Relation of Urinary Mercury Level to Chronic Fatigue Syndrome among Workers of Artisanal and Small-scale Gold Mining: 2022

[Sly Saint]

Relation of Urinary Mercury Level to Chronic Fatigue Syndrome among Workers of Artisanal and Small-scale Gold Mining: A Study of 3 Districts in West Nusa Tenggara Province and Lebak District of Banten Province, Indonesia

Abstract
Introduction. Chronic Fatigue Syndrome (CFS) is a collection of symptoms from a substantial reduction in the ability to engage in preillness levels of occupational, educational, social, or personal activities that persists for more than six months and is accompanied by fatigue, post-exertional malaise, and unrefreshing sleep. One of the effects of heavy metal exposure is the occurrence of CFS among workers. Artisanal and Small-scale Gold Mining (ASGM) workers used mercury in their work, and this leads to a higher risk of chronic mercury poisoning. One of the health problems dueto mercury exposure is the occurrence of CFS and this has not been studied among ASGM workers.

Objective. This study intended to discover the prevalence of CFS among ASGM workers and the factors associated with it.

Method. This study used a cross-sectional design to find the relationship between independent variables such as age, sex, working period as a miner, type of work activities in ASGM, and cumulative urinary mercury levels with CFS in ASGM workers in West Nusa Tenggara and Banten province. CFS was measured using standardized questionnaire on effect on mercury released by WHO-UNEP, and creatinine-corrected urinary mercury levels.

Results. The prevalence of CFS in ASGM workers in West Nusa Tenggara and Banten provinces was 17.9%. Based on the results, the factors of age, sex, work period, type of work, province of origin and cumulative urinary mercury levels did not have a statistically significant relationship with CFS (p> 0.05).

Conclusion. There was no significant relationship between age, sex, work period, type of work, urinary mercury level and cumulative urinary mercury levels with CFS in ASGM workers.

https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/3832

 

[RedFox]

These people have no idea what ME/CFS actually is. They're trying to say, with a straight face, that 17 percent of people working a highly strenuous job meet the IOM criteria for ME/CFS by using single questions from a questionnaire not designed to screen for ME:

Fatigue is defined as answering “Worse than usual” or “Much worse than usual” in the questionnaire. Post exertional Malaise is defined as answering “worse” or “much worse than usual” in question “Do you feel weak”, or “Can you start things without difficulties, but get weak as you go on?”. Sleep Disorder is defined as answering “bad” to the question “How do you feel after a usual night of sleep?”. Cognitive Disorder is defined as scoring 1 – 2 in the matchbox test. Orthostatic Intolerance is when there is rigidity of gait.

Rigidity of gait?! These people have no idea what orthostatic intolerance is. I'm not exaggerating. I'm saying they misunderstand ME it like many researchers do. They literally have no clue.

Frivolous, but can't help notice it due to my previous career: They got the boolean order of operations wrong.

According to the questionnaire, CFS is defined by subjects who experienced Fatigue AND Post Exertional Malaise AND Sleep Disorder AND Cognitive Disorder OR Orthostatic Intolerance.

AND is evaluated before OR in formal logic and most programming languages. Adding parenthesis to show how this is evaluated:
ME/CFS = (Fatigue AND Post Exertional Malaise AND Sleep Disorder AND Cognitive Disorder) OR Orthostatic Intolerance
Should be:
ME/CFS = Fatigue AND Post Exertional Malaise AND Sleep Disorder AND (Cognitive Disorder OR Orthostatic Intolerance)

 

[Ravn]

CFS was measured using standardized questionnaire on effect on mercury released by WHO-UNEP, and creatinine-corrected urinary mercury levels.

The WHO-UNEP questionnaire can be accessed here https://wedocs.unep.org/handle/20.500.11822/22513. It doesn't mention CFS at all but includes a fatigue questionnaire attributed to Wessely & Powell.

Not sure why the authors want turn mercury poisoning into CFS, would have thought the former diagnosis, mercury poisoning, would be more helpful to patients, as in less "contested". Unless the authors want to shift blame from mercury to patient psychology (though no conflicts of interest declared and the funders were Indonesian Ministry of Health and WHO)

This study found a prevalence of CFS of 17.9%. When compared with Wessely's study which found prevalence of 2.6%,(15) the prevalence of the results of this study was greater. This can be caused by other factors that have not been studied. Chronic fatigue can be caused by psychological factors. This study did not examine mental causes such as responsibility, worries and conflicts.

 

[Wonko]

Presumably it's more helpful to the mining/refining companies involved who wish to not give compensation, mercury poisoning, when mercury is used in the extraction/purification of gold, they would be liable, but CFS, nothing to do with them = no compensation payable.

Or something similar.

 

[NelliePledge]

Presumably it's more helpful to the mining/refining companies involved who wish to not give compensation, mercury poisoning, when mercury is used in the extraction/purification of gold, they would be liable, but CFS, nothing to do with them = no compensation payable.

Or something similar.

yes @Wonko was going to write the same post

 

[Hutan]

The 'artisanal and small-scale' gold mining in Indonesia is often done just by individuals or families using very basic equipment. This isn't corporate mining. These small-scale miners typically live in awful conditions; often this work is done illegally and out of desperation. The workers in this study sound to be typical of these artisanal miners:

These ASGM workers performed their mining activities without personal protective equipment and under inadequate ventilation. The level of exposure of the workers was also worsened by poor control from local officials since their activities took place illegally

I'm struggling to make sense of this paper or the motivations behind it. The authors seem to have muddled a lot of things e.g.

One of the effects of heavy metal exposure is the occurrence of CFS in workers. Association of mercury exposure with CFS was confirmed by Kern et al.11 In the study, the author explained that mercury exposure from dental amalgam (containing elemental mercury, and hence the mercury vapor) caused CFS. This is understandable because one of mercury’s target organ is the central nervous system. There are plenty of evidences that some form of fatigue can be caused or exacerbated by work. The working relationship and CFS can be questioned, but the elements in the workplace can worsen the symptoms of CFS.

The data does indeed suggest that there is no relationship between exposure to mercury (as measured by the concentration in the urine or reported involvement in the processes that use mercury) and the weird definition of CFS. There's a lot of 'fatigue' in these workers though. This is hardly surprising. These people are probably suffering from a lack of food, exhausting work, horrible living conditions that make sleep difficult and a heavy chronic and acute illness burden (e.g. malaria, dengue fever). However, even the measurement of the symptom of just fatigue is vague - fatigue that is 'worse' or 'much worse' than usual. I bet the workers interpreted that in various ways.

The results of the study showed that the clinical consequences of ASGM workers are not due to mercury vapor from ASGM activities. However, the risk of CFS is present and control measures are needed.

I guess maybe the motivation was to produce a paper that suggests that exposure to mercury doesn't cause problems, but that idea in a paper investigating the prevalence of CFS is clearly nonsense. It's as sensible as saying that putting your arm in fire isn't a problem because it doesn't cause the flu.

I'm really not sure what to make of this paper. It's definitely a missed opportunity to highlight the awful health conditions endured by these workers. With funding from WHO, this paper should have been much better.