Ana Paula Scalia Carneiro

Perfil de 300 trabalhadores expostos à sílica atendidos ambulatorialmente em Belo Horizonte

Introduction: Silicosis is the most prevalent pneumoconiosis in Brazil, with most of the registered cases occurring in the State of Minas Gerais. Although it is a preventable disease, silicosis is still epidemic in some areas. Objective: To describe the profile of workers seen at the Clinics Hospital of the Federal University of Minas Gerais. Patients and methods: 300 medical records of silica-exposed workers in different occupations, seen between 1989-2000, were reviewed. Clinical and occupational information, radiographic and spirometric data were analyzed. Statistical methods included univariate analyses with chi-square and t tests. Results and conclusion: The mean age of the exposed patients was 51 years, with mean exposure duration of 15.6 years. 126/300 (42%) were radiologically classified as cases of silicosis. Increasing grades of profusion were associated with lower spirometric indices and more frequent associations with tuberculosis and chronic airflow limitation. Most of the workers were regularly registered employees and the main occupational activity was mining, accounting for the exposure of 197 (66%) workers. Non-registered workers presented more severe radiological grades of silicosis, suggesting, possibly, worse conditions of silica exposure in this group of workers.

Diagnosis of Severe Silicosis in Young Adults Working in Stone Polishing and Mining in Minas Gerais, Brazil

Abstract This study describes the occurrence of silicosis in a group of stone polishing and/or mining workers who began working under the age of 18, the minimum age in Brazil for working in hazardous or unhealthy conditions. The design is that of a case series with medical follow up via a surveillance program that included medical and occupational histories, chest radiography interpreted according to International Labour Organization (ILO) Classification, and spirometry. The findings call attention to the importance of the problem of silicosis, which persists in the region despite new production technologies, legal requirements, and initiatives to protect workers. Silicosis is a public health problem that must be addressed by the implementation of public policies to improve working conditions and ensure children and teenagers are kept away from hazardous work. While Brazil has started to be a part of the global effort to eliminate silicosis and the worst forms of child labor, there are still problems that must be addressed.

The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil.

BACKGROUND There are limited data on mesothelioma mortality in industrializing countries, where, at present, most of the asbestos consumption occurs. OBJECTIVES To analyze temporal trends and to calculate mortality rates from mesothelioma and cancer of the pleura in Brazil from 2000 to 2012 and to estimate future mortality rates. METHODS We retrieved records of deaths from mesothelioma (ICD-10C45) and cancer of the pleura (ICD-10C38.4) from 2000 to 2012 in adults aged 30 years and over. Crude and age-standardized mortality rates (ASMR) were calculated. Rate ratios of mean crude mortality for selected municipalities were compared to the Brazilian rate. A regression was carried out of the annual number of deaths against asbestos consumption using a Generalized Additive Model (GAM). The best model was chosen to estimate the future burden and peak period of deaths. RESULTS There were 929C45 and 1379 C38.4 deaths. The ratio of men to women for C45 was 1.4. A positive trend in C45 numbers was observed in Brazil (p=0.0012), particularly in São Paulo (p=0.0004) where ASMRs presented an increasing linear trend (p=0.0344). Selected municipalities harboring asbestos manipulation presented 3.7-11 fold rate ratios of C45 compared to Brazil. GAM presented best fits for latencies of 34 years or more. It is estimated that the peak incidence of C45 mortality will occur between 2021 and 2026. CONCLUSIONS The observed ASMRs and the gender ratio close to 1 suggest underreporting. Even so, deaths are increasing and mesothelioma clusters were identified. Compared to industrialized countries Brazil displays a 15-20 year lag in estimated peak mesothelioma mortality which is consistent with the lag of asbestos peak consumption in the country.

Talcose entre artesãos em pedra-sabão em uma localidade rural do Município de Ouro Preto, Minas Gerais, Brasil

Talc pneumoconiosis in Brazil has received little research attention to date. The disease was investigated in Mata dos Palmitos, a district of Ouro Preto, Minas Gerais State, among soapstone handicraft workers. The district has some 180 inhabitants, of whom 108 are engaged in handicrafts production, while 15 alternate handicrafts production with work in the soapstone quarries. A clinical and occupational investigation was conducted, along with a respiratory symptoms standardized questionnaire, chest x-ray (ILO standard), and spirometry. Clinical data showed a low prevalence of respiratory complaints. Dyspnea was the most frequent symptom. Chronic bronchitis was identified in 12 adult workers. Chest x-rays showed evidence of small lung opacities in 5 workers, and in 11 there was suspicion of the same opacities. One worker showed a plaque-shaped pleural thickening. Seven workers showed abnormal spirometry. The soapstone dust composition showed breathable asbestos fibers from the amphibole group (tremolite-actinolite). The results suggest talc asbestosis occurrence among soapstone handicraft workers.

A silicose e o perfil dos lapidários de pedras semipreciosas em Joaquim Felício, Minas Gerais, Brasil

A cross-sectional study was performed to determine the prevalence of silicosis among semiprecious gem cutters (n=70) and describe their clinical, epidemiological, and occupational profiles in Joaquim Felício, Minas Gerais State, Brazil, from April to December 2002. Occupational history was used with a respiratory questionnaire, chest x-ray, and spirometry. Silicosis prevalence was 7.1%. All affected individuals were men, with a mean age of 21.5 and mean exposure to silica of 7.1 years. All belonged to the informal economy and had been working at small and rudimentary workshops, using improvised lathes, with intense exposure to silica dust. According to the ILO Radiological Classification, four of the five cases of silicosis were classified as grade 1 and one as grade 3. Silicosis among gem cutters constitutes a serious public health problem that requires efforts to minimize risk through work by multidisciplinary teams from government agencies and nongovernmental organizations, with active participation by the workers themselves.

Respiratory effects from industrial talc exposure among former mining workers

OBJETIVO: Evaluar efectos respiratorios tardios de la inhalacion ocupacional de talco contaminado por asbesto. METODOS: Analisis de serie de casos de 29 extrabajadores de mineria de talco contaminado con asbestos provenientes de Carandai, sureste de Brasil, atendidos en el Centro de Referencia Estatal de Salud del Trabajador de Minas Gerais en 2004-2005. Los extrabajadores fueron sometidos a anamnesis clinico-ocupacional, radiografia de torax y espirometria. Fue creado un escore de exposicion que multiplicado por la duracion, origino un indice de exposicion acumulativa al talco. Para testar la asociacion del indice de exposicion acumulativa con la presencia de alteraciones radiologicas, sugestivas de neumoconiosis e/o alteraciones pleurales, fue ajustado un modelo de regresion logistica exacta. RESULTADOS: Todos los extrabajadores eran hombres, con promedio de edad de 48,2 anos. En las radiografias de torax fueron encontradas alteraciones pleurales en tres de ellos, opacidades parenquimatosas compatibles con neumoconiosis en uno y sospecha en seis. Alteraciones espirometricas ocurrieron en tres. La regresion logistica indico odds ratio de 1,059 (IC 95%:1,012;1,125) para el indice acumulado, es decir, cada unidad en el indice resulta en un aumento de 5,9% en el chance de presentar alteracion radiologica compatible o con sospecha de neumoconiosis. Con relacion a la mediana del tiempo estimado de latencia entre el inicio de la exposicion y el diagnostico de las placas pleurales, ocurrio diferencia significativa (p=0,013) entre los casos (27,0 anos) y no casos (14,3 anos). CONCLUSIONES: Los resultados muestran la necesidad de control clinico en los trabajadores que fueron expuestos a asbesto, particularmente debido a los efectos tardios de la exposicion a este mineral.

Câncer de pulmão em trabalhadores expostos à sílica

Silica is one of the main occupational agents associated with lung cancer. It is classified by the International Agency for Research on Cancer (IARC) as a Group 1 substance, i.e., carcinogenic for humans, since 1996. The objective of this paper is to report two cases of workers previously exposed to silica who developed lung cancer, seen in an out-patient clinic, focusing on important points of the current literature on the subject.

Indice de exposição à sílica na atividade de mineração de ouro

OBJECTIVE To develop a cumulative silica exposure index, including time period, duration and intensity of exposure, and to test this index as for occurrence and severity of silicosis. METHODS A cross-sectional study was carried out comprising 140 former gold miners from two localities in Southeastern Brazil between November 1997 and December 1999. Complete data on occupational and medical histories, chest x-rays and spirometry were analyzed. Borderline cases on the x-rays were also submitted to high-resolution chest computed tomography. The exposure index was the sum of scores obtained by logarithmic transformation of respirable silica concentration related to job tasks, mines and work time. Parametric tests were used for comparing averages between the groups of interest. RESULTS The silica exposure index was able to discriminate the main outcome (silicosis) as well as other outcomes (tuberculosis and lung emphysema) in the whole group at p-values of 0.008, 0.016 and <0.001 respectively. In regard to the four main categories of silicosis, the Tukey test showed differences in the averages of the exposure index in the categories 0 and 3 and 1 and 3. However, in the borderline cases subgroup, the exposure index was not satisfactory for cases submitted to x-rays and tomography and it could not differentiate other outcomes. CONCLUSIONS The silica exposure index represents an advance in exposure evaluation of former miners. However, other information, such as clinical and lung functional data are needed for better understanding disease progress in silica exposed cases, especially among borderline cases.OBJETIVO: Propor um indice que sintetize a exposicao cumulativa a silica, incluindo intensidade, duracao e epoca da exposicao e testa-lo em relacao a presenca e gravidade de silicose. METODOS: Estudo transversal realizado com 140 ex-mineiros de ouro, residentes em duas localidades do Estado de Minas Gerais, examinados entre 11/1997 e 12/1999. Foram analisadas informacoes sobre historia clinica e ocupacional, radiografia de torax e espirometria. Casos borderline de silicose pela radiografia foram submetidos a tomografia computadorizada de alta resolucao. O indice representa a soma dos escores extraidos da transformacao logaritmica das taxas de concentracao de silica respiravel nas diversas funcoes, minas e periodos trabalhados. Foram aplicados testes parametricos para comparacao das medias entre os grupos de interesse. RESULTADOS: O indice proposto apresentou-se discriminativo em relacao ao desfecho principal (silicose) e aos desfechos secundarios (enfisema e tuberculose) pulmonar no grupo total, incluindo os diversos estagios da doenca, com valores p: 0,008, 0,016 e <0,001 respectivamente. Em relacao as quatro categorias principais da silicose, o teste de Tukey evidenciou diferencas nas medias do indice entre as categorias 0 e 3 e 1 e 3. Porem, no subgrupo constituido pelos casos borderline, a discriminacao entre os desfechos nao foi satisfatoria, tanto com diagnosticos obtidos pela radiografia quanto pela tomografia. CONCLUSOES: O indice proposto representa um avanco na sintese da exposicao ocupacional dos participantes, podendo ser usado para outras profissoes. Entretanto, torna-se importante a incorporacao de fatores clinicos e funcionais para entender a evolucao da doenca em expostos a silica, especialmente nos casos duvidosos.

Silicose em trabalhadores de quartzito da região de São Thomé das Letras - Minas Gerais: dados iniciais indicam um grave problema de saúde pública

Introduction: Quatzite quarrying has been a long ongoing activity in the region of Sao Thome das Letras, Minas Gerais, Brazil, and 2000 workers are involved in its extraction and processing. However, only recently silicosis has been consistently reported. Objective: To describe the occupational and radiologic profiles of a group of workers in Sao Thome stone production. Methods: Occupational and X-rays data were analized in a workers’ health center, and a series of 46 cases were selected from a group of 185 extraction and processing workers. Results: All 185 subjects were male, with average age of 41.3 years and median exposure time of 6.1 years, and 46 of them (24.9%) presented radiological images compatible with silicosis. Silicosis was more frequent in stone processing, where the most severe cases were found, including 3 workers with large opacities and 8 with accelerated forms of the disease. The latter were, generally, of younger age and with shorter exposure time, suggesting exposure to higher silica concentrations. Conclusion: Despite the limitations of the study, the high occurence of silicosis in the group suggests that adopted measures to prevent silica dust inhalation has been inefficient and have worsen in recent times as a consequence of the intense mechanization taken place in the last years. Adequate surveillance and prevention measures should, therefore, become priority in this industrial sector.

Estudo comparativo entre tomografia computadorizada de alta resolução e radiografia de tórax no diagnóstico da silicose em casos incipientes

Introduction: At present, chest radiography (CR) is the main instrument used in the diagnosis of silicosis, following the International Labor Organization (ILO) recommendations. In incipient cases, the interpretation of radiographs is difficult and disagreement may occur, even among experienced readers. Recently, the possibility of evaluating incipient cases by using high resolution computed tomography (HRCT) has been considered. Objective: To compare CR with HRCT results. Patients and methods: An original group of 135 ex-miners were evaluated by CR, according to ILO recommendations, examined by three readers, from November 1997 to December 1999. HRCT was indicated to 68 patients whose median profusion readings was 1/0 or below. HRCT results were examined by two readers and, in cases of disagreement, a third reader was consulted. HRCT results were classified according to micronodule profusion into categories 0 to 3. CR and HRCT results were compared using McNemar test, weighed Kappa coefficient and log-linear models. Results and conclusion: There was good agreement among the methods in category 0, so it was concluded that both methods are similar in excluding the diagnosis of silicosis. However, in category 1 or greater (diagnosis of the disease) a good agreement among the methods was not observed.