The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program

BACKGROUND: Approximately 40,000 rescue and recovery workers were exposed to caustic dust and toxic pollutants following the 11 September 2001 attacks on the World Trade Center (WTC). These workers included traditional first responders, such as firefighters and police, and a diverse population of construction, utility, and public sector workers. METHODS: To characterize WTCrelated health effects, the WTC Worker and Volunteer Medical Screening Program was established. This multicenter clinical program provides free standardized examinations to responders. Examinations include medical, mental health, and exposure assessment questionnaires; physical examinations; spirometry; and chest X rays. RESULTS: Of 9,442 responders examined between July 2002 and April 2004, 69% reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59% of these workers. Among those who had been asymptomatic before September 11, 61% developed respiratory symptoms while performing WTC work. Twenty-eight percent had abnormal spirometry; forced vital capacity (FVC) was low in 21%; and obstruction was present in 5%. Among nonsmokers, 27% had abnormal spirometry compared with 13% in the general U.S. population. Prevalence of low FVC among nonsmokers was 5-fold greater than in the U.S. population (20% vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site. CONCLUSION: WTC responders had exposure-related increases in respiratory symptoms and pulmonary function test abnormalities that persisted up to 2.5 years after the attacks. Longterm medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters.     

Relationship Between Asthma, Overweight, And Physical Activity Among U.S. High School Students

Asthma is a leading chronic illness among children and adolescents in the United States. This study examined the relationship between asthma and both overweight and physical activity levels. Results are based on data from the Centers for Disease Control and Prevention’s 2003 national Youth Risk Behavior Survey, a cross-sectional survey of health risk behaviors among a representative sample of high school students in the United States. The overall survey response rate was 67% and the results are based on weighted data. SUDAAN was used for all data analysis (prevalence estimates and logistic regression) because it accounts for the complex sampling design of the survey. Significantly more students with current asthma than without were overweight (odds ratio [OR] = 1.4; 95% confidence interval [CI] = 1.1, 1.6) and described themselves as overweight (OR = 1.2; 95% CI = 1.0, 1.4). Significantly more students with current asthma than without used a computer for non-schoolwork 3 or more hours/day (OR = 1.3; 95% CI = 1.1, 1.5). No significant differences were found for participation in sufficient vigorous or moderate physical activity or strengthening exercises among students with and without current asthma. Unlike some other risk factors for developing or exacerbating asthma, overweight and physical activity are generally modifiable. School and community policies and programs can play an important role in asthma management, including promoting the maintenance of an appropriate weight and encouraging continued physical activity.The findings and conclusions in this report are those of the authors and do not necessarily represent the views of Centers for Disease Control and Prevention.     

Drug treatment disparities among Hispanic drug-using women in Puerto Rico and New York City

This paper reports findings on 334 out-of-treatment drug users in Puerto Rico and 617 in New York City, at the 6-month follow-up interview of a Longitudinal Survey. Main outcomes were health care and drug treatment utilization since baseline, assessed by asking participants if they had received physical or mental health services (including HIV medications), and if they had been in methadone maintenance, inpatient or outpatient drug treatment, or drug treatment while incarcerated. Chi-square tests were used to evaluate associations between gender and the various correlates. Logistic regression was used to calculate the contribution of each variable in predicting use of drug treatment. The analysis suggests that women in both sites were likely to suffer from disparities in both health care and drug treatment utilization when compared with men, albeit women in New York utilized more drug treatment resources and were more embedded in the immediate family than their female peers in Puerto Rico. Further research to specify the impact of contextual factors at the organizational and community levels, among members of the same ethnic group residing in different sites, may prove valuable in identifying the health needs and the factors that impede or facilitate drug-using women in obtaining the most appropriate treatment. Findings from these studies can help in developing appropriate public health policy and science-based drug treatment programs to eliminate disparities such as the ones detected in this study.     

Workshop recommendations for the preconception cohort of the National Children's Study

This paper summarises discussions on incorporating preconception recruitment in the National Children's Study (NCS); these were part of the workshop on Expanding Methodologies for Capturing Day-Specific Probabilities of Conception. Four key issues were discussed in relation to the NCS: (1) differences between pregnancy 'planners' and 'non-planners'; (2) a tiered approach to preconception data collection; (3) data gaps in preconception studies; and (4) assessment of early pregnancy in subsequent pregnancies for women with a child already in the study. Practical recommendations were developed for each theme, which have relevance for other prospective studies of conception, pregnancy and human development.     

Venovenous extracorporeal membrane oxygenation for cyanotic congenital heart disease

Background

Severe, refractory hypoxemia complicating uncorrected cyanotic congenital heart disease is a potentially lethal condition, even when urgent surgical intervention is undertaken. When a viral pneumonia initiates hypoxemia, the likelihood of a satisfactory outcome is further reduced. We examined our policy of venovenous extracorporeal membrane oxygenation support through the hypoxic event and performing delayed surgery, if required, to separate from extracorporeal membrane oxygenation.

Methods

A single institution, retrospective review of an Institutional Review Board approved database was undertaken. Over a 6-year period, 18 instances were identified for 17 patients who became acutely hypoxemic from either inadequate pulmonary blood flow (8 instances) or a viral pneumonia (10 instances) complicating their cyanotic heart disease. Demographics, duration of venovenous extracorporeal membrane oxygenation and outcomes are reported.

Results

The length of venovenous extracorporeal membrane oxygenation ranged from 13.5 to 362.5 hours (mean 130 ± 121 hours). During 10 supports, operations were performed to facilitate weaning from support. In 7 patients, extracorporeal support was weaned during this surgery. Follow-up was obtained in all patients over a period ranging from 4 months to 7 years (mean 39.0 ± 23.0 months). There were two late deaths due to sepsis 1.4 and 2.5 months after extracorporeal support.

Conclusions

Venovenous extracorporeal membrane oxygenation allows time for the recovery of acute hypoxic insult and resolution of some viral pneumonia processes. Palliative surgical procedures may be safely undertaken during extracorporeal support. Viral pneumonia is a risk for prolonged support. Venovenous extracorporeal membrane oxygenation is useful in these high-risk patients.     

Cardiovascular Disease

HEALTH ISSUE: Cardiovascular disease (CVD) is the leading cause of death in Canadian women and men. In general, women present with a wider range of symptoms, are more likely to delay seeking medial care and are less likely to be investigated and treated with evidence-based medications, angioplasty or coronary artery bypass graft than men. KEY FINDINGS: In 1998, 78,964 Canadians died from CVD, almost half (39,197) were women. Acute myocardial infarction, which increases significantly after menopause, was the leading cause of death among women.Cardiovascular disease accounted for 21% of all hospital admissions for Canadian women over age 50 in 1999. Admissions to hospital for ischemic heart disease were more frequent for men, but the mean length of hospital stay was longer for women.Mean blood pressure increases with age in both men and women. After age 65, however, high blood pressure is more common among Canadian women. More than one-third of postmenopausal Canadian women have hypertension.Diabetes increases the mortality and morbidity associated with CVD in women more than it does in men. Depression also contributes to the incidence and recovery from CVD, particularly for women who experience twice the rate of depression as men. DATA GAPS AND RECOMMENDATIONS: CVD needs to be recognized as a woman's health issue given Canadian mortality projections (particularly heart failure). Health professionals should be trained to screen, track, and address CVD risk factors among women, including hypertension, elevated lipid levels, smoking, physical inactivity, depression, diabetes and low socio-economic status.     

Isolation, flexibility and change in vocational training for general practice: personal and educational problems experienced by general practice registrars in Australia

BACKGROUND: GP registrars, in common with other doctors, frequently experience high levels of stress; however, little is known about the nature and outcomes of personal and educational problems experienced during vocational training for general practice. OBJECTIVES: The purpose of our study was to elicit the nature, causes and effects of more severe problems experienced during vocational training for general practice from the registrar's viewpoint and put these into the context of their personal circumstances and background. METHODS: This qualitative study used detailed semi-structured telephone interviews with a selected subgroup of 33 of the 1999 entry cohort of general practice registrars in Australia who had reported serious self-defined problems during an earlier longitudinal questionnaire study. Registrars were asked about the nature, antecedents and outcomes of problems experienced during GP training, actions taken to resolve the problem, and their perceptions of what might have helped prevent or minimize the problem. RESULTS: Problems reported by registrars fell into five major themes: isolation (structural isolation, social isolation and professional isolation); flexibility and choice (administrative issues and balancing work with personal life); change and uncertainty (within general practice and training, intergenerational changes); teaching problems; and work conditions. Actions taken and effects of problems are also discussed in the light of workforce imperatives. Results have been used to develop a list of suggestions for the providers of general practice training. CONCLUSIONS: Registrars commonly experience problems during vocational training. These may be related to structural, social and professional isolation, or a lack of flexibility in training arrangements and balancing work and other commitments. Some of these problems may be amenable to relatively simple solutions involving term placements, selection of training practices and administrative adjustments.     

Self-oriented and socially prescribed perfectionism in the Eating Disorder Inventory Perfectionism subscale

OBJECTIVE: The purpose of this study was to demonstrate the existence and the importance of the distinction between self-oriented and socially prescribed perfectionism in the Eating Disorder Inventory Perfectionism subscale (EDI-P). METHOD: Trait perfectionism, measured by the EDI-P, and eating disorder symptoms, measured by the 26-item Eating Attitudes Test, were examined in 220 university students (110 women and 110 men) belonging to a campus-based fitness facility. RESULTS: Confirmatory factor analysis indicated that, for both genders, the EDI-P is best represented by a multidimensional factor structure with three self-oriented perfectionism items (EDI-SOP) and three socially prescribed perfectionism items (EDI-SPP). Structural equation modeling demonstrated that, for both genders, EDI-SOP and EDI-SPP are related independently to eating disorder symptoms. Moderational analysis indicated that, for women, the impact of EDI-SOP on eating disorder symptoms is dependent on the level of EDI-SPP. DISCUSSION: It is suggested that future research should acknowledge the empirical and theoretical implications of having EDI-SOP and EDI-SPP in the EDI-P. It is cautioned that EDI-SOP and EDI-SPP are a partial representation of an already published multidimensional model of trait perfectionism.     

Lutein supplements are not bioavailable in the Mongolian gerbil while consuming a diet with or without cranberries

Lutein is a carotenoid that may be involved in the prevention of macular degeneration and is available as supplements. Cranberries are a potential "functional food" due to anti-adhesion and antioxidant properties. This study was designed to determine the bioavailability of lutein supplements in Mongolian gerbils, as prior studies have focused on beta-carotene, and to investigate any interactions between a lutein supplement and a diet containing cranberries. Gerbils (n = 28) were divided into treatment groups: lutein + cranberry; lutein + control; cottonseed oil + cranberry; and cottonseed oil + control. The lutein supplement (50 microg lutein in oil) was delivered orally for 14 days, and then blood, livers, and eyes were collected. Samples were analyzed by high-performance liquid chromatography (HPLC) and total antioxidant status was determined. Serum and liver were analyzed for lutein, retinol, and alpha-tocopherol. Serum lutein concentrations were extremely low in all four groups. Serum total antioxidants did not differ (p > 0.2) among diet groups. Serum retinol concentrations were significantly lower in the cranberry groups (p = 0.0024). In conclusion, gerbils are able to thrive on a high cranberry diet. However, this study showed that lutein, as a daily supplement in oil, is not bioavailable in Mongolian gerbils.     

Thy-1 distinguishes human corneal fibroblasts and myofibroblasts from keratocytes

After corneal injury, keratocytes become activated and transform into repair phenotypes-corneal fibroblasts or myofibroblasts, however, these important cells are difficult to identify histologically, compromising studies of stromal wound healing. Recent studies indicate that expression of the cell surface protein, Thy-1, is induced in fibroblast populations associated with wound healing and fibrosis in other tissues. We investigated whether keratocyte transformation to either repair-associated phenotype induced Thy-1 expression. Human corneal keratocytes were isolated by collagenase digestion. The cells were either processed immediately (i.e. freshly isolated keratocytes) or were cultured in the presence of 10% fetal bovine serum or transforming growth factor-beta to induce transformation to the corneal fibroblast and myofibroblast phenotypes, respectively. Thy-1 mRNA and protein expression by freshly isolated keratocytes and corneal fibroblasts were assessed by RT-PCR and Western blotting. mRNA also was extracted from the whole intact stroma and assessed by RT-PCR. Thy-1 was localised immunocytochemically in cultured human corneal fibroblasts, myofibroblasts, and in keratocytes in normal human corneal tissue sections. Thy-1 mRNA and protein were detectable in cultured human corneal fibroblasts, but not freshly isolated keratocytes. Whole uninjured stroma showed no detectable Thy-1 mRNA expression. Cultured human corneal fibroblasts and myofibroblasts both labelled for Thy-1, but keratocytes in the stroma of normal human cornea did not. We conclude that Thy-1 expression is induced by transformation of keratocytes to corneal fibroblasts and myofibroblasts, suggesting a potential functional role for Thy-1 in stromal wound healing and providing a surface marker to distinguish the normal keratocyte from its repair phenotypes.