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1.
Work ; 63(2): 199-204, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156201

RESUMO

BACKGROUND: Emotional Freedom Techniques (EFT) and Eye Movement Desensitization and Reprocessing (EMDR) have been empirically validated as effective psychotherapeutic interventions for treating Post Traumatic Stress Disorder (PTSD). This single subject design case study is of a survivor of the Twin Towers collapse who was treated for prolonged PTSD complicated by dissociated memories. OBJECTIVE: EMDR and EFT's effectiveness in treating PTSD were evaluated. METHOD: Multiple assessments using Trauma Symptom Inventory (TSI) and Personality combination with EMDR were conducted. RESULTS: Effects of a single session of EFT assessed immediately after treatment demonstrated an elimination of clinically significant scores on both the TSI and PAI. The participant concluded treatment with nearly complete symptom remediation and a return to work. CONCLUSION: The combination of treatment methods appears to be highly effective and allowed this subject to return to work after many years of disability.


Assuntos
Dessensibilização e Reprocessamento através dos Movimentos Oculares/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Estudos de Casos e Controles , Emoções , Dessensibilização e Reprocessamento através dos Movimentos Oculares/instrumentação , Humanos , Estudos Longitudinais , Masculino , Psicometria/instrumentação , Psicometria/métodos , Ataques Terroristas de 11 de Setembro/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/psicologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-31067756

RESUMO

Thyroid cancer incidence is higher in World Trade Center (WTC) responders compared with the general population. It is unclear whether this excess in thyroid cancer is associated with WTC-related exposures or if instead there is an over-diagnosis of malignant thyroid cancer among WTC first responders due to enhanced surveillance and physician bias. To maximize diagnostic yield and determine the false positive rate for malignancy, the histological diagnoses of thyroid cancer tumors from WTC responders and age, gender, and histology matched non-WTC thyroid cancer cases were evaluated using biomarkers of malignancy. Using a highly accurate panel of four biomarkers that are able to distinguish benign from malignant thyroid cancer, our results suggest that over-diagnosis by virtue of misdiagnosis of a benign tumor as malignant does not explain the increased incidence of thyroid cancer observed in WTC responders. Therefore, rather than over-diagnosis due to physician bias, the yearly screening visits by the World Trade Center Health Program are identifying true cases of thyroid cancer. Continuing regular screening of this cohort is thus warranted.


Assuntos
Socorristas/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro , Neoplasias da Glândula Tireoide , Adulto , Biomarcadores/metabolismo , Estudos de Coortes , Erros de Diagnóstico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Preconceito , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/metabolismo
3.
Artigo em Inglês | MEDLINE | ID: mdl-31052246

RESUMO

The World Trade Center Health Program (WTCHP) provides mental health services through diverse service delivery mechanisms, however there are no current benchmarks to evaluate utilization or quality. This quality improvement (QI) initiative sought to examine the delivery and effectiveness of WTCHP mental health services for World Trade Center (WTC) responders who receive care through the Northwell Health Clinical Center of Excellence (CCE), and to characterize the delivery of evidence-based treatments (EBT) for mental health (MH) difficulties in this population. Methods include an analysis of QI data from the Northwell CCE, and annual WTCHP monitoring data for all responders certified for mental health treatment. Nearly 48.9% of enrolled responders with a WTC-certified diagnosis utilized treatment. The majority of treatment delivered was focused on WTC-related conditions. There was significant disagreement between provider-reported EBT use and independently-evaluated delivery of EBT (95.6% vs. 54.8%, p ≤ 0.001). EBT delivery was associated with a small decrease in Posttraumatic Stress Disorder (PTSD) symptoms over time. Providers engaged in the process of data collection, but there were challenges with adherence to outcome monitoring and goal setting. Data from this report can inform continued QI efforts in the WTCHP, as well as the implementation and evaluation of EBT.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Socorristas/psicologia , Serviços de Saúde Mental/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Idoso , Socorristas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-31035527

RESUMO

Airway hyperreactivity (AHR) related to environmental exposure is a significant public health risk worldwide. Similarly, metabolic syndrome (MetSyn), a risk factor for obstructive airway disease (OAD) and systemic inflammation, is a significant contributor to global adverse health. This prospective cohort study followed N = 7486 World Trade Center (WTC)-exposed male firefighters from 11 September 2001 (9/11) until 1 August 2017 and investigated N = 539 with newly developed AHR for clinical biomarkers of MetSyn and compared them to the non-AHR group. Male firefighters with normal lung function and no AHR pre-9/11 who had blood drawn from 9 September 2001-24 July 2002 were assessed. World Trade Center-Airway Hyperreactivity (WTC-AHR) was defined as either a positive bronchodilator response (BDR) or methacholine challenge test (MCT). The electronic medical record (EMR) was queried for their MetSyn characteristics (lipid profile, body mass index (BMI), glucose), and routine clinical biomarkers (such as complete blood counts). We modeled the association of MetSyn characteristics at the first post-9/11 exam with AHR. Those with AHR were significantly more likely to be older, have higher BMIs, have high intensity exposure, and have MetSyn. Smoking history was not associated with WTC-AHR. Those present on the morning of 9/11 had 224% increased risk of developing AHR, and those who arrived in the afternoon of 9/11 had a 75.9% increased risk. Having ≥3 MetSyn parameters increased the risk of WTC-AHR by 65.4%. Co-existing MetSyn and high WTC exposure are predictive of future AHR and suggest that systemic inflammation may be a contributor.


Assuntos
Hiper-Reatividade Brônquica , Síndrome Metabólica/fisiopatologia , Ataques Terroristas de 11 de Setembro , Adulto , Biomarcadores , Bombeiros , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Estudos Prospectivos
5.
Qual Life Res ; 28(10): 2787-2797, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31073819

RESUMO

PURPOSE: This study compares life satisfaction and limited activity days among 9/11 survivors with and without physical injuries using quantitative and qualitative approaches. METHODS: The study population included World Trade Center Health Registry enrollees who reported being injured on 9/11 in 2003-2004 and a sample of non-injured enrollees who participated in a cross-sectional substudy. We used multivariable logistic regression to examine differences in life satisfaction and number of limited activity days in the last 30 days between those with and without injuries. The free-response section of the survey was analyzed qualitatively to compare themes of those with and without injuries. RESULTS: The final sample consisted of 2821 adult enrollees. Compared to those who were not injured, those who were injured on 9/11 were more likely to report being unsatisfied with their life (adjusted odds ratio (AOR): 1.5, 95% confidence intervals (CI) 1.1-2.0) and have 14 or more limited activity days in the last 30 days (AOR: 1.4, 95% CI 1.0-1.9). Among those who were injured, being partially or completely prevented from working increased the odds of being unsatisfied with life and having 14 or more limited activity days. In qualitative analysis, the emotional trauma experienced from 9/11 was a major and common theme, regardless of injury status. Those with injuries were more likely to express anger/lack of recognition/appreciation, describe substance use/abuse, and have financial/health care access issues. CONCLUSIONS: More than 15 years after 9/11, those who were injured continue to be impacted, reporting lower life satisfaction and more functional impairment.


Assuntos
Satisfação Pessoal , Qualidade de Vida/psicologia , Ataques Terroristas de 11 de Setembro/psicologia , Sobreviventes/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
6.
Artigo em Inglês | MEDLINE | ID: mdl-30934818

RESUMO

Background: This study sought to examine whether handgrip strength (HGS), a measure of muscle strength and a biomarker of aging, was associated with post-traumatic stress disorder (PTSD) in a cohort of World Trade Center (WTC) responders at midlife. Methods: HGS was assessed utilizing a computer-assisted hand dynamometer administered to a consecutive sample of men and women (n = 2016) who participated in rescue and recovery efforts following the World Trade Center (WTC) attacks and subsequently attended monitoring appointments in Long Island, NY. PTSD symptom severity and depressive symptoms were assessed using the PTSD specific-trauma checklist (PCL-S) and the Patient Health Questionnaire (PHQ-9). General linear models were used to examine the association of WTC-related PTSD with HGS after adjusting for confounders. Results: The sample was at midlife (mean age = 53.3) when assessed, and 91.3% were men. Nearly 10% of the sample had probable PTSD (PCL ≥ 44) with concomitant depression (PHQ ≥ 10), while 5.1% had probable PTSD without depression. Average HGS was 57.4 lbs. (95% confidence interval (95% CI): 56.6⁻58.1) among men and 36.1 lbs. (95% CI = 33.8⁻38.5) among women. Mean HGS of those with probable PTSD with concomitant depression was lower (45.9 lbs., 95% CI = 43.6⁻48.2) than responders with only PTSD (49.1 lbs., 95% CI = 46.0⁻52.4) and those without PTSD or depression (57.5 lbs., 95% CI = 56.2⁻57.8). Subdomain analyses of PTSD symptoms revealed that re-experiencing symptoms at enrollment (p = 0.003) was associated with lower HGS after adjusting for depressive symptoms and other confounders. Discussion: Results suggested that higher WTC-related PTSD symptom severity was associated with lower HGS. Results support ongoing work suggesting that PTSD may be associated with more rapid physical aging. The potential for developing interventions that might simultaneously improve physical and mental health in the aftermath of trauma may be considered.


Assuntos
Socorristas , Força da Mão/fisiologia , Ataques Terroristas de 11 de Setembro , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Estudos de Coortes , Depressão/fisiopatologia , Depressão/psicologia , Socorristas/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ataques Terroristas de 11 de Setembro/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-30959865

RESUMO

Background: World Trade Center (WTC) dust-exposed subjects have multiple comorbidities that affect sleep. These include obstructive sleep apnea (OSA), chronic rhinosinusitis (CRS), gastroesophageal-reflux disorder (GERD) and post-traumatic stress disorder (PTSD). We examined the impact of these conditions to sleep-related outcomes. Methods: Demographics, co-morbidities and symptoms were obtained from 626 WTC (109F/517M), 33⁻87years, BMI = 29.96 ± 5.53 kg/m²) subjects. OSA diagnosis was from a 2-night home sleep test (ARESTM). Subjective sleep quality, sleep-related quality of life (QOL, Functional Outcomes of Sleep Questionnaire), excessive daytime sleepiness (Epworth Sleepiness Scale), sleep duration and sleep onset and maintenance complaints were assessed. Results: Poor sleep quality and complaints were reported by 19⁻70% of subjects and average sleep duration was 6.4 h. 74.8% of subjects had OSA. OSA diagnosis/severity was not associated with any sleep-related outcomes. Sleep duration was lower in subjects with all conditions (p < 0.05) except OSA. CRS was a significant risk factor for poor sleep-related QOL, sleepiness, sleep quality and insomnia; PTSD for poor sleep-related QOL and insomnia; GERD for poor sleep quality. These associations remained significant after adjustment for, age, BMI, gender, sleep duration and other comorbidities. Conclusions: Sleep complaints are common and related to several health conditions seen in WTC responders. Initial interventions in symptomatic patients with both OSA and comorbid conditions may need to be directed at sleep duration, insomnia or the comorbid condition itself, in combination with intervention for OSA.


Assuntos
Refluxo Gastroesofágico/epidemiologia , Qualidade de Vida , Rinite/epidemiologia , Ataques Terroristas de 11 de Setembro , Sinusite/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Doença Crônica , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Fatores de Risco , Inquéritos e Questionários
8.
Artigo em Inglês | MEDLINE | ID: mdl-30986914

RESUMO

The health consequences of the 9/11 World Trade Center (WTC) terrorist attacks are well documented, but few studies have assessed the disaster's impact on employment among individuals exposed to the disaster. We examined the association between 9/11-related health conditions and early retirement among residents and workers who resided and/or worked near the WTC site on 9/11, and the association between such conditions and post-retirement income loss. The study included 6377 residents and/or area workers who completed the WTC Health Registry longitudinal health surveys in 2003-2004 and 2006-2007, and the 2017-2018 Health and Employment Survey. Logistic regression models were used to examine the associations. We found that 9/11-related health conditions were significantly associated with the likelihood of early retirement. Residents and/or area workers with more physical health conditions, especially when comorbid with posttraumatic stress disorder (PTSD), were more likely to retire before age 60 than those with no conditions. For retirees, having PTSD or PTSD comorbid with any number of physical conditions increased the odds of reporting substantial post-retirement income loss. Disaster-related outcomes can negatively impact aging individuals in the form of early retirement and income loss. Long-term effects of major disasters must continue to be studied.


Assuntos
Desastres , Renda , Aposentadoria , Ataques Terroristas de 11 de Setembro , Sobreviventes , Adulto , Idoso , Comorbidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Sistema de Registros , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Inquéritos e Questionários
9.
Artigo em Inglês | MEDLINE | ID: mdl-30970543

RESUMO

An increased incidence of thyroid cancer among 9/11 rescue workers has been reported, the etiology of which remains unclear but which may, at least partly, be the result of the increased medical surveillance this group undergoes. This study aimed to investigate thyroid cancer in World Trade Center (WTC) responders by looking at the demographic data and questionnaire responses of thyroid cancer cases from the Mount Sinai WTC Health Program (WTCHP). WTCHP thyroid cancer tumors were of a similar size (p = 0.4), and were diagnosed at a similar age (p = 0.2) compared to a subset of thyroid cancer cases treated at Mount Sinai without WTC exposure. These results do not support the surveillance bias hypothesis, under which smaller tumors are expected to be diagnosed at earlier ages. WTCHP thyroid cancer cases also reported a past history of radiation exposure and a family history of thyroid conditions at lower rates than expected, with higher than expected rates of previous cancer diagnoses, family histories of other cancers, and high Body Mass Indexes (BMIs). Further research is needed to better understand the underlying risk factors that may play a role in the development of thyroid cancer in this group.


Assuntos
Socorristas/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Trabalho de Resgate/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro/estatística & dados numéricos , Neoplasias da Glândula Tireoide/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Vigilância da População
10.
Artigo em Inglês | MEDLINE | ID: mdl-30979006

RESUMO

This study investigated the prevalence of unmet mental health care needs (UMHCN) and their associated factors among 2344 Asian Americans directly exposed to the World Trade Center (WTC) attack 10-11 years afterwards. Given the pervasive underutilization of mental health services among Asians, their subjective evaluation of unmet needs could provide more nuanced information on disparities of service. We used the WTC Health Registry data and found that 12% of Asian Americans indicated UMHCN: 69% attributing it to attitudinal barriers, 36% to cost barriers, and 29% to access barriers. Among all the factors significantly related to UMHCN in the logistic model, disruption of health insurance in the past year had the largest odds ratio (OR = 2.37, 95% confidence interval: 1.61-3.48), though similar to functional impairment due to mental disorders. Post-9/11 mental health diagnosis, probable mental disorder and ≥14 poor mental health days in the past month were also associated with greater odds of UMHCN, while greater social support was associated with lower odds. Results suggest that continued outreach efforts to provide mental health education to Asian communities to increase knowledge about mental illness and treatment options, reduce stigmatization of mental illness, and offer free mental health services are crucial to address UMHCN.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prevalência , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-31013580

RESUMO

We examined whether time to onset of paresthesia was associated with indicators of severity of World Trade Center (WTC) exposure. We analyzed data from 3411 patients from the Bellevue Hospital-WTC Environmental Health Center. Paresthesia was defined as present if the symptom occurred in the lower extremities with frequency "often" or "almost continuous." We plotted hazard functions and used the log-rank test to compare time to onset of paresthesia between different exposure groups. We also used Cox regression analysis to examine risk factors for time-to-paresthesia after 9/11/2001 and calculate hazard ratios adjusted for potential confounders. We found significantly elevated hazard ratios for paresthesia for (a) working in a job that required cleaning of WTC dust in the workplace; and (b) being heavily exposed to WTC dust on September 11, 2001, after adjusting for age, race/ethnicity, depression, anxiety, post-traumatic stress disorder, and body mass index. These observational data are consistent with the hypothesis that exposure to WTC dust or some other aspect of cleaning WTC dust in the workplace, is associated with neuropathy and paresthesia. Further neurological evaluations of this and other WTC-exposed populations is warranted.


Assuntos
Poeira , Parestesia/epidemiologia , Ataques Terroristas de 11 de Setembro , Adulto , Idoso , Desastres , Exposição Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
12.
Artigo em Inglês | MEDLINE | ID: mdl-31003460

RESUMO

The World Trade Center Health Registry includes 9/11 survivors who have been surveyed about their health conditions over time. The prevalence of posttraumatic stress disorder (PTSD) remains high among the cohort and is a risk factor for cognitive impairment or dementia. We thus sought to examine the degree to which confusion or memory loss (CML)-potential symptoms of cognitive decline-are occurring among enrollees aged 35-64 years. Cognitive reserve theory suggests that higher levels of education and engaging in cognitively challenging activities can create stronger neural connections, offering protection against cognitive decline. We hypothesized that enrollees with less cognitive reserve would be more likely to report CML. In this study, we: (1) estimated the incidence of CML in our study sample; (2) identified indicators of cognitive reserve (e.g., indicators of educational attainment, social support); and (3) determined whether CML is associated with cognitive reserve level, stratified by PSTD status. First, we described demographics of the study sample (n = 14,574) and probable PTSD status, also stratifying by CML. Next, we conducted a latent class analysis on two groups: those with probable PTSD and those without probable PTSD, creating classes with varying cognitive reserve levels. Finally, using adjusted log binomial models, we predicted risk of CML based on cognitive reserve level. The probable PTSD group (n = 1213) and not probable PTSD group (n = 13,252) each had four latent classes: low, medium-low, medium-high, and high cognitive reserve. In the probable PTSD model, compared to the high cognitive reserve class, those with medium-low cognitive reserve were 35% more likely to report CML (relative risk (RR) = 1.4, 95% confidence interval (CI): 1.1, 1.7). Among the not probable PTSD group, those with low and medium levels of cognitive reserve were significantly more likely to report CML (RR = 1.8 and 1.4, respectively). Overall, those with less cognitive reserve were more likely to report CML regardless of PTSD status.


Assuntos
Reserva Cognitiva , Confusão , Transtornos da Memória , Autorrelato , Ataques Terroristas de 11 de Setembro , Apoio Social , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Fatores de Risco , Inquéritos e Questionários , Sobreviventes/psicologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-31009988

RESUMO

The evolution of lung function, including assessment of small airways, was assessed in individuals enrolled in the World Trade Center Environmental Health Center (WTC-EHC). We hypothesized that a bronchodilator response at initial evaluation shown by spirometry or in small airways, as measured by forced oscillation technique (FOT), would be associated with improvement in large and small airway function over time. Standardized longitudinal assessment included pre and post bronchodilator (BD) spirometry (forced vital capacity, FVC; forced expiratory volume in 1 second, FEV1) and FOT (resistance at 5 Hz, R5; resistance at 5 minus 20 Hz, R5-20). Longitudinal changes were assessed using linear mixed-effects modelling with adjustment for potential confounders (median follow-up 2.86 years; 95% measurements within 4.9 years). Data demonstrated: (1) parallel improvement in airflow and volume measured by spirometry and small airway function (R5 and R5-20) measured by FOT; (2) the magnitude of longitudinal improvement was tightly linked to the initial BD response; and (3) longitudinal values for small airway function on FOT were similar to residual abnormality observed post BD at initial visit. These findings suggest presence of reversible and irreversible components of small airway injury that are identifiable at initial presentation. These results have implications for treatment of isolated small airway abnormalities that can be identified by non-invasive effort independent FOT particularly in symptomatic individuals with normal spirometry indices. This study underscores the need to study small airway function to understand physiologic changes over time following environmental and occupational lung injury.


Assuntos
Broncodilatadores/farmacologia , Poeira , Volume Expiratório Forçado , Ataques Terroristas de 11 de Setembro , Capacidade Vital , Brônquios/efeitos dos fármacos , Brônquios/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espirometria
14.
Artigo em Inglês | MEDLINE | ID: mdl-30974916

RESUMO

Background: Sarcoidosis is a granulomatous disease involving intrathoracic and extrathoracic organs. Genetic and environmental factors, such as exposure to World-Trade Center (WTC) dust after 9/11, may play a role in clinical presentation. Characterization of sarcoidosis in community members with exposure to the WTC dust can provide further insight into the relationship between environmental exposure and sarcoidosis. Methods: Patients with documented sarcoidosis were identified in the WTC Environmental Health Center (EHC), a treatment program for community members. Demographic and clinical data were collected from standardized questionnaires and chart review. Organ involvement was assessed with a standard instrument. Results: Among patients in the WTC EHC, 87 were identified with sarcoidosis after 9/11. Sarcoidosis cases were more likely African-American, local workers, and had more respiratory symptoms, compared with non-sarcoidosis WTC EHC patients. Many (46%) had ≥ Scadding stage 3 on chest imaging, and had reduced lung function measures. Extrathoracic involvement was identified in 33/87 (38%) with a diversity of organs involved. Conclusions: WTC-exposed sarcoidosis in community members is often characterized by severe pulmonary disease and a high rate of diverse extrathoracic involvement. Further analysis is required to characterize the course of disease progression or resolution.


Assuntos
Exposição Ambiental/efeitos adversos , Pneumopatias/diagnóstico , Sarcoidose/diagnóstico , Ataques Terroristas de 11 de Setembro , Adulto , Poeira , Feminino , Humanos , Pulmão/fisiopatologia , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Sarcoidose/fisiopatologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-30987367

RESUMO

The World Trade Center (WTC) Environmental Health Center (EHC) is a treatment program for community members with exposure to the 9/11 terrorist attack and its physical and emotional aftermath. Compared to the general responders program, the WTC EHC is diverse with equal gender distribution, representation of many races and ethnicities, and a wide range of social economic status. Patients in the WTC EHC were initially enrolled for physical symptoms, most of which were respiratory, however a large portion of the enrollees scored positive for probable posttraumatic stress disorder (PTSD). In this paper we identify patient characteristics associated with probable PTSD. We also determine the characteristics associated with the longitudinal change of PTSD symptoms, including persistence and remittance, using the widely used Posttraumatic Check List-17 (PCL) cut-off value of 44, as well as changes in PCL total score and symptom cluster scores in patients of Low and High PTSD symptom severity. Few patients with elevated scores achieved a score below 44. However, longitudinal improvement in PCL score at follow-up was identified for patients with High PTSD scores (PCL > 57.5). Changes in PCL symptom clusters differed between those with High and Low PCL scores. These data suggest improvement over time in PCL score that differs depending on the severity of the score and variable responses in the PCL symptom clusters.


Assuntos
Ataques Terroristas de 11 de Setembro/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Lista de Checagem , Progressão da Doença , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Testes de Função Respiratória , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Fatores de Tempo , Estados Unidos/epidemiologia , Capacidade Vital
16.
Artigo em Inglês | MEDLINE | ID: mdl-30823641

RESUMO

A large number of World Trade Center (WTC) rescue and recovery workers are affected by asthma. While physical and mental health comorbidities have been associated with poor asthma control in this population, the potential role of allergen sensitization is unknown. This study examined the association of indoor sensitization and exposure as a risk factor for increased asthma morbidity in WTC workers. We used data from a prospective cohort of 331 WTC workers with asthma. Sensitization to indoor allergens was assessed by measurement of antigen-specific serum immunoglobulin E (IgE) levels. We used validated tools to evaluate the exposure to indoor allergens. Asthma morbidity outcomes included level of control (Asthma Control Questionnaire, ACQ), quality of life (Asthma Quality of Life Questionnaire, AQLQ) and acute resource utilization. The prevalence of sensitization to cat, dog, mouse, dust mite, cockroach, and mold allergens were 33%, 21%, 17%, 40%, 17%, and 17%, respectively. Unadjusted and regression analyses showed no significant relationship between sensitization and increased asthma morbidity (p > 0.05 for all comparisons), except for sensitization to Aspergillus Fumigatus, cat and mouse epithelium, which were associated with decreased morbidity.


Assuntos
Alérgenos/imunologia , Asma/etiologia , Exposição Ambiental , Trabalho de Resgate , Ataques Terroristas de 11 de Setembro , Animais , Asma/epidemiologia , Baratas/imunologia , Estudos de Coortes , Feminino , Recursos em Saúde , Humanos , Masculino , Morbidade , Prevalência , Estudos Prospectivos , Pyroglyphidae/imunologia , Qualidade de Vida , Fatores de Risco
17.
Artigo em Inglês | MEDLINE | ID: mdl-30845693

RESUMO

Sarcoid-like granulomatous diseases (SGD) have been previously identified in cohorts of World Trade Center (WTC) dust-exposed individuals. In the present studies, we analyzed lung and/or lymph node biopsies from patients referred to our clinic with suspected WTC dust-induced lung disease to evaluate potential pathophysiologic mechanisms. Histologic sections of lung and/or lymph node samples were analyzed for markers of injury, oxidative stress, inflammation, fibrosis, and epigenetic modifications. Out of seven patients examined, we diagnosed four with SGD and two with pulmonary fibrosis; one was diagnosed later with SGD at another medical facility. Patients with SGD were predominantly white, obese men, who were less than 50 years old and never smoked. Cytochrome b5, cytokeratin 17, heme oxygenase-1, lipocalin-2, inducible nitric oxide synthase, cyclooxygenase 2, tumor necrosis factor α, ADP-ribosylation factor-like GTPase 11, mannose receptor-1, galectin-3, transforming growth factor ß, histone-3 and methylated histone-3 were identified in lung and lymph nodes at varying levels in all samples examined. Three of the biopsy samples with granulomas displayed peri-granulomatous fibrosis. These findings are important and suggest the potential of WTC dust-induced fibrotic sarcoid. It is likely that patient demographics and/or genetic factors influence the response to WTC dust injury and that these contribute to different pathological outcomes.


Assuntos
Exposição Ocupacional , Sarcoidose/etiologia , Ataques Terroristas de 11 de Setembro , Adulto , Poeira , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Artigo em Inglês | MEDLINE | ID: mdl-30866415

RESUMO

Dust created by the collapse of the World Trade Center (WTC) towers on 9/11 included metals and toxicants that have been linked to an increased risk of pulmonary fibrosis (PF) in the literature. Little has been reported on PF among WTC responders. This report used self-reported physician diagnosis of PF with an unknown sub-type to explore the association between levels of WTC dust exposure and PF. We included 19,300 WTC responders, enrolled in the WTC Health Registry in 2003⁻2004, who were followed for 11 years from 2004 to 2015. Exposure was defined primarily by intensity and duration of exposure to WTC dust/debris and work on the debris pile. Stratified Cox regression was used to assess the association. We observed 73 self-reported physician-diagnosed PF cases, with a PF incidence rate of 36.7/100,000 person-years. The adjusted hazard ratio (AHR) of PF was higher in those with a medium (AHR = 2.5, 95% CI = 1.1⁻5.8) and very high level of exposure (AHR = 4.5, 95% CI = 2.0⁻10.4), compared to those with low exposure. A test for exposure-response trend was statistically significant (Ptrend = 0.004). Future research on WTC dust exposure and PF would benefit from using data from multiple WTC Health Program responder cohorts for increased statistical power and clinically confirmed cases.


Assuntos
Poeira , Socorristas/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Fibrose Pulmonar/epidemiologia , Ataques Terroristas de 11 de Setembro/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros
19.
Artigo em Inglês | MEDLINE | ID: mdl-30909548

RESUMO

Fifteen years after the disaster, the World Trade Center Health Registry (Registry) conducted The Health and Quality of Life Survey (HQoL) assessing physical and mental health status among those who reported sustaining an injury on 11 September 2001 compared with non-injured persons. Summary scores derived from the Short Form-12 served as study outcomes. United States (US) population estimates on the Physical Component Score (PCS-12) and Mental Component Score (MCS-12) were compared with scores from the HQoL and were stratified by Post-traumatic Stress Disorder (PTSD) and injury status. Linear regression models were used to estimate the association between both injury severity and PTSD and PCS-12 and MCS-12 scores. Level of injury severity and PTSD history significantly predicted poorer physical health (mean PCS-12). There was no significant difference between injury severity level and mental health (mean MCS-12). Controlling for other factors, having PTSD symptoms after 9/11 predicted a nearly 10-point difference in mean MCS-12 compared with never having PTSD. Injury severity and PTSD showed additive effects on physical and mental health status. Injury on 9/11 and a PTSD history were each associated with long-term decrements in physical health status. Injury did not predict long-term decrements in one's mental health status. Although it is unknown whether physical wounds of the injury healed, our results suggest that traumatic injuries appear to have a lasting negative effect on perceived physical functioning.


Assuntos
Nível de Saúde , Saúde Mental/estatística & dados numéricos , Qualidade de Vida/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Estudos Prospectivos , Ataques Terroristas de 11 de Setembro/psicologia , Ataques Terroristas de 11 de Setembro/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-30841531

RESUMO

Thousands of lower Manhattan residents sustained damage to their homes following the collapse of the Twin Towers on 11 September 2001. Respiratory outcomes have been reported in this population. We sought to describe patterns of home damage and cleaning practices in lower Manhattan and their impacts on respiratory outcomes among World Trade Center Health Registry (WTCHR) respondents. Data were derived from WTCHR Wave 1 (W1) (9/2003⁻11/2004) and Wave 2 (W2) (11/2006⁻12/2007) surveys. Outcomes of interest were respiratory symptoms (shortness of breath (SoB), wheezing, persistent chronic cough, upper respiratory symptoms (URS)) first occurring or worsening after 9/11 W1 and still present at W2 and respiratory diseases (asthma and chronic obstructive pulmonary disease (COPD)) first diagnosed after 9/11 W1 and present at W2. We performed descriptive statistics, multivariate logistic regression and geospatial analyses, controlling for demographics and other exposure variables. A total of 6447 residents were included. Mean age on 9/11 was 45.1 years (±15.1 years), 42% were male, 45% had ever smoked cigarettes, and 44% reported some or intense dust cloud exposure on 9/11. The presence of debris was associated with chronic cough (adjusted OR (aOR) = 1.56, CI: 1.12⁻2.17), and upper respiratory symptoms (aOR = 1.56, CI: 1.24⁻1.95). A heavy coating of dust was associated with increased shortness of breath (aOR = 1.65, CI: 1.24⁻2.18), wheezing (aOR = 1.43, CI: 1.03⁻1.97), and chronic cough (aOR = 1.59, CI: 1.09⁻2.28). Dusting or sweeping without water was the cleaning behavior associated with the largest number of respiratory outcomes, such as shortness of breath, wheezing, and URS. Lower Manhattan residents who suffered home damage following the 9/11 attacks were more likely to report respiratory symptoms and diseases compared to those who did not report home damage.


Assuntos
Doenças Respiratórias/epidemiologia , Ataques Terroristas de 11 de Setembro , Adulto , Doença Crônica , Poeira , Dispneia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Sistema de Registros , Sons Respiratórios , Inquéritos e Questionários
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