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.

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.

Secondhand tobacco smoke exposure and pulmonary function: a cross-sectional study among non-smoking employees of bar and restaurants in Santiago, Chile.

INTRODUCTION: The workplace remains a significant source of secondhand smoke (SHS) exposure. This pollutant is known to be associated with respiratory and cardiovascular problems, but its effects on specific pulmonary function parameters remain largely unexplored. The objectives of this study were to measure SHS exposure among non-smoking employees of bar and restaurants in Santiago, Chile and to evaluate the effects of such exposure on pulmonary function. METHODS: Cross-sectional design. The study sample included non-smoking workers from 57 restaurants and bars in Santiago, Chile. The outcome variable was pulmonary function and the exposure variables were urine cotinine concentration, a biomarker for current SHS exposure, and years of SHS exposure in the workplace as proxy of chronic exposure. Personal and occupational variables were also recorded. Data analysis was performed using linear regression models adjusted by confounders. RESULTS: The median age of the workers was 35 years and the median employment duration at the analysed venues was 1 year. Workers in smoking facilities reported greater SHS exposure (36 hours per week) than workers in smoke-free locations (4 hours per week). Urine cotinine levels were inversely correlated with forced vital capacity, but the finding was not statistically significant (ß=-0.0002; 95% CI -0.007 to 0.006). Years of exposure to SHS showed to be significantly associated with forced expiratory flow25/75 (ß=-0.006; 95% CI -0.010 to -0.0004). CONCLUSION: These findings suggest that cumulative exposure to SHS at work may contribute to deterioration of pulmonary function in non-smoking employees.

Occupational exposure to polycyclic aromatic hydrocarbons: A cross-sectional study in bars and restaurants in Santiago, Chile.

OBJECTIVE: To evaluate indoor polycyclic aromatic hydrocarbon (PAH) concentrations in bars and restaurants and identify the main determinants of airborne PAH concentrations. METHODS: This study included 57 bars/restaurants in Santiago, Chile. PAH concentrations (ng/m(3) ) were measured using photoelectric aerosol sensor equipment (PAS 2000CE model). Nicotine concentrations (µg/m(3) ) were measured using active sampling pumps followed by gas-chromatography. Linear regression models were used to identify determinants of PAH concentrations. RESULTS: PAH concentrations were higher in venues that allowed smoking compared to smoke-free venues. After adjusting, the air PAH concentrations were 1.40 (0.64-3.10) and 3.34 (1.43-7.83) ng/m(3) higher for tertiles 2 and 3 of air nicotine compared to the lowest tertile. CONCLUSIONS: In hospitality venues where smoking is allowed, secondhand smoke exposure is a major source of PAHs in the environment. This research further supports the importance of implementing complete smoking bans to protect service industry workers from PAH exposure. Am. J. Ind. Med. 59:887-896, 2016. © 2016 Wiley Periodicals, Inc.

Validación de un cuestionario para evaluar riesgos psicosociales en el ambiente laboral en Chile / Validation of a questionnaire for psychosocial risk assessment in the workplace in Chile

Background: The measurement of psychosocial risk among workers is becoming increasingly important. Aim: To adapt, validate and standardize a questionnaire to measure psychosocial risks in the workplace. Material and Methods: The Spanish version of the Copenhagen Psychosocial Questionnaire was adapted and evaluated. Its contents were first validated with a panel of experts. Afterwards a semantic adaptation of the questionnaires was carried out applying it to a pilot sample. Finally, it was applied to 1,557workers (65% men). Results: A preliminary questionnaire containing 97 questions was constructed. A good item-test correlation was found, the factorial structure was similar to the original questionnaire and it had a good internal consistency, convergent validity with the Goldberg Health Questionnaire and test-retest correlation. Ranges for the different dimensions and sub-dimensions of psychosocial risk were calculated by tertiles. Conclusions: The resulting questionnaire is useful for measuring psychosocial risk factors at work, with good psychometric properties.

[Validation of a questionnaire for psychosocial risk assessment in the workplace in Chile]. / Validación de un cuestionario para evaluar riesgos psicosociales en el ambiente laboral en Chile.

BACKGROUND: The measurement of psychosocial risk among workers is becoming increasingly important. AIM: To adapt, validate and standardize a questionnaire to measure psychosocial risks in the workplace. MATERIAL AND METHODS: The Spanish version of the Copenhagen Psychosocial Questionnaire was adapted and evaluated. Its contents were first validated with a panel of experts. Afterwards a semantic adaptation of the questionnaires was carried out applying it to a pilot sample. Finally, it was applied to 1,557 workers (65% men). RESULTS: A preliminary questionnaire containing 97 questions was constructed. A good item-test correlation was found, the factorial structure was similar to the original questionnaire and it had a good internal consistency, convergent validity with the Goldberg Health Questionnaire and test-retest correlation. Ranges for the different dimensions and sub-dimensions of psychosocial risk were calculated by tertiles. CONCLUSIONS: The resulting questionnaire is useful for measuring psychosocial risk factors at work, with good psychometric properties.

Implementation of virtual patients in the training for occupational health in Latin America.

Health professionals trained in occupational health are essential to reduce the burden of occupational accidents and diseases. However, training resources are limited globally. We aimed to promote occupational health and safety (OHS) using virtual patients (VPs) in Brazil, Chile, and Germany. Virtual patients were created in three Latin-American health centers. So-called "partner VPs" comparing the distinct health care systems were designed. Translation, adaptation to different medical and legal systems, expert review, implementation into under- and postgraduate teaching, and user evaluation were performed. Twelve VPs covering traditional and contemporary OHS issues are available in Spanish, Portuguese, and English. Overall, 2371 students used the VPs. The number of Latin American users who evaluated VP content and relevance for their professional career was statistically significantly higher than the number of German students. VPs are a feasible learning method for OHS in middle-income countries. Partner VPs seem to be useful for teaching global aspects.

Educación de adultos en determinantes sociales de la salud: experiencia con la Seremi de Salud de la Región de Los Ríos / Adult education on the social determinants of health: the experience of the Regional Ministerial Secretary of Health, Los Ríos Region

Introducción: La necesidad contextual e incremental de generar espacios educativos en torno a los determinantes sociales de la salud (DSS), motivó a la Escuela de Salud Pública de la Universidad de Chile (Espuch) en conjunto con la Secretaría Regional Ministerial de Salud de la Región de los Ríos, a la construcción de un espacio educativo basado en metodologías de educación de adultos y la aplicación de la guía de evaluación de la equidad (GEE). El objetivo de este informe es describir los hallazgos, logros y aprendizajes del proceso. Materiales y Método: Esta sistematización está basada en la planificación del marco de educación de adultos adoptado, el uso del cine en la educación y la utilización de métodos cualitativos para la exploración de percepciones y aprendizajes. Resultados: Se sistematizan las expectativas de los participantes, así como importantes avances en la identificación de determinantes, características del empleo, posibles mecanismos causales involucrados en las inequidades de salud, además de la visualización de grupos vulnerables y barreras implicadas, con mayores dificultades para la reorientación de programas y prácticas laborales cotidianas. Conclusiones y Discusión: La experiencia educativa se mostró como una estrategia facilitadora de aprendizajes para la comprensión de la complejidad de las problemáticas de salud, siendo valorada desde varias perspectivas por los participantes. Se muestra también como un espacio valioso para la comprensión de las dificultades en la implementación de un enfoque local de equidad de los programas de salud y de las prácticas laborales cotidianas del personal sanitario.

Introduction: The increasing, contextual need for generating spaces for education on the social determinants of health (SDH) motivated the School of Public Health at the University of Chile (SPH-UC) and the Regional Ministerial Secretary of Health of the Los Rios Region, to create an educational methodology based on adult education and applying the Guide for Evaluating Equity (GEE). The goal of this report is to describe the findings, achievements, and lessons of this process. Materials and Methods: This systematization is based on the adoption of a planning framework for adult education, the use of cinema en education, and the use of qualitative methods to explore perceptions and lessons learned. Results: Results include the systematization of participants' expectations, as well as important advances in identifying determinants, job characteristics, and possible causal mechanisms of health inequity, visualization of the vulnerable groups and barriers involved, in addition to greater difficulties in reorienting programs and everyday work practices. Conclusions and Discussion: Participants' experience showed that the strategy facilitated learning comprehension of complex health problems. It was also shown to be a valued space for understanding the difficulties in implementing a local approach to health equity programs and everyday work practices of health workers.

Adaptación y análisis psicométrico de un cuestionario para evaluar riesgos psicosociales en el trabajo en Chile: versión media del CoPsoQ / Adaptation and psychometric analysis of a questionnaire used to evaluate psychosocial risks in the workplace in Chile: CoPsoQ medium

Objetivo: Describir las propiedades psicométricas de un cuestionario para medir riesgos psicosociales en el trabajo, aplicado a una muestra chilena de trabajadores del rubro servicios. Material y Método: se comenzó con un proceso de adaptación semántica, para posteriormente aplicarlo a una nuestra de 1.087 personas (332 varones y 775 mujeres), con promedio de edad de 41,0 +/- 11,9 años. Resultados: Se eliminó 1 de las 73 preguntas del instrumento original. Se encontró buenas correlaciones ítem-test, una composición factorial similar a la original, buenos indicadores de consistencia interna y buenos indicadores de validez convergente (con el GHO-12). los mejores resultados se obtienen para las grandes dimensiones, más que para las subdimensiones específicas. Conclusiones: se trata de un cuestionario útil para la medición de factores de riesgos psicosociales en el trabajo en nuestro medio y se comporta de manera similar al instrumento original. Se recomienda su uso utilizando las grandes dimensiones.

Objective: Describe the psychometric properties of a questionnaire used to measure psychosocial risks at work, applying it to a sample of workers from the service sector in Chile. Materials and methods: We began with a process of semantic adaptation, in order to later apply it to a sample of 1,087 people (332 male and 775 female), with an average age of 41.0 +/- 11.9 years. Results: One of the 73 questions was eliminated from the original instrument. We found good item-test correlation, a factorial composition similar to the original, good indicators of internal consistency and good indicators of convergent validity (GHQ - 12). The best results were obtained for the main dimensions, more than for the specific sub-dimensions. Conclusions: This was shown to be a useful questionnaire for measuring psychosocial risk factors in the workplace in Chile and behaves similarly to the original instrument. Use of the main dimensions is recommended.