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      Metodología para evaluar la exposición ocupacional a contaminantes químicos en altitud Translated title: Methodology to evaluate occupational exposure to chemical contaminants at high altitude

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          Abstract

          Resumen Este artículo examina el actual método para evaluar la exposición a contaminantes químicos en altitud usando los Threshold Limit Value (TLV). Estos valores son establecidos para trabajos a nivel del mar en jornadas de 8 horas diarias y 40 horas semanales. Se analiza este problema aplicándolo a un grupo específico de mineros chilenos que trabaja sobre los 3000 m con jornadas excepcionales de 12 horas diarias. Se comparan dos alternativas para evaluar la exposición a contaminantes químicos: ajustes al TLV en altitud, y el cálculo de la dosis inhalada. Puesto que la ventilación por minuto es el parámetro fisiológico que cambia en altitud se propone y fundamenta como método de evaluación el cálculo de la dosis inhalada del contaminante químico.

          Translated abstract

          Abstract This study reviews the current method for assessing exposure to chemical contaminants at high altitude, which is based on the use of Threshold Limit Values (TLV). These TLVs were originally established for work performed at sea level, for 8-hour shifts over a 40-hour work week. Our study analyzes the problem for a specific group of Chilean miners working at altitudes above 3000, and for shifts of up to 12 hours a day. We examined different approaches for the evaluation of exposure to chemical contaminants: adjusting the TLV for work at high altitude and calculating inhaled dose. Since minute ventilation changes at different altitudes, we propose using calculated inhaled dose of the chemical contaminant as the method of choice.

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          Occupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance.

          Mining operations conducted at high altitudes provide health challenges for workers as well as for medical personnel. To review the literature regarding adverse health effects and toxic exposures that may be associated with mining operations conducted at altitude and to discuss pre-placement screening, acclimatization issues, and on-site surveillance strategies. We used the Ovid ( http://ovidsp.tx.ovid.com ) search engine to conduct a MEDLINE search for "coal mining" or "mining" and "altitude sickness" or "altitude" and a second MEDLINE search for "occupational diseases" and "altitude sickness" or "altitude." The search identified 97 articles of which 76 were relevant. In addition, the references of these 76 articles were manually reviewed for relevant articles. CARDIOVASCULAR EFFECTS: High altitude is associated with increased sympathetic tone that may result in elevated blood pressure, particularly in workers with pre-existing hypertension. Workers with a history of coronary artery disease experience ischemia at lower work rates at high altitude, while those with a history of congestive heart failure have decreased exercise tolerance at high altitude as compared to healthy controls and are at higher risk of suffering an exacerbation of their heart failure. PULMONARY EFFECTS: High altitude is associated with various adverse pulmonary effects, including high-altitude pulmonary edema, pulmonary hypertension, subacute mountain sickness, and chronic mountain sickness. Mining at altitude has been reported to accelerate silicosis and other pneumoconioses. Miners with pre-existing pneumoconioses may experience an exacerbation of their condition at altitude. Persons traveling to high altitude have a higher incidence of Cheyne-Stokes respiration while sleeping than do persons native to high altitude. Obesity increases the risk of pulmonary hypertension, acute mountain sickness, and sleep-disordered breathing. NEUROLOGICAL EFFECTS: The most common adverse neurological effect of high altitude is acute mountain sickness, while the most severe adverse neurological effect is high-altitude cerebral edema. Poor sleep quality and sleep-disordered breathing may contribute to daytime sleepiness and impaired cognitive performance that could potentially result in workplace injuries, particularly in miners who are already at increased risk of suffering unintentional workplace injuries. OPHTHALMOLOGICAL EFFECTS: Adverse ophthalmological effects include increased exposure to ultraviolet light and xerophthalmia, which may be further exacerbated by occupational dust exposure. RENAL EFFECTS: High altitude is associated with a protective effect in patients with renal disease, although it is unknown how this would affect miners with a history of chronic renal disease from exposure to silica and other renal toxicants. HEMATOLOGICAL EFFECTS: Advanced age increases the risk of erythrocytosis and chronic mountain sickness in miners. Thrombotic and thromboembolic events are also more common at high altitude. MUSCULOSKELETAL EFFECTS: Miners are at increased risk for low back pain due to occupational factors, and the easy fatigue at altitude has been reported to further predispose workers to this disorder. TOXIC EXPOSURES: Diesel emissions at altitude contain more carbon monoxide due to increased incomplete combustion of fuel. In addition, a given partial pressure of carbon monoxide at altitude will result in a larger percentage of carboxyhemoglobin at altitude. Miners with a diagnosis of chronic obstructive pulmonary disease may be at higher risk for morbidity from exposure to diesel exhaust at altitude. Both mining and work at altitude have independently been associated with a number of adverse health effects, although the combined effect of mining activities and high altitude has not been adequately studied. Careful selection of workers, appropriate acclimatization, and limited on-site surveillance can help control most health risks. Further research is necessary to more completely understand the risks of mining at altitude and delineate what characteristics of potential employees put them at risk for altitude-related morbidity or mortality.
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            Estimating minute ventilation and air pollution inhaled dose using heart rate, breath frequency, age, sex and forced vital capacity: A pooled-data analysis

            Air pollution inhaled dose is the product of pollutant concentration and minute ventilation ( V ˙ E ). Previous studies have parameterized the relationship between V ˙ E and variables such as heart rate (HR) and have observed substantial inter-subject variability. In this paper, we evaluate a method to estimate V ˙ E with easy-to-measure variables in an analysis of pooled-data from eight independent studies. We compiled a large diverse data set that is balanced with respect to age, sex and fitness level. We used linear mixed models to estimate V ˙ E with HR, breath frequency (fB), age, sex, height, and forced vital capacity (FVC) as predictors. FVC was estimated using the Global Lung Function Initiative method. We log-transformed the dependent and independent variables to produce a model in the form of a power function and assessed model performance using a ten-fold cross-validation procedure. The best performing model using HR as the only field-measured parameter was V ˙ E = e-9.59HR2.39age0.274sex-0.204FVC0.520 with HR in beats per minute, age in years, sex is 1 for males and 2 for females, FVC in liters, and a median(IQR) cross-validated percent error of 0.664(45.4)%. The best performing model overall was V ˙ E = e-8.57HR1.72fB 0.611age0.298sex-0.206FVC0.614, where fB is breaths per minute, and a median(IQR) percent error of 1.20(37.9)%. The performance of these models is substantially better than any previously-published model when evaluated using this large pooled-data set. We did not observe an independent effect of height on V ˙ E , nor an effect of race, though this may have been due to insufficient numbers of non-white participants. We did observe an effect of FVC such that these models over- or under-predict V ˙ E in persons whose measured FVC was substantially lower or higher than estimated FVC, respectively. Although additional measurements are necessary to confirm this finding regarding FVC, we recommend using measured FVC when possible.
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              Respiratory parameters at varied altitudes in intermittent mining work.

              Workers in the mining industry in altitude are subjected to several risk factors, e.g., airborne silica and low barometric pressure. The aim of this study has been to assess the risks for this work category, evaluating single risk factors as airborne silica, altitude and work shift, and relating them with cardiovascular and ventilatory parameters.
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                Author and article information

                Journal
                aprl
                Archivos de Prevención de Riesgos Laborales
                Arch Prev Riesgos Labor
                Societat Catalana de Salut Laboral y Asociación de Medicina del Trabajo de la Comunidad Valenciana (Barcelona, Barcelona, Spain )
                1578-2549
                December 2021
                : 24
                : 4
                : 404-409
                Affiliations
                [1] Santiago orgnameDUOC Universidad Católica orgdiv1Escuela de Construcción Chile
                [3] Santiago orgnameMillennium Institute for Subatomic physics at high energy frontier - SAPHIR Chile
                [2] Santiago orgnameUniversidad Andrés Bello orgdiv1Departamento de Ciencias Físicas Chile
                Article
                S1578-25492021000400404 S1578-2549(21)02400400404
                10.12961/aprl.2021.24.04.06
                cdc34f57-6220-458a-b582-5246c4a87a4a

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 26 August 2021
                : 24 April 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 6
                Product

                SciELO Spain

                Categories
                Estudios de Casos

                Threshold Limit Value,dosis inhalada,altitud,Valores límites,inhaled dose,high altitude

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