During medical examination, a port crane operator has complains of dizziness, nausea, a feeling of pressure in his eardrums, tremor, asphyxia, and cough. He is working at a high altitude associated with nervous and emotional strain. Also, the workers are exposed to vibration (general and local), noise, infrasound, and a microclimate that heats them in summer and cools them in winter. What factor is the most likely cause of the worker’s complaints?