Introdução: A exposição ocupacional na mineração de pedras preciosas e semipreciosas pode causar silicose. Os efeitos da silicose sobre a qualidade de vida relacionada à saúde (QVRS) dos trabalhadores não são bem conhecidos. Objetivo: Estudar a prevalência de silicose em trabalhadores de mineração de pedras preciosas e semipreciosas e avaliar as repercussões da silicose sobre a QVRS destes trabalhadores. Método: Num estudo transversal realizado em Ametista do Sul, Rio Grande do Sul, Brasil foram estudados 348 mineradores. O diagnóstico de silicose foi estabelecido pela história de exposição e alterações compatíveis com a doença observadas na radiografia de tórax. Foram coletados dados antropométricos e socioeconômicos, história tabágica, dados sobre exposição ocupacional e resultados da espirometria e da radiografia de tórax. A QVRS foi avaliada através do questionário World Health Organization Quality of Life (WHOQoL-Bref) e do Saint George's Hospital Respiratory Questionnaire (SGRQ). Os dados são apresentados como média ± DP ou mediana (IQR). Resultados: Foram avaliados 348 trabalhadores, do sexo masculino, com idade de 40±12 anos. A prevalência de silicose foi de 37% (95% DP 32-42). Trabalhadores com silicose eram mais velhos (47±10 anos vs 36±11 anos; p<0,001), tinham menor escolaridade (5±2 anos vs 7±3 anos p<0.001), menor renda (R$ 1152 [835-1411] vs R$ 1382 [1152-1736]; p=0,001) e maior tempo de exposição (28±10 anos vs 16±10 sem silicose, p<0,001). Trabalhadores com silicose tinham pior capacidade vital forçada (CVF; 71±20 % predito vs 93±15% predito; p<0,001) e volume expiratório forçado no primeiro segundo (VEF1; 65±21 % predito vs 92±11% predito; p<0,001). A qualidade de vida esteve mais comprometida nos trabalhadores com silicose (WHOQoL-Bref 11,9±4,0 pontos vs 14,7±2,4 pontos, p<0,001) em comparação com os sem silicose. No SGRQ o maior comprometimento foi observado no domínio atividades no grupo com silicose em comparação com o grupo sem silicose (31,9±26,2 vs 2,8±8,7; p<0,001). Conclusões: A prevalência de silicose em trabalhadores de mineração foi elevada. A doença está relacionada com a exposição à sílica e proteção individual inadequada e tem um impacto negativo na qualidade de vida dos trabalhadores. / Rationale: Occupational exposure in the mining of precious and semi-precious stones can cause silicosis. The effect of silicosis on the health related quality of life (HRQL) is not well known. Aims: To study the prevalence of silicosis in mining of precious and semi-precious stones workers and to evaluate the impact of the disease on workers’ HRQL. Methods: In this cross-sectional study, 348 mining workers from Ametista do Sul, Rio Grande do Sul, Brazil, were examined. The diagnosis of silicosis was established by the history of dust exposure and chest radiographic findings. Demographics and socio-economic data, medical and occupational history and results of spirometry and chest radiography were collected. HRQL was assessed using the World Health Organization Quality of Life (WHOQOL-Bref) questionnaire and the Saint George's Hospital Respiratory Questionnaire (SGRQ). Data are presented as mean ± SD or median (IQR). A p value <0.05 was considered significant. Results: All workers were male, the mean±SD of age was 40±12 years. The prevalence of silicosis was 37% (95% CI 32-42). Workers with silicosis were older (47±10 years vs 36±11 years; p <0.001), had longer exposure time (28±10 years vs 16±10; p<0.001), had less education (5±2 years vs 7±3 years; p <0.001) and lower income (R$ 1152 [835-1411] vs R$ 1382 [1152-1736]; p=0.001). Workers with silicosis had worse forced vital capacity (FVC; 71±20% predicted vs 93±15% predicted; p<0.001) and forced expiratory volume in one second (FEV1; 65±21% predicted vs 92±11% predicted; p<0.001). The quality of life was worse in workers with silicosis (WHOQoL-Bref 11.9±4.0 vs 14.7±2.4 points, p <0.001) compared with those without silicosis. The greatest impairment in SGRQ was observed in the domain activity in the group with silicosis compared to the group without silicosis (31.9±26.2 vs 2.8±8.7; p<0.001). Conclusions: The prevalence of silicosis in mining workers was found to be high. The disease is related to silica dust exposure with inappropriate personal protection and has a negative impact on workers’ quality of life.

Introdução: A exposição ocupacional na mineração de pedras preciosas e semipreciosas pode causar silicose. Os efeitos da silicose sobre a qualidade de vida relacionada à saúde (QVRS) dos trabalhadores não são bem conhecidos. Objetivo: Estudar a prevalência de silicose em trabalhadores de mineração de pedras preciosas e semipreciosas e avaliar as repercussões da silicose sobre a QVRS destes trabalhadores. Método: Num estudo transversal realizado em Ametista do Sul, Rio Grande do Sul, Brasil foram estudados 348 mineradores. O diagnóstico de silicose foi estabelecido pela história de exposição e alterações compatíveis com a doença observadas na radiografia de tórax. Foram coletados dados antropométricos e socioeconômicos, história tabágica, dados sobre exposição ocupacional e resultados da espirometria e da radiografia de tórax. A QVRS foi avaliada através do questionário World Health Organization Quality of Life (WHOQoL-Bref) e do Saint George's Hospital Respiratory Questionnaire (SGRQ). Os dados são apresentados como média ± DP ou mediana (IQR). Resultados: Foram avaliados 348 trabalhadores, do sexo masculino, com idade de 40±12 anos. A prevalência de silicose foi de 37% (95% DP 32-42). Trabalhadores com silicose eram mais velhos (47±10 anos vs 36±11 anos; p<0,001), tinham menor escolaridade (5±2 anos vs 7±3 anos p<0.001), menor renda (R$ 1152 [835-1411] vs R$ 1382 [1152-1736]; p=0,001) e maior tempo de exposição (28±10 anos vs 16±10 sem silicose, p<0,001). Trabalhadores com silicose tinham pior capacidade vital forçada (CVF; 71±20 % predito vs 93±15% predito; p<0,001) e volume expiratório forçado no primeiro segundo (VEF1; 65±21 % predito vs 92±11% predito; p<0,001). A qualidade de vida esteve mais comprometida nos trabalhadores com silicose (WHOQoL-Bref 11,9±4,0 pontos vs 14,7±2,4 pontos, p<0,001) em comparação com os sem silicose. No SGRQ o maior comprometimento foi observado no domínio atividades no grupo com silicose em comparação com o grupo sem silicose (31,9±26,2 vs 2,8±8,7; p<0,001). Conclusões: A prevalência de silicose em trabalhadores de mineração foi elevada. A doença está relacionada com a exposição à sílica e proteção individual inadequada e tem um impacto negativo na qualidade de vida dos trabalhadores. / Rationale: Occupational exposure in the mining of precious and semi-precious stones can cause silicosis. The effect of silicosis on the health related quality of life (HRQL) is not well known. Aims: To study the prevalence of silicosis in mining of precious and semi-precious stones workers and to evaluate the impact of the disease on workers’ HRQL. Methods: In this cross-sectional study, 348 mining workers from Ametista do Sul, Rio Grande do Sul, Brazil, were examined. The diagnosis of silicosis was established by the history of dust exposure and chest radiographic findings. Demographics and socio-economic data, medical and occupational history and results of spirometry and chest radiography were collected. HRQL was assessed using the World Health Organization Quality of Life (WHOQOL-Bref) questionnaire and the Saint George's Hospital Respiratory Questionnaire (SGRQ). Data are presented as mean ± SD or median (IQR). A p value <0.05 was considered significant. Results: All workers were male, the mean±SD of age was 40±12 years. The prevalence of silicosis was 37% (95% CI 32-42). Workers with silicosis were older (47±10 years vs 36±11 years; p <0.001), had longer exposure time (28±10 years vs 16±10; p<0.001), had less education (5±2 years vs 7±3 years; p <0.001) and lower income (R$ 1152 [835-1411] vs R$ 1382 [1152-1736]; p=0.001). Workers with silicosis had worse forced vital capacity (FVC; 71±20% predicted vs 93±15% predicted; p<0.001) and forced expiratory volume in one second (FEV1; 65±21% predicted vs 92±11% predicted; p<0.001). The quality of life was worse in workers with silicosis (WHOQoL-Bref 11.9±4.0 vs 14.7±2.4 points, p <0.001) compared with those without silicosis. The greatest impairment in SGRQ was observed in the domain activity in the group with silicosis compared to the group without silicosis (31.9±26.2 vs 2.8±8.7; p<0.001). Conclusions: The prevalence of silicosis in mining workers was found to be high. The disease is related to silica dust exposure with inappropriate personal protection and has a negative impact on workers’ quality of life.

Orientador: Ericson Batagin / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-16T01:08:42Z (GMT). No. of bitstreams: 1 Lido_AlessandroVito_D.pdf: 2831589 bytes, checksum: 2f68fd40daf7194e03697f9f188576a1 (MD5) Previous issue date: 2010 / Resumo: As pneumoconioses são doenças respiratórias caracterizadas por fibrose pulmonar de caráter progressivo, irreversível e sem tratamento, consequentes à inalação de poeiras nos ambientes de trabalho. (CORN, 1980), (NIOSH, 2002). Com o objetivo de avaliar as alterações estruturais e funcionais dos pacientes portadores de pneumoconioses com grandes opacidades pulmonares foi realizado um estudo retrospectivo observacional dos pacientes acompanhados no ambulatório de Medicina do Trabalho do HC-Unicamp no período de 1978 a 2008. Os critérios estabelecidos para o diagnóstico das pneumoconioses, neste estudo, seguem as recomendações estabelecidas pela Organização Internacional do Trabalho (OIT,2000), para a definição do diagnóstico. As grandes opacidades (GO) caracterizam-se como áreas homogêneas de consolidação, resultantes da confluência dos pequenos nódulos fibróticos com diâmetro igual ou maior que 10 mm. A casuística deste estudo partiu de um universo de 1.147 casos de pneumoconiose, diagnosticados neste serviço, destes 192 apresentaram grande opacidade pulmonar. Foram selecionados para este estudo o prontuário de 40 pacientes. O tempo médio de exposição a poeiras fibrogênica foi de 11 anos ±8, sendo 33 (88,2%) o sexo masculino e 7 (17,5 %) do sexo feminino, com idade média de 54 ±11 anos quanto queixas clássicas houve predomínio de dispensa em 30 (75%) pacientes. Identificamos 7 (17,5%) casos com antecedente de tuberculose pulmonar e 11 (27,5%) com doenças crônicas obstrutivas das vias aéreas inferiores. Em relação ao consumo tabágico, 23 (57,5%) tinham histórico de tabagismo e 17 (42,5%) nunca fumaram. s exames radiológicos foram classificados de acordo com a Organização Internacional o Trabalho (OIT, 2000) por 2 leitores experientes. Foram identificados 9 (25%) casos de grande opacidade do tipo A, 18 (50%) do tipo B, 9 (25%) do tipo C. Foi analisada a regressão da doença através do histórico radiológico de cada paciente. As tomografias computadorizadas de alta resolução foram interpretadas para identificar e quantificar as alterações estruturais do parênquima pulmonar. oram realizados testes de espirometria, da pletismografia e da capacidade de difusão o monóxido de carbono, para estudar os efeitos das grandes opacidades, bem como o tabagismo, a influência da tuberculose e o enfisema pulmonar. Em conclusão: os resultados a avaliação das alterações estruturais e funcionais dos pacientes com grande opacidade revelaram importantes correlações. Apesar de não haver significância estatística na categorização das grandes opacidades entre os métodos radiológicos, através da TCAR foi possível identificar 4 pacientes com grande opacidade não identificada através nas radiografias. Os resultados enfatizaram a importância clínica da PMF e sua associação com enfisema como determinantes da obstrução do fluxo aéreo. Ao contrário do tabagismo que não demonstrou associação significativa com as anormalidades das variáveis funcionais. Os resultados deste estudo sugerem que o enfisema nos pacientes com grande opacidade está relacionado com o aumento do espaço aéreo distal. A progressão das grandes opacidades ode ser considerada como um indicador da gravidade da doença. Observou-se uma relação significativa entre as variáveis VEF1%, VEF1/CVF, FEF 25-75% e Dco%, com as categorias das grandes opacidades, na qual as medias das variáveis funcionais são inversamente proporcionais ao aumento da categoria radiológica / Abstract: Pneumoconioses are respiratory diseases characterized by a pulmonary fibrosis of a progressive and irreversible nature, for which no treatment is available, resulting from nhaling dust in work environments. (CORN, 1980), (NIOSH, 2002). order to evaluate the structural and functional alterations in patients of pneumoconioses with large pulmonary opacities, an observational retrospective study of patients monitored by the Occupational Disease Outpatient Clinic of the University of Campinas Clinics Hospital, in the period from 1978 to 2008. The criteria established for the diagnosis of pneumoconioses in this study follow the recommendations established by the International Labour Organization (ILO, 2000) for determining a diagnosis. The large opacities (LO) are characterized as homogenous consolidation areas resulting from the confluence of small fibrotic nodules having a diameter of at least 10 mm. The casuistics of this study started from a universe of 1,147 pneumoconiosis cases, diagnosed in said service, 192 of which showed large pulmonary opacities. For this study the medical records of 40 patients were selected. The average time of exposure to fibrogenic dusts was 11 ±8 years, and 33 patients (88.2%) were male and 7 (17.5 %) were female. The average age was 54 ±11 years. The predominant complaint was dyspnea, by 30 patients (75%). We identified that 7 cases 17.5%) had an antecedent of pulmonary tuberculosis and 11 cases (27.5%) had chronic obstructive diseases of the lower airways. Regarding tobacco consumption, 23 patients (57.5%) had a history of smoking, whereas 17 (42.5%) had never smoked. Radiological exams were classified in accordance with the rules established by the International Labour Organization (ILO, Revision of 2000) by 2 experienced readers. The result was the identification of 9 cases (22.5%) of type A large opacity, 18 cases (45%) of type B, 9 cases (22.5%) of type C. he radiological progression was analyzed from the radiological history of each patient. High-Resolution CT (HRCT) scans were carried out in order to identify structural alterations and to classify the large opacities and the percentage of emphysema identified in he pulmonary parenchyma. Spirometry, pletismography and carbon monoxide diffusion capacity tests were carried out to study the effects of the large opacities, as well as of smoking and the influence of tuberculosis and pulmonary emphysema. Conclusion: The results of evaluations of structural and functional alterations in patients with large opacities disclosed important correlations. Although there is no statistical significance in the categorization of the large opacities among radiological methods, HRCT identified 4 patients with large opacity not identified by radiography. The results emphasize the clinical importance of Progressive Massive Fibrosis and its association with emphysema as determinants in air flow obstruction. Unlike smoking and tuberculosis sequels - which showed no significant association with the abnormalities of functional variables - the results of this study suggest that emphysema in patients with large opacities is related to an increase in distal air space. The progression of large opacities may be considered as an indicator of the seriousness of the disease. A significant correlation was observed between the variables FEV1%, FEV1/FVC, FEF 25-75% and DLCO% and the large opacity categories, since the functional variable averages are inversely proportional to the increase in size of the opacities / Doutorado / Epidemiologia / Doutor em Saude Coletiva

Orientador: Ericson Batagin / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T10:27:03Z (GMT). No. of bitstreams: 1 Lido_AlessandroVito_M.pdf: 591520 bytes, checksum: 2689b2b924e9a05658e2ce48f82eb0f6 (MD5) Previous issue date: 2004 / Resumo: Os dados brasileiros sobre a epidemiologia das pneumoconioses são limitados; ainda não dispomos de informações suficientes para o dimensionamento desse problema em nosso país. A consolidação dos dados, que permitem avaliar os agravos à saúde e seus fatores intervenientes, é uma ferramenta fundamental para seu controle e a avaliação e para a elaboração de políticas de saúde, através da vigilância epidemiológica. Com o objetivo de estudarmos a demanda ambulatorial das pneumoconioses no Hospital das Clínicas da UNICAMP, realizamos um estudo descritivo baseado na análise de prontuários. Os critérios básicos de inclusão foram: diagnóstico de pneumoconiose; histórico ocupacional compatível; e um radiograma do tórax. Através do registro hospitalar, dos relatórios médicos emitidos pela Área de Saúde Ocupacional (do Departamento de Medicina Preventiva e Social da Faculdade de Ciências Médicas da UNICAMP) e da análise dos prontuários, foram obtidas as informações necessárias para a consolidação de um banco de dados. Detectamos um universo de 1.147 casos de pneumoconiose, diagnosticados no período de 1978 a 2003, sendo 1.075 (93,72 %) do sexo masculino e 72 (6,28 %) do sexo feminino, com média de idade de 47,9 ± 10,14 anos (mediana em 46,86) e tempo médio de exposição aos agentes causadores das pneumoconioses de 17,1 ± 8,4 anos. Quanto ao tabagismo, 634 (65,43 %) eram fumantes (21,93 ± 17,53 anos-maço), 335 (34,57 %) não fumavam e em 178 a informação não estava disponível. Quanto às queixas respiratórias, a dispnéia foi o sintoma mais freqüente (560 pacientes, ou 48,82 %), seguido por tosse (261, ou 22,76 %), catarro (182, ou 15,87 %) e chiado (168, ou 14,65 %). Foram identificados 1.061 (92,50 %) casos de silicose, 51 (4,45 %) de pneumoconiose por poeira mista, 15 (1,31 %) de asbestose, 13 (1,13 %) de pneumoconiose por rocha fosfática e 7 (0,61 %) de outras pneumoconioses (por carvão, grafite e metais duros). Os radiogramas foram classificados quanto à qualidade; em 1, foram 330 (28,77 %); 2, foram 293 (25,54 %); 3, foram 401 (34,96 %). Quanto à profusão, em profusão 1 foram 657 (57,28 %); 2, foram 339 (29,56 %); 3, foram 145 (12,64 %). Os radiogramas apresentavam diversas combinações de forma e tamanho; 192 deles foram classificados com grandes opacidades: A, 58; B, 72; C, 62. Foram realizadas análises comparativas entre o primeiro e o último radiograma do tórax dos pacientes que fizeram seguimento, para avaliação da progressão radiológica. Também foram comparados os radiogramas com tomografias computadorizadas de alta resolução do tórax (TCAR), para o estudo comparativo no diagnóstico das pneumoconioses. A demanda ambulatorial de pacientes com pneumoconiose no Hospital das Clínicas da UNICAMP, nos 25 anos de atendimento que cobrem o período de 1978 a 2003, é uma das mais expressivas do país. A silicose foi a pneumoconiose de maior ocorrência, entre esses pacientes, seguido da pneumoconiose por poeira mista, da asbestose e da pneumoconiose por rocha fosfática. Os pacientes com pneumoconiose são predominantemente ceramistas fundidores de louças sanitárias e estampadores de louça doméstica, procedentes dos municípios de Jundiaí e Pedreira, ambos no estado de São Paulo. Encontramos uma maior freqüência (780 pacientes, ou 68 %) com tempo de exposição a poeiras maior que 10 anos, caracterizando a predominância da forma crônica da doença. As pneumoconioses foram diagnosticadas predominantemente em pacientes com faixa etária entre 40 e 54 anos, caracterizando o acometimento de adultos em plena idade produtiva. A categoria 1 da profusão das opacidades foi a mais freqüente (ocorre em 657 radiogramas, ou 57,28 %), caracterizando predominância da forma simples da doença. Foram observadas progressões radiológicas, com aumento da categoria da profusão das opacidades em 18,55 %, e surgimento ou aumento do tamanho das grandes opacidades em 18,12 %. A relação entre os exames de imagem mostrou discordância entre o radiograma do tórax (padrão OIT) e a tomografia computadorizada de alta resolução (TCAR) para a definição do diagnóstico. A atualização e o aprimoramento do banco de dados foram consolidados através da inclusão de casos e do acréscimo de novas variáreis para o estudo das pneumoconioses / Abstract: The Brazilian data on pneumoconiosis epidemiology are limited, and we have not enough information for the measurement of such problem in our country yet. The data consolidation that allows the evaluation of the health hazard and its interposing factors is a fundamental tool to control, evaluate, and elaborate health politics, through epidemiological surveillance. In order to assess its occurrence, we carried out a descriptive study whose basic criteria of admission were the preceding data of occupational exposure to pneumoconiosis causing agents and the chest radiography. Through medical register, and reports from the Área de Saúde Ocupacional do Departamento de Medicina Preventiva e Social of the Faculdade de Ciências Médicas da UNICAMP, it was possible to accomplish the identification of all patients with pneumoconiosis diagnoses in the Hospital das Clínicas da UNICAMP. The necessary information for this survey was obtained from medical records and the interpretation of the radiological exams that were collected in standardized form, composing a database. It includes 1,147 cases of pneumoconiosis diagnosed from 1978 to 2003. There are in it 1,075 (93.72 %) male and 72 (6.28 %) female workers, and their average age and standard deviation are 47.9 ± 10.14 years (median in 46.86). The average period of exposure for pneumoconiosis was 17.1 ± 8.4 years. With regard to smoking, there were 634 smokers (65.43 %) with an average consumption of 21.93 ± 17.53 packs-year; 335 (34.57 %) did not smoke, and the information was not available in 178 records. Concerning the respiratory symptoms, dyspnea was the most frequent, occurring in 560 cases (48.82 %), and then cough (261 cases; 22.76 %), sputum (182 cases; 15.87 %), and sizzle (168 cases; 14.65 %). We found 1,061 (92.50 %) cases of silicosis, 51 (4.45 %) of mixed dust pneumoconiosis (on abrasive industry), 15 (1.31 %) of asbestosis, 13 (1.13 %) of phosphorite pneumoconiosis, and 7 (0.6 %) of mineral dust pneumoconiosis (coal, graphite, and hard metals). The chest radiographs with predominant profusion-1 were 657 (57.28 %), with 2-profusion were 339 (29.55 %), and with profusion-3 were 145 (12.64 %), in several combinations of shapes and sizes. We found 192 radiographs with large opacities; the A type were 58; B, 72; and C, 62. From those patients who have undergone a radiological attendance, we carried out a comparative analysis between the first and the last chest radiograph, for the progression assessment. We also compared the high-resolution computer-assisted tomography (HRCT), when available, with the chest radiograph to study the pneumoconiosis diagnosis. The ambulatory medical demand of pneumoconiosis patients at the Hospital das Clínicas da UNICAMP from 1978 to 2003 is one of the most relevant in the country. The silicosis was the pneumoconiosis with the greatest frequency, followed by mixed dust pneumoconiosis, asbestosis, and phosphorite pneumoconiosis. The patients with pneumoconiosis are predominantly workers of the ceramics industries located in the cities of Jundiaí and Pedreira, both at São Paulo state. We found 780 patients (68 %) who have undergone a period of exposure to dust longer than 10 years. The pneumoconioses were diagnosed in patients whose age was predominantly between 40 and 54; the disease attacks the workers when they are in their best productive condition. The category profusion-1 of opacity was the most frequent (57.28 % of the cases), predominating the simple form of the disease. Radiological progression was found in 18.55 % of the cases, which had an increase in profusion of small opacities, and 18.12 % developed large opacities. The relation among the radiological exams showed divergence between chest radiograph (ILO standard) and high-resolution computer-assisted tomography (HRCT) for the diagnosis definition. The updating and improvement of database were compiled through the inclusion of new variables / Mestrado / Saude Coletiva / Mestre em Saude Coletiva

Background: Nuclear and conventional weapons industry workers are at risk for exposures to beryllium, asbestos, high explosives and barium, all of which are implicated in the pathogenesis of pneumoconiosis. Beryllium has also been shown to cause sensitization (BeS) carrying a risk of progression to Chronic Beryllium Lung Disease (CBD). Data are lacking on the epidemiology of beryllium related health effects in conventional munitions workers and limited studies have been published on the prevalence of BeS in workers with minimal exposure. Data on the prevalence of pneumoconiosis in nuclear weapons workers is also lacking. The main objectives of this study were to determine prevalence and risk factors for beryllium sensitization in former nuclear and conventional munitions workers and rates of and risk factors for pneumoconiosis in former nuclear weapons workers, both cohorts from the Iowa Army Ammunition Plant (IAAAP) in Burlington, IA. Methods: Former nuclear weapons workers were offered chest x-ray (CXR) and blood screening for sensitization with beryllium lymphocyte proliferation test (BeLPT) as part of the Department of Energy (DoE) Former Worker Medical Screening Program. Conventional munitions workers were offered BeLPT and clinical follow-up if sensitized, as part of a Department of Defense (DOD) funded study. Chest x-rays were reviewed by three readers according to the International Labour Organization's Classification system for Radiographs for Pneumoconioses (ILO system). Exposures under study were characterized qualitatively by the industrial hygiene team and based on former worker interviews and historical industrial hygiene records. Results: The prevalence of beryllium sensitization in nuclear and conventional munitions workers was found to be slightly higher than in other workforces and weapons worker populations at low risk for exposure. The prevalence of parenchymal disease was higher in these nuclear weapons workers than in other DoE studies, while the prevalence of coincident parenchymal and pleural and isolated pleural disease was lower than in other nuclear weapons populations. Workers who occasionally dressed the copper-beryllium alloy tools were found to have an increased risk of beryllium sensitization, compared to those in administrative or other jobs with insignificant potential for exposure on site. Exposure to beryllium, asbestos, high explosives or barium was not associated with lung disease in this population. Conclusions: The findings from this study have potential policy implications for DOE and DOD to extend or implement beryllium surveillance and lung disease screening for their workforces and better control use of the copper-beryllium alloy tools in their production processes.

The purpose of this thesis is to examine the potential of a novel method for analysis and characterization of coal mine dust. Respirable dust has long been an industry concern due to the association of overexposure leading to the development occupational lung disease. Recent trends of increased incidence of occupational lung disease in miners, such as silicosis and Coal Workers Pneumoconiosis, has shown there is a need for a greater understanding of the respirable fraction of dust in underground coal mines. This study will examine the development of a comprehensive standard methodology for characterization of respirable dust via thermogravimetric analysis (TGA). This method was verified with laboratory-generated respirable dust samples analogous to those commonly observed in underground coal mines. Results of this study demonstrate the ability of the novel TGA method to characterize dust efficiently and effectively. Analysis of the dust includes the determination of mass fractions of coal and non-coal, as well as mass fractions of coal, carbonate, and non-carbonate minerals for larger respirable dust samples. Characterization occurs through the removal of dust particulates from the filter and analysis with TGA, which continuously measures change in mass with specific temperature regions associated with chemical changes for specific types of dust particulates. Results obtained from the verification samples reveal that this method can provide powerful information that may help to increase the current understanding of the health risks linked with exposure to certain types of dust, specifically those found in underground coal mines. / Master of Science

It has long been known that chronic exposures to high concentrations of respirable coal mine dust can lead to the development of lung diseases such as Coal Worker's Pneumoconiosis, commonly referred to as "black lung", and silicosis. Since the mid-1990s, an alarming resurgence of diseases has been documented in central Appalachia, where underground mining often necessitates significant extraction of rock strata along with the thin seams of coal. These circumstances have prompted concern over if or how changing dust composition might be a factor in contemporary disease prevalence. Until now, the total mass concentration and quartz mass fraction of respirable dust have been regulated and monitored in US coal mines. Unfortunately, however, these two metrics alone do not paint a full picture of dust composition. Earlier work in the author's research group established a preliminary thermogravimetric analysis (TGA) method for coal mine dust. The method is intended to allow estimation of three key mass fractions of the dust from separate sources: coal from the coal strata being mined; non-carbonate minerals from the rock strata being mined or drilled; and carbonates that are primarly sourced from application of rock dust products to the mine floor or ribs. However, accuracy of the preliminary method was substantially limited by poor dust recovery from the fibrous filter media used for sample collection. This thesis includes two studies: The first study aims to establish an improved TGA method. It uses smooth polycarbonate (PC) filters for dust sampling and a modified thermal ramping routine. The method is verified using laboratory-generated respirable dust samples. In the second study, the improved TGA method is used to analyze 75 respirable mine dust samples, collected in 15 US mines. Replicate samples are also analyzed by scanning electron microscopy using energy dispersive X-ray (SEM-EDX). TGA and SEM-EDX results are compared to gain insights regarding the analytical methods and general trends in dust composition within and between mines. / Master of Science / It has long been known that chronic exposures to excessive respirable coal mine dust can lead to the development of lung diseases such as Coal Worker’s Pneumoconiosis (“Black Lung”) and silicosis. Disease rates in central Appalachia have shown an alarming and unexpected increase since the mid-1990s, despite declining dust concentrations evident from regulatory compliance monitoring data. Clearly, there is a need to better understand coal mine dust composition, which will require additional analytical methods. Thermogravimetric analysis (TGA) has been proposed as one possible method, because it should allow estimation of three key dust components from separate sources: coal from the coal strata being mined; non-carbonate minerals from the rock strata being mined or drilled; and carbonates from application of rock dust products to the mine floor and ribs. However, preliminary work with TGA showed limited accuracy, mostly due to sampling materials. In this thesis, two studies were performed. The first study aims to establish an improved TGA method using smooth, polycarbonate (PC) filters. The second study demonstrates the method on a large number of mine dust samples, and compares the results to those gained by an alternative method that uses electron microscopy.

Objetivo. No Brasil encontram-se em crescimento os índices de prevalência das doenças crônicas causadas pela exposição dos trabalhadores a poeiras minerais. Realizou-se estudo com objetivo de avaliar as condições de trabalho e de saúde dos trabalhadores em marmorarias e propor ações preventivas. Métodos. Realizou-se estudo transversal em 27 marmorarias, no Município de São Paulo que executavam o beneficiamento final de rochas ornamentais, incluindo: a) avaliação da exposição a poeiras e à sílica cristalina respirável por meio de coleta de amostras de ar (n=762), análise por gravimetria e Difração de Raios X e acumulação das exposições estimadas por função conforme história ocupacional; b) aplicação de questionário de sintomas respiratórios (n=267) e avaliação médica, por espirometria e radiogradia de tórax; d) correlação dos resultados de exposição acumulada com achados clínicos e radiológicos por meio de análises estatísticas; e) levantamento de informações sobre os processos de trabalho e alternativas de controle. Resultados. Para os acabadores encontrou-se a maior exposição: concentração de 0,36 mg/m³ (IC95% 0,29 e 0,42) para os granitos e de 0,19 mg/m3 (IC95% 0,16-0,22) para a mistura de matérias-primas. Para estimativa de exposição acumulada à sílica cristalina respirável com mediana de 0,56 mg/m3-anos existiu risco de Odds Ratio igual a 1,2 (IC95% 1,02-1,40) de o trabalhador exposto apresentar classificação radiológica com alterações, presença de pequenas opacidades - profusão ³ 0/1, em relação a um trabalhador não-exposto. A população possuía baixo nível de escolaridade e de renda familiar, com média de idade 35,8 (±11,6) anos. Conclusões. Há exposição excessiva à sílica cristalina respirável nas marmorarias, com valores de concentração ultrapassando até 54 vezes o valor de referência recomendado pela NIOSH 0,05 mg/m3. As matérias-primas mais perigosas foram rochas silicáticas (silestoneÒ, granitos, arenitos e quartzitos). Entre as medidas de controle para as poeiras, caracterizaram-se como mais eficientes as aplicadas a úmido em máquinas e ferramentas. / Objective. In Brazil it can be seen growing prevalence rates of chronic diseases due to occupational exposure to mineral dusts, being silicosis the greater prevalence of pneumoconiosis. A study was carried out with the aim to evaluate the work conditions and of the workers’ health in granite and marble sheds and to propose preventive actions. Methods: A cross sectional study was performed among 27 sheds in Sao Paulo county that perform the finishing work of ornamental rocks. The study included: a) evaluation of dust exposure and respirable crystalline silica, by means of air sampling (n=762), analysis by gravimetry and X-Ray diffraction, and cumulative silica exposure estimates in each job according to the occupational history; b) applying a questionnaire of respiratory symptoms (n=267) and medical evaluation, espirometry and chest X-Ray; d) results correlation of cumulative exposure with the clinical and radiological data by statistical means; e) search of working process information and control alternatives. Results: Finishing workers had the greater exposition: concentration of 0.36 mg/m3 (CI95% 0.29-0.42) for granites and of 0.19 mg/m3 (CI95% 0.16-0.22) for the mixture of raw materials. To the estimated cumulative exposure to respirable crystalline silica with median equal to 0.56 mg/m3-years there was a risk Odds Ratio =OR=1.20 (CI95%1.02 1.40) of the exposed worked to present an altered radiological classification with alterations, presence of small opacities - perfusion &#8805;0/1, in relation to a non exposed worker. The population studied had low scholar education and low familiar income, with average age 35.8 (±11,6) years. Conclusions: There is excessive exposure to respirable crystalline silica in sheds with concentrations 54 times over the recommended exposure limit by NIOSH of 0.05 mg/m3. The most dangerous raw materials were silicatious rocks (silestoneÒ, granites, sandstones and quartzites). Among the control measures for dusts, were characterized as more efficient the applied ones the humid in machines and tools.

Objetivo. No Brasil encontram-se em crescimento os índices de prevalência das doenças crônicas causadas pela exposição dos trabalhadores a poeiras minerais. Realizou-se estudo com objetivo de avaliar as condições de trabalho e de saúde dos trabalhadores em marmorarias e propor ações preventivas. Métodos. Realizou-se estudo transversal em 27 marmorarias, no Município de São Paulo que executavam o beneficiamento final de rochas ornamentais, incluindo: a) avaliação da exposição a poeiras e à sílica cristalina respirável por meio de coleta de amostras de ar (n=762), análise por gravimetria e Difração de Raios X e acumulação das exposições estimadas por função conforme história ocupacional; b) aplicação de questionário de sintomas respiratórios (n=267) e avaliação médica, por espirometria e radiogradia de tórax; d) correlação dos resultados de exposição acumulada com achados clínicos e radiológicos por meio de análises estatísticas; e) levantamento de informações sobre os processos de trabalho e alternativas de controle. Resultados. Para os acabadores encontrou-se a maior exposição: concentração de 0,36 mg/m³ (IC95% 0,29 e 0,42) para os granitos e de 0,19 mg/m3 (IC95% 0,16-0,22) para a mistura de matérias-primas. Para estimativa de exposição acumulada à sílica cristalina respirável com mediana de 0,56 mg/m3-anos existiu risco de Odds Ratio igual a 1,2 (IC95% 1,02-1,40) de o trabalhador exposto apresentar classificação radiológica com alterações, presença de pequenas opacidades - profusão ³ 0/1, em relação a um trabalhador não-exposto. A população possuía baixo nível de escolaridade e de renda familiar, com média de idade 35,8 (±11,6) anos. Conclusões. Há exposição excessiva à sílica cristalina respirável nas marmorarias, com valores de concentração ultrapassando até 54 vezes o valor de referência recomendado pela NIOSH 0,05 mg/m3. As matérias-primas mais perigosas foram rochas silicáticas (silestoneÒ, granitos, arenitos e quartzitos). Entre as medidas de controle para as poeiras, caracterizaram-se como mais eficientes as aplicadas a úmido em máquinas e ferramentas. / Objective. In Brazil it can be seen growing prevalence rates of chronic diseases due to occupational exposure to mineral dusts, being silicosis the greater prevalence of pneumoconiosis. A study was carried out with the aim to evaluate the work conditions and of the workers’ health in granite and marble sheds and to propose preventive actions. Methods: A cross sectional study was performed among 27 sheds in Sao Paulo county that perform the finishing work of ornamental rocks. The study included: a) evaluation of dust exposure and respirable crystalline silica, by means of air sampling (n=762), analysis by gravimetry and X-Ray diffraction, and cumulative silica exposure estimates in each job according to the occupational history; b) applying a questionnaire of respiratory symptoms (n=267) and medical evaluation, espirometry and chest X-Ray; d) results correlation of cumulative exposure with the clinical and radiological data by statistical means; e) search of working process information and control alternatives. Results: Finishing workers had the greater exposition: concentration of 0.36 mg/m3 (CI95% 0.29-0.42) for granites and of 0.19 mg/m3 (CI95% 0.16-0.22) for the mixture of raw materials. To the estimated cumulative exposure to respirable crystalline silica with median equal to 0.56 mg/m3-years there was a risk Odds Ratio =OR=1.20 (CI95%1.02 1.40) of the exposed worked to present an altered radiological classification with alterations, presence of small opacities - perfusion &#8805;0/1, in relation to a non exposed worker. The population studied had low scholar education and low familiar income, with average age 35.8 (±11,6) years. Conclusions: There is excessive exposure to respirable crystalline silica in sheds with concentrations 54 times over the recommended exposure limit by NIOSH of 0.05 mg/m3. The most dangerous raw materials were silicatious rocks (silestoneÒ, granites, sandstones and quartzites). Among the control measures for dusts, were characterized as more efficient the applied ones the humid in machines and tools.

Made available in DSpace on 2014-12-17T15:54:52Z (GMT). No. of bitstreams: 1 ElisangelaML.pdf: 3702195 bytes, checksum: 706cae0d6a157da81de334adcc48655b (MD5) Previous issue date: 2009-02-26 / This work aims to characterize the workers in mineral activities exposed to lung injuries in Parelhas Municipality, Rio Grande do Norte State, seeking to relate respiratory diseases to the mining activity. The studied area (Parelhas City), with about 19,700 inhabitants, is located in the Serido region, approximately 232 km far from Natal City. The number of people involved in informal mining activity (garimpo) in the Serid? region reaches about 5,000. These workers generally do not use any kind of individual protection equipments and develop, at early ages of greater productivity, severe forms of diseases, which end up disabling them to professional activities, family and social life. Deceases by respiratory problems (e.g. silicosis) have been reported in very young adults. A descriptive observational study was conducted based on information from the records found in Dr. Jos? Augusto Dantas Hospital, between the years 1996- 2006. The occupational and socio-economic features of the population, which was selected by using the hospital records, were achieved through individually answered forms. The purpose was to link the occupational activities with the respiratory diseases. The next stage of the research was an observational case-control study, in the 1:1 proportion. The achieved data allowed confirming the central hypothesis of the research, which states that the pneumoconiosis cases are due to the mineral-based activities in the studied area. The final step of the investigation tried to assess the knowledge of relatives of students in public and private elementary and high schools from Parelhas City, regarding silicosis. About 15.4% of urban schools were analyzed through application of a structured questionnaire. The results show distinct socio-economic levels and a difference in the perception of the relatives of students in public and private schools, concerning silicosis. It was possible to identify the characteristics of the population economically involved with mineral-based activities and to define the group that deserves preferential attention in preventive actions. The work indicates some environmental problems caused by inadequate mining operations in the region / O presente trabalho tem por objetivo a caracteriza??o de trabalhadores em atividades de base mineral expostos aos danos pulmonares, no Munic?pio de Parelhas/RN, buscando relacionar as patologias respirat?rias que mais se manifestam nesta popula??o a atividades de base mineral. A ?rea estudada (cidade de Parelhas) localiza-se no Serid? oriental norte-riograndense a aproximadamente 232 km de Natal com cerca de 19.700 habitantes. A quantidade de pessoas envolvidas na atividade informal de minera??o (garimpo) na regi?o do Serid? norte-riograndense chega a cerca de 5.000. Esses trabalhadores em geral n?o utilizam equipamentos de prote??o individual (EPIs) de qualquer esp?cie e desenvolvem, na faixa et?ria de maior produtividade, formas graves da doen?a, que acabam incapacitando-os para atividades profissionais, vida familiar e social, existindo relatos de mortes por problemas respirat?rios (silicose, por exemplo) em adultos muito jovens. Foi realizado estudo observacional do tipo descritivo transversal, a partir de informa??es sintomatol?gicas presentes nos prontu?rios do Hospital Dr. Jos? Augusto Dantas da cidade de Parelhas, entre os anos de 1996-2006. A caracteriza??o ocupacional e socioecon?mica da popula??o selecionada atrav?s dos prontu?rios foi feita atrav?s de aplica??o de formul?rios, respondidos individualmente e ap?s leitura do termo de consentimento livre e esclarecido (TCLE). Esta caracteriza??o objetivou vincular a atividade ocupacional com as patologias respirat?rias sofridas A etapa seguinte da pesquisa correspondeu a estudo observacional anal?tico do tipo casocontrole, na propor??o 1:1. Os dados obtidos possibilitaram a confirma??o da hip?tese central da pesquisa, de que os casos de pneumoconioses devem-se ? presen?a de atividades de base mineral na ?rea de estudo. Na fase final do trabalho, buscou-se avaliar o conhecimento da popula??o de familiares de estudantes do ensino fundamental e m?dio de escolas p?blicas e privadas do Munic?pio de Parelhas/RN referente ? silicose. Foram analisadas 15,4% das escolas urbanas, atrav?s da aplica??o de question?rio estruturado. Os resultados mostram distintos n?veis socioecon?micos e uma diferen?a na percep??o nos familiares de estudantes das escolas p?blica e privada, em rela??o ? silicose, permitindo identificar as caracter?sticas das popula??es economicamente envolvidas com atividades de base mineral e definir o grupo que mereceria aten??o preferencial em a??es preventivas. O trabalho possibilitou tamb?m apontar alguns problemas ambientais deixados pela inadequada explora??o mineral existente na