Invasive coronary procedure use and outcomes among veterans with posttraumatic stress disorder: insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.

BACKGROUND: Posttraumatic stress disorder (PTSD) is prevalent in the general population and US veterans in particular and is associated with an increased risk of developing coronary artery disease (CAD). We compared the patient characteristics and postprocedural outcomes of veterans with and without PTSD undergoing coronary angiography. METHODS: This is a multicenter observational study of patients who underwent coronary angiography in Veterans Affairs hospitals nationally from October 2007 to September 2011. We described patient characteristics at angiography, angiographic results, and after coronary angiography, we compared risk-adjusted 1-year rates of all-cause mortality, myocardial infarction (MI), and revascularization by the presence or absence of PTSD. RESULTS: Overall, of 116,488 patients undergoing angiography, 14,918 (12.8%) had PTSD. Compared with those without PTSD, patients with PTSD were younger (median age 61.9 vs 63.7; P < .001), had higher rates of cardiovascular risk factors, and were more likely to have had a prior MI (26.4% vs 24.7%; P < .001). Patients with PTSD were more likely to present for stable angina (22.4% vs 17.0%) or atypical chest pain (58.5% vs 48.6%) and less likely to have obstructive CAD identified at angiography (55.9% vs 62.2%; P < .001). After coronary angiography, PTSD was associated with lower unadjusted 1-year rates of MI (hazard ratio (HR), 0.86; 95% CI [0.75-1.00]; P = 0.04), revascularization (HR, 0.88; 95% CI [0.83-0.93]; P < .001), and all-cause mortality (HR, 0.66; 95% CI [0.60-0.71]; P < .001). After adjustment for cardiovascular risk, PTSD was no longer associated with 1-year rates of MI or revascularization but remained associated with lower 1-year all-cause mortality (HR, 0.91; 95% CI [0.84-0.99]; P = .03). Findings were similar after further adjustment for depression, anxiety, alcohol or substance use disorders, and frequency of outpatient follow-up. CONCLUSIONS: Among veterans undergoing coronary angiography in the Veterans Affairs, those with PTSD were more likely to present with elective indications and less likely to have obstructive CAD. After coronary angiography, PTSD was not associated with adverse 1-year outcomes of MI, revascularization, or all-cause mortality.

Submicron particle monitoring of paving and related road construction operations.

This study identified activities and sources that contribute to ultrafine and other submicron particle exposure that could trigger respiratory symptoms in highway repair workers. Submicron particle monitoring was conducted for paving, milling, and pothole repair operations in a major metropolitan area where several highway repair workers were identified as symptomatic for respiratory illness following exposures at the 2001 World Trade Center disaster site. Exposure assessments were conducted for eight trades involved in road construction using a TSI P-Trak portable condensation particle counter. Direct readings near the workers' breathing zones and observations of activities and potential sources were logged on 7 days on 27 workers using four different models of pavers and two types of millers. Average worker exposure levels ranged from 2 to 3 times background during paving and from 1 to 4 times background during milling. During asphalt paving, average personal exposures to submicron particulates were 25,000-60,000, 28,000-70,000, and 23,000-37,000 particles/ cm(3) for paver operators, screed operators, and rakers, respectively. Average personal exposures during milling were 19,000-111,000, 28,000-81,000, and 19,000 particles/cm(3) for the large miller operators, miller screed operators, and raker, respectively. Personal peak exposures were measured up to 467,000 and 455,000 particles/cm(3) in paving and milling, respectively. Several sources of submicron particles were identified. These included the diesel and electric fired screed heaters; engine exhaust from diesel powered construction vehicles passing by or idling; raking, dumping, and paving of asphalt; exhaust from the hotbox heater; pavement dust or fumes from milling operations, especially when the large miller started and stopped; and secondhand cigarette smoke. To reduce the potential for health effects in workers, over 40 recommendations were made to control exposures, including improved maintenance of paver ventilation systems; diesel fume engineering controls; reduced idling; provision of cabs for the operators; and improved dust suppression systems on the milling machine.

An innovative approach to interdisciplinary occupational safety and health education.

BACKGROUND: The New York and New Jersey Education and Research Center (ERC) provides a range of graduate continuing education for occupational safety and health (OSH) professionals in training. A key element of the education is to provide interdisciplinary training to industrial hygienists, ergonomists, occupational medicine physicians and other health and safety trainees to prepare them for the collaboration required to solve the complex occupational health and safety problems they will face in their careers. METHODS: This center has developed an innovative interdisciplinary training approach that provides an historical aspect, while allowing the graduate students to identify solutions to occupational issues from a multi-disciplinary approach. The ERC developed a tour that brings students to sites of historical and/or contemporary significance in the occupational safety and health and environmental fields. RESULTS: The ERC has conducted five tours, and has included 85 students and residents as participants. 80% of participants rated the tour as providing a high amount of OSH knowledge gained. 98% of the participants felt the goal of providing interdisciplinary education was achieved. CONCLUSIONS: This tour has been successful in bridging the OSH fields to better understand how occupational and environmental exposures have occurred, in order to prevent future exposures so that workplace conditions and health can be improved.