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Silicosis: A former occupational disease with new occupational exposure scenarios
Silicosis: una antigua enfermedad profesional con nuevos escenarios de exposición laboral
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García Sevila, M.d.M. García Rodenas, E. Barroso Medel, E. Flores Reos, Juan Gil Carbonell" "autores" => array:6 [ 0 => array:3 [ "nombre" => "M.A." "apellidos" => "Pascual del Pobil y Ferré" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "García Sevila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "M.d.M." "apellidos" => "García Rodenas" "email" => array:1 [ 0 => "margarciarodenas@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Barroso Medel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "E." "apellidos" => "Flores Reos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Juan" "apellidos" => "Gil Carbonell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Salud Laboral, Centro de Salud Pública de Alicante, Conselleria de Sanidad Universal y Salud Pública, Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital General Universitario de Alicante, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Silicosis: una antigua enfermedad profesional con nuevos escenarios de exposición laboral" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 834 "Ancho" => 1570 "Tamanyo" => 56513 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of the mean exposure time, at the time of the declaration, of the workers with silicosis, exposed and not exposed to artificial quartz aggregates (AQA). <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0064.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Silicosis is an occupational diffuse interstitial lung disease caused by inhaling free crystalline silicon dioxide. The disease is included in the group of pneumoconioses and is the most common and severe of them. The disease has 3 clinical forms: acute silicosis, chronic silicosis (simple silicosis and progressive massive fibrosis) and accelerated silicosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis requires a detailed occupational history, radiological data and the ruling out of other diagnoses.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> In exceptional cases, the diagnosis is performed with a histological study.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Silicosis is recognized as an occupational disease in Spain<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> and in Europe.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> The risk of developing the disease depends on 3 factors: the concentration of dust in the air, the percentage of silica in the dust and the duration of exposure.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The incidence of silicosis has gradually decreased thanks to improvements in ventilation and dust suppression systems in the workplace<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> but is still a public health problem worldwide and one of the most common occupational respiratory diseases of Spain.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2009, the Community of Valencia implemented a pioneering computer tool, the Healthcare Information System for Occupational Epidemiological Surveillance of the Community of Valencia (SISVEL).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> This system helps physicians of the Regional Ministry of Universal Healthcare and Public Health and physicians of the Occupational Risk Prevention Services (ORPS) comply with the requirement to report to mutual insurance societies, collaborating companies of the Spanish Social Security and the National Social Security Institute those diseases they suspect might be considered occupational diseases.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objective</span><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this study was to assess cases of pneumoconiosis due to silica, reported to SISVEL, to reveal new agents of exposure to silica, working conditions that promote its onset and to propose appropriate preventive measures.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A descriptive study was conducted of all cases of pneumoconiosis due to silica reported to SISVEL in the departments of health of University General Hospital of Alicante and University Hospital of San Juan, from the implementation of SISVEL in January 2009 to September 2016. The departments’ total population is 485,917 inhabitants (Spanish National Statistics Institute, January 1, 2016). The study variables were origin of the notification, age, sex, history of smoking, spirometric values, diagnostic method, presentation, job, exposure time and preventive measures employed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The data sources were occupational epidemiological surveys, hospital and ORPS medical reports, occupational risk assessments for some of the jobs and safety data sheets of the products employed. The quantitative variables (mean and standard deviation) were compared using Student's t-test, using the statistical program EPIDAT version 4.2.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">During the study period, a total of 19 cases of silicosis were reported to SISVEL.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Seventy-nine percent of the cases (15/19) were declared by the public healthcare system, and only 21% (4/19) were declared by ORPS. Fourteen cases (74%) were diagnosed, reported and monitored in the University General Hospital of Alicante. The mean age was 51.58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.74 years. Ninety-five percent of the cases involved men. The mean exposure time was 16.11<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.38 years. Of those patients for whom a history of smoking was known (16), 75% were ex-smokers or active smokers, with a cumulative consumption of 29.58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.04 packs/year. Spirometric data was obtained in only 14 patients. Of these, 50% had a normal spirometry, 1 patient had mild restrictive ventilatory dysfunction, and 6 had obstructive ventilatory dysfunction (1 very severe, 4 moderate and 1 mild). The patients with obstruction had a history of smoking more than 30 packs/year on average. The most common presentation was simple chronic silicosis (79%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Four cases (21%) presented progressive massive fibrosis (3 workers with AQA exposure [<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>] and 1 miner). Thoracic HRCT was performed in 14 cases (74%), showing a micronodular pattern with hilar and mediastinal adenopathies. Four patients (21%) underwent surgical video-assisted thoracoscopic biopsy for the differential diagnosis. The diagnoses were consistent with silicosis-type pneumoconiosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In terms of the patients’ jobs, 68.4% were employed for the handling of AQA, with a high content of crystalline silica (70–90%), in the position of assembler/cutter/sander of kitchen and bath countertops. One of the cases occurred in a woman who worked as a laboratory dental assistant tasked with burring and polishing dental prostheses. The other patients had jobs traditionally related to silica exposure.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The mean age of the group exposed to AQA was 46.62<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.33 years, and the patients who worked in other jobs had a mean age of 62.33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.22 years, with a statistically significant difference between the 2 groups (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.039) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0065" class="elsevierStylePara elsevierViewall">In terms of the exposure duration, the group exposed to AQA had a mean exposure of 11.00<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.58 years, while the rest had an exposure of 27.16 years<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.44 years, which also achieved statistical significance (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0064) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><p id="par0070" class="elsevierStylePara elsevierViewall">The workers exposed to AQA only occasionally used individual protection equipment, the ventilation was inadequate, and the collective protection measures (dust aspiration or work in humid environments) were not practicable most of the time, because the assembly of kitchens and baths is conducted in homes and building sites and not in the workshop.</p><p id="par0075" class="elsevierStylePara elsevierViewall">After following the progression of these patients for 5 years, there were no cases of neoplastic disease or tuberculosis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">During the study period, we detected 19 cases of silicosis, 13 of them from exposure to AQA. The use of these new construction materials has resulted in new cases of silicosis in activities that, until recently, did not cause the disease. Various recent publications have reported clusters of silicosis cases from exposure to these materials: 46 cases in Cadiz,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> 3 cases in Asturias,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> 6 cases in Vizcaya<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> and 25 cases of advanced silicosis in Israel, of which 10 cases required transplantation, revealing the severity of the disease.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">It is worth noting the case of silicosis in another job position: The only woman in the study, who worked as a dental prosthesis laboratory assistant for 27 years. Our patient was mainly exposed to feldspathic ceramic with a high quartz content in crystalline form.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> Various studies have related silicosis with this job position.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">12–14</span></a> Ergün et al. found a 10% rate of pneumoconiosis in the review of 893 dental technicians.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Since the end of the 1990s, alternative materials to natural stone have been introduced to the market, materials known as AQA, with a high percentage of breathable silica. In our study, the patients exposed to AQA had a lower mean age and a shorter exposure time than the other workers with silicosis. These data agree with those found by Kramer et al., Martinez et al. and Perez-Alonso.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">7,8,10</span></a> These results show a new epidemiological pattern of silicosis, which presents in younger active workers, with shorter exposure times and greater risk of developing complicated forms. Deficiencies were detected in occupational risk prevention at various levels. We found that a number of AQA safety datasheets from 2009 incorrectly identified the dangers of using the product in all of its potential scenarios (especially in cutting and shaping the product), which were corrected in subsequent safety data sheets.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> The ORPS of some of these companies did not consider the risk of pneumoconiosis for these job positions in the Occupational Risk Assessment; they therefore did not perform measurements, establish appropriate protection measures or give their workers information or training on this risk and on how to prevent it. The ORPS also did not apply the Health Surveillance Protocol for Silicosis, which includes chest radiography.</p><p id="par0095" class="elsevierStylePara elsevierViewall">All these factors explain how a preventable disease, with known causes, has become a reemerging occupational disease. However, as shown in a number of studies,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> it is possible to achieve a situation of well-controlled risk against silicosis by implementing basic measures such as wet cleaning of facilities, training in the use of respiratory protective equipment, the use of pneumatic tools for working with water and adapting the workplace.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">The workplace for assembling/cutting/sanding kitchen and bath countertops has a high risk for developing the disease due to exposure to these new agents.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Our series revealed another unusual workplace with a risk for silicosis, that of the dental laboratory assistant.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Comprehensive occupational risk assessments need to be performed to identify all workplaces where silica is present and improve the preventive planning of companies with exposure to this mineral.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Greater awareness is needed of the occupational risks of these workplaces and in risk prevention among companies in the sector, ORPS and insurance companies.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1142540" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1073205" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1142541" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1073206" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objective" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Methods" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack389299" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-31" "fechaAceptado" => "2018-06-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1073205" "palabras" => array:6 [ 0 => "Silicosis" 1 => "Silica" 2 => "Pneumoconiosis" 3 => "Quartz aggregates" 4 => "Occupational diseases" 5 => "Marble workers" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1073206" "palabras" => array:6 [ 0 => "Silicosis" 1 => "Sílice" 2 => "Neumoconiosis" 3 => "Conglomerados de cuarzo" 4 => "Enfermedades profesionales" 5 => "Trabajadores del mármol" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recent studies have shown an increase in the prevalence of silicosis due to the use of artificial quartz aggregates (AQA). The aim of this study was to assess the cases of silicosis in our area reported to the Healthcare Information System for Occupational Epidemiological Surveillance of the Autonomous Community of Valencia to detect new agents of exposure to silica and working conditions that promote its onset.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A descriptive study was conducted of cases of silicosis reported to the Healthcare Information System for Occupational Epidemiological Surveillance of the Autonomous Community of Valencia from January 2009 to September 2016. The data sources include epidemiological-occupational surveys and medical reports.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nineteen cases of silicosis were reported, 74% of which were diagnosed using high-resolution computed tomography. Some 68.4% of the cases were related to the handling of AQA, as assemblers/cutters/sanders of countertops. The subgroup's mean age was 46.62<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.33 years, and the mean exposure was 11.00<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.58 years. The rest of the patients worked in companies with no AQA exposure, with a mean age of 62.33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.22 years and a mean exposure of 27.16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.44 years (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Four cases presented complicated forms (3 exposed to AQA).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The work of assembling/cutting/sanding AQA countertops presents a high risk of developing the disease. The mean age at onset and the exposure time for this group is lower, and the percentage of complicated clinical forms is higher. Improvements need to be made in preventive planning for companies with exposure to these new agents.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Recientes estudios evidencian un aumento de la prevalencia de la silicosis por el uso de conglomerados artificiales de cuarzo (CAC). El objetivo de este trabajo es la valoración de los casos de silicosis declarados al Sistema de Información Sanitaria de Vigilancia Epidemiológica Laboral de la Comunidad Valenciana en nuestra área, para detectar: nuevos agentes de exposición al sílice y condiciones de trabajo que favorecen su aparición.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo de casos de silicosis declarados al Sistema de Información Sanitaria de Vigilancia Epidemiológica Laboral de la Comunidad Valenciana desde enero de 2009 hasta septiembre de 2016. Las fuentes de datos incluyen encuestas epidemiológico-laborales e informes médicos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se declaran 19 casos de silicosis. El 74% fue diagnosticado mediante tomografía computarizada de alta resolución. El 68,4% estaba relacionado con manipulación de CAC, en puestos de montador/cortador/lijador de encimeras. La edad media de este subgrupo fue de 46,62<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13,33 años y la media de exposición, de 11,00<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3,58 años. El resto trabajó en empresas sin exposición a CAC, con una edad media de 62,33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16,22 años y un tiempo de exposición de 27,16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8,44 años (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05). Presentaron formas complicadas 4 casos (3 expuestos a CAC).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El trabajo de montador/cortador/lijador de encimeras de CAC presenta un alto riesgo de desarrollar la enfermedad. La edad media de presentación y el tiempo de exposición en este grupo es menor y el porcentaje de formas clínicas complicadas, mayor. Es necesario establecer mejoras en la planificación preventiva de empresas con exposición a estos nuevos agentes.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pascual del Pobil y Ferré MA, García Sevila R, García Rodenas MdM, Barroso Medel E, Flores Reos E, Gil Carbonell J. Silicosis: una antigua enfermedad profesional con nuevos escenarios de exposición laboral. Rev Clin Esp. 2019;219:26–29.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 781 "Ancho" => 1593 "Tamanyo" => 53666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of the mean age, at the time of the declaration, of the workers with silicosis, exposed or not exposed to artificial quartz aggregates (AQA). <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.039.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 834 "Ancho" => 1570 "Tamanyo" => 56513 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of the mean exposure time, at the time of the declaration, of the workers with silicosis, exposed and not exposed to artificial quartz aggregates (AQA). <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0064.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Stellman JM, directora. 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Available from: <a id="intr0020" class="elsevierStyleInterRef" href="http://www.litosonline.com/">www.litosonline.com</a>." ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack389299" "titulo" => "Acknowledgements" "texto" => "<p id="par0125" class="elsevierStylePara elsevierViewall">We would like to thank SEPAR for granting the SEPAR-PATIENTS First Prize in the EROM area to the best presentation at the Annual Congress in 2017.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021900000001/v1_201901300620/S2254887418301814/v1_201901300620/en/main.assets" "Apartado" => array:4 [ "identificador" => "1903" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief Original" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021900000001/v1_201901300620/S2254887418301814/v1_201901300620/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301814?idApp=WRCEE" ]
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