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

The purpose of this thesis is to examine the potential for a more comprehensive method of analysis of coal mine dust. Respirable dust is specifically of interest due to its ability to cause occupational lung disease when miners are overexposed to airborne concentrations. A detailed standard methodology to characterize respirable mine dust is carefully investigated with the use of scanning electron microscopy with energy dispersive x-ray (SEM-EDX). In addition to a thorough description of the developed particle level characterization approach, the method is demonstrated with underground respirable dust samples collected from an underground coal mine in Central Appalachia. Results of this thesis indicate that a comprehensive dust characterization method is possible and can be efficient and effective, when standardized. This analytical approach uses measured compositions, dimensions, and shapes to produce an abundance of data in even a single sample of dust. Verification results show the method is suitable for analysis of respirable particles of common coal mine mineralogy and analysis of many samples in a timely manner. The results obtained from the underground samples in Central Appalachia reveal the quantity of information which can be generated using the developed method. The amount of data which is acquired using the more comprehensive dust characterization method may aid in understanding the health effects of various dust characteristics. / Master of Science

Thesis (MPH. (Occupational and Environmental Health))-- University of Limpopo, 2012 / Background: The objective of this study was to quantify personal time-weighted average respirable dust and silica exposure of workers at foundries in Gauteng and to rank the occupations in foundries according to the risk of exposure to silica quartz. Methods: A task-based risk assessment of 56 personal samples from two foundries was conducted. Personal exposure data was collected from workers’ breathing zones for the full working shift. All analyses of samples for silica dust were carried out in the CSIR Centre for Mining Innovation’s Laboratory, which has SANAS accreditation (ISO 17025) for both x-ray powder diffraction and particle size analysis methods. Results: The personal time-weighted average mean and median respirable silica dust concentration was 0.184 mg/m³ and 0.167 mg/m³ respectively. The maximum exposure concentration was 0.835 mg/m³ and minimum exposure was 0.010 mg/m³. The occupations within the foundries with the highest exposures were moulders, sand mixers, furnace operators and the lowest exposed occupations were grinders, closers, and casting operators. The majority of foundry workers (62%) in both foundries are exposed to respirable silica dust at above the South African occupational exposure level (OEL). Conclusion and recommendations: Foundry workers are over-exposed to respirable silica dust and are potentially at high risk of contracting silicosis and other occupational diseases associated with respirable silica dust. It is recommended that a dust control programme be implemented and a baseline study be conducted.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Silicose é uma doença pulmonar causada pela inalação de partículas de sílica, na qual vários são os mediadores inflamatórios implicados. Neste estudo investigamos o envolvimento do óxido nítrico (NO) nas alterações de função pulmonar e hiper-reatividade das vias aéreas, em camundongos estimulados com sílica por via intranasal. Foram analisados parâmetros como i) função pulmonar (resistência e elastância) e hiper-reatividade das vias aéreas ao aerossol com metacolina (3 27 mg/mL) através de sistema de pletismografia invasiva, e ii) alterações morfológicas, mediante técnicas clássicas de histologia e imuno-histoquímica. Verificamos que a instilação de partículas de sílica (10 mg) causou aumento nos níveis basais de resistência e elastância pulmonar, bem como de hiper-reatividade das vias aéreas à metacolina, em tempos que variaram de 2 a 28 dias. Observamos uma correlação temporal com as alterações morfológicas no tecido pulmonar, que refletiram presença de resposta inflamatória e infiltrado celular intenso, seguidos de progressiva fibrose e formação de granulomas. Os tempos de 7 e 28 dias pós-estimulação com sílica foram selecionados para os ensaios subsequentes, por corresponderem às fases aguda e crônica da silicose experimental, respectivamente. Foram detectados níveis elevados de óxido nítrico (NO), bem como de peroxinitrito/expressão da enzima iNOS no lavado broncoalveolar e no tecido pulmonar de camundongos estimulados com sílica, respectivamente. Em outro grupo de experimentos, observamos que camundongos depletados para o gene codificante para a enzima NOS induzida (iNOS) apresentaram abolidas as respostas de aumento nos níveis basais de resistência e elastância pulmonares, bem como da hiper-reatividade das vias aéreas à metacolina em comparação aos animais selvagens (C57BL/6). A inibição da resposta inflamatória e fibrótica granulomatosa foi também notada no caso dos animais nocautes para iNOS. O tratamento com 1400W, um inibidor da enzima iNOS, diminui de forma marcada as alterações de função pulmonar e fibrose tecidual verificadas nos camundongos silicóticos. Em conclusão, nossos resultados mostram que o comprometimento da função pulmonar, representado pelo aumento na resistência/elastância e hiper-reatividade das vias aéreas, mostraram-se correlacionados à maior geração de NO e de peroxinitrito, assim como da expressão da enzima iNOS. A depleção do gene codificante ou, ainda, o bloqueio da enzima iNOS aboliram a resposta de comprometimento da função pulmonar e fibrose tecidual na silicose experimental. Em conjunto estes achados indicam que o NO parece ser um mediador importante no contexto da silicose, colocando-se como um alvo terapêutico em potencial no tratamento de doenças de caráter fibrótico. / Silicosis is a lung disease caused by inhalation of silica particles, which is dependent on several inflammatory mediators. In this study we investigated the role of nitric oxide (NO) in the alteration of lung function and airways hyperreactivity caused by intranasal silica stimulation in mice. The parameters analyzed included: i) lung function (resistance and elastance) and airways hyperreactivity to aerosolized methacholine (3 - 27 mg/mL) by invasive plethysmography, and ii) morphological changes, by classical histological techniques and immunohistochemistry. We found that the instillation of silica particles (10 mg) caused an increase in the baseline levels lung of resistance and elastance and airways hyperreactivity to methacholine, from 2 to 28 days. We noted that there was a temporal correlation with morphological changes in lung tissue, which reflected the presence of an intense inflammatory cell infiltrate, followed by progressive fibrosis and granuloma formation. The time-points of 7 and 28 days post-silica stimulation were chosen for subsequent experiments, because they corrrespond to acute and chronic phases of experimental silicosis, respectively. Higher levels of nitric oxide (NO) and peroxynitrite as well as iNOS expression were detected in the bronchoalveolar lavage and lung tissue of silica-stimulated mice stimulated, respectively. In another group of experiments, we observed that mice depleted for the gene encoding for inducible NOS (iNOS) had the responses of increased basal levels of resistance and elastance lung and airways hyperreactivity abolished as compared to wildtype animals (C57BL/6). Inhibition of the inflammatory and fibrotic granulomatous responses were also inhibited in the case iNOS knockout mice. Treatment with the iNOS inhibitor 1400W markedly suppressed changes in lung function and tissue fibrosis observed in silicotic mice. In conclusion, our results show that suppression of lung function failure, including increased in resistance/elastance as well as airways hyperreactivity were correlated with NO and peroxynitrite generation as well as the iNOS expression. The depletion of the gene encoding to or inhibition of iNOS enzymatic activity abolished the response of lung function and tissue fibrosis in experimental silicosis. Together, these findings indicate that NO is an important mediator in the context of silicosis and suggest that it can be considered a potential therapeutic target for the treatment of fibrotic diseases.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Silicose é uma doença pulmonar causada pela inalação de partículas de sílica, na qual vários são os mediadores inflamatórios implicados. Neste estudo investigamos o envolvimento do óxido nítrico (NO) nas alterações de função pulmonar e hiper-reatividade das vias aéreas, em camundongos estimulados com sílica por via intranasal. Foram analisados parâmetros como i) função pulmonar (resistência e elastância) e hiper-reatividade das vias aéreas ao aerossol com metacolina (3 27 mg/mL) através de sistema de pletismografia invasiva, e ii) alterações morfológicas, mediante técnicas clássicas de histologia e imuno-histoquímica. Verificamos que a instilação de partículas de sílica (10 mg) causou aumento nos níveis basais de resistência e elastância pulmonar, bem como de hiper-reatividade das vias aéreas à metacolina, em tempos que variaram de 2 a 28 dias. Observamos uma correlação temporal com as alterações morfológicas no tecido pulmonar, que refletiram presença de resposta inflamatória e infiltrado celular intenso, seguidos de progressiva fibrose e formação de granulomas. Os tempos de 7 e 28 dias pós-estimulação com sílica foram selecionados para os ensaios subsequentes, por corresponderem às fases aguda e crônica da silicose experimental, respectivamente. Foram detectados níveis elevados de óxido nítrico (NO), bem como de peroxinitrito/expressão da enzima iNOS no lavado broncoalveolar e no tecido pulmonar de camundongos estimulados com sílica, respectivamente. Em outro grupo de experimentos, observamos que camundongos depletados para o gene codificante para a enzima NOS induzida (iNOS) apresentaram abolidas as respostas de aumento nos níveis basais de resistência e elastância pulmonares, bem como da hiper-reatividade das vias aéreas à metacolina em comparação aos animais selvagens (C57BL/6). A inibição da resposta inflamatória e fibrótica granulomatosa foi também notada no caso dos animais nocautes para iNOS. O tratamento com 1400W, um inibidor da enzima iNOS, diminui de forma marcada as alterações de função pulmonar e fibrose tecidual verificadas nos camundongos silicóticos. Em conclusão, nossos resultados mostram que o comprometimento da função pulmonar, representado pelo aumento na resistência/elastância e hiper-reatividade das vias aéreas, mostraram-se correlacionados à maior geração de NO e de peroxinitrito, assim como da expressão da enzima iNOS. A depleção do gene codificante ou, ainda, o bloqueio da enzima iNOS aboliram a resposta de comprometimento da função pulmonar e fibrose tecidual na silicose experimental. Em conjunto estes achados indicam que o NO parece ser um mediador importante no contexto da silicose, colocando-se como um alvo terapêutico em potencial no tratamento de doenças de caráter fibrótico. / Silicosis is a lung disease caused by inhalation of silica particles, which is dependent on several inflammatory mediators. In this study we investigated the role of nitric oxide (NO) in the alteration of lung function and airways hyperreactivity caused by intranasal silica stimulation in mice. The parameters analyzed included: i) lung function (resistance and elastance) and airways hyperreactivity to aerosolized methacholine (3 - 27 mg/mL) by invasive plethysmography, and ii) morphological changes, by classical histological techniques and immunohistochemistry. We found that the instillation of silica particles (10 mg) caused an increase in the baseline levels lung of resistance and elastance and airways hyperreactivity to methacholine, from 2 to 28 days. We noted that there was a temporal correlation with morphological changes in lung tissue, which reflected the presence of an intense inflammatory cell infiltrate, followed by progressive fibrosis and granuloma formation. The time-points of 7 and 28 days post-silica stimulation were chosen for subsequent experiments, because they corrrespond to acute and chronic phases of experimental silicosis, respectively. Higher levels of nitric oxide (NO) and peroxynitrite as well as iNOS expression were detected in the bronchoalveolar lavage and lung tissue of silica-stimulated mice stimulated, respectively. In another group of experiments, we observed that mice depleted for the gene encoding for inducible NOS (iNOS) had the responses of increased basal levels of resistance and elastance lung and airways hyperreactivity abolished as compared to wildtype animals (C57BL/6). Inhibition of the inflammatory and fibrotic granulomatous responses were also inhibited in the case iNOS knockout mice. Treatment with the iNOS inhibitor 1400W markedly suppressed changes in lung function and tissue fibrosis observed in silicotic mice. In conclusion, our results show that suppression of lung function failure, including increased in resistance/elastance as well as airways hyperreactivity were correlated with NO and peroxynitrite generation as well as the iNOS expression. The depletion of the gene encoding to or inhibition of iNOS enzymatic activity abolished the response of lung function and tissue fibrosis in experimental silicosis. Together, these findings indicate that NO is an important mediator in the context of silicosis and suggest that it can be considered a potential therapeutic target for the treatment of fibrotic diseases.

A THESIS SUBMITTED TO THE FACULTY OF ARTS, UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY. / In its chronic form silicosis had always been been taken for granted as one of the occupational hazards of mining. But both during and shortly after the Anglo-Boer War it manifested itself in a new accelerated form amongst former Witwatersrand rock drillers. Despite the appointment in the Transvaal of a commission of enquiry in 1902 and the promulgation of dust precaution measures, by 1912 the prevalence of and mortality from the disease amongst the Witwatersrand miners had not diminished. This finding suggests two of the purposes of the study: first, the reasons for the continued prevalence of the disease; and second, the extent of the mortality from silicosis amongst the miners. Because of the apparently low prevalence of and mortality from the disease amongst African mineworkers, the disease was ironically nick-named the "white death". Therefore another aim of the study is to examine the validity of the medical claim that the short contracts of African migrant workers safeguarded them from contracting accelerated si licosis. As the subject is complex, the study uses a thematic approach. Chapters two to nine deal with significant themes: first, the growing medical knowledge concerning silicosis, the mining and medical precautions against the disease and the age-old disregard for the occupational illness in its chronic form; second, the industrialists* need to reduce working costs, the development of mass-production technologies and the resort by management to "speeding up"; and third, the miners' needs for job and wage security, the encroachment of African competitors in semi-skilled and skilled spheres of mining and the introduction and the extension of the colour bar. Chapter nine deals with underground health conditions. Chapter ten explores the awareness of the new form of the disease, accelerated silicosis, and the establishment in 1902 of the first Transvaal commission on silicosis. Chapter eleven discusses the failure to implement remedies. Finally, chapter twelve explores the prevalence of and mortality from silicosis and the impact of the disease on the workforce of the mines. In chapters ten, eleven and twelve a synthesis is offered of the themes and findings of the previous chapters. The project is based almost entirely on contemporary primary and published sources. Apart from silicosis, a unifying theme throughout the discrete sections is the perceptions of miners of their vocation in general, and of this occupational disease in particular. The study requires periodization. As silicosis is a slow-developing disease the starting point of the investigation is 1886, when gold was discovered on the Rand. The study ends in 1910 because the establishment of Union in 1910 and the legal award of compensation in 1911 heralded a new era in the history of silicosis on the South African gold mines. The following are the conclusions. First, almost an entire generation of overseas miners, most of whom remained migrants and whose skills pioneered the South African gold mining industry, died from silicosis. Second, for reasons of self-interest, some of which they shared with one another, both the Transvaal state and the Randlords did virtually nothing to remedy the occurrence of the disease. Both parties were culpable for the neglect of the health of the industry's workforce: using only perfunctory dust safeguards, management intensified production through the deployment of both modern technology and labour intensive practices, peculiar to the Witwatersrand; and most of the state's interventionist initiatives were the result of pressure from the British House of Commons. Third, the fear and anger of miners at being the victims of a preventable occupational disease, provided the catalyst for their militancy during the period. Fourth, the industry's power was partly responsible for causing both the press and medical profession to be silent about the problem until 1910. Finally, the mineowners both seized and promoted the unsubstantiated medical orthodoxy, namely that the short contracts of African mineworkers protected them from accelerated silicosis, as an important rationale for perpetuating the migrant labour system / Andrew Chakane 2018

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