • Koigeldinova Sh, Alexeyev A, Zharylkassyn Zh. Immune Status of Workers with Professional Risk of Being Affected by Chrysotile Asbestos in Kazakhstan. J Environ Res Public Health. 2022; 19(21): 14603. https://doi.org/10.3390/ijerph192114603.
  • Kumagai-Takei N, Maeda M, Chen Y. Asbestos induces reduction of tumor immunity. Clin Dev Immunol. 2011: 481439. https://doi.org/10.1155/2011/481439.
  • Brims F. Epidemiology and Clinical Aspects of Malignant Pleural Mesothelioma. Cancers (Basel). 2021;13(16): 4194. https://doi.org/10.3390/cancers13164194.
  • Chiappino G. Mesothelioma: the aetiological role of ultrathin fibres and repercussions on prevention and medical legal evaluation [in Italian]. Med Lav. 2005; 96(1): 3–23.
  • Klochkov NМ. Current state of chrysotile asbestos production in JSC Kostanay Minerals of the Republic of Kazakhstan [in Russian]. Current state and development prospects of the asbestos cement industry of the CIS countries of the Central Asian region in the conditions of controlled, safe use of asbestos-containing products and materials, Tashkent. 2004: 36–41.
  • Burdin VN, Grebennikova VV, Lebedev VI, Burdin NV. Asbestosis at asbestos mining enterprises [in Russian]. Advances in modern natural science. 2007; 12(3): 35–37.
  • Convention No 162 concerning safety in the use of asbestos International Labour Conference (72 session), Geneva. 1986.
  • Plyukhin AE, Burmistrova AE. Occupational lung diseases from exposure to chrysotile asbestos dust and measures for their prevention [in Russian]. Labor Medicine and Industrial Ecology. 2014; 7: 24–28.
  • Kovalevsky EV, Shuts J, Kashansky SV. Comparative assessment of causes of death in a cohort of workers in the extraction and enrichment of chrysotile asbestos [in Russian]. Proceedings of the 16th Russian National Congress with international participation "Profession and Health". Vladivostok. September 21–24, 2021. 2021: 255–260.
  • Boffetta P, Donato F, Pira E. Risk of mesothelioma after cessation of asbestos exposure: a systematic review and meta-regression. Int Arch Occup Environ Health. 2019; 92(7): 94–957. https://doi.org/10.1007/s00420-019-01433-4.
  • Magnani C, Ferrante D, Barone-Adesi F. Cancer risk after cessation of asbestos exposure: a cohort study of Italian asbestos cement workers. Occup Environ Med. 2008; 65(3): 164–170. https://doi.org/10.1136/oem.2007.032847.
  • Järvholm B, Astrom E. The risk of lung cancer after cessation of asbestos exposure in construction workers using pleural malignant mesothelioma as a marker of exposure. J Occup Environ Med. 2014; 56(12): 1297–1301. https://doi.org/10.1097/JOM.0000000000000258.
  • Ibraev SA, Amanbekova AU, Poltaretskaya GS, Bekpan AZ. On the health status of workers at JSC "Kostanay Minerals" according to periodic medical examinations [in Russian]. Proc. republican scientific and practical. conf. with international participation, Karaganda. 2006: 76–79.
  • Zharylkassyn ZhZh, Otarov YeZh, Koigeldinova ShS, Ibrayev SA. Working conditions and health status of workers in chrysotile production [in Russian]. Monography, Karaganda. 2022: 88.
  • Kundiyev YuI, Chernyuk VI, Basanets A, Ostapenko TYa. Clinical and hygienic aspects of the use of chrysotile asbestos in Ukraine [in Russian]. Environment and health. 2011; 3: 12–18.
  • Obukhova TY, Budkar LN, Hurvych VB. Prediction of the risk of developing occupational pulmonary fibrosis against the background of cardiovascular pathology in asbestos processing workers. Ural Medical Journal. 2020; 8: 140–144.
  • Świątkowska B, Szeszenia-Dąbrowska Т. Spirometry: a predictor of lung cancer among asbestos workers. Inhal Toxicol. 2017; 29(1): 18–22. https://doi.org/10.1080/08958378.2016.1272652.
  • Li B, Tang SP, Wang KZ. Esophagus cancer and occupational exposure to asbestos: results from a meta-analysis of epidemiology studies. Dis Esophagus. 2016; 29(5): 421–428. https://doi.org/10.1111/dote.12341.
  • Rong Y, Luo X, Zhang Z, Cui X, Liu Yu, Chen W. Occupational exposure to asbestos and cardiovascular related diseases: a meta-analysis. Prev Med Rep. 2015; 2: 920–926. https://doi.org/10.1016/j.pmedr.2015.10.005.
  • Richardson DB, Cole SR, Langholz B. Regression models for the effects of exposure rate and cumulative exposure. Epidemiology. 2012; 23(6): 892–899. https://doi.org/10.1097/EDE.0b013e31826c3149.
  • Laaksonen M, Pitkäniemi J. The durations of past sickness absences predict future absence episodes. Occup Environ Med. 2013; 55(1): 87–92. https://doi.org/10.1097/JOM.0b013e318270d724.
  • Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, Brauer M, Burnett R, Cercy K, Charlson FJ, Cohen AJ, Dandona L, Estep K, Ferrari AJ, Frostad JJ, Fullman N, Gething PW, Godwin WW, Griswold M, Hay SI, Kinfu Yo, Kyu HH, Larson HJ, Liang X, Lim SS, Liu PY, Lopez AD, Lozano R, Marczak L, Mensah GA, Mokdad AH, Moradi-Lakeh M, Naghavi M, Neal B, Reitsma MB, Roth GA. Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016; 388 (10053): 1659-1724. https://doi.org/10.1016/S0140-6736(16)31679-8.
  • Huss A, Spoerri A, Egger M, Kromhout H, Vermeulen R. Occupational exposure to magnetic fields and electric shocks and risk of ALS: the Swiss national cohort. Amyotroph Lateral Scler Frontotemporal Degener. 2015; 16(1–2): 80–5. https://doi.org/10.3109/21678421.2014.954588.
  • Romaniuk P, Brukalo K. Designing solutions for the retirement system - in search of balance between economy and health. Front Public Health. 2016; 16: 4. https://doi.org/10.3389/fpubh.2016.00184.
  • Varyvonchyk DV. Study of cancer incidence and carcinogenic risks among asbestos cement production workers in Ukraine [in Russian]. Population health and environment. 2013; 4(241): 18–20.
  • Kovalevsky EV, Kashansky SV, Shuts I. Retrospective cohort study of cancer mortality among workers engaged in the extraction and enrichment of chrysotile asbestos in Russia. Population Health and Habitat. 2013; 4(241): 20–23.
  • Tskhomariya IM, Kovalevsky EV. Assessment of the possibility of air pollution by asbestos fibers during the operation of road surfaces containing stabilizing asbestos-containing additives [in Russian]. Hygiene and Sanitation. 2022; 101(2): 146–152. https://doi.org/10.47470/0016-9900-2022-101-2-146-152.
  • Kovalevsky EV, Kashansky SV. Modern approaches to standardization of asbestos-containing dusts. Occupational medicine and industrial ecology. 2008; 3: 9-15.
  • IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Arsenic, Metals, Fibres and Dusts. Lyon (FR): International Agency for Research on Cancer; 2012. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 100C.) ASBESTOS (CHRYSOTILE, AMOSITE, CROCIDOLITE, TREMOLITE, ACTINOLITE AND ANTHOPHYLLITE) Available from: https://www.ncbi.nlm.nih.gov/books/NBK304374/.
  • Frank AL, Joshi TK. The global spread of asbestos. Ann Glob Health. 2014; 80(4): 257–62. https://doi.org/10.1016/j.aogh.2014.09.016.
  • Varivonchik DV. Assessment of carcinogenic hazard of asbestos-cement production in Ukraine [in Russiam]. Ukrainian Journal of Occupational Medicine. 2012; 2(30): 3–13.
  • Grigorenko TI, Zakharova NA, Kartel NT, Brichka AV, Oranskaya YeI, Gorelov BM, Brichka SYa. Changes in the structure and chemical composition of chrysotile asbestos fibers under the influence of technological factors in the production of lime-siliceous thermal insulation products [in Russian]. Chemistry, physics and technology on top. 2014; 5(3): 349–357.
  • Kashansky SV. Mesothelioma in Russia: a systemic review of 3576 published cases from the standpoint of occupational medicine [in Russian]. Occupational Medicine and Industrial Ecology. 2008; 3: 15–21.
  • Gibbs GW, Berry G. Mesothelioma, and asbestos. Regul. Toxicol. Pharmacol. 2008; 5(1): 223-231. https://doi.org/doi: 10.1016/j.yrtph.2007.10.003.
  • Adib G, Labreche F., De Guir L, Dion C, Dufresne A. Short, fine and who asbestos fibers in the lungs of Quebec workers with an asbestos-related disease. Am. J. Ind. Med. 2013; 56(9): 1001–1014. https://doi.org/10.1002/ajim.22180.
  • Elovskaya LT. Professional view on the anti-asbestos campaign. Construction materials. 2008; 9: 32–33.
  • White N, Nelson G, Murray J. South African experience with asbestos-related environmental mesothelioma: is asbestos fiber type important? Regulatory Toxicology and Pharmacology. 2008; 52(1): 92-S96. https://doi.org/10.1016/j.yrtph.2007.09.013.
  • NTP 11th Report on Carcinogens. National Toxicology Program (NTP). Rep Carcinog. 2004: 11–1.
  • Pyatnitsa-Gorpinchenko NK. Asbestos and fibrous carcinogenesis. Environment and Health. 2014; 1: 4–9.
  • International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 42(7). Lyon, France: IARC; 1987:106–116.
  • International Agency for Research on Cancer (IARC). Overall Evaluations of Carcinogenicity: An Updating of IARC Monographs. Lyon, France: IARC; 1987:1–42.
  • IARC Monographs on the Identification of Carcinogenic Hazards to Humans. Talc and Acrylonitrile; 2025. (IARC Monographs on the Identification of Carcinogenic Hazards to Humans, No. 136.) Talc and Acrylonitrile Available from: https://publications.iarc.who.int/646
  • Sabirov Z. B. et al. Biological (microfloral) factors of influence on cytogenetic stability during chemical mutagenesis. Biodemography and Social Biology. 2023; 68 (2-3): 101-112.
  • Parida L., Patel T. N. Systemic impact of heavy metals and their role in cancer development: a review. Environmental Monitoring and Assessment. 2023; 195(6): 766.
  • Naim MAAZ, Ahmed R. Occupational Hazards in the Mining Industry: A Focus on Chrysotile Asbestos Exposure and Health Outcomes. Epidemiology and Health Data Insights. 2025;1(1):ehdi005. https://doi.org/10.63946/ehdi/16411.