No abstract

Background:Diving within artisanal fishing is a profession carried out by many men in coastal communities of southern Chile. These shellfish divers use surface supplied air for breathing. Among potential health threats are occupational accidents, decompression sickness and barotrauma. Repeated middle and inner ear barotrauma and decompression sickness of the ear may result in hearing loss.Objective:To determine the prevalence of hearing loss and related risk factors in artisanal shellfish divers.Methods:A cross–sectional study including 125 male shellfish divers was carried out in a coastal village in southern Chile. Participants were interviewed using a standard Spanish questionnaire adapted for this population. Hearing loss was assessed through audiometry. Any hearing loss, sensorineural hearing loss and other types of hearing loss (conduction, unilateral and mixed) were used as the outcomes. Bivariate and multiple logistic regression models were carried out to identify risk factors for hearing loss.Findings:Median duration on the job was 25 years (range 1–52), 64% of divers had a low level of schooling and 52% reported not knowing how to use decompression tables. Most (86%) of the divers dove deeper than 30 meters exceeding the 20 meters permitted by law. The majority (80%) reported having experienced several episodes of type II decompression sickness during their working life. The prevalence of any type of hearing loss was 54.4%: 29.0% presented sensorineural hearing loss and 25.6% presented other types of hearing impairment. After adjustment for age and other potential risk factors, diving more than 25 years was the main predictor for all kinds of hearing loss under study.Conclusions:Hearing loss is frequent in artisanal shellfish divers and safety measures are limited. Although based on small numbers and lacking an unexposed comparison group, our results suggest the need for community-based interventions.

Integrating basic occupational health services into primary care is encouraged by the Pan American Health Organization. However, concrete initiatives are still scarce. We aimed to develop a training program focusing on prevention of occupational risks for primary healthcare professionals. This train-the-trainer program was piloted at four universities in Chile and Peru. Occupational health or primary healthcare lecturers formed a team with representative(s) of one rural primary healthcare center connected to their university (Nparticipants = 15). Training started with a workshop on participatory diagnosis of working conditions. Once teams had conducted the participatory diagnosis in the rural communities, they designed in a second course an active teaching intervention. The intervention was targeted at the main occupational health problem of the community. After implementation of the intervention, teams evaluated the program. Evaluation results were very positive with an overall score of 9.7 out of 10. Teams reported that the methodology enabled them to visualize hazardous working conditions. They also stated that the training improved their abilities for problem analysis and preventive actions. Aspects like time constraints and difficult geographical access were mentioned as challenges. In summary, addressing occupational health in primary care through targeted training modules is feasible, but long-term health outcomes need to be evaluated.

Knowledge about professional diving-related risk factors for reduced executive function is limited. We therefore evaluated the association between decompression illness and executive functioning among artisanal divers in southern Chile. The cross-sectional study included 104 male divers and 58 male non-diving fishermen from two fishing communities. Divers self-reported frequency and severity of symptoms of decompression illness. Executive function was evaluated by perseverative responses and perseverative errors in the Wisconsin Card Sorting Test. Age, alcohol consumption, and symptoms of depression were a-priori defined as potential confounders and included in linear regression models. Comparing divers and non-divers, no differences in the executive function were found. Among divers, 75% reported a history of at least mild decompression sickness. Higher frequency and severity of symptoms of decompression illness were associated with reduced executive function. Therefore, intervention strategies for artisanal divers should focus on prevention of decompression illness.

The long-term effects of diving on human lung function are controversially discussed. We investigated the lung function of traditional shellfish divers in southern Chile and identified risk factors for reduced lung volumes in divers. In a cross-sectional study, we assessed lung function in traditional shellfish divers and fishermen from two fishing communities. Male divers and fishermen aged 18–­60 years were recruited. Participants’ health and diving habits were assessed via standardized questionnaires. Descriptive statistics, chi-squared tests and multiple linear regression models were applied. Through door-to-door sampling, we recruited 112 divers and 63 fishermen (response 67%). Valid spirometries were obtained from 98 divers and 52 fishermen. Divers had higher values of forced vital capacity (FVC, Beta = 0.28, 95% confidence interval (CI): 0.09; 0.47) and forced expiratory volume in 1 s (FEV1, Beta = 0.23, 95%-CI: 0.07; 0.39) compared to fishermen. Among divers, lower values of FVC (Beta = −0.35, 95%–CI: −0.65; −0.05) were found in those with a high diving frequency, while diving depth was associated with higher values of FVC (Beta = 0.28, 95%–CI = 0.04; 0.52). Professional divers had better lung function compared to fishermen. However, among divers, lung function decreased with cumulative diving exposure, warranting approval in future studies to ensure the safety and health of divers.