1
|
Loupasakis K, Berman J, Jaber N, Zeig-Owens R, Webber MP, Glaser MS, Moir W, Qayyum B, Weiden MD, Nolan A, Aldrich TK, Kelly KJ, Prezant DJ. Refractory sarcoid arthritis in World Trade Center-exposed New York City firefighters: a case series. J Clin Rheumatol 2015; 21:19-23. [PMID: 25539429 DOI: 10.1097/rhu.0000000000000185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to describe cases of sarcoid arthritis in firefighters from the Fire Department of the City of New York (FDNY) who worked at the World Trade Center (WTC) site. METHODS All WTC-exposed FDNY firefighters with sarcoidosis and related chronic inflammatory arthritis (n = 11) are followed jointly by the FDNY-WTC Health Program and the Rheumatology Division at the Hospital for Special Surgery. Diagnoses of sarcoidosis were based on clinical, radiographic, and pathological criteria. Patient characteristics, WTC exposure information, smoking status, date of diagnosis, and pulmonary findings were obtained from FDNY-WTC database. Joint manifestations (symptoms and duration, distribution of joints involved), radiographic findings, and treatment responses were obtained from chart review. RESULTS Nine of 60 FDNY firefighters who developed sarcoidosis since 9/11/2001 presented with polyarticular arthritis. Two others diagnosed pre-9/11/2001 developed sarcoid arthritis after WTC exposure. All 11 were never cigarette smokers, and all performed rescue/recovery at the WTC site within 3 days of the attacks. All had biopsy-proven pulmonary sarcoidosis, and all required additional disease-modifying antirheumatic drugs for adequate control (stepwise progression from hydroxychloroquine to methotrexate to anti-tumor necrosis factor α agents) of their joint manifestations. CONCLUSIONS Chronic inflammatory polyarthritis appears to be an important manifestation of sarcoidosis in FDNY firefighters with sarcoidosis and WTC exposure. Their arthritis is chronic and, unlike arthritis in non-WTC-exposed sarcoid patients, inadequately responsive to conventional oral disease-modifying antirheumatic drugs, often requiring anti-tumor necrosis factor α agents. Further studies are needed to determine the generalizability of these findings to other groups with varying levels of WTC exposure or with other occupational/environmental exposures.
Collapse
Affiliation(s)
- Konstantinos Loupasakis
- From the *Hospital for Special Surgery/Weill Cornell Medical College; †Department of Medicine, Montefiore Medical Center, Brooklyn; ‡Bureau of Health Services, Fire Department of New York, Brooklyn; §Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx; ║Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine; and ¶Division of Rheumatology, New York University School of Medicine, NY
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Webber MP, Moir W, Zeig-Owens R, Glaser MS, Jaber N, Hall C, Berman J, Qayyum B, Loupasakis K, Kelly K, Prezant DJ. Nested case-control study of selected systemic autoimmune diseases in World Trade Center rescue/recovery workers. Arthritis Rheumatol 2015; 67:1369-76. [PMID: 25779102 DOI: 10.1002/art.39059] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 01/29/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To test the a priori hypothesis that acute and chronic work exposures to the World Trade Center (WTC) site on or after September 11, 2001 were associated with risk of new-onset systemic autoimmune diseases. METHODS A nested case-control study was performed in WTC rescue/recovery workers who had received a rheumatologist-confirmed systemic autoimmune disease diagnosis between September 12, 2001 and September 11, 2013 (n = 59), each of whom was individually matched to 4 randomly selected controls (n = 236) on the basis of year of hire (±1 year), sex, race, and work assignment (firefighter or emergency medical service). Acute exposure was defined according to the earliest time of arrival (morning of 9/11 versus later) at the WTC site, and chronic exposure was defined as duration (number of months) of WTC site-related work. Rheumatologists were blinded with regard to each subject's exposure status. The conditional odds ratios (CORs) with 95% confidence intervals (95% CIs) for incident autoimmune disease were derived from exact conditional logistic regression models. RESULTS Rheumatoid arthritis was the most common autoimmune diagnosis (37% of subjects), followed by spondyloarthritis (22%), inflammatory myositis (14%), systemic lupus erythematosus (12%), systemic sclerosis (5%), Sjögren's syndrome (5%), antiphospholipid syndrome (3%), and granulomatosis with polyangiitis (Wegener's) (2%). The COR for incident autoimmune disease increased by 13% (COR 1.13, 95% CI 1.02-1.26) for each additional month worked at the WTC site. These odds were independent of the association between high acute exposure (working during the morning of 9/11) and disease outcome, which conveyed an elevated, but not statistically significant, risk (COR 1.85, 95% CI 0.86-3.89). CONCLUSION Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. The WTC Health Program should expand surveillance efforts for those with extended exposures, as early detection can facilitate early treatment, which has been shown to minimize organ damage and improve quality of life.
Collapse
Affiliation(s)
- M P Webber
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, and Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Glaser MS, Shah N, Webber MP, Zeig-Owens R, Jaber N, Appel DW, Hall CB, Weakley J, Cohen HW, Shulman L, Kelly K, Prezant D. Obstructive sleep apnea and World Trade Center exposure. J Occup Environ Med 2015; 56 Suppl 10:S30-4. [PMID: 25285973 DOI: 10.1097/jom.0000000000000283] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To describe the proportion of at-risk World Trade Center (WTC)-exposed rescue/recovery workers with polysomnogram-confirmed obstructive sleep apnea (OSA) and examine the relationship between WTC exposure, physician-diagnosed gastroesophageal reflux disease (GERD), and rhinosinusitis and OSA. METHODS A total of 636 male participants completed polysomnography from September 24, 2010, to September 23, 2012. Obstructive sleep apnea was classified as mild, moderate, or severe. Associations were tested using nominal polytomous logistic regression. RESULTS Eighty-one percent of workers were diagnosed with OSA. Using logistic regression models, severe OSA was associated with WTC exposure on September 11, 2001 (odds ratio, 1.91; 95% confidence interval, 1.15 to 3.17), GERD (odds ratio, 2.75; 95% confidence interval, 1.33 to 5.70), and comorbid GERD/rhinosinusitis (odds ratio, 2.31; 95% confidence interval, 1.22 to 4.40). CONCLUSIONS We found significant associations between severe OSA and WTC exposure, and with diseases prevalent in this population. Accordingly, we recommend clinical evaluation, including polysomnography, for patients with high WTC exposure, other OSA risk factors, and a physician diagnosis of GERD or comorbid GERD and rhinosinusitis.
Collapse
Affiliation(s)
- Michelle S Glaser
- From the Department of Medicine (Ms Glaser, Dr Shah, Ms Zeig-Owens, Dr Appel, and Ms Weakley), Montefiore Medical Center, Bronx, NY; Bureau of Health Services (Ms Glaser, Ms Zeig-Owens, Ms Jaber, Ms Weakley, Dr Kelly, and Dr Prezant), Fire Department of the City of New York, Brooklyn, NY; Department of Epidemiology and Population Health (Drs Webber, Hall, and Cohen), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Pulmonary Medicine (Drs Shah, Appel, and Prezant), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; and Pulmonary, Critical Care, and Sleep Medicine Department (Dr Shulman), ProHEALTH Care Associates, LLP, Lake Success, NY
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Hall CB, Liu X, Zeig-Owens R, Webber MP, Aldrich TK, Weakley J, Schwartz T, Cohen HW, Glaser MS, Olivieri BL, Weiden MD, Nolan A, Kelly KJ, Prezant DJ. The Duration of an Exposure Response Gradient between Incident Obstructive Airways Disease and Work at the World Trade Center Site: 2001-2011. PLoS Curr 2015; 7. [PMID: 26064784 PMCID: PMC4449208 DOI: 10.1371/currents.dis.8a93e7682624698558a76a1fa8c5893f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Adverse respiratory effects of World Trade Center (WTC) exposure have been widely documented, but the length of time that exposure remains associated with disease is uncertain. We estimate the incidence of new cases of physician-diagnosed obstructive airway disease (OAD) as a function of time since 9/11/2001 in WTC-exposed firefighters. Methods: Exposure was categorized by first WTC arrival time: high (9/11/2001 AM); moderate (9/11/2001 PM or 9/12/2001); or low (9/13-24/2001). We modeled relative rates (RR) and 95% confidence intervals (CI) of OAD incidence by exposure over the first 10 years post-9/11/2001, estimating the time(s) of change in the RR with change point models. We further examined the relationship between self-reported lower respiratory symptoms and physician diagnoses. Results: Change points were observed at 15 and 84 months post-9/11/2001, with relative incidence rates for the high versus low exposure group of 4.02 (95% CI 2.62-6.16) prior to 15 months, 1.90 (95% CI 1.49-2.44) from months 16 to 84, and 1.20 (95% CI 0.92-1.56) thereafter. Incidence in all exposure groups increased after the WTC health program began to offer free coverage of OAD medications in month 63. Self-reported lower respiratory symptoms in the first 15 months had 80.6% sensitivity, but only 35.9% specificity, for eventual OAD diagnoses. Conclusions: New OAD diagnoses are associated with WTC exposure for at least seven years. Some portion of the extended duration of that association may be due to delayed diagnoses. Nevertheless, our results support recognizing OAD among rescue workers as WTC-related even when diagnosed years after exposure.
Collapse
Affiliation(s)
- Charles B Hall
- Department of Epidemiology and Population Health and Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xiaoxue Liu
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Mayris P Webber
- Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Thomas K Aldrich
- Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jessica Weakley
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Theresa Schwartz
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michelle S Glaser
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Brianne L Olivieri
- Montefiore Medical Center, Bronx, New York, USA; The Fire Department of the City of New York, Brooklyn, New York, USA
| | - Michael D Weiden
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York, USA; The Fire Department of the City of New York, Brooklyn, New York, USA
| | - Anna Nolan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York, USA; The Fire Department of the City of New York, Brooklyn, New York, USA
| | - Kerry J Kelly
- The Fire Department of the City of New York, Brooklyn, New York, USA
| | - David J Prezant
- The Fire Department of the City of New York, Brooklyn, New York, USA; Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
5
|
Glaser MS, Webber MP, Zeig-Owens R, Weakley J, Liu X, Ye F, Cohen HW, Aldrich TK, Kelly KJ, Nolan A, Weiden MD, Prezant DJ, Hall CB. Estimating the time interval between exposure to the World Trade Center disaster and incident diagnoses of obstructive airway disease. Am J Epidemiol 2014; 180:272-9. [PMID: 24980522 PMCID: PMC4108044 DOI: 10.1093/aje/kwu137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Respiratory disorders are associated with occupational and environmental exposures. The latency period between exposure and disease onset remains uncertain. The World Trade Center (WTC) disaster presents a unique opportunity to describe the latency period for obstructive airway disease (OAD) diagnoses. This prospective cohort study of New York City firefighters compared the timing and incidence of physician-diagnosed OAD relative to WTC exposure. Exposure was categorized by WTC arrival time as high (on the morning of September 11, 2001), moderate (after noon on September 11, 2001, or on September 12, 2001), or low (during September 13–24, 2001). We modeled relative rates and 95% confidence intervals of OAD incidence by exposure over the first 5 years after September 11, 2001, estimating the times of change in the relative rate with change point models. We observed a change point at 15 months after September 11, 2001. Before 15 months, the relative rate for the high- versus low-exposure group was 3.96 (95% confidence interval: 2.51, 6.26) and thereafter, it was 1.76 (95% confidence interval: 1.26, 2.46). Incident OAD was associated with WTC exposure for at least 5 years after September 11, 2001. There were higher rates of new-onset OAD among the high-exposure group during the first 15 months and, to a lesser extent, throughout follow-up. This difference in relative rate by exposure occurred despite full and free access to health care for all WTC-exposed firefighters, demonstrating the persistence of WTC-associated OAD risk.
Collapse
Affiliation(s)
| | - Mayris P. Webber
- Correspondence to Dr. Mayris P. Webber, Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, 5E-63-K, Brooklyn, NY 11201 (e-mail: )
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Niles JK, Webber MP, Liu X, Zeig-Owens R, Hall CB, Cohen HW, Glaser MS, Weakley J, Schwartz TM, Weiden MD, Nolan A, Aldrich TK, Glass L, Kelly KJ, Prezant DJ. The upper respiratory pyramid: early factors and later treatment utilization in World Trade Center exposed firefighters. Am J Ind Med 2014; 57:857-65. [PMID: 24898816 DOI: 10.1002/ajim.22326] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND We investigated early post 9/11 factors that could predict rhinosinusitis healthcare utilization costs up to 11 years later in 8,079 World Trade Center-exposed rescue/recovery workers. METHODS We used bivariate and multivariate analytic techniques to investigate utilization outcomes; we also used a pyramid framework to describe rhinosinusitis healthcare groups at early (by 9/11/2005) and late (by 9/11/2012) time points. RESULTS Multivariate models showed that pre-9/11/2005 chronic rhinosinusitis diagnoses and nasal symptoms predicted final year healthcare utilization outcomes more than a decade after WTC exposure. The relative proportion of workers on each pyramid level changed significantly during the study period. CONCLUSIONS Diagnoses of chronic rhinosinusitis within 4 years of a major inhalation event only partially explain future healthcare utilization. Exposure intensity, early symptoms and other factors must also be considered when anticipating future healthcare needs.
Collapse
Affiliation(s)
- Justin K. Niles
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Mayris P. Webber
- Department of Epidemiology & Population Health; Montefiore Medical Center; Bronx New York
- Department of Epidemiology & Population Health; Albert Einstein College of Medicine; Bronx New York
| | - Xiaoxue Liu
- Department of Medicine; Montefiore Medical Center; Bronx New York
| | | | - Charles B. Hall
- Department of Epidemiology & Population Health; Albert Einstein College of Medicine; Bronx New York
| | - Hillel W. Cohen
- Department of Epidemiology & Population Health; Albert Einstein College of Medicine; Bronx New York
| | | | - Jessica Weakley
- Department of Medicine; Montefiore Medical Center; Bronx New York
| | | | - Michael D. Weiden
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
- Division of Pulmonary; Critical Care and Sleep; New York University, School of Medicine; New York New York
| | - Anna Nolan
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
- Division of Pulmonary; Critical Care and Sleep; New York University, School of Medicine; New York New York
| | - Thomas K. Aldrich
- Department of Medicine; Montefiore Medical Center; Bronx New York
- Department of Medicine; Albert Einstein College of Medicine; Bronx New York
| | - Lara Glass
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Kerry J. Kelly
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - David J. Prezant
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
- Department of Medicine; Montefiore Medical Center; Bronx New York
- Department of Medicine; Albert Einstein College of Medicine; Bronx New York
| |
Collapse
|
7
|
Niles JK, Webber MP, Cohen HW, Hall CB, Zeig-Owens R, Ye F, Glaser MS, Weakley J, Weiden MD, Aldrich TK, Nolan A, Glass L, Kelly KJ, Prezant DJ. The respiratory pyramid: From symptoms to disease in World Trade Center exposed firefighters. Am J Ind Med 2013; 56:870-80. [PMID: 23788055 DOI: 10.1002/ajim.22171] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study utilizes a four-level pyramid framework to understand the relationship between symptom reports and/or abnormal pulmonary function and diagnoses of airway diseases (AD), including asthma, recurrent bronchitis and COPD/emphysema in WTC-exposed firefighters. We compare the distribution of pyramid levels at two time-points: by 9/11/2005 and by 9/11/2010. METHODS We studied 6,931 WTC-exposed FDNY firefighters who completed a monitoring exam during the early period and at least two additional follow-up exams 9/11/2005-9/11/2010. RESULTS By 9/11/2005 the pyramid structure was as follows: 4,039 (58.3%) in Level 1, no respiratory evaluation or treatment; 1,608 (23.2%) in Level 2, evaluation or treatment without AD diagnosis; 1,005 (14.5%) in Level 3, a single AD diagnosis (asthma, emphysema/COPD, or recurrent bronchitis); 279 (4.0%) in Level 4, asthma and another AD. By 9/11/2010, the pyramid distribution changed considerably, with Level 1 decreasing to 2,612 (37.7% of the cohort), and Levels 3 (N = 1,530) and 4 (N = 796) increasing to 22.1% and 11.5% of the cohort, respectively. Symptoms, spirometry measurements and healthcare utilization were associated with higher pyramid levels. CONCLUSIONS Respiratory diagnoses, even four years after a major inhalation event, are not the only drivers of future healthcare utilization. Symptoms and abnormal FEV-1 values must also be considered if clinicians and healthcare administrators are to accurately anticipate future treatment needs, years after initial exposure.
Collapse
Affiliation(s)
- Justin K. Niles
- Fire Department of the City of New York; Bureau of Health Services; Brooklyn; New York
| | | | - Hillel W. Cohen
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx; New York
| | - Charles B. Hall
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx; New York
| | | | - Fen Ye
- Department of Medicine; Montefiore Medical Center; Bronx; New York
| | | | - Jessica Weakley
- Department of Medicine; Montefiore Medical Center; Bronx; New York
| | | | | | | | - Lara Glass
- Fire Department of the City of New York; Bureau of Health Services; Brooklyn; New York
| | - Kerry J. Kelly
- Fire Department of the City of New York; Bureau of Health Services; Brooklyn; New York
| | | |
Collapse
|
8
|
Nolan A, Naveed B, Comfort AL, Ferrier N, Hall CB, Kwon S, Kasturiarachchi KJ, Cohen HW, Zeig-Owens R, Glaser MS, Webber MP, Aldrich TK, Rom WN, Kelly K, Prezant DJ, Weiden MD. Inflammatory biomarkers predict airflow obstruction after exposure to World Trade Center dust. Chest 2012; 142:412-418. [PMID: 21998260 DOI: 10.1378/chest.11-1202] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The World Trade Center (WTC) collapse on September 11, 2001, produced airflow obstruction in a majority of firefighters receiving subspecialty pulmonary evaluation (SPE) within 6.5 years post-September 11, 2001. METHODS In a cohort of 801 never smokers with normal pre-September 11, 2001, FEV1, we correlated inflammatory biomarkers and CBC counts at monitoring entry within 6 months of September 11, 2001, with a median FEV(1) at SPE (34 months; interquartile range, 25-57). Cases of airflow obstruction had FEV(1) less than the lower limit of normal (LLN) (100 of 801; 70 of 100 had serum), whereas control subjects had FEV(1) greater than or equal to LLN (153 of 801; 124 of 153 had serum). RESULTS From monitoring entry to SPE years later, FEV(1) declined 12% in cases and increased 3% in control subjects. Case subjects had elevated serum macrophage derived chemokine (MDC), granulocyte-macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor, and interferon inducible protein-10 levels. Elevated GM-CSF and MDC increased the risk for subsequent FEV(1) less than LLN by 2.5-fold (95% CI, 1.2-5.3) and 3.0-fold (95% CI, 1.4-6.1) in a logistic model adjusted for exposure, BMI, age on September 11, 2001, and polymorphonuclear neutrophils. The model had sensitivity of 38% (95% CI, 27-51) and specificity of 88% (95% CI, 80-93). CONCLUSIONS Inflammatory biomarkers can be risk factors for airflow obstruction following dust and smoke exposure. Elevated serum GM-CSF and MDC levels soon after WTC exposure were associated with increased risk of airflow obstruction in subsequent years. Biomarkers of inflammation may help identify pathways producing obstruction after irritant exposure.
Collapse
Affiliation(s)
- Anna Nolan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York; Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn
| | - Bushra Naveed
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York
| | - Ashley L Comfort
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York; Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn
| | - Natalia Ferrier
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Sophia Kwon
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York; Touro College of Osteopathic Medicine, New York
| | - Kusali J Kasturiarachchi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Rachel Zeig-Owens
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn
| | - Michelle S Glaser
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn
| | - Mayris P Webber
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Thomas K Aldrich
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - William N Rom
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York
| | - Kerry Kelly
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn
| | - David J Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Michael D Weiden
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York; Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn.
| |
Collapse
|
9
|
Webber MP, Glaser MS, Weakley J, Soo J, Ye F, Zeig-Owens R, Weiden MD, Nolan A, Aldrich TK, Kelly K, Prezant D. Physician-diagnosed respiratory conditions and mental health symptoms 7-9 years following the World Trade Center disaster. Am J Ind Med 2011; 54:661-71. [PMID: 21966080 DOI: 10.1002/ajim.20993] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study examines the prevalence of physician-diagnosed respiratory conditions and mental health symptoms in firefighters and emergency medical service workers up to 9 years after rescue/recovery efforts at the World Trade Center (WTC). METHODS We analyzed Fire Department of New York (FDNY) physician and self-reported diagnoses by WTC exposure and quintiles of pulmonary function (FEV1% predicted). We used screening instruments to assess probable post-traumatic stress disorder (PTSD) and probable depression. RESULTS FDNY physicians most commonly diagnosed asthma (8.8%) and sinusitis (9.7%). The highest prevalence of physician-diagnosed obstructive airway disease (OAD) was in the lowest FEV1% predicted quintile. Participants who arrived earliest on 9/11 were more likely to have physician-diagnosed asthma (OR = 1.4). Seven percent had probable PTSD. 19.4% had probable depression. CONCLUSIONS Self-reported and physician-diagnosed respiratory conditions remain common, especially among those who arrived earliest at the WTC site. OAD was associated with the lowest pulmonary function. Since respiratory and mental health conditions remain prevalent, ongoing monitoring and treatment is important.
Collapse
Affiliation(s)
- Mayris P Webber
- Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Glaser MS, Chui S, Webber MP, Gustave J, Lee R, McLaughlin MT, Ortiz V, Prezant D, Kelly K. Predictors of acceptance of H1N1 influenza vaccination by FDNY firefighters and EMS workers. Vaccine 2011; 29:5675-80. [PMID: 21693157 DOI: 10.1016/j.vaccine.2011.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 05/24/2011] [Accepted: 06/07/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a widely recognized need for vaccination of health care workers (HCWs). We undertook this study to assess the 2009-2010 H1N1 vaccination rates in ∼14,000 firefighters and emergency medical service (EMS) workers at the Fire Department of New York (FDNY) and to determine predictors of H1N1 vaccine acceptance. METHODS After 9/11/01, FDNY developed a bio-preparedness drill where units are dispatched to FDNY-BIOPOD (biologic points of distributions) for rapid distribution of medications/vaccines in the event of a biological disaster. Since 2005, FDNY offers free, voluntary seasonal influenza vaccination during routine medical monitoring/treatment examinations and at FDNY-BIOPOD. In 2009, FDNY-BIOPOD instead offered the H1N1 vaccine. We report on FDNY H1N1 vaccination rates and on predictors of acceptance using bivariate and multivariable techniques. RESULTS Overall, 10,612 (77%) FDNY workers were offered H1N1 vaccination, of whom 5831 (55%) accepted. Acceptance was 57.2% during FDNY-BIOPOD compared with 34.4% during medical monitoring/treatment exams (p=0.0001). Workers who accepted prior seasonal influenza vaccinations were 4 times more likely to accept H1N1 vaccination (AOR=4.4, CI(95)=4.0-4.8). CONCLUSION FDNY offered H1N1 vaccination to 77% of its workforce during the 2009-2010 season. Prior seasonal vaccine acceptance and vaccination in a group setting such as FDNY-BIOPOD dramatically increased acceptance of the H1N1 vaccine. However, within a voluntary program, additional strategies are needed to further increase vaccine acceptance in first responders and other HCWs.
Collapse
Affiliation(s)
- Michelle S Glaser
- Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | | | | | | | | | | | | | | | | |
Collapse
|