An evaluation of the impact of social and structural determinants of health on forgone care during the COVID-19 pandemic in Baltimore, Maryland.

Evidence suggests that reductions in healthcare utilization, including forgone care, during the COVID-19 pandemic may be contributing towards excess morbidity and mortality. The objective of this study was to describe individual and community-level correlates of forgone care during the COVID-19 pandemic. We conducted a cross-sectional, secondary data analysis of participants (n = 2,003) who reported needing healthcare in two population-representative surveys conducted in Baltimore, MD in 2021 and 2021-2022. Abstracted data included the experience of forgone care, socio-demographic data, comorbidities, financial strain, and community of residence. Participant's community of residence were linked with data acquired from the Baltimore Neighborhood Indicators Alliance relevant to healthcare access and utilization, including walkability and internet access, among others. The data were analyzed using weighted random effects logistic regression. Individual-level factors found to be associated with increased odds for forgone care included individuals age 35-49 (compared to 18-34), female sex, experiencing housing insecurity during the pandemic, and the presence of functional limitations and mental illness. Black/African American individuals were found to have reduced odds of forgone care, compared to any other race. No community-level factors were significant in the multilevel analyses. Moving forward, it will be critical that health systems identify ways to address any barriers to care that populations might be experiencing, such as the use of mobile health services or telemedicine platforms. Additionally, public health emergency preparedness planning efforts must account for the unique needs of communities during future crises, to ensure that their health needs can continue to be met. Finally, additional research is needed to better understand how healthcare access and utilization practices have changed during versus before the pandemic.

Interstitial Lung Disease and Progressive Pulmonary Fibrosis: a World Trade Center Cohort 20-Year Longitudinal Study.

PURPOSE: World Trade Center (WTC) exposure is associated with obstructive airway diseases and sarcoidosis. There is limited research regarding the incidence and progression of non-sarcoidosis interstitial lung diseases (ILD) after WTC-exposure. ILD encompasses parenchymal diseases which may lead to progressive pulmonary fibrosis (PPF). We used the Fire Department of the City of New York's (FDNY's) WTC Health Program cohort to estimate ILD incidence and progression. METHODS: This longitudinal study included 14,525 responders without ILD prior to 9/11/2001. ILD incidence and prevalence were estimated and standardized to the US 2014 population. Poisson regression modeled risk factors, including WTC-exposure and forced vital capacity (FVC), associated with ILD. Follow-up time ended at the earliest of incident diagnosis, end of study period/case ascertainment, transplant or death. RESULTS: ILD developed in 80/14,525 FDNY WTC responders. Age, smoking, and gastroesophageal reflux disease (GERD) prior to diagnosis were associated with incident ILD, though FVC was not. PPF developed in 40/80 ILD cases. Among the 80 cases, the average follow-up time after ILD diagnosis was 8.5 years with the majority of deaths occurring among those with PPF (PPF: n = 13; ILD without PPF: n = 6). CONCLUSIONS: The prevalence of post-9/11 ILD was more than two-fold greater than the general population. An exposure-response gradient could not be demonstrated. Half the ILD cases developed PPF, higher than previously reported. Age, smoking, and GERD were risk factors for ILD and PPF, while lung function was not. This may indicate that lung function measured after respirable exposures would not identify those at risk for ILD or PPF.

Habits, attitudes, and expectations of regular users of partial driving automation systems.

INTRODUCTION: Little is known about regular users' perceptions of partial (Level 2) automation or how those perceptions affect behind-the-wheel behavior. METHOD: A mixed mode (phone and online) survey explored the habits, expectations, and attitudes among regular users of General Motors Super Cruise (n = 200), Nissan/Infiniti ProPILOT Assist (n = 202), and Tesla Autopilot (n = 202). RESULTS: All three groups reported being more likely to engage in non-driving-related activities while using their systems than while driving unassisted. Super Cruise and Autopilot users especially were more likely to report engaging in activities that involved taking their hands off the wheel or their eyes off the road. Many Super Cruise and Autopilot users also said they could perform secondary (non-driving-related) tasks better and more often while using their systems, while fewer ProPILOT Assist users shared this opinion. Super Cruise users were most likely and ProPILOT Assist users least likely to think that secondary activities were safer to perform while using their systems. While some drivers said they found user safeguards (e.g., attention reminders, lockouts) annoying and tried to circumvent them, most people said they found them helpful and felt safer with them. Large percentages of users (53% Super Cruise, 42% Autopilot and 12% ProPILOT Assist) indicated they were comfortable treating their systems as self-driving. CONCLUSIONS: Some regular users have a poor understanding of their technology's limits. System design appears to contribute to user perceptions and behavior. However, owner populations also differ, which means habits, attitudes, and expectations may not generalize. Most people value user safeguards, but some implementations may not be effective for everyone. PRACTICAL APPLICATIONS: Multifaceted, proactive user-centric safeguards are needed to shape proper behavior and understanding about drivers' roles and responsibilities while using partial driving automation.

Consumer experiences with crash avoidance feature repairs.

INTRODUCTION: Popularity of crash avoidance features is growing, but so too is confusion around how to repair them, how much repairs should cost, and who should pay for those repairs. This study's purpose was to capture how these issues are affecting consumers. METHOD: A total of 496 vehicle owners in the United States were surveyed online and by phone about their experiences repairing front crash prevention (n = 359), blind spot detection (n = 317), and/or driver assistance cameras (n = 348) equipped on their personal vehicles. RESULTS: Owners tended to have multiple reasons for repairs. Repairs due to vehicle (i.e., crash or windshield) damage corresponded with the greatest likelihood of post-repair issues, especially if calibration was performed, and higher out-of-pocket costs (possibly because of deductibles or other repair work). About half of respondents who had calibrations performed on features repaired because of vehicle damage reported persisting issues with the features after repair. Post-repair issues were more common for repairs performed at independent repairers than dealership service centers, yet similar feature calibration rates were reported for both types of repairers. More people went to dealership service centers than independent repairers, and these respondents were more likely to say they would return to this type of facility for a similar repair in the future. Although most repairers explained why repairs occurred, less than half of respondents said they completely understood the reasons given. CONCLUSIONS: There are new complications in the repair cycle affecting consumers. Post-repair issues are more prevalent than previously assumed, regardless of the crash avoidance feature repaired. PRACTICAL APPLICATIONS: Post-repair issues risk undermining consumer acceptance and the safety potential of critical features. Simplifying the repair process and establishing affordable and accessible centralized databases with repair specifications and instructions from the manufacturers would be a start to addressing industry-wide challenges.

Self-reported Cardiovascular Disease in Career Firefighters With and Without World Trade Center Exposure.

OBJECTIVE: To assess the effect of World Trade Center (WTC) exposure on cardiovascular disease (CVD) in career firefighters. Methods: Firefighters from four US cities completed health questionnaires that provide information about demographics, CVD diagnoses, and CVD risk factors. Firefighters were also compared with respondents of the 2019 National Health Interview Survey. Results: Greater WTC exposure was positively associated with combined coronary artery disease, myocardial infarction, and angina (termed "CAD") when comparing WTC-exposed with non-WTC-exposed firefighters. Compared with the National Health Interview Survey population, firefighters had lower odds of CAD and stroke. Conclusions: An occupationally appropriate comparison is important to mitigate potential bias from the healthy worker effect. While the risk of CVD in WTC-exposed and non-WTC-exposed firefighters was significantly lower than a general US population, we observed an exposure gradient where greater WTC exposure was associated with greater odds of CVD.

Interleukin-22 suppresses major histocompatibility complex II in mucosal epithelial cells.

Major histocompatibility complex (MHC) II is dynamically expressed on mucosal epithelial cells and is induced in response to inflammation and parasitic infections, upon exposure to microbiota, and is increased in chronic inflammatory diseases. However, the regulation of epithelial cell-specific MHC II during homeostasis is yet to be explored. We discovered a novel role for IL-22 in suppressing epithelial cell MHC II partially via the regulation of endoplasmic reticulum (ER) stress, using animals lacking the interleukin-22-receptor (IL-22RA1), primary human and murine intestinal and respiratory organoids, and murine models of respiratory virus infection or with intestinal epithelial cell defects. IL-22 directly downregulated interferon-γ-induced MHC II on primary epithelial cells by modulating the expression of MHC II antigen A α (H2-Aα) and Class II transactivator (Ciita), a master regulator of MHC II gene expression. IL-22RA1-knockouts have significantly higher MHC II expression on mucosal epithelial cells. Thus, while IL-22-based therapeutics improve pathology in chronic disease, their use may increase susceptibility to viral infections.

Safety potential of crash avoidance features, improved headlights, and V2V-enhanced technologies for older drivers.

INTRODUCTION: Age-related changes and frailty are among the reasons that older drivers are overrepresented in certain crash types. Vehicle safety features that address these crash types may therefore deliver greater safety benefits for older drivers than for other age groups even though they are designed for the general population. METHODS: U.S. crash data from 2016-2019 were used to estimate the proportion of crash involvements and fatal and nonfatal driver injuries for older (70 years old and above) and middle-aged (35-54 years old) drivers from crash scenarios to which current crash avoidance features, improved headlights, and forthcoming vehicle-to-vehicle (V2V)-connected intersection-assistance features could be relevant. Risk ratios were then calculated to determine the relative benefits of each technology for older drivers compared with middle-aged drivers. RESULTS: Combined, these technologies were potentially relevant to 65 % of older driver and 72 % of middle-aged driver fatalities during the study period. Intersection assistance features showed the most promise for older drivers. Such features were potentially relevant to 32 % of older driver crash involvements, 38 % of older driver injuries, and 31 % of older driver fatalities. Intersection assistance features were significantly more likely to be relevant to older driver deaths than middle-aged driver fatalities (RR, 3.52; 95 % CI, 3.33-3.71). CONCLUSIONS: Vehicle technologies have the potential to substantially reduce or mitigate crashes and the injuries that they cause for everyone, but the potential safety impact of each technology varies by driver age because different age groups are over- or underrepresented in specific crash scenarios. PRACTICAL APPLICATIONS: With the older driver population growing, these findings underscore the need to bring intersection assistance technologies to the consumer market. At the same time, everyone stands to benefit from currently available crash avoidance features and improved headlights, so their use should be promoted among all drivers.

Consumer demand for partial driving automation and hands-free driving capability.

INTRODUCTION: It is often assumed that consumers want partial driving automation in their vehicles, yet there has been little research on the topic. Also unclear is what the public's appetite is for hands-free driving capability, automated (auto)-lane-change functionality, and driver monitoring that helps reinforce proper use of these features. METHOD: Through an internet-based survey of a nationally representative sample of 1,010 U.S. adult drivers, this study explored consumer demand for different aspects of partial driving automation. RESULTS: Eighty percent of drivers want to use lane centering, but more prefer versions with a hands-on-wheel requirement (36%) than hands-free (27%). More than half of drivers are comfortable with different driver monitoring strategies, but comfort level is related to perceptions of feeling safer with it given its role in helping drivers use the technology properly. People who prefer hands-free lane centering are the most accepting of other vehicle technologies, including driver monitoring, but some also indicate an intent to misuse these features. The public is somewhat more reluctant to accept auto lane change, with 73% saying they would use it, and more often prefer it to be driver-initiated (45%) than vehicle-initiated (14%). More than three quarters of drivers want auto lane change to have a hands-on-wheel requirement. CONCLUSION: Consumers are interested in partial driving automation, but there is resistance to more sophisticated functionality, especially vehicle-initiated auto lane change, in a vehicle that cannot technically drive itself. PRACTICAL APPLICATIONS: This study confirms the public's appetite for partial driving automation and possible intention for misuse. It is imperative that the technology be designed in ways that deter such misuse. The data suggest that consumer information, including marketing, has a role to play to communicate the purpose and safety value of driver monitoring and other user-centric design safeguards to promote their implementation, acceptance, and safe adoption.

Comparing self-reported obstructive airway disease in firefighters with and without World Trade Center exposure.

BACKGROUND: The degree to which routine, non-World Trade Center (WTC) firefighting exposures contribute to the WTC exposure-obstructive airway disease (OAD) relationship is unknown. Our objective was to compare the frequency of self-reported OAD diagnoses in WTC-exposed firefighters from the Fire Department of the City of New York (FDNY) compared with non-WTC-exposed firefighters from other cities and the general population. METHODS: A total of 9792 WTC-exposed male FDNY firefighters and 3138 non-WTC-exposed male firefighters from Chicago, Philadelphia, and San Francisco who were actively employed on 9/11/01 and completed a health questionnaire were included. Logistic regression estimated odds ratios of self-reported asthma and COPD diagnoses in firefighters (WTC-exposed vs. non-WTC-exposed; all firefighters vs. general population), adjusting for age, race, smoking status, and last medical visit. RESULTS: WTC-exposed firefighters were, on average, younger on 9/11 (mean ± SD = 40.2 ± 7.4 vs. 44.1 ± 9.1) and less likely to report ever-smoking (32.9% vs. 41.8%) than non-WTC-exposed firefighters. Odds of any OAD and asthma were 4.5 and 6.3 times greater, respectively, in WTC-exposed versus non-WTC-exposed. Odds of COPD were also greater in WTC-exposed versus non-WTC-exposed, particularly among never-smokers. Compared with the general population, WTC-exposed firefighters had greater odds of both asthma and COPD, while the nonexposed had lower odds of asthma and greater odds of COPD. CONCLUSIONS: Odds ratios for OAD diagnoses were greater in WTC-exposed firefighters versus both non-WTC-exposed and the general population after adjusting for covariates. While asthma and other OADs are known occupational hazards of firefighting, WTC exposure significantly compounded these adverse respiratory effects.

Myeloma precursor disease (MGUS) among rescue and recovery workers exposed to the World Trade Center disaster.

An elevated risk of myeloma precursor disease, monoclonal gammopathy of undetermined significance (MGUS), was identified among Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed firefighters. Further investigation was needed to determine if these findings were reproducible in a more heterogeneous WTC-exposed rescue/recovery workers cohort, the Stony Brook University-General Responder Cohort GRC (SBU-GRC). MGUS risk was compared between the cohorts and to published general population estimates from Olmsted County, MN, USA. In this observational seroprevalence study, odds ratios (OR) and age-standardized risk ratios (RR) of MGUS (M-spike and light-chain-MGUS combined), M-spike, and light-chain-MGUS were estimated using logistic regression. Age-standardized prevalences were calculated for white males aged 50-79; RRs were estimated by comparing risk in the WTC-exposed cohort with the Olmsted County screened cohort. SBU-GRC had elevated odds of MGUS compared with FDNY (OR = 1.38; 95%CI = 1.00-1.89). The age-standardized prevalence of MGUS was 9.0/100 persons (95%CI = 7.5-10.6), over two-fold higher than the general population (RR = 2.08; 95%CI = 1.72-2.51); the age-standardized prevalence of light-chain-MGUS was 3.5-fold higher (RR = 3.54; 95%CI = 2.52-4.97). This study adds to mounting evidence supporting an association between WTC/environmental exposures and MGUS among rescue/recovery workers. Access to MGUS screenings for the entire WTC-exposed cohort could allow for treatment interventions that improve survival.

Relationship between low serum immunoglobulin E levels and malignancies in 9/11 World Trade Center responders.

BACKGROUND: Individuals with very low immunoglobulin E (IgE) levels have a high risk of developing malignancy. Previous studies have revealed that World Trade Center (WTC) responders exposed to carcinogens have an elevated risk of some cancers. OBJECTIVE: To evaluate the association between low-serum IgE levels and cancer development in WTC-exposed responders. METHODS: IgE levels were measured in 1851 WTC responders after September 11, 2001. This is the first pilot study in humans comparing the odds of developing cancer in this high-risk population, between the "low-IgE" (IgE in the lowest third percentile) vs "non-low-IgE" participants. RESULTS: A significantly higher proportion of hematologic malignancies was found in low-IgE (4/55, 7.3%) compared with non-low-IgE (26/1796, 1.5%, P < .01) responders. The proportion of solid tumors were similar in both groups (5.5% vs 11.4%, P > .05). After adjustment for relevant confounders (race, sex, age at blood draw, WTC arrival time, smoking status), the low-IgE participants had 7.81 times greater odds (95% confidence interval, 1.77-29.35) of developing hematologic cancer when compared with non-low-IgE participants. The hematologic cancers found in this cohort were leukemia (n = 1), multiple myeloma (n = 1), and lymphoma (n = 2). No statistical significance was found when estimating the odds ratio for solid tumors in relation to IgE levels. CONCLUSION: WTC responders with low serum IgE levels had the highest odds of developing hematologic malignancies. This hypothesis-generating study suggests that low serum IgE levels might be associated with the development of specific malignancies in at-risk individuals exposed to carcinogens. Larger, multicenter studies with adequate follow-up of individuals with different IgE levels are needed to better evaluate this relationship.

The Unmeasured Burden of Febrile, Respiratory, and Diarrheal Illnesses Identified Through Active Household Surveillance in a Low Malaria Transmission Setting in Southern Zambia.

Malaria incidence has declined in southern Zambia over recent decades, leading to efforts to achieve and sustain malaria elimination. Understanding the remaining disease burden is key to providing optimal health care. A longitudinal study conducted in a rural area of Choma District, Southern Province, Zambia, assessed the prevalence of and factors associated with symptoms of non-malarial illnesses and treatment-seeking behavior. We analyzed data collected monthly between October 2018 through September 2020 from 1,174 individuals from 189 households. No incident malaria cases were detected by rapid diagnostic tests among febrile participants. Mixed-effects logistic regression identified factors associated with cough, fever, diarrhea, and treatment-seeking. Incidence rates of cough (192 of 1,000 person-months), fever (87 of 1,000 person-months), and fever with cough (37 of 1,000 person-months) were highest among adults older than 65 years. Diarrhea incidence (37 of 1,000 person-months) was highest among children younger than 5 years. For every additional symptomatic household member, one's odds of experiencing symptoms increased: cough by 47% (95% CI, 40-55), fever by 31% (95% CI, 23-40), diarrhea by 31% (95% CI, 17-46), and fever with cough by 112% (95% CI, 90-137), consistent with household clustering of illnesses. However, between 35% and 75% of participants did not seek treatment for their symptoms. Treatment-seeking was most common for children 5 to 9 years old experiencing diarrhea (adjusted odds ratio, 3.61; 95% CI, 1.42-9.18). As malaria prevalence reduces, respiratory and diarrheal infections persist, particularly among young children but, notably, also among adults older than 65 years. Increasing awareness of the disease burden and treatment-seeking behavior are important for guiding resource re-allocation as malaria prevalence declines in this region.

Teen driver crashes potentially preventable by crash avoidance features and teen-driver-specific safety technologies.

INTRODUCTION: Vehicle technologies have the potential to help address the disproportionate crash risk that teen drivers face. While crash avoidance features benefit the general population, several address crash scenarios for which teen drivers are particularly at risk, such as rear-end and lane-drift crashes. Other emerging technologies have been designed for teen drivers by addressing certain crash or injury risk factors associated with risky driving behavior, such as speeding or not wearing a seat belt. METHODS: Using nationwide U.S. crash data from 2016 to 2019, this study examined the maximum potential safety benefits of three currently available crash avoidance features (front crash prevention, lane departure prevention, and blind spot monitoring) and three teen-driver-specific technologies (speeding prevention, extended seatbelt reminders and interlocks, and nighttime curfew violation alerts). RESULTS: Teen-driver-specific features have the largest potential for reducing teen driver injuries and fatalities, followed by lane departure prevention, front crash prevention, and blind spot monitoring; however, altogether these technologies have the potential to prevent 78% of teen driver fatalities, 47% of injured teen drivers, and 41% of crashes involving teen drivers. CONCLUSIONS: Crash avoidance features and teen-driver-specific vehicle technologies appear to address different risk factors and crash scenarios, which emphasizes the importance of utilizing both types of safety features to reduce the crash risk of teen drivers. PRACTICAL APPLICATIONS: Wider acceptance, accessibility, and use of these technologies are needed for their safety potential to be realized. More manufacturers should offer and advertise teen-driver-specific technology suites that integrate crash avoidance systems and safety features that address risky driving behavior. While this study shows the maximum potential safety benefits of these technologies, further research is needed to understand the behavioral implications as teens learn to drive with these features.

Characterization of the deterioration of diabetes control in patients with a subsequent diagnosis of pancreatic cancer: A descriptive study.

BACKGROUND: Deterioration of diabetes control can be the first harbinger of pancreatic cancer. However, little is known about how to distinguish patients with pancreatic cancer-related diabetes deterioration from those with type 2 diabetes progression. We aimed to characterize the glycated hemoglobin (HbA1c) and body weight profile of pancreatic cancer patients with deteriorating diabetes before the cancer diagnosis. METHODS: Using data from the UK-based Clinical Practice Research Datalink (CPRD) GOLD, we established a study population including pancreatic cancer patients with diabetes deterioration in the >0.5-3 years before the cancer diagnosis and non-cancer patients with deterioration of type 2 diabetes (comparison group). Patients were considered to have diabetes deterioration if their glucose-lowering treatment was intensified. We characterized the longitudinal trajectories of HbA1c and body weight in pancreatic cancer patients compared with non-cancer patients before and after treatment intensification. RESULTS: The mean absolute increase in HbA1c from the pre-deterioration period, i.e. the time >1-2 years before treatment intensification, to the time of treatment intensification, was 1.5% ± 1.6% in pancreatic cancer patients vs. 0.9% ± 1.4% in non-cancer patients. After treatment intensification, mean HbA1c remained elevated in pancreatic cancer patients, while it returned to the pre-deterioration level in non-cancer patients. Body weight decreased by 1.9% ± 6.4% in cancer patients and increased by 0.3% ± 5.2% in non-cancer patients between the pre-deterioration period and treatment intensification, on average. CONCLUSIONS: Pancreatic cancer-related diabetes deterioration may frequently be characterized by pronounced increases in HbA1c, persistent elevation of HbA1c after treatment intensification, and concomitant weight loss.

Learning to drive: Parental attitudes toward introducing teen drivers to advanced driver assistance systems.

OBJECTIVE: Advanced driver assistance systems (ADAS) have the potential to help mitigate the crash risk faced by new teen drivers. There has been little research on how these drivers use ADAS, as most only have access to these systems in their parents' vehicles when learning to drive because teens tend to drive older, less expensive vehicles when driving independently. This study examined how parental attitudes toward ADAS influence how and when parents introduce their teens to these systems when teaching them to drive. METHODS: Three web-based focus groups were conducted with parents who owned ADAS-equipped vehicles and who either had a teen with either a learner permit or a teen who recently began driving independently. The moderator-led discussion examined participant attitudes about teen driving risk, the perceived benefits or risks associated with teen use of ADAS, and parents' teaching strategies for ADAS. Researchers generated a list of likely themes from a review of existing literature and then coded participant responses according to those themes. RESULTS: Parents who chose to introduce ADAS to their new teen drivers did so while also reporting conflicting opinions about the reliability of vehicle technologies and the impact of such systems on driving safety and skill acquisition. Many parents reported some distrust of ADAS and concerns that some features could hinder the development of good driving habits, although most participants stated that ADAS have had a positive impact on their teen drivers' safety. Opinions were split about the best point at which to introduce ADAS to teens, with half preferring introduction at the outset and half preferring to wait until the teen had mastered basic driving skills. Attitudes varied according to individual vehicle systems, with a preference for blind spot monitoring and a general dislike of lane-keeping assistance. CONCLUSIONS: Specific concerns about the potential impact of ADAS on teen driving safety and skill acquisition do not prevent parents from using such systems, although the teaching strategies parents use vary according to their preferences for individual systems.

IL-20 Activates ERK1/2 and Suppresses Splicing of X-Box Protein-1 in Intestinal Epithelial Cells but Does Not Improve Pathology in Acute or Chronic Models of Colitis.

The cytokine Interleukin (IL)-20 belongs to the IL-10 superfamily. IL-20 levels are reported to increase in the intestines of Ulcerative Colitis (UC) patients, however not much is known about its effects on intestinal epithelial cells. Here, we investigated the influence of IL-20 on intestinal epithelial cell lines and primary intestinal organoid cultures. By using chemical-induced (dextran sodium sulphate; DSS) colitis and a spontaneous model of colitis (Winnie mice), we assess whether recombinant IL-20 treatment is beneficial in reducing/improving pathology. Following stimulation with IL-20, intestinal primary organoids from wild-type and Winnie mice increased the expression of ERK1/2. However, this was lost when cells were differentiated into secretory goblet cells. Importantly, IL-20 treatment significantly reduced endoplasmic reticulum (ER) stress, as measured by spliced-XBP1 in epithelial cells, and this effect was lost in the goblet cells. IL-20 treatment in vivo in the DSS and Winnie models had minimal effects on pathology, but a decrease in macrophage activation was noted. Taken together, these data suggest a possible, but subtle role of IL-20 on epithelial cells in vivo. The therapeutic potential of IL-20 could be harnessed by the development of a targeted therapy or combination therapy to improve the healing of the mucosal barrier.

PTSD symptoms, depressive symptoms, and subjective cognitive concerns in WTC-exposed and non-WTC-exposed firefighters.

BACKGROUND: Firefighting has been associated with posttraumatic stress disorder (PTSD) and other mental health conditions. We previously found that among Fire Department of the City of New York (FDNY) responders to the World Trade Center (WTC) disaster, higher-intensity WTC-exposure predicted PTSD symptoms, depressive symptoms, and subjective cognitive concerns. The present study aims to compare these symptoms in the FDNY WTC-exposed cohort versus a comparison cohort of non-FDNY, non-WTC-exposed firefighters. METHODS: The study population included WTC-exposed male firefighters from FDNY (N = 8466) and non-WTC-exposed male firefighters from Chicago (N = 1195), Philadelphia (N = 770), and San Francisco (N = 650) fire departments who were employed on 9/11/2001 and completed a health questionnaire between 3/1/2018 and 12/31/2020. Current PTSD symptoms, depressive symptoms, and subjective cognitive concerns were assessed via validated screening instruments. Multivariable linear regression analyses stratified by fire department estimated the impact of covariates on each outcome. RESULTS: Adjusted mean PTSD symptom scores ranged from 23.5 ± 0.6 in Chicago firefighters to 25.8 ± 0.2 in FDNY, and adjusted mean depressive symptom scores ranged from 7.3 ± 0.5 in Chicago to 9.4 ± 0.6 in Philadelphia. WTC-exposure was associated with fewer subjective cognitive concerns (ß = -0.69 ± 0.05, p < .001) after controlling for covariates. Across cohorts, older age was associated with more cognitive concerns, but fewer PTSD and depressive symptoms. CONCLUSIONS: WTC-exposed firefighters had fewer cognitive concerns compared with non-WTC-exposed firefighters. We were unable to estimate associations between WTC exposure and PTSD symptoms or depressive symptoms due to variability between non-WTC-exposed cohorts. Longitudinal follow-up is needed to assess PTSD, depressive, and cognitive symptom trajectories in firefighter populations as they age.