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Thompson HM, Thanik E, Sabra A, Ko F, Hung WW, Colicino E, Lucchini RG, Bello G, Crane M, Teitelbaum SL, Ornstein KA. A pilot study to identify factors associated with frailty within the World Trade Center general responder cohort. Am J Ind Med 2024; 67:582-591. [PMID: 38735862 DOI: 10.1002/ajim.23590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Given the significant exposures experienced by the World Trade Center (WTC) general responders, there is increasing interest in understanding the effect of these exposures on aging in this population. We aim to identify factors that may be associated with frailty, a clinical syndrome characterized by a decrease in one's reserve that has been linked to poor health outcomes. METHODS WTC general responders enrolled in the WTC Health Program aged 50 and older provided informed consent. Validated frailty assessments, the Frailty Phenotype (with the Johns Hopkins Frailty Assessment Calculator) along with the FRAIL scale, categorized nonfrail from prefrail/frail. Fall risk, functional status, and cognition were also assessed. WTC variables, including an identified WTC-certified condition, were utilized. The risk of frailty was estimated using log binomial regression analysis. A 95% confidence interval (CI) was used to estimate the prevalence ratio (PR). RESULTS One hundred and six participants were included; 38 (35.8%) were classified as pre-frail or frail. More of the pre-frail/frail group were obese (57.9% vs. 25%; p = 0.004) and had a WTC-certified condition (78.9% vs. 58.8%; p = 0.036). Obesity (PR = 2.43, 95% CI = 1.31, 4.53), a WTC-certified condition (PR = 1.77, 95% CI = 1.09, 2.89), and risk of falling (PR = 1.97, 95% CI = 1.01, 3.84) were independently associated with frailty. CONCLUSIONS Obesity and having a WTC-certified condition were found to be risk factors for frailty in our pilot study. Future work may focus on further identifying risk factors for frailty in the larger WTC general responder population.
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Affiliation(s)
- Hannah M Thompson
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmad Sabra
- General Responder Data Center, Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fred Ko
- Brookdale Department of Geriatrics and Palliative Medicine, Geriatric, Research, Education and Clinical Center, Icahn School of Medicine at Mount Sinai, James J Peters VA Medical Center, New York, New York, USA
| | - William W Hung
- Brookdale Department of Geriatrics and Palliative Medicine, Geriatric, Research, Education and Clinical Center, Icahn School of Medicine at Mount Sinai, James J Peters VA Medical Center, New York, New York, USA
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto G Lucchini
- Department of Environmental Health Sciences, School of Public Health, Florida International University, Miami, Florida, USA
| | - Ghalib Bello
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan L Teitelbaum
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Boster JM, Moore Iii WJ, Stoffel ST, Anderson JT, Gonzales MA, Houle MC, Walter RJ, Morris MJ. Bronchoalveolar Lavage Fluid Cytology of Deployed Military Personnel With Chronic Respiratory Symptoms From the STAMPEDE III Study. Mil Med 2024:usae056. [PMID: 38430524 DOI: 10.1093/milmed/usae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 03/04/2024] Open
Abstract
INTRODUCTION Deployed military personnel may be at risk for developing acute and chronic lung disease. Prior studies of this patient population have revealed that unexplained exertional dyspnea is the most common diagnosis despite an extensive evaluation. There is a concern that an occult disorder may be affecting this population. This study evaluated the role for bronchoalveolar lavage (BAL) fluid analysis in the evaluation of chronic deployment-associated dyspnea. MATERIALS AND METHODS Military personnel who reported chronic respiratory symptoms were evaluated as part of the Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures III study. Participants underwent bronchoscopy with BAL as part of a standardized evaluation. RESULTS A total of 308 patients with a mean age of 38 ± 8.6 years underwent bronchoscopy with BAL. BAL cell-count percentages of macrophages, lymphocytes, neutrophils, and eosinophils were: 76.2 ± 17.0%, 16.3 ± 13.4%, 6.6 ± 8.9%, and 0.9 ± 3.2%, respectively. There was no clear differentiation between groups based on increases in lymphocyte counts (P = .640), although lymphocyte values were more elevated (21.4 ± 12.1%) in the interstitial lung disease category. Neutrophil counts (6.6 ± 8.9%) were elevated compared to the reported normal reference values and were increased in the isolated pulmonary function test abnormality (9.4 ± 11.6%), large airway disorder (10.0 ± 7.5%), miscellaneous (10.9 ± 20.2%), and obstructive lung disease (11.0 ± 15.6%) groups. Eosinophil counts were within normal limits (0.9 ± 3.2%) and showed no differences between groups (P = .545); asthma patients trended higher (1.6 ± 5.7%). BAL counts for the exertional dyspnea group were within normal reference values and showed no differences from the entire cohort. CONCLUSIONS The addition of BAL cytology did not help differentiate those patients with unexplained dyspnea from other etiologies.
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Affiliation(s)
- Joshua M Boster
- Pulmonary/Critical Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - William J Moore Iii
- Pulmonary/Critical Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Steven T Stoffel
- Pulmonary/Critical Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Jess T Anderson
- Pulmonary/Critical Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Michael A Gonzales
- Pulmonary/Critical Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Mateo C Houle
- Pulmonary/Critical Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Robert J Walter
- Pulmonary/Critical Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Michael J Morris
- Pulmonary/Critical Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
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Hryhorczuk D, Levy BS, Prodanchuk M, Kravchuk O, Bubalo N, Hryhorczuk A, Erickson TB. The environmental health impacts of Russia's war on Ukraine. J Occup Med Toxicol 2024; 19:1. [PMID: 38183124 PMCID: PMC10768292 DOI: 10.1186/s12995-023-00398-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Russia's invasion of Ukraine in February 2022 ignited the largest armed conflict in Europe since World War II. Ukrainian government agencies, civil society organizations, and international agencies have gathered an unprecedented amount of data about the impact of war on the environment, which is often the silent victim of war. We review these data and highlight the limitations of international governance for protection of the environment during time of war. METHODS We performed an integrative review of academic, institutional, and media information resources using the search terms "Ukraine", "Russia", "war", "environment", "health", "human rights", "international humanitarian law", "international human rights law", "ecocide", and "war crimes". MAIN TEXT Nearly 500,000 military personnel have been killed or wounded during the war, and more than 30,000 civilians have been killed or injured. Indirect health effects of the war have likely accounted for an even greater amount of civilian morbidity and mortality. The war has displaced more than 11 million people. Russia's military forces have caused extensive damage to civilian infrastructure. The war has devastated Ukraine's economy and reduced food and energy security in many countries. The war has caused more than $56.4 billion in damage to the environment. There has been widespread chemical contamination of air, water, and soil, and 30% of Ukraine has been contaminated with landmines and unexploded ordnance. Landscape destruction, shelling, wildfires, deforestation, and pollution have adversely affected 30% of Ukraine's protected areas. Russia's seizure of the Zaporizhzhia Nuclear Power Plant and destruction of the Nova Kakhovka Dam have posed risks of long-term environmental catastrophe. Most of these environmental impacts threaten human health. CONCLUSION In addition to enormous human costs, Russia's war on Ukraine has had devastating impacts on the natural environment and the built environment. International law mandates that methods of warfare must be implemented with due regard to the protection and preservation of the natural environment. A just and lasting peace necessitates, among other requirements, rebuilding and restoration of Ukraine's natural environment and built environment. The environmental consequences of all wars need to be investigated and more effective measures need to be implemented to protect the environment during war.
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Affiliation(s)
- Daniel Hryhorczuk
- Divisions of Environmental and Occupational Health Sciences and Epidemiology, University of Illinois School of Public Health, Chicago, USA.
| | - Barry S Levy
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | - Mykola Prodanchuk
- L.I.Medved's Research Center of Preventive Toxicology, Food and Chemical Safety, Ministry of Health, Kiev, Ukraine
| | - Oleksandr Kravchuk
- L.I.Medved's Research Center of Preventive Toxicology, Food and Chemical Safety, Ministry of Health, Kiev, Ukraine
| | - Nataliia Bubalo
- L.I.Medved's Research Center of Preventive Toxicology, Food and Chemical Safety, Ministry of Health, Kiev, Ukraine
| | | | - Timothy B Erickson
- Department of Emergency Medicine, Division of Medical Toxicology, Mass General Brigham, Harvard Medical School, Harvard Humanitarian Initiative, Boston, USA
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Hu Y, Zheng Y, Wang Y, Yu S, Li M, Zhou J, Wu G, Xing W, Dong L, Liu Y, Fang G, Li J, Zhao J, Zhang X, Gao F. Temperature-dependent metabolite orchestration to acute submaximal exercise indicates cardiorespiratory fitness in humans. Life Sci 2023; 313:121284. [PMID: 36529280 DOI: 10.1016/j.lfs.2022.121284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
AIMS Cardiorespiratory fitness (CRF), an important biomarker of human health, is impaired in cold environment compared to thermoneutral condition. The study aimed to investigate the role of metabolome response to acute exercise in regulation of CRF at different ambient temperatures. MAIN METHODS A total of 27 young adults were recruited, and each subject underwent a cardiopulmonary exercise test (CPET) and a constant load submaximal exercise at both room temperature (25 °C) and cold temperature (0 °C). The serum samples were collected before and immediately after constant load exercise. KEY FINDINGS Acute cold exposure decreased CRF by 41 %, accompanied by a metabolic shift to anaerobic respiration. It also decreased VO2 and increased respiratory quotient during constant load exercise. Metabolome profiling revealed that acute exercise reprogrammed serum metabolome in an ambient temperature-dependent manner. Specifically, exercise increased a cluster of fatty acids during cold exposure, possibly due to impaired fatty acid oxidation. The correlations between metabolite responses to acute exercise and exercise parameters were analyzed using partial least squares regression and machine learning, revealing that metabolite responses to acute exercise were highly correlated with exercise parameters and predictive of CRF. Among the contributors, tryptophan and its metabolites stood out as important ones. SIGNIFICANCE These results suggested that the metabolite responses to acute submaximal exercise unmasks the exercise performance at different ambient temperatures, highlighting the role of metabolite orchestration in the physiological regulation of CRF.
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Affiliation(s)
- Yang Hu
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Yao Zheng
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an 710032, China
| | - Yongchun Wang
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Sen Yu
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Min Li
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Jiaheng Zhou
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Guiling Wu
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Wenjuan Xing
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Ling Dong
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Yang Liu
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an 710032, China
| | - Guoliang Fang
- Exercise Biological Center, China Institute of Sport Science, Beijing 100061, China
| | - Jia Li
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Jiexiu Zhao
- Exercise Biological Center, China Institute of Sport Science, Beijing 100061, China
| | - Xing Zhang
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China.
| | - Feng Gao
- Key Laboratory of Aerospace Medicine of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an 710032, China.
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