High altitude exposure affects male reproductive parameters: could it also affect the prostate?†.

Living at high altitudes and living with prostatic illness are two different conditions closely related to a hypoxic environment. People at high altitudes exposed to acute, chronic or intermittent hypobaric hypoxia turn on several mechanisms at the system, cellular, and molecular level to cope with oxygen atmosphere scarcity maintaining the oxygen homeostasis. This exposure affects the whole organism and function of many systems, such as cardiovascular, respiratory, and reproductive. On the other hand, malignant prostate is related to the scarcity of oxygen in the tissue microenvironment due to its low availability and high consumption due to the swift cell proliferation rates. Based on the literature, this similarity in the oxygen scarcity suggests that hypobaric hypoxia, and other common factors between these two conditions, could be involved in the aggravation of the pathological prostatic status. However, there is still a lack of evidence in the association of this disease in males at high altitudes. This review aims to examine the possible mechanisms that hypobaric hypoxia might negatively add to the pathological prostate function in males who live and work at high altitudes. More profound investigations of hypobaric hypoxia's direct action on the prostate could help understand this exposure's effect and prevent worse prostate illness impact in males at high altitudes.

Effects of chronic intermittent hypobaric hypoxia on prostate-specific antigen (PSA) in Chilean miners.

OBJECTIVE: The aim was to determine the effects of chronic intermittent hypobaric hypoxia (CIHH) on prostate-specific antigen (PSA) levels in Chilean miners who work at different altitudes. METHODS: A cross-sectional study was conducted between April and July 2019. Miners from five mines (N=338) at different altitudes were evaluated. We recorded sociodemographic, working and altitude information. Haemoglobin oxygen saturation (SaO2) and haemoglobin (Hb) were measured in situ, while PSA and testosterone were analysed at a low level. Linear mixed-effect models were used to evaluate the association between PSA level and two CIHH exposures: composite CIHH (with four descriptors) and ChileStd-CIHH (CIHH Chilean standard; based on the Chilean technical guide for occupational exposure to CIHH). All models were adjusted by age, body mass index and day of the work the samples were taken. RESULTS: Highest and lowest PSA levels were found in mines ≥3000 m above sea level (mine 3: median=0.75, IQR=-0.45; mine 4: median=0.46, IQR=-0.35). In the multilevel models, the wider altitude difference between mining operation and camp showed lower PSA levels (model D: ßPSA=-0.93 ng/mL, ßlogPSA=-0.07, p<0001), adjusted for other CIHH descriptors, SaO2, Hb and testosterone. The descriptors of composite CIHH explained better PSA variations than ChileStd-CIHH (model D: marginal R2=0.090 vs model A: marginal R2=0.016). CONCLUSIONS: Occupational health regulations and high altitude medicine should consider these results as initial evidence on the inclusion of new descriptors for CIHH and the possible effect of this exposure on PSA levels in this male-dominated occupational sector.

Association of serum hepcidin with prostate-specific antigen levels in men from high Andean cities of Peru.

Objective: The prostate-specific antigen (PSA) is the primary biomarker to diagnose prostate cancer. Hepcidin has been reported as an alternative for this diagnosis; however, it is unclear how PSA and hepcidin function at high altitude (HA). This study aims to assess the association between hepcidin with PSA in HA residents chronically exposed to hypobaric hypoxia. Methods: We retrospectively examined data of 70 healthy males (aged 18-65-years-old) from four different altitudes cities in Peru: Lima (<150 m), Huancayo (2380 m), Puno (3800 m), and Cerro de Pasco (4320 m). Serum hepcidin, testosterone, and PSA were analyzed by chemiluminescence immunoassay. HA parameters (hemoglobin [Hb], pulse oxygen saturation [SpO2], and chronic mountain sickness [CMS] score) were also included in the study. Bivariate analyses and a multivariate linear mixed model were used to evaluate the association between hepcidin and PSA, adjusted by HA parameters, age, and body mass index (BMI). Results: Cases of excessive erythrocytosis (EE) (Hb >21 g/dL) were observed in the three highest cities. Hepcidin was positively correlated with Hb, CMS score, and BMI (P ≤ 0.05). Hepcidin was higher in Huancayo with respect to Puno, while PSA was lower in Cerro de Pasco in regard to Puno and Lima (P ≤ 0.05). Neither hepcidin nor PSA was increased by altitude in each city (P > 0.05). We did not find an association between hepcidin and PSA, even adjusted by age, BMI, Hb, and SpO2 (P ≤ 0.05). Conclusion: These findings showed no association between hepcidin and PSA levels in healthy residents at HA.

Varicocele at High Altitude; Venous Outflow Restriction by Hypobaric Hypoxia.

BACKGROUND: Testicular aches have been reported to occur on exposure to high altitude (HA). As a painful expression of venous congestion at the pampiniform plexus, varicocele (VC) might be a consequence of cardiovascular adjustments at HA. Chile's National Social Security Regulatory Body (SUSESO) emphasized evaluating this condition in the running follow-up study "Health effects of exposure to chronic intermittent hypoxia in Chilean mining workers." OBJECTIVES: This study aimed at investigating the prevalence of VC in a population usually shifting between sea level and HA, thereby intermittently being exposed to hypobaric hypoxia. METHODOLOGY: Miners (n=492) agreed to be examined at their working place by a physician, in the context of a general health survey, for the presence of palpable VC, either visible or not. Among them was a group exposed to low altitude (LA) <2,400 m; n=123; another one exposed to moderate high altitude (MHA) working 3,050 m; n=70, and a third one exposed to very high altitude (VHA) >3,900 m, n=165. The Chi2 test and Kruskal-Wallis test were used for the descriptive analyses, and logistic regression was applied to evaluate the association of VC with exposure to HA. The Ethics Committee for Research in Human Beings, Faculty of Medicine, University of Chile, approved this project. RESULTS: VC prevalence (grades 2 and 3) was found to be 10% at LA, 4.1% at MHA, and 16.7% at VHA (p≤0.05). Hemoglobin oxygen saturation (SaO2) was lower, and hemoglobin concentrations were higher in workers with high-grade VC at VHA compared to LA and MHA (Wilcoxon tests, p<0.001). Odds ratios (OR) for the association of VC with HA were 3.7 (95%CI: 1.26 to 12.3) and 4.06 (95%CI: 1.73 to 11.2) for MHA and VHA, respectively. CONCLUSION: Association of VC with HA, a clinically relevant finding, may be related to blood volume centralization mediated by hypobaric hypoxia.

Health Effects of Chronic Intermittent Hypoxia at a High Altitude among Chilean Miners: Rationale, Design, and Baseline Results of a Longitudinal Study.

OBJECTIVES: This study aims to assess the health effects on mining workers of exposure to chronic intermittent hypoxia (CIH) at high- and very high-altitude mining compared with similar work at lower altitudes in Chile, and it also aims to constitute the baseline of a 5-year follow-up study. METHODS: We designed a cross-sectional study to assess health conditions in 483 miners working at 2 levels of altitude exposure: 336 working at a very high or high altitude (HA; 247 above 3900-4400 m, and 89 at 3000-3900 m), and 147 below 2400 m. Subjects were randomly selected in two stages. First, a selection of mines from a census of mines in each altitude stratum was made. Secondly, workers with less than 2 years of employment at each of the selected mines were recruited. The main outcomes measured at the baseline were mountain sickness, sleep alterations, hypertension, body mass index, and neurocognitive functions. RESULTS: Prevalence of acute mountain sickness (AMS) was 28.4% in the very high-altitude stratum (P = 0.0001 compared with the low stratum), and 71.7% experienced sleep disturbance (P = 0.02). The adjusted odds ratio for AMS was 9.2 (95% confidence interval: 5.2-16.3) when compared with the very high- and low-altitude groups. Motor processing speed and spatial working memory score were lower for the high-altitude group. Hypertension was lower in the highest-altitude subjects, which may be attributed to preoccupational screening even though this was not statistically significant. CONCLUSIONS: Despite longer periods of acclimatization to CIH, subjects continue to present AMS and sleep disturbance. Compromise of executive functions was detected, including working memory at HA. Further rigorous research is warranted to understand long-term health impacts of high-altitude mining, and to provide evidence-based policy recommendations.

Association between maximum temperature and PM2.5 with pregnancy outcomes in Lima, Peru.

BACKGROUND: We have previously documented an inverse relationship between PM2.5 in Lima, Peru, and reproductive outcomes. Here, we investigate the effect of temperature on birth weight, birth weight-Z-score adjusted for gestational age, low birth weight, and preterm birth. We also explore interactions between PM2.5 and temperature. METHODS: We studied 123,034 singleton births in three public hospitals of Lima with temperature and PM2.5 during gestation between 2012 and 2016. We used linear, logistic, and Cox regression to estimate associations between temperature during gestation and birth outcomes and explored possible modification of the temperature effect by PM2.5. RESULTS: Exposure to maximum temperature in the last trimester was inversely associated with both birth weight [ß: -23.7; 95% confidence interval [CI]: -28.0, -19.5] and z-score weight-for-gestational-age (ß: -0.024; 95% CI: -0.029, -0.020) with an interquartile range of 5.32 °C. There was also an increased risk of preterm birth with higher temperature (interquartile range) in the first trimester (hazard ratio: 1.04; 95% CI: 1.001, 1.070). The effect of temperature on birthweight was primarily seen at higher PM2.5 levels. There were no statistically significant associations between temperature exposure with low birth weight. CONCLUSIONS: Exposition to maximum temperature was associated with lower birth weight and z-score weight-for-gestational-age and higher risk of preterm birth, in accordance with much of the literature. The effects on birth weight were seen only in the third trimester.

[Bioethics and environmental justice in the health of the Andean residents of Peru]. / Bioética y justicia ambiental en la salud de los pobladores andinos de Perú.

This article attempts to capture the bioethical-environmental panorama of the health in the residents who live on the Peruvian highlands, highlighting the inequity in access to health services that exist in this region and reflecting on the possible historical and current contextual causes that have originated differences between Inca-Andean settler and modern-Andean settler. The change in the view of the world about the environment and natural resources, the decline of justice approach, loss of solidarity, welfare, and respect to human being and nature. Besides, we describe health from a historical scenario of this region, where Public health has and will have as a challenge the application of programs that respond to the specific needs of this population, with a focus on the environment.

Bioética y justicia ambiental en la salud de los pobladores andinos de Perú / Bioethics and environmental justice in the health of the Andean residents of Peru / Bioética e justiça ambiental na saúde dos habitantes andinos do Peru

Resumen Este artículo intenta plasmar el panorama bioético-ambiental de la salud del poblador que habita en la sierra peruana, remarcando la inequidad en el acceso a los servicios de salud que existe en esta región y reflexionando sobre las posibles causas contextuales, históricas y actuales que han originado diferencias entre el poblador andino del incanato y el poblador andino actual, el cambio de cosmovisón sobre el ambiente y los recursos, el deterioro del enfoque de justicia, solidaridad, bienestar y respeto hacia el ser humano y la naturaleza. Además, se describe la salud desde el escenario histórico de esta región, donde la salud pública tiene y tendrá como desafío la aplicación de programas que respondan a las necesidades específicas de esta población, con un enfoque dirigido hacia lo ambiental.

Abstract This article attempts to capture the bioethical-environmental panorama of the health in the residents who live on the Peruvian highlands, highlighting the inequity in access to health services that exist in this region and reflecting on the possible historical and current contextual causes that have originated differences between Inca-Andean settler and modern-Andean settler. The change in the view of the world about the environment and natural resources, the decline of justice approach, loss of solidarity, welfare, and respect to human being and nature. Besides, we describe health from a historical scenario of this region, where Public health has and will have as a challenge the application of programs that respond to the specific needs of this population, with a focus on the environment.

Resumo Este artigo tenta capturar o panorama bioético-ambiental da saúde dos habitantes que vivem nas ser as peruanas, destacando a desigualdade no acesso aos serviços de saúde que existe nesta região e refletindo sobre as possíveis causas contextuais, históricas e atuais que têm originado diferenças entre o habitante andino do Incanato e a atual população andina, a mudança de cosmovisão sobre o meio ambiente e os recursos, a deterioração da abordagem de justiça, solidariedade, bem-estar e respeito pelos seres humanos e a natureza. Além disso, a saúde é descrita a partir do cenário histórico desta região, onde a saúde pública tem e terá como desafio a aplicação de programas que respondam às necessidades específicas dessa população, com uma abordagem dirigida para o meio ambiente.