Coal mine dust lung disease. New lessons from old exposure

[Occupational interstitial lung diseases]

A variety of workplace exposures (organic or inorganic dusts as well as gases, fumes, or vapors) can cause diffuse interstitial lung disease. The latency period until onset of the disease can exceed 30 years. The disease course varies greatly and depends on the quantity of the inhaled substance and its fibrogenic effect. Pulmonary high-resolution computed tomography (HRCT) patterns do not differ significantly from those of interstitial lung diseases (ILD) of other etiologies. Therefore, without knowledge of the occupational history, work-related ILDs are often classified as idiopathic. In addition, there is increasing evidence in the recent literature that high exposure to silica dust can trigger autoimmune diseases (also involving the lungs). For this reason, a qualified occupational history is now an indispensable part of the interdisciplinary diagnosis of ILDs.

In Situ Lung Dust Analysis by Automated Field Emission Scanning Electron Microscopy With Energy Dispersive X-ray Spectroscopy: A Method for Assessing Inorganic Particles in Lung Tissue From Coal Miners

CONTEXT.—

Overexposure to respirable coal mine dust can cause severe lung disease including progressive massive fibrosis (PMF). Field emission scanning electron microscopy with energy dispersive x-ray spectroscopy (FESEM-EDS) has been used for in situ lung dust particle analysis for evaluation of disease etiology. Automating such work can reduce time, costs, and user bias.

OBJECTIVE.—

To develop and test an automated FESEM-EDS method for in situ analysis of inorganic particles in coal miner lung tissue.

DESIGN.—

We programmed an automated FESEM-EDS procedure to collect particle size and elemental data, using lung tissue from 10 underground coal miners with PMF and 4 control cases. A statistical clustering approach was used to establish classification criteria based on particle chemistry. Data were correlated to PMF/non-PMF areas of the tissue, using corresponding brightfield microscopy images. Results for each miner case were compared with a separate corresponding analysis of particles recovered following tissue digestion.

RESULTS.—

In situ analysis of miner tissues showed higher particle number densities than controls and densities were generally higher in PMF than non-PMF areas. Particle counts were typically dominated by aluminum silicates with varying percentages of silica. Compared to digestion results for the miner tissues, in situ results indicated lower density of particles (number per tissue volume), larger size, and a lower ratio of silica to total silicates-probably due to frequent particle clustering in situ.

CONCLUSIONS.—

Automated FESEM-EDS analysis of lung dust is feasible in situ and could be applied to a larger set of mineral dust-exposed lung tissues to investigate specific histologic features of PMF and other dust-related occupational diseases.

Racial Differences in Respiratory Impairment, Pneumoconiosis, and Federal Compensation for Western U.S. Indigenous Coal Miners

Rationale: Indigenous populations in the United States face numerous health disparities, but the health of Indigenous workers is less well understood. In a recent surveillance study of active Indigenous coal miners, 3% had coal workers' pneumoconiosis/black lung, and 9% had respiratory impairment. However, occupational lung disease prevalence among Indigenous coal miners has not been directly compared with that among other race/ethnicity groups. Coal miners who are totally disabled from black lung may qualify for U.S. Department of Labor (DOL) compensation benefits, but it is unclear how current federal spirometry criteria affect qualification for Indigenous coal miners.Objectives: To compare findings of pneumoconiosis and respiratory impairment in Indigenous and non-Indigenous coal miners in the western United States and assess federal compensation qualification for Indigenous miners using different spirometry standards.Methods: We used voluntary medical surveillance data from 2002 to 2023 to compare the adjusted odds of pneumoconiosis and respiratory impairment between Indigenous/non-Indigenous coal miners. We examined the proportion of Indigenous miners meeting DOL criteria for federal compensation using different spirometry standards.Results: We identified 691 western U.S. coal miners with at least one year of coal mining employment, 289 Indigenous and 402 non-Indigenous (96% White/Hispanic). Indigenous miners had a greater odds ratio for pneumoconiosis for each additional decade of life (2.47 [95% confidence interval (CI), 1.66-3.68]) compared with non-Indigenous coal miners (1.48 [95% CI, 1.19-1.85]). For each decade, Indigenous coal miners also had a greater adjusted odds ratio for respiratory impairment (1.67 [95% CI, 1.25-2.24]) than non-Indigenous miners (1.06 [95% CI, 0.90-1.25]). Indigenous miners had an additional decline of 71 ml (95% CI, 6-136 ml) in forced expiratory volume in 1 second for each decade of life compared with non-Indigenous coal miners. Using the DOL-mandated Knudson (1976) spirometry standard rather than an Indigenous-specific standard, 6 of 18 (33%) Indigenous miners would not qualify for federal compensation.Conclusions: Indigenous coal miners experience greater adjusted odds for pneumoconiosis and respiratory impairment per decade of life and greater decline in forced expiratory volume in 1 second despite lower smoking rates. Structural inequities exist in federal spirometry requirements for Indigenous miners seeking DOL black lung benefits. Regulatory reform is needed to address barriers to compensation for these underrepresented workers.

Transfer of Knowledge on Pneumoconiosis Care Among Rural-Based Members of a Digital Community of Practice: Cross-Sectional Study

BACKGROUND

Given the re-emergence of coal workers' pneumoconiosis in Appalachia and Mountain West United States, there is a tremendous need to train rural professionals in its multidisciplinary management. Since 2016, the Miners' Wellness TeleECHO (Extension for Community Health Outcomes) Program held by the University of New Mexico, Albuquerque, and Miners' Colfax Medical Center, Raton, New Mexico, provides structured longitudinal multidisciplinary telementoring to diverse professionals taking care of miners by creating a digital community of practice. Program sessions emphasize active learning through discussion, rather than didactic training. Professional stakeholder groups include respiratory therapists, home health professionals, benefits counselors, lawyers or attorneys, clinicians, and others. Rural-urban differences in knowledge transfer in such a community of practice, however, remain unknown.

OBJECTIVE

We aim to evaluate the role of the rurality of the patient or client base in the transfer of knowledge to professionals caring for miners using the digital community of practice approach.

METHODS

This is a cross-sectional study of 70 professionals participating in the Miners' Wellness TeleECHO Program between 2018 and 2019. Drawing insights from social network analysis, we examined the association between the rurality of participants' patient or client base and their self-reported receipt of knowledge. Our focal independent variable was the respondent's self-reported percentage of patients or clients who reside in rural areas. We measured knowledge transfer sources by asking participants if they received knowledge regarding the care of miners during and outside of TeleECHO sessions from each of the other participants. Our dependent variables included the number of knowledge sources, number of cross-stakeholder knowledge sources, number of same stakeholder knowledge sources, and range and heterogeneity of knowledge sources.

RESULTS

Respondents, on average, identified 4.46 (SD 3.16) unique knowledge sources within the community, with a greater number of cross-stakeholder knowledge sources (2.80) than same stakeholder knowledge sources (1.72). The mean knowledge source range was 2.50 (SD 1.29), indicating that, on average, respondents received knowledge sources from roughly half of the 5 stakeholder groups. Finally, the mean heterogeneity of knowledge sources, which can range between 0 and 0.80, was near the midpoint of the scale at 0.44 (SD 0.30). Multivariable analyses revealed that as the rurality of patient or client bases increased, participants reported more knowledge sources overall, more knowledge sources from outside of their stakeholder groups, a higher knowledge source range, and greater heterogeneity of knowledge sources (P<.05 for all comparisons).

CONCLUSIONS

Our findings suggest that participants who serve rural areas especially benefit from knowledge transfer within the TeleECHO community of practice. Additionally, the knowledge they receive comes from diverse information sources, emphasizing its multidisciplinary nature. Our results underscore the capacity of the TeleECHO model to leverage technology to promote rural health equity for miners.

Analyses of oxidative DNA damage among coal vendors via single cell gel electrophoresis and quantification of 8-hydroxy-2'-deoxyguanosine

Looking at the development status of Nigeria and other developing nations, most low-income and rural households often use coal as a source of energy which necessitates its trade very close to the communities. Moreover, the effects of exposure to coal mining activities are rarely explored or yet to be studied, not to mention the numerous street coal vendors in Nigeria. This study investigated the oxidative stress levels in serum and urine through the biomarker 8-OHdG and DNA damage via single cell gel electrophoresis (alkaline comet assay). Blood and urine levels of 8-OHdG from 130 coal vendors and 130 population-based controls were determined by ELISA. Alkaline comet assay was also performed on white blood cells for DNA damage. The average values of 8-OHdG in serum and urine of coal vendors were 22.82 and 16.03 ng/ml respectively, which were significantly greater than those detected in controls (p < 0.001; 15.46 and 10.40 ng/ml of 8-OHdG in serum and urine respectively). The average tail length, % DNA in tail and olive tail moment were 25.06 μm, 18.71% and 4.42 respectively for coal vendors. However, for controls, the average values were 4.72 μm, 3.63% and 1.50 for tail length, % DNA in tail and olive tail moment respectively which were much lower than coal vendors (p < 0.001). Therefore, prolonged exposure to coal dusts could lead to higher serum and urinary 8-OHdG and significant DNA damage in coal vendors observed in tail length, % DNA in tail, and olive tail moment by single cell gel electrophoresis. It is therefore established that coal vendors exhibit a huge risk from oxidative stress and assessment of 8-OHdG with single cell gel electrophoresis has proven to be a feasible tool as biomarkers of DNA damage.

Comparative 6+studies of environmentally persistent free radicals on nano-sized coal dusts

Coal dust is the major hazardous pollutant in the coal mining environment. Recently environmentally persistent free radicals (EPFRs) were identified as one of the key characteristics which could impart toxicity to the particulates released into the environment. The present study used Electron Paramagnetic Resonance (EPR) spectroscopy to analyze the characteristics of EPFRs present in different types of nano-size coal dust. Further, it analyzed the stability of the free radicals in the respirable nano-size coal dust and compared their characteristics in terms of EPR parameters (spin counts and g-values). It was found that free radicals in coal are remarkably stable (can remain intact for several months). Also, Most of the EPFRs in the coal dust particles are either oxygenated carbon centered or a mixture of carbon and oxygen-centered free radicals. EPFRs concentration in the coal dust was found to be proportional to the carbon content of coal. The characteristic g-values were found to be inversely related to the carbon content of coal dust. The spin concentrations in the lignite coal dust were between 3.819 and 7.089 μmol/g, whereas the g-values ranged from 2.00352 to 2.00363. The spin concentrations in the bituminous coal dust were between 11.614 and 25.562 μmol/g, whereas the g-values ranged from 2.00295 to 2.00319. The characteristics of EPFRs present in coal dust identified by this study are similar to the EPFRs, which were found in other environmental pollutants such as combustion-generated particulates, PM_2.5, indoor dust, wildfires, biochar, haze etc., in some of the previous studies. Considering the toxicity analysis of environmental particulates containing EPFRs similar to those identified in the present study, it can be confidently hypothesized that the EPFRs in the coal dust might play a major role in modulating the coal dust toxicity. Hence, it is recommended that future studies should analyze the role of EPFR-loaded coal dust in mediating the inhalation toxicity of coal dust.

Exposure to coal mining can lead to imbalanced levels of inorganic elements and DNA damage in individuals living near open-pit mining sites

Coal mining activities are considered harmful to living organisms. These activities release compounds to the environment, such as polycyclic aromatic hydrocarbons (PAHs), metals, and oxides, which can cause oxidative damage to DNA. In this study, we compared the DNA damage and the chemical composition of peripherical blood of 150 individuals exposed to coal mining residues and 120 non-exposed individuals. Analysis of coal particles revealed the presence of elements such as copper (Cu), aluminum (Al), chrome (Cr), silicon (Si) and iron (Fe). The exposed individuals in our study had significant concentrations of Al, sulfur (S), Cr, Fe, and Cu in their blood, as well as hypokalemia. Results from the enzyme-modified comet assay (FPG enzyme) suggest that exposure to coal mining residues caused oxidative DNA damage, particularly purine damage. Furthermore, particles with a diameter of <2.5 μm indicate that direct inhalation could promote these physiological alterations. Finally, a systems biology analysis was performed to investigate the effects of these elements on DNA damage and oxidative stress pathways. Interestingly, Cu, Cr, Fe, and K are key nodes that intensely modulate these pathways. Our results suggest that understanding the imbalance of inorganic elements caused by exposure to coal mining residues is crucial to understanding their effect on human health.

Imaging diagnosis of pneumoconiosis with predominant nodular pattern: HRCT and pathologic findings

The radiological patterns of known pneumoconiosis have been changing in recent years. The basic pathology in pneumoconiosis is the presence of dust macules, mixed dust fibrosis, nodules, diffuse interstitial fibrosis, and progressive massive fibrosis. These pathologic changes can coexist in dust-exposed workers. High resolution CT reflects pathological findings in pneumoconiosis and is useful for the diagnosis. Pneumoconiosis such as silicosis, coal workers' pneumoconiosis, graphite pneumoconiosis, and welder's pneumoconiosis, has predominant nodular HRCT pattern. Diffuse interstitial pulmonary fibrosis is sometimes found in the lungs of this pneumoconiosis. In the early stages of metal lung, such as aluminosis and hard metal lung, centrilobular nodules are predominant findings, and in the advanced stages, reticular opacities are predominant findings. The clinician must understand the spectrum of expected imaging patterns related to known dust exposures and novel exposures. In this article, HRCT and pathologic findings of pneumoconiosis with predominant nodular opacities are shown.

Combined Pulmonary Fibrosis and Emphysema: When Scylla and Charybdis Ally

Combined pulmonary fibrosis and emphysema (CPFE) is a recently recognized syndrome that, as its name indicates, involves the existence of both interstitial lung fibrosis and emphysema in one individual, and is often accompanied by pulmonary hypertension. This debilitating, progressive condition is most often encountered in males with an extensive smoking history, and is presented by dyspnea, preserved lung volumes, and contrastingly impaired gas exchange capacity. The diagnosis of the disease is based on computed tomography imaging, demonstrating the coexistence of emphysema and interstitial fibrosis in the lungs, which might be of various types and extents, in different areas of the lung and several relative positions to each other. CPFE bears high mortality and to date, specific and efficient treatment options do not exist. In this review, we will summarize current knowledge about the clinical attributes and manifestations of CPFE. Moreover, we will focus on pathophysiological and pathohistological lung phenomena and suspected etiological factors of this disease. Finally, since there is a paucity of preclinical research performed for this particular lung pathology, we will review existing animal studies and provide suggestions for the development of additional in vivo models of CPFE syndrome.

Global Trends in Occupational Lung Disease

Lung diseases caused by workplace exposure are too often mis- or underdiagnosed due in part to nonexistent or inadequate health surveillance programs for workers. Many of these diseases are indistinguishable from those that occur in the general population and are not recognized as being caused at least in part by occupational exposures. More than 10% of all lung diseases are estimated to result from workplace exposures. This study reviews recent estimates of the burden of the most important occupational lung diseases using data published by United Nations specialized agencies as well as the Global Burden of Disease studies. We focus on occupational chronic respiratory disease of which chronic obstructive lung disease and asthma are the most significant. Among occupational cancers, lung cancer is the most common, and is associated with more than 10 important workplace carcinogens. Classic occupational interstitial lung diseases such as asbestosis, silicosis, and coal workers' pneumoconiosis still comprise a substantial burden of disease in modern industrial societies, while other occupational causes of pulmonary fibrosis and granulomatous inflammation are frequently misclassified as idiopathic. Occupational respiratory infections gained prominence during the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic, eclipsing influenza and tuberculosis and other less common workplace infectious agents. The most significant risks are workplace exposures to particulate matter, gases, and fumes as well as occupational carcinogens and asthmagens. We present data on the burden of disease measured by deaths attributable to occupational respiratory disease as well as disability-adjusted years of life lost. Where available, prevalence and incidence data are also presented. These diseases are unique in that they are theoretically 100% preventable if appropriate exposure controls and workplace medical surveillance are implemented. This remains a continuing challenge globally and requires steadfast commitment on the part of government, industry, organized labor, and the medical profession.

The dependence of particle size on cell toxicity for modern mining dust

Progressive massive pulmonary fibrosis among coal miners has unexpectedly increased. It would likely due to the greater generation of smaller rock and coal particles produced by powerful equipment used in modern mines. There is limited understanding of the relationship between micro- or nanoparticles with pulmonary toxicity. This study aims to determine whether the size and chemical characteristics of typical coal-mining dust contribute to cellular toxicity. Size range, surface features, morphology, and elemental composition of coal and rock dust from modern mines were characterized. Human macrophages and bronchial tracheal epithelial cells were exposed to mining dust of three sub- micrometer and micrometer size ranges at varying concentrations, then assessed for cell viability and inflammatory cytokine expression. Coal had smaller hydrodynamic size (180–3000 nm) compared to rock (495–2160 nm) in their separated size fractions, more hydrophobicity, less surface charge, and consisted of more known toxic trace elements (Si, Pt, Fe, Al, Co). Larger particle size had a negative association with in-vitro toxicity in macrophages (p < 0.05). Fine particle fraction, approximately 200 nm for coal and 500 nm for rock particles, explicitly induced stronger inflammatory reactions than their coarser counterparts. Future work will study additional toxicity endpoints to further elucidate the molecular mechanism causing pulmonary toxicity and determine a dose–response curve.

Pathology and Mineralogy of the Pneumoconioses

Pneumoconioses represent the spectrum of lung diseases caused by inhalation of respirable particulate matter small enough (typically <5-µm diameter) to reach the terminal airways and alveoli. Pneumoconioses primarily occur in occupational settings where workers perform demanding and skilled manual labor including mining, construction, stone fabrication, farming, plumbing, electronics manufacturing, shipyards, and more. Most pneumoconioses develop after decades of exposure, though shorter latencies can occur from more intense particulate matter exposures. In this review, we summarize the industrial exposures, pathologic findings, and mineralogic features of various well-characterized pneumoconioses including silicosis, silicatosis, mixed-dust pneumoconiosis, coal workers' pneumoconiosis, asbestosis, chronic beryllium disease, aluminosis, hard metal pneumoconiosis, and some less severe pneumoconioses. We also review a general framework for the diagnostic work-up of pneumoconioses for pulmonologists including obtaining a detailed occupational and environmental exposure history. Many pneumoconioses are irreversible and develop due to excessive cumulative respirable dust inhalation. Accurate diagnosis permits interventions to minimize ongoing fibrogenic dust exposure. A consistent occupational exposure history coupled with typical chest imaging findings is usually sufficient to make a clinical diagnosis without the need for tissue sampling. Lung biopsy may be required when exposure history, imaging, and testing are inconsistent, there are unusual or new exposures, or there is a need to obtain tissue for another indication such as suspected malignancy. Close collaboration and information-sharing with the pathologist prior to biopsy is of great importance for diagnosis, as many occupational lung diseases are missed due to insufficient communication. The pathologist has a broad range of analytic techniques including bright-field microscopy, polarized light microscopy, and special histologic stains that may confirm the diagnosis. Advanced techniques for particle characterization such as scanning electron microscopy/energy dispersive spectroscopy may be available in some centers.

Development and Internal Validation of Risk Assessment Models for Chronic Obstructive Pulmonary Disease in Coal Workers

Coal workers are more likely to develop chronic obstructive pulmonary disease due to exposure to occupational hazards such as dust. In this study, a risk scoring system is constructed according to the optimal model to provide feasible suggestions for the prevention of chronic obstructive pulmonary disease in coal workers. Using 3955 coal workers who participated in occupational health check-ups at Gequan mine and Dongpang mine of Hebei Jizhong Energy from July 2018 to August 2018 as the study subjects, random forest, logistic regression, and convolutional neural network models are established, and model performance is evaluated to select the optimal model, and finally a risk scoring system is constructed according to the optimal model to achieve model visualization. The training set results show that the logistic, random forest, and CNN models have sensitivities of 78.55%, 86.89%, and 77.18%; specificities of 85.23%, 92.32%, and 87.61%; accuracies of 81.21%, 85.40%, and 83.02%; Brier scores of 0.14, 0.10, and 0.14; and AUCs of 0.76, 0.88, and 0.78, respectively, and similar results are obtained for the test set and validation set, with the random forest model outperforming the other two models. The risk scoring system constructed according to the importance ranking of random forest predictor variables has an AUC of 0.842; the evaluation results of the risk scoring system shows that its accuracy rate is 83.7% and the AUC is 0.827, and the established risk scoring system has good discriminatory ability. The random forest model outperforms the CNN and logistic regression models. The chronic obstructive pulmonary disease risk scoring system constructed based on the random forest model has good discriminatory power.

Bayesian Hierarchical Framework from Expert Elicitation in the South African Coal Mining Industry for Compliance Testing

Occupational exposure assessment is important in preventing occupational coal worker's diseases. Methods have been proposed to assess compliance with exposure limits which aim to protect workers from developing diseases. A Bayesian framework with informative prior distribution obtained from historical or expert judgements has been highly recommended for compliance testing. The compliance testing is assessed against the occupational exposure limits (OEL) and categorization of the exposure, ranging from very highly controlled to very poorly controlled exposure groups. This study used a Bayesian framework from historical and expert elicitation data to compare the posterior probabilities of the 95th percentile (P95) of the coal dust exposures to improve compliance assessment and decision-making. A total of 10 job titles were included in this study. Bayesian framework with Markov chain Monte Carlo (MCMC) simulation was used to draw a full posterior probability of finding a job title to an exposure category. A modified IDEA ("Investigate", "Discuss", "Estimate", and "Aggregate") technique was used to conduct expert elicitation. The experts were asked to give their subjective probabilities of finding coal dust exposure of a job title in each of the exposure categories. Sensitivity analysis was done for parameter space to check for misclassification of exposures. There were more than 98% probabilities of the P95 exposure being found in the poorly controlled exposure group when using expert judgments. Historical data and non-informative prior tend to show a lower probability of finding the P95 in higher exposure categories in some titles unlike expert judgments. Expert judgements tend to show some similarity in findings with historical data. We recommend the use of expert judgements in occupational risk assessment as prior information before a decision is made on current exposure when historical data are unavailable or scarce.

Particulate matter exposure in construction sites is associated with health effects in workers

Background

Exposure to suspended particulate matters (PMs) at high concentrations, mainly observed in the construction workplace, is found to be a risk factor for major health outcomes. The present study was conducted to investigate the degree of exposure to suspended PMs in different stages of construction of the buildings and the health risk associated with the exposure in Lar, Fars, Iran.

Methods

In this cross-sectional study, two construction sites were selected in Lar. Cancer and non-cancer health risks of exposure to PM_2.5 and PM₁₀ were assessed using the US Environmental Protection Agency method in three-dimensions: inhalation, digestion, and dermal absorption. The hazard quotient (HQ) and total cancer risk (TCR) were considered as parameters for risk analysis.

Results

The highest level of non-cancer risk for workers in the concentrations of PM_2.5 and PM₁₀ particles in the drilling process were determined to be 2.97 × 10^-1 and 8.52 × 10^-2, respectively. In the cancer risk analysis, PM₁₀ concentrations were estimated to be at the highest level (1.7 × 10^-7) in the drilling process and the lowest level (4.29 × 10^-8) in the facilities process. For suspended PM_2.5, it was an unacceptable risk level in all processes, except for the implementation of facilities.

Conclusion

These results show that the construction industry, especially in developing countries such as Iran, needs better management to maintain the health of construction workers.

Overview of lunar dust toxicity risk

Lunar dust (LD), the component of lunar regolith with particle sizes less than 20 μm, covers the surface of the Moon. Due to its fineness, jagged edges, and electrostatic charge, LD adheres to and coats almost any surface it contacts. As a result, LD poses known risks to the proper functioning of electronic and mechanical equipment on the lunar surface. However, its mechanical irritancy and chemical reactivity may also pose serious health risks to humans by a number of mechanisms. While Apollo astronauts reported mild short-lived respiratory symptoms, the spectrum of health effects associated with high-dose acute exposure or chronic low-dose exposure are not yet well-understood. This paper explores known and potential human risks of exposure to LD which are thought to be important in planning upcoming lunar missions and planetary surface work.

Inhalational lung diseases

The term inhalational lung disease comprises a group of entities that develop secondary to the active aspiration of particles. Most are occupational lung diseases. Inhalational lung diseases are classified as occupational diseases (pneumoconiosis, chemical pneumonitis), hypersensitivity pneumonitis, and electronic-cigarette-associated lung diseases. The radiologic findings often consist of nonspecific interstitial patterns that can be difficult to interpret. Therefore, radiologists' experience and multidisciplinary teamwork are key to ensure correct evaluation. The role of the radiologist is fundamental in preventive measures as well as in diagnosis and management, having an important impact on patients' overall health. It is crucial to take into account patients' possible exposure to particles both at work and at home.

The Association between Exposures and Disease Characteristics in Familial Pulmonary Fibrosis

Rationale: Heterogeneous characteristics are observed in familial pulmonary fibrosis (FPF), suggesting that nongenetic factors contribute to disease manifestations. Objectives: To determine the relationship between environmental exposures and disease characteristics of FPF, including the morphological characteristics on chest computed tomography (CT) scan, and timing of FPF symptom onset, lung transplantation, or death. Methods: Subjects with FPF with an exposure questionnaire and chest CT were selected from a prospective cohort at Vanderbilt. Disease characteristics were defined by lung parenchymal findings on chest CT associated with fibrotic hypersensitivity pneumonitis (fHP) or usual interstitial pneumonia (UIP) and by time from birth to symptom onset or a composite of lung transplantation or death. After assessing the potential for confounding by sex or smoking, adjusted logistic or Cox proportional hazards regression models identified exposures associated with fHP or UIP CT findings. Findings were validated in a cohort of patients with sporadic pulmonary fibrosis enrolled in the LTRC (Lung Tissue Research Consortium) study. Results: Among 159 subjects with FPF, 98 (61.6%) were males and 96 (60.4%) were ever-smokers. Males were less likely to have CT features of fHP, including mosaic attenuation (FPF: adjusted [for sex and smoking] odds ratio [aOR], 0.27; 95% confidence interval [CI], 0.09-0.76; P = 0.01; LTRC: aOR, 0.35; 95% CI, 0.21-0.61; P = 0.0002). Organic exposures, however, were not consistently associated with fHP features in either cohort. Smoking was a risk factor for honeycombing in both cohorts (FPF: aOR, 2.19; 95% CI, 1.12-4.28; P = 0.02; LTRC: aOR, 1.69; 95% CI, 1.22-2.33; P = 0.002). Rock dust exposure may also be associated with honeycombing, although the association was not statistically-significant when accounting for sex and smoking (FPF: aOR, 2.27; 95% CI, 0.997-5.15; P = 0.051; LTRC: aOR, 1.51; 95% CI, 0.97-2.33; P = 0.07). In the FPF cohort, ever-smokers experienced a shorter transplant-free survival (adjusted hazard ratio, 1.64; 95% CI, 1.07-2.52; P = 0.02), whereas sex was not associated with differential survival (male adjusted hazard ratio, 0.75; 95% CI, 0.50-1.14; P = 0.18). Conclusions: In FPF, smoking contributes to shortened transplant-free survival and development of honeycombing, a finding that is also likely applicable to sporadic pulmonary fibrosis. Females are more likely to manifest CT features of fHP (mosaic attenuation), a finding that was incompletely explained by sex differences in exposures. These findings may have implications for pulmonary fibrosis classification and management.

Postexposure progression of pneumoconiosis among former Appalachian coal miners

BACKGROUND

The prevalence of pneumoconiosis among working United States underground coal miners has been increasing for the past two decades, with the highest rates of disease observed among miners in the central Appalachian states of Kentucky, Virginia, and West Virginia. Surveillance for this disease in the United States focuses on working coal miners, who continue to be occupationally exposed to dust. This study examines the radiographic evidence for postexposure progression of pneumoconiosis in a population of former coal miners no longer occupationally exposed to coal mine dust who were seen at a community radiology clinic in eastern Kentucky.

METHODS

Data were obtained and analyzed from clinical records of former coal miners who had a clinic encounter during January 1, 2017-August 1, 2019, a recorded final year of employment, and ≥2 postemployment digital chest radiographs. Radiographs were classified according to the International Labour Office guidelines by at least two B Readers. A final summary pneumoconiosis severity score (range, 0-13), accounting for both small and large opacities, was assigned to each chest radiograph. Progression was defined as an increase in severity score between a miner's radiographs over time.

RESULTS

Data for 130 former coal miners were analyzed. All miners were male and most (n = 114, 88%) had worked primarily in Kentucky. Information on race/ethnicity was not available. The most common job types were roof bolters (n = 51, 39%) and continuous miner operators (n = 46, 35%). Forty-one (31.5%) miners had evidence of radiographic disease progression after leaving the workforce, with a median of 3.6 years between first and latest postretirement radiograph. A total of 80 (62%) miners had evidence of pneumoconiosis on their latest radiograph, and two-thirds (n = 53) of these were classified as progressive massive fibrosis (PMF), the most severe form of the disease.

CONCLUSIONS

Postexposure progression can occur in former coal miners, emphasizing the potential benefits of continued radiographic follow-up postemployment. In addition to participating in disease screening throughout their careers to detect pneumoconiosis early and facilitate intervention, radiographic follow-up of former coal miners can identify new or progressive radiographic findings even after workplace exposure to respirable coal mine dust ends. Identification of progressive pneumoconiosis in former miners has potential implications for clinical management and eligibility for disability compensation.

Progressive massive fibrosis: An overview of the recent literature

This review provides an overview of literature addressing progressive massive fibrosis (PMF) from September 2009 to the present. Advances are described in understanding its pathophysiology, epidemiology of the occurrence of PMF and related conditions, the impact of PMF on pulmonary function, advances in imaging of PMF, and factors affecting progression of pneumoconiosis in dust-exposed workers to PMF. Basic advances in understanding the etiology of PMF are impeded by the lack of a well-accepted animal model for human PMF. Recent studies evaluating lung tissue samples and epidemiologic investigations support an important role for the silica component of coal mine dust in causing coal workers' pneumoconiosis and PMF in contemporary coal miners in the United States and for silica in causing silicosis and PMF in artificial stone workers throughout the world. Development of PMF is associated with substantial decline in pulmonary function relative to no disease or small opacity pneumoconiosis. In recent reports, computed tomography has had greater sensitivity for detecting PMF than chest x-ray. Magnetic resonance imaging shows promise in differentiating between PMF and lung cancer. Although PMF develops in dust-exposed workers without previously identified small opacity pneumoconiosis, the presence of small opacity pneumoconiosis increases the risk for progression to PMF, as does heavier dust exposure. Recent literature does not document any effective new treatments for PMF and new therapies to prevent and treat PMF are an important need.

Risk and Status of Gastrointestinal Cancer According to the International Standard Industrial Classification in Korean Workers

Simple Summary

The risk of developing cancers varies depending on occupation, which is a well-known fact. It is crucial to investigate the risk of developing gastrointestinal (GI) cancer in the entire industry. In this study, we calculated the standardized incidence ratios (SIRs) of GI cancer by all industrial sectors as classified in the Korean Standard Industrial Classification (KSIC). There were noticeable differences among industries in the risk of GI cancer. The SIR of all GI cancer was highest among miners and quarriers, and second highest among transportation workers. These results suggest that further research is required to identify the risk factors present in each industry that contribute to the development of GI cancers. We believe this study can help to create tailored cancer prevention strategies for different industrial sectors.

Abstract

To compare the risk of developing gastrointestinal (GI) cancer according to industrial groups, we performed a retrospective cohort study using the database of the Korea National Health Insurance Service (NHIS). We calculated the age-standardized incidence ratios (SIRs) and 95% confidence intervals (95% CIs) for the types of GI cancers according to the Korean Standard Industrial Classification (KSIC) compared with the whole employee population. The highest SIR for all GI cancer was found in the “Mining and quarrying” section (SIR, 1.30; 95% CI, 1.14–1.47), followed by the “Transportation and storage” section (SIR, 1.27; 95% CI, 1.24–1.30). Miners and quarriers had the highest risk of developing gastric cancer (SIR, 1.29; 95% CI, 1.06–1.55) and cancer of the liver and intrahepatic bile ducts (SIR, 1.48; 95% CI, 1.17–1.86). Transportation workers had the highest SIR of cancer of the lip, oral cavity, and pharynx (SIR, 1.27; 95% CI, 1.13–1.43) and cancers of the rectum, anus, and anal canal (SIR, 1.27; 95% CI, 1.19–1.35). There were distinct GI cancers with an elevated risk in each industry group. Our findings imply that distinct cancer prevention programs should be developed for each industrial sector.

Understanding the pathogenesis of occupational coal and silica dust-associated lung disease

Workers in the mining and construction industries are at increased risk of respiratory and other diseases as a result of being exposed to harmful levels of airborne particulate matter (PM) for extended periods of time. While clear links have been established between PM exposure and the development of occupational lung disease, the mechanisms are still poorly understood. A greater understanding of how exposures to different levels and types of PM encountered in mining and construction workplaces affect pathophysiological processes in the airways and lungs and result in different forms of occupational lung disease is urgently required. Such information is needed to inform safe exposure limits and monitoring guidelines for different types of PM and development of biomarkers for earlier disease diagnosis. Suspended particles with a 50% cut-off aerodynamic diameter of 10 µm and 2.5 µm are considered biologically active owing to their ability to bypass the upper respiratory tract's defences and penetrate deep into the lung parenchyma, where they induce potentially irreversible damage, impair lung function and reduce the quality of life. Here we review the current understanding of occupational respiratory diseases, including coal worker pneumoconiosis and silicosis, and how PM exposure may affect pathophysiological responses in the airways and lungs. We also highlight the use of experimental models for better understanding these mechanisms of pathogenesis. We outline the urgency for revised dust control strategies, and the need for evidence-based identification of safe level exposures using clinical and experimental studies to better protect workers' health.

Health impacts of air pollution in Chinese coal-based clean energy industry: LCA-based and WTP-oriented modeling

The evolution of energy system occupies an important position in economic development and quality of life. Influenced by the energy endowment in China, developing the coal-based clean energy industry has been regarded as a guaranteed path to realizing the clean and efficient use of coal resources. However, an evaluation paradigm that could systematically assess the health impacts of airborne pollution in this industry is still lacking, which is our concern. Combining with life cycle analysis, probabilistic risk models, and health impact models, this study proposes a series of models which are consistent enough to unite pollutant concentration, health risk, and health impact, and equip assessment results with more intuitive significance of life and economic loss. Further, case studies for three typical clean coal technologies, namely, coal mining, coal-fired power generation, and coal liquefaction, are presented to verify the reliability of these models. Results show that the most severe health impact occurred at the worksite of driving face, the substage of coal combustion, and coal mining and processing, respectively, for the three technologies. Further, coal dust brought about the greatest pollution to coal mining and coal liquefaction, and for coal-fired power generation, SO₂, NO₂, and PM₁₀ were the commonest and toughest pollutants. In conclusion, the proposed evaluation paradigm can help to find out the worksite, substage, and airborne pollutant with the most severe impact and is more intuitive to provide references for minimizing or eliminating environmental pollution. Additionally, three aspects of implications are confirmed in this study, namely, social mobilization promoting, government policy making, and environmental pollution prejudging.

Pulmonary Capacity, Blood Composition and Metabolism among Coal Mine Workers in High- and Low-Altitude Aboveground and Underground Workplaces

(1) Background: While previous studies revealed how underground mining might adversely affect the cardiopulmonary functions of workers, this study further investigated the differences between under- and aboveground mining at both high and low altitudes, which has received little attention in the literature. (2) Methods: Seventy-one healthy male coal mine workers were recruited, who had worked at least 5 years at the mining sites located above the ground at high (>3900 m; n = 19) and low (<120 m; n = 16) altitudes as well as under the ground at high (n = 20) and low (n = 16) altitudes. Participants’ heart rates, pulmonary functions, total energy expenditure and metabolism were measured over a 5-consecutive-day session at health clinics. (3) Results: Combining the results for both above- and underground locations, workers at high-altitude mining sites had significantly higher peak heart rate (HR), minimum average HR and training impulse as well as energy expenditure due to all substances and due to fat than those at low-altitude sites. They also had significantly higher uric acid, total cholesterol, creatine kinase and N-osteocalcin in their blood samples than the workers at low-altitude mining sites. At underground worksites, the participants working at high-altitude had a significantly higher average respiratory rate than those at low-altitude regions. (4) Conclusion: In addition to underground mining, attention should be paid to high-altitude mining as working under a hypoxia condition at such altitude likely presents physiological challenges.

Fibrinogen mediates cadmium-induced macrophage activation and serves as a predictor of cadmium exposure in chronic obstructive pulmonary disease

The etiologies of chronic obstructive pulmonary disease (COPD) remain unclear. Cadmium (Cd) causes both pulmonary fibrosis and emphysema; however, the predictors for Cd exposure and the mechanisms by which Cd causes COPD remain unknown. We demonstrated that Cd burden was increased in lung tissue from subjects with COPD and this was associated with cigarette smoking. Fibrinogen levels increased markedly in lung tissue of patients with smoked COPD compared with never-smokers and control subjects. Fibrinogen concentration also correlated positively with lung Cd load, but inversely with the predicted % of FEV1 and FEV1/FVC. Cd enhanced the secretion of fibrinogen in a cdc2-dependent manner, whereas fibrinogen further mediated Cd-induced peptidylarginine deiminase 2 (PAD2)-dependent macrophage activation. Using lung fibroblasts from CdCl2-treated Toll-like receptor 4 (TLR4) wild-type and mutant mice, we demonstrated that fibrinogen enhanced Cd-induced TLR4-dependent collagen synthesis and cytokine/chemokine production. We further showed that fibrinogen complexed with connective tissue growth factor (CTGF), which in turn promoted the synthesis of plasminogen activator inhibitor-2 (PAI-2) and fibrinogen and inhibited fibrinolysis in Cd-treated mice. The amounts of fibrinogen were increased in the bronchoalveolar lavage fluid (BALF) of Cd-exposed mice. Positive correlations were observed between fibrinogen with hydroxyproline. Our data suggest that fibrinogen is involved in Cd-induced macrophage activation and increases in fibrinogen in patients with COPD may be used as a marker of Cd exposure and predict disease progression.

Prolonged Inhalation Exposure to Coal Dust on Irradiated Rats and Consequences

The purposes of this study were to research immune system changes and liver and lung tissues in irradiated rats after prolonged exposure to coal dust. A study was carried out on 30 male Wistar rats that were divided into 3 groups: group I, intact animals; group II, exposure to coal dust and 0.2 Gy γ-irradiation; and group III, combined exposure to 6 Gy γ-irradiation and coal dust. The combination of a low and sublethal dose of γ-irradiation with coal dust leads to a significant change in immunity at the remote period. Particularly, the increase in radioactivity at the combined effect causes weakening of phagocytosis, and reduction in T lymphocytes by a factor of 2, immunoglobulin imbalance, and cytokine dysfunction develop secondary immune failure. During prolonged inhalation with coal dust of irradiated animals with the dose of 0.2 Gy, fibrosis and perivascular sclerosis of the bronchial wall of the lungs are formed, and perivascular fibrosis is formed in the liver. The increase in exposure dose up to 6 Gy in combination with coal, in the distant period, caused pulmonary hypertension amid hypertrophy of light arterial vessels and fibrous changes in arteriole, and destructive changes and collection necrosis develop in liver parenchyma. In the case of dust radiation synergy, the increase in doses leads to a significant immune deficiency, which occurs according to the “dose effect” principle; increases damage to animal tissues; and leads to liver tissue necrosis, pulmonary fibrosis, and pulmonary hypertension.

Analysis of Histopathological Findings of Lung Carcinoma in Czech Black Coal Miners in Association with Coal Workers' Pneumoconiosis

Coal miners with coal workers' pneumoconiosis (CWP, J60 according to ICD-10) were previously found to have a significantly higher risk of lung carcinoma compared to the general male population. The presented study aimed to analyze the (i) incidence of lung carcinoma in miners, (ii) histopathological findings in cohorts with and without CWP, and (iii) effect of smoking cessation on the histopathological profile. Analyzed cohorts consisted of miners with (n = 3476) and without (n = 6687) CWP. Data on personal and working history obtained from the medical records were combined with information on lung cancer from the Czech Oncological Register and histopathological findings. Statistical analysis was performed using non-parametric tests and the incidence risk ratio at the significance level of 5%. In 1992-2015, 180 miners (2.7%) without CWP and 169 (4.9%) with CWP, respectively, were diagnosed with lung carcinoma. The risk of lung cancer in miners with CWP was 1.82 (95% CI: 1.48-2.25) times higher than in those without CWP. Squamous cell carcinoma (37%) was the most common histopathological type, followed by adenocarcinoma (22%) and small cell carcinoma (21%). A statistically significant difference between the cohorts (p = 0.003) was found in the histopathological subtypes, with the incidence of small cell carcinoma being 2 times higher in miners without CWP than in those with CWP. Only a few individuals with lung carcinoma were non-smokers. The incidence of small cell carcinoma, which is strongly associated with smoking, is significantly higher in miners without CWP. Smoking constitutes the most important risk factor for developing lung carcinoma even in that cohort. However, CWP remains a very important risk factor.

Cancer and mortality in coal mine workers: a systematic review and meta-analysis

Coal mine workers are exposed to a number of workplace hazards which may increase the risk of cancer and mortality. We conducted a systematic review and meta-analysis to investigate cancer and mortality in coal mine workers We searched in Ovid Medline, PubMed, Embase and Web of Science databases using keywords and text words related to coal mines, cancer and mortality and identified 36 full-text articles using predefined inclusion criteria. Each study's quality was assessed using the Newcastle-Ottawa Scale. We performed random-effect meta-analyses including 21 of the identified articles evaluating cancer and/or mortality of coal mine workers. The meta-analysis showed an increased risk of all-cause mortality (SMR 1.14, 95% CI 1.00 to 1.30) and mortality from non-malignant respiratory disease (NMRD) (3.59, 95% CI 3.00 to 4.30) in cohorts with coal workers' pneumoconiosis (CWP). We found a somewhat increased risk of stomach cancer (1.11, 95% CI 0.97 to 1.35) and of mortality from NMRD (1.26, 95% CI 0.99 to 1.61) in the cohorts of coal miners with unknown CWP status. The meta-analysis also showed a decreased risk of prostate cancer and cardiovascular and cerebrovascular mortality among coal miners. This may be a result of the healthy worker effect and possible lower smoking rates, and perhaps also reflect the physically active nature of many jobs in coal mines. The meta-analysis for lung cancer did not show increased risk in coal miners with CWP (1.49, 95% CI 0.70 to 3.18) or for coal miners of unknown CWP status (1.03, 95% CI 0.91 to 1.18). Lower smoking rates in coal mine workers could explain why case-control studies where smoking was controlled for showed higher risks for lung cancer than were seen in cohort studies. Coal mine workers are at increased risk of mortality from NMRD but decreased risk of prostate cancer and cardiovascular and cerebrovascular mortality. Studies of coal mine workers need long-term follow-up to identify increased mortality and cancer incidence.

Forgotten but not gone: Particulate matter as contaminations of mucosal systems

A decade ago, environmental issues, such as air pollution and the contamination of the oceans with microplastic, were prominently communicated in the media. However, these days, political topics, as well as the ongoing COVID-19 pandemic, have clearly taken over. In spite of this shift in focus regarding media representation, researchers have made progress in evaluating the possible health risks associated with particulate contaminations present in water and air. In this review article, we summarize recent efforts that establish a clear link between the increasing occurrence of certain pathological conditions and the exposure of humans (or animals) to airborne or waterborne particulate matter. First, we give an overview of the physiological functions mucus has to fulfill in humans and animals, and we discuss different sources of particulate matter. We then highlight parameters that govern particle toxicity and summarize our current knowledge of how an exposure to particulate matter can be related to dysfunctions of mucosal systems. Last, we outline how biophysical tools and methods can help researchers to obtain a better understanding of how particulate matter may affect human health. As we discuss here, recent research has made it quite clear that the structure and functions of those mucosal systems are sensitive toward particulate contaminations. Yet, our mechanistic understanding of how (and which) nano- and microparticles can compromise human health via interacting with mucosal barriers is far from complete.

Characterization of nano-to-micron sized respirable coal dust: Particle surface alteration and the health impact

Chemical and physical properties of coal dust particles significantly influence the inhalation of respirable coal dust by miners, causing several lung diseases such as coal workers' pneumoconiosis (CWP) and silicosis. Multiple experimental techniques, including proximate/ultimate analyses, X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), laser diffraction, and low-pressure CO₂ and N₂ adsorption, were used to investigate the chemical and physical properties of micron-/nano-coal particles comprehensively. Compared to the micron-scale coal dust, the nano-coal dust (prepared by cryogenic ballmill) shows the increase of carbon content and aromaticity and a decrease of oxygen content along with the reduction of oxygen-containing functional groups. Pore volume and surface area estimated by low-pressure CO₂ and N₂ adsorption have more than five-time increase for the nano-coal dust. The reduction of oxygen functional groups suggests the dropped wetting behavior of coal nanoparticles. The significantly increased pore volume and surface area in coal nanoparticles could be caused by the enhanced pore interconnectivity on the particle surface and the alteration of coal macromolecules. Weaker wettability and the highly enhanced surface area suggest potentially more significant toxicity of nano-coal dust inhaled by coal miners.

Respirable Coal Mine Dust: A Review of Respiratory Deposition, Regulations, and Characterization

In the late 1990s, despite years of efforts to understand and reduce coal worker’s pneumoconiosis (CWP) prevalence from more than 30% in 1970 to less than 4.2%, the level of occurrence among the US coal miners increased unexpectedly. The recent resurgence of lung diseases has raised concerns in the scientific and regulatory communities. In 2014, the United States Mine Safety and Health Administration (MSHA) issued a new dust rule changing the respirable coal mine dust (RCMD) exposure limits, measurement technology, and sampling protocol. The analysis for probable causes for the substantial increase in the CWP incidence rate is rather complicated. This paper aims to conduct a review of RCMD respiratory deposition, health effects, monitoring, regulations, and particle characteristics. The primary sources of RCMD along with the health risks from potential exposure are highlighted, and the current RCMD exposure regulations of the major coal producer countries are compared. A summary of RCMD characterization studies from 1972 to the present is provided. A review of the literature revealed that numerous factors, including geological and mining parameters, advancements in mining practices, particle characteristics, and monitoring approaches are considered to contribute to the recent resurgence of RCMD lung diseases. However, the root causes of the problem are still unknown. The effectiveness of the new dust rules in the United States will probably take years to be correctly assessed. Therefore, future research is needed to understand the relationship between RCMD particle characteristics and lung deposition, and the efficacy of current monitoring practices to measure the true dose of RCMD exposure.

Compliance Testing and Homogenous Exposure Group Assessment in the South African Coal Mining Industry

OBJECTIVES

Globally, several strategies for compliance testing and within-group exposure variability have been suggested. This study aimed to evaluate the performance of the South African Mining Industry Code of Practice (SAMI CoP) approach for grouping and compliance testing against international standards.

METHODS

A total of 28 homogenous exposure groups (HEGs) with 728 underground coal mine workers' eight-hour time-weighted average coal dust concentration data were obtained. Compliance testing was assessed using 10% exceedance above occupational exposure limit (OEL) for SAMI CoP, and the 95th percentile of the lognormal distribution was computed for the European Standardization Committee (CEN) and American Industrial Hygiene Association (AIHA). Comparison of the homogeneity of the HEGs was done between SAMI CoP which mandates that both the arithmetic mean (AM) and 90th percentile must fall in the same exposure band to certify homogeneity and the global geometric standard deviation (GSD) and Rappaport ratio (R-ratio) with specific acceptability criteria. To test the homogeneity of exposure within job titles, eight non-homogenous HEGs that have two or more job titles with three measurements were investigated using GSD and the SAMI CoP criteria.

RESULTS

A total of 21 HEGs out of 28 were non-compliant to the OEL across SAMI CoP, CEN, and AIHA criteria. Compliance to the OEL was observed for seven HEGs according to the SAMI CoP approach, whereas only one HEG was compliant according to both the SAMI CoP and CEN approaches. The GSD criterion and SAMI CoP revealed that 11 and 6 HEGs were homogenous, respectively, and only on 4 occasions, the 2 approaches agreed. The job titles of the majority of non-homogenous HEGs in both SAMI CoP and GSD were actually homogenous. Five out of 10 sub-groups have their AM above that of HEG B. Other HEGs had at least one of their AM and 90th percentile values above that of their respective parent HEGs.

CONCLUSIONS

All three approaches mainly confirmed non-compliance of HEGs. SAMI CoP tended to show compliance of HEGs more than CEN. Non-homogenous HEGs had many job titles that were homogenous according to both SAMI CoP and GSD criteria. There was no perfect agreement of homogeneity by all the indicators. For both future constitutions of HEGs as well as a retrospective assessment of high exposure groups, homogeneity can be improved by using job titles.

Characterization of Mental Illness Among US Coal Miners

This cohort study examines the prevalence of and risk factors for mental illness among current and former coal miners in the United States.

Characterizing patterns of small pneumoconiotic opacities on chest radiographs of New Mexico coal miners

Small pneumoconiotic opacities in coal miners are usually described as rounded, regular, and upper zone predominant. We aim to characterize chest radiographic patterns in New Mexico coal miners in comparison with other miners. Of the 330 chest radiographs reviewed, small pneumoconiotic opacities in New Mexico miners were almost always irregularly shaped, and lower lung zone predominant, consistent with diffuse dust-related pulmonary fibrosis. There was no significant difference in patterns of opacities between miners with exposure to coal mine dust exclusively, mixed coal and noncoal mine dust, and no coal dust. Our findings indicate that New Mexico coal miners demonstrate a different pattern of small pneumoconiotic opacities than the classic nodular pneumoconiosis described in the literature, predominantly from Appalachian miners. This may indicate differences in racial/ethnic characteristics or in the silica/silicate content of dust between the Appalachian and Mountain West regions.

A 2019 Update on Occupational Lung Diseases: A Narrative Review

Occupational lung diseases (OLDs) are caused, aggravated or exacerbated by exposures at the workplace. OLDs encompass a wide range of respiratory diseases similar to that found outside the work environment. Occupational asthma is the most commonly diagnosed OLD. Other OLDs may include acute and chronic conditions, ranging from hypersensitivity pneumonitis to chronic obstructive pulmonary disease (COPD) to pulmonary fibrosis. Historically, research into OLDs has centered on diseases resulting from exposures relevant to high-income countries and more obvious hazardous occupations, such as silicosis in coal miners. Peer-reviewed publications in 2019 have broadened the focus to include low- and middle-income countries and once-overlooked occupations such as dry cleaning and animal husbandry. Technological advances and greater understanding of disease etiology have allowed researchers and clinicians to implement improved risk analysis, screening and mitigation strategies to not only treat disease once it occurs, but to identify at-risk populations and institute protections to prevent or limit the negative impacts of workplace hazards. As recognition of OLDs as a worldwide threat in a variety of occupations increases, research is allowing for the development of better treatments and preventive measures that advance workers’ rights and ensure their continued good health.

Telementoring of Healthcare Teams in the Care of Miners

Background: Given the reemergence of pneumoconiosis in the United States, there is a tremendous need to train rural professionals in its multidisciplinary management. The Miners' Wellness TeleECHO (Telementoring Extension for Community Health Outcomes) Program in New Mexico, United States, provides longitudinal multidisciplinary telementoring to professionals taking care of miners. The impact of this approach has not been previously evaluated.

Objective: To examine the change in self-efficacy of professionals taking care of miners and participating in the TeleECHO Program.

Methods: This is a 12-month longitudinal study involving clinical and nonclinical professionals caring for miners. The study outcome was the change in self-efficacy scores, using a customized instrument of 14 measures grouped into three domains: clinical, medicolegal, and soft skills. The primary outcome used a retrospective pre-post design that collects "pretest" data at the postintervention timeframe.

Results: Participants reported significant improvements in 10 of 14 items (P < 0.05) and a significant decline in 1 of 14 items (with respect to their ability to interpret pulmonary function test results, P < 0.001) since their start dates in the program. Subjects also reported significant improvement with respect to their scores for all three domains and for the 14-item total score (P ⩽ 0.01). Existing participants and clinical professional groups demonstrated greater improvement in selected items than fresh participants and nonclinical professional groups, respectively.

Conclusion: This study is the first in a stepwise approach to determine the benefit of participating in a multidisciplinary telementoring intervention by improving participant self-efficacy in caring for miners with complex mining-related diseases. Our study finding represents a potential solution to a growing access-to-care gap for miners with pneumoconiosis.

The impacts of coal dust on miners' health: A review

As one of the most important energy resources in the world, coal contributes a great deal to the world economy. Coal mining and processing involve multiple dust generation processes including coal cutting, transport, crushing and milling etc. Coal dust is one of the main sources of health hazard for the coal workers. Exposure of coal dusts can be prevented through administrative controls and engineering controls. Ineffective control of coal dust exposure can harm coal workers' health. Although many efforts have been made to eliminate these threats, recent years have seen an unexpected increase in coal workers' pneumoconiosis (CWP) in Appalachian basin in US. To explore the reasons for this phenomenon, in this review, we first reviewed the historical studies on coal mine dust including the regulation and engineering controls. Then, the effects of coal dust on human health was comprehensively reviewed. Next, the effects of nanoparticles on human health were reviewed, with an emphasis on toxicity of nanoparticles such as carbon nanotubes in other industries. From all this information, we hypothesize that nano-sized coal dust has contributed to the increase of CWP prevalence in recent years. As no research has been reported in this area, four directions which may need further investigation and future studies are recommended in this review. They include: 1) Systematic characterization of physicochemical properties of nano-size coal dust; 2) Toxicity and pathogenesis of nano-sized coal dust; 3) Development of real-time monitoring technology and equipment for nano-sized coal dust; 4) Development of exposure control technology and equipment. The intent of this review paper is to demonstrate the variation of coal dust properties and their impact on the mine worker's health. We suggest that the impact of nano-sized coal mine dust on miner's health has not yet been understood well and further improvements are necessary.

Respiratory surveillance for coal mine dust and artificial stone exposed workers in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand

Coal mine lung dust disease (CMDLD) and artificial stone (AS) silicosis are preventable diseases which have occurred in serious outbreaks in Australia recently. This has prompted a TSANZ review of Australia's approach to respiratory periodic health surveillance. While regulating respirable dust exposure remains the foundation of primary and secondary prevention, identification of workers with early disease assists with control of further exposure, and with the aims of preserving lung function and decreasing respiratory morbidity in those affected. Prompt detection of an abnormality also allows for ongoing respiratory specialist clinical management. This review outlines a medical framework for improvements in respiratory surveillance to detect CMDLD and AS silicosis in Australia. This includes appropriate referral, improved data collection and interpretation, enhanced surveillance, the establishment of a nationwide Occupational Lung Disease Registry and an independent advisory group. These measures are designed to improve health outcomes for workers in the coal mining, AS and other dust-exposed and mining industries.

Causes of death among Federal Black Lung Benefits Program beneficiaries enrolled in Medicare, 1999-2016

BACKGROUND

Coal miners with totally disabling pneumoconiosis are eligible for benefits through the Federal Black Lung Benefits Program (FBLP). We identify the causes of death among Medicare beneficiaries with a claim for which the FBLP was the primary payer and compare these causes of death to all deceased Medicare beneficiaries to better understand elevated death and disease among miners with occupational respiratory exposures.

METHODS

From 1999 to 2016 Medicare data, we extracted beneficiary and National Death Index data for 28,003 beneficiaries with an FBLP primary payer claim. We summarized the International Classification of Diseases, Clinical Modification 10th revision-coded underlying causes of death and entity-axis multiple causes of death for 22,242 deceased Medicare beneficiaries with an FBLP primary payer Medicare claim and compared their causes of death to the deceased Medicare beneficiary population.

RESULTS

Among deceased FBLP beneficiaries, the three leading underlying causes of death were chronic obstructive pulmonary disease, unspecified (J44.9, 10.1%), atherosclerotic heart disease (I25.1, 9.3%), and coal workers' pneumoconiosis (CWP) (J60, 9.2%). All diseases of the respiratory system combined (J00-J99) were the underlying cause of death for 29.1% of all beneficiaries, with pneumoconioses (J60-J64) as the underlying cause for 11.0% of all beneficiaries.

CONCLUSIONS

Coal miners enrolled in Medicare with an FBLP primary payer claim were more likely to have specific respiratory and cardiovascular diseases listed as a cause of death than deceased Medicare beneficiaries overall, and were also more likely to die from CWP or any pneumoconioses.

Oxidative Stress From Exposure to the Underground Space Environment

There are a growing number of people entering underground spaces. However, underground spaces have unique environmental characteristics, and little is known about their effects on human health. It is crucial to elucidate the effects of the underground space environment on the health of humans and other organisms. This paper reviews the effects of hypoxia, toxic atmospheric particles, and low background radiation in the underground space environment on living organisms from the perspective of oxidative stress. Most studies have revealed that living organisms maintained in underground space environments exhibit obvious oxidative stress, which manifests as changes in oxidants, antioxidant enzyme activity, genetic damage, and even disease status. However, there are few relevant studies, and the pathophysiological mechanisms have not been fully elucidated. There remains an urgent need to focus on the biological effects of other underground environmental factors on humans and other organisms as well as the underlying mechanisms. In addition, based on biological research, exploring means to protect humans and living organisms in underground environments is also essential.

Associations of VDR gene polymorphisms with risk of coal workers' pneumoconiosis in Chinese Han population

Some studies showed that the polymorphisms of vitamin D receptor (VDR) gene were associated with pulmonary diseases. However, the relationship between the VDR variations and susceptibility to coal worker's pneumoconiosis (CWP) remains unclear. The study aimed to determine the associations between VDR polymorphisms and susceptibility to CWP in Chinese Han population. The study involved 340 CWP patients and 312 healthy controls. The VDR polymorphisms were determined by DNA sequencing, and serum 25(OH)2D levels were detected by Ultra High-Performance Liquid Chromatography-Tandem Mass Spectrometry. The results showed that the VDR gene ApaI T allele increased the risk of CWP (OR = 1.486, 95% CI = 1.125-1.963, P = 0.006) and ApaI GT genotype as well as TT genotype increased the risk of CWP (GT vs. GG, OR = 1.461, 95% CI = 1.048-2.038, P = 0.025; TT vs. GG, OR = 2.673, 95% CI = 1.017-7.025, P = 0.039). Five haplotypes were identified and we found that the TGGT haplotype was associated with a lower risk of CWP (OR = 0.755, 95% CI = 0.603-0.946, P = 0.014). Meanwhile, multifactor dimensionality reduction analysis showed that the interaction between ApaI and exposure was the strongest, followed by TaqI and then BsmI. The study also found that the serum 25(OH)2D mean levels of the case group were significantly lower than that of the control group, and the serum 25(OH)2D mean levels of ApaI homozygous mutant and heterozygous mutant subjects were lower than that of the wild homozygosity, respectively (P < 0.001). The results suggested that ApaI T allele and GT or TT genotype and lower 25(OH)2D levels were increased the risk of CWP in Chinese Han population.

Coal mining and lung disease in the 21st century

PURPOSE OF REVIEW

To review the impact of coal mining and resurgence of coal workers' pneumoconiosis (CWP) in 21st century and effect of ambient air pollution on lung function.

RECENT FINDINGS

At the beginning of 21st century, statistics by National Institute for Occupational Safety and Health showed a steep rise in pneumoconiosis. This was followed by numerous epidemiologic and pathologic studies that confirmed increasing CWP prevalence as well as disease in younger miners and those with a shorter mining tenure. Recent studies have demonstrated that poor dust control in mines, a relative shift in composition of the coal mine dust, small sized mines and increase in surface mining are all possible contributors to this resurgence. There is also growing literature evaluating the effects of worsening air pollution on health, including decreasing lung function and development of emphysema, worsening quality of life measures and lung cancer.

SUMMARY

This irreversible but preventable disease currently haunts approximately 60 000 miners across United States and millions across the world. Its resurgence despite the strict dust regulations is a setback from the public health standpoint. The continued reliance on coal for energy will continue to place coal miners at danger of developing disease as well as the world.

Dust Suppression Analysis of a New Spiral Hopper Using CFD-DEM Simulations and Experiments

A new dust suppression hopper with a spiral guide plate embedded in the conventional hopper is proposed for the dust suppression of hopper transfer processes in this article. The Computational Fluid Dynamics-Discrete Element Method (CFD-DEM) coupling numerical method is used to investigate the particle motion and flow field distribution of the hopper transfer process. The experiment is undertaken to determine dust suppression performance. The results show that the maximum particle velocity for the spiral hopper is dropped by 1.6 m/s compared to the conventional hopper, which means the collision of the particles and the spiral hopper is weakened. The axial airflow velocity of the spiral is reduced. In addition, the maximum dust concentration of the spiral hopper inlet is reduced by 56.9% due to the impact velocity of particles is small, and the secondary fugitive dust is controlled inside a semi-closed space formed by the spiral guide plate. It is thus concluded that the spiral hopper provides an effective way in dust control.

Associations of HMGB1 gene polymorphisms with risk of coal workers' pneumoconiosis susceptibility in Chinese Han population

Background: High-mobility group box 1 (HMGB1) protein plays an important pathogenic role in various diseases such as pulmonary fibrosis. However, the relationship between variation of HMGB1 gene and susceptibility to coal worker's pneumoconiosis (CWP) remains unclear. The objective of the study was to determine the association between HMGB1 polymorphisms and CWP in Chinese Han population.Methods: The genotypes of HMGB1 gene rs1045411, rs2249825, rs1412125 and rs1360485 in 340 CWP patients and 312 healthy controls were determined and serum HMGB1 levels were detected.Results: Our finding showed that the HMGB1 rs1360485 G allele increased the risk of CWP in comparison with A allele (P = 0.005). HMGB1 rs1360485 GG genotype as well as AG+GG genotype increased the risk of CWP in comparison with AA genotype (P = 0.010, P = 0.025, respectively). Four haplotypes were identified and we found that the GCTA haplotype was associated with resistance to CWP (P = 0.005), while GCTG haplotype was associated with risk to CWP (P<0.001). Meanwhile, multifactor dimensionality reduction (MDR) analysis showed that the interaction between rs1360485 and exposure had the strongest, followed by rs2249825 and rs1412125. This study also found that the serum HMGB1 levels of the case group were significantly higher than that of the control group, and the serum HMGB1 levels of homozygous subjects with rs1360485 mutant were higher than that of the heterozygous wild type, respectively (P<0.001). Meanwhile, the levels of HMGB1 with GCTA haplotype was lower than with GCTG haplotype (P<0.001)Conclusion: Our findings indicated that HMGB1 gene rs1360485 polymorphism was associated with the susceptibility to CWP in Chinese Han population.

Association between duration of coal dust exposure and respiratory impairment in coal miners of West Bengal, India

Purpose. The prevalence and severity of respiratory disorders are very high among coal miners as continuous exposure of workers in such an environment leads to accumulation of dust in the lungs. This study was designed to assess the prevalence of lung function impairment and to determine whether there is any correlation between dust exposure duration and lung function indices. Materials. Two hundred and thirty underground coal dust-exposed workers and 130 age-matched non-exposed workers were recruited from an underground mine in West Bengal, India. A spirometry test was performed for lung function and also basic information on personnel's dust exposure, smoking and respiratory morbidity was collected. Student's t test, Pearson's correlation coefficient (r), uncorrected Pearson's χ² test and Fischer's exact test were performed for statistical analysis. Results. Lung function indices were significantly (p < 0.050) impaired between the exposed (43.91%) and non-exposed (23.85%) groups. In addition, highly significant decrements in the pulmonary volumes of exposed subjects were also noted. Furthermore, a high negative correlation was observed between spirometric results and exposure time in the exposed group compared with the non-exposed group. Conclusion. This study suggested a positive relationship between exposure time and lung function deterioration.

NAF1 rs4691896 Is Significantly Associated with Coal Workers' Pneumoconiosis in a Chinese Han Population: A Case-Control Study

Background

Previous studies have demonstrated the important role of genetic predisposition in coal workers’ pneumoconiosis (CWP) in addition to environmental factors. The pathogenesis of pulmonary fibrosis disease is related to telomere activity. We performed this study to assess the association between genetic variants of telomere-related genes and the risk of CWP.

Material/Methods

We enrolled 652 CWP Chinese Han patients and 648 dust-exposed controls in this case-control design study, genotyping 8 single-nucleotide polymorphisms (SNPs) including TERT (rs2736100), TERC (rs10936599 and rs12696304), and NAF1 (rs7675998, rs3822304, rs12331717, rs936562 and rs4691896) using the Sequenom MassARRAY system.

Results

We identified a significant allele association between NAF1 rs4691896 and CWP by comparing patients with controls (22.0% vs. 13.0%, odds ratio [OR]: 1.89, 95% confidence interval [CI]: 1.54–2.33, Pc=1.14×10⁻⁸). The genotype frequency of rs4691896 differed significantly between the patients and controls (Pc=1.49×10⁻⁸). In addition, rs4691896 was correlated with CWP in an additive genetic model (OR: 1.96, 95% CI: 1.58–2.44, Pc=8.96×10⁻⁹) and a dominant model (OR: 2.15, 95% CI: 1.70–2.73, Pc=2.39×10⁻⁹).

Conclusions

Our study for the first time demonstrates an association between a telomere-related gene (NAF1) and CWP in a Chinese Han population, and provides valuable insight to further understand the possible pathogenetic mechanism of fibrosis in CWP.