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Seidman AJ, Born W, Corriveau E. First Responders During COVID-19: Career Calling, PTSD, and Work Self-Efficacy. Am J Prev Med 2024; 66:1017-1023. [PMID: 38211731 DOI: 10.1016/j.amepre.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION During the COVID-19 pandemic, first responders were identified as a high-risk group for developing symptoms of post-traumatic stress disorder (PTSD) and depression, which are commonly associated with negative thoughts about oneself. This may pose risk to perceptions of work self-efficacy, an integral component of employee well-being and occupational functioning. In line with the Job Demands-Resources Model (Demerouti et al., 2001), the present study examined whether the degree to which first responders' perceived career calling (i.e., a "summons" to work) served as a protective factor in the relationship between PTSD symptoms associated with the COVID-19 pandemic and perceptions of self-efficacy in the workplace. METHODS Participants were 138 first responders from local county police and fire departments who completed online screening measures for probable PTSD and depression, as well as self-reports of work self-efficacy and career calling, between May and June 2020. Statistical analysis occurred between 2020 and 2021. RESULTS Moderation analysis, controlling for depression and relevant covariates, revealed an interaction between PTSD symptoms and career calling, ΔR2=0.04, p=0.017. At low levels of career calling, there was a significant and negative relationship between PTSD symptoms and work self-efficacy (b=‒0.14, p=0.023), but not among first responders with average or high calling (p's>0.58). Positive screening rates were 22% for probable PTSD and 19% for depression. CONCLUSIONS Perceiving a career calling may help protect first responders during COVID-19 from the deleterious effects of PTSD symptomatology on work self-efficacy. Prevention efforts targeting first responders with low calling strength may be warranted.
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Affiliation(s)
| | - Wendi Born
- Department of Psychiatry, University of Kansas School of Medicine, Kansas City, Kansas
| | - Erin Corriveau
- Department of Family Medicine & Community Health, University of Kansas School of Medicine, Kansas City, Kansas
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Cannon MF, Goldfarb DG, Zeig-Owens RA, Hall CB, Choi J, Cohen HW, Prezant DJ, Weiden MD. Normal Lung Function and Mortality in World Trade Center Responders and National Health and Nutrition Examination Survey III Participants. Am J Respir Crit Care Med 2024; 209:1229-1237. [PMID: 38163381 DOI: 10.1164/rccm.202309-1654oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
Rationale: Low FEV1 is a biomarker of increased mortality. The association of normal lung function and mortality is not well described. Objectives: To evaluate the FEV1-mortality association among participants with normal lung function. Methods: A total of 10,999 Fire Department of the City of New York (FDNY) responders and 10,901 Third National Health and Nutrition Examination Survey (NHANES III) participants, aged 18-65 years with FEV1 ⩾80% predicted, were analyzed, with FEV1 percent predicted calculated using Global Lung Function Initiative Global race-neutral reference equations. Mortality data were obtained from linkages to the National Death Index. Cox proportional hazards models estimated the association between FEV1 and all-cause mortality, controlling for age, sex, race/ethnicity, smoking history, and, for FDNY, work assignment. Cohorts were followed for a maximum of 20.3 years. Measurements and Main Results: We observed 504 deaths (4.6%) of 10,999 for FDNY and 1,237 deaths (9.4% [weighted]) of 10,901 for NHANES III. Relative to FEV1 ⩾120% predicted, mortality was significantly higher for FEV1 100-109%, 90-99%, and 80-89% predicted in the FDNY cohort. In the NHANES III cohort, mortality was significantly higher for FEV1 90-99% and 80-89% predicted. Each 10% higher predicted FEV1 was associated with 15% (hazard ratio, 0.85; 95% confidence interval, 0.80-0.91) and 23% (hazard ratio, 0.77; 95% confidence interval, 0.71-0.84) lower mortality for FDNY and NHANES III, respectively. Conclusions: In both cohorts, higher FEV1 is associated with lower mortality, suggesting higher FEV1 is a biomarker of better health. These findings demonstrate that a single cross-sectional measurement of FEV1 is predictive of mortality over two decades, even when FEV1 is in the normal range.
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Affiliation(s)
- Madeline F Cannon
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Rachel A Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Michael D Weiden
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- New York University Grossman School of Medicine, New York, New York
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Gamberini L, Del Giudice D, Tartaglione M, Allegri D, Coniglio C, Pastori A, Gordini G, Semeraro F. Logistic and cognitive-emotional barriers experienced by first responders when alarmed to get dispatched to out-of-hospital cardiac arrest events: a region-wide survey. Intern Emerg Med 2024; 19:813-822. [PMID: 38123905 DOI: 10.1007/s11739-023-03487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major public health concern with low survival rates. First responders (FRs) and public access defibrillation (PAD) programs can significantly improve survival, although barriers to response activation persist. The Emilia Romagna region in Italy has introduced a new system, the DAE RespondER App, to improve the efficiency of FR dispatch in response to OHCA. The study aimed to evaluate the association between different logistic factors, FRs' perceptions, and their decision to accept or decline dispatch to an OHCA scene using the DAE RespondER App. A cross-sectional web survey was conducted, querying 14,518 registered FRs using the DAE RespondER app in Emilia Romagna. The survey explored logistic and cognitive-emotional perceptions towards barriers in responding to OHCAs. Statistical analysis was conducted, with responses adjusted using non-response weights. 4,644 responses were obtained (32.0% response rate). Among these, 1,824 (39.3%) had received at least one dispatch request in the past year. Multivariable logistic regression showed that being male, having previous experience with OHCA situations, and having an automated external defibrillator (AED) available at the moment of the call were associated with a higher probability of accepting the dispatch. Regarding FRs' perceptions, logistic obstacles were associated with mission rejection, while higher scores in cognitive-emotional obstacles were associated with acceptance. The study suggests that both logistical and cognitive-emotional factors are associated with FRs' decision to accept a dispatch. Addressing these barriers and further refining the DAE RespondER App can enhance the effectiveness of PAD programs, potentially improving survival rates for OHCA. The insights from this study can guide the development of interventions to improve FR participation and enhance overall OHCA response systems.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | | | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Antonio Pastori
- Settore Assistenza Ospedaliera, Direzione Generale Cura Della Persona, Salute E Welfare, Assessorato Politiche Per La Salute, Regione Emilia, Bologna, Italy
| | - Giovanni Gordini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Federico Semeraro
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
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Kaminskyi OV, Kopylova OV, Afanasyev DE, Muraviova IM, Chikalova IG, Dombrovska NS. CLINICAL-METABOLIC AND HORMONAL RELATIONSHIPS BETWEEN PARATHYROID DISEASE AND OTHER NON-CANCEROUS ENDOCRINE DISORDERS IN THE CHORNOBYL NPP ACCIDENT SURVIVORS. Probl Radiac Med Radiobiol 2021; 26:410-425. [PMID: 34965563 DOI: 10.33145/2304-8336-2021-26-410-425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE to investigate the clinical, hormonal-metabolic and structural features of parathyroid injuries in sur-vivors exposed to ionizing radiation after the Chornobyl NPP accident in adulthood and childhood, both with theirconnections to other non-cancerous endocrine disorders, and to establish the respective interhormonal and dys-metabolic relationships. MATERIALS AND METHODS Clinical effects of ionizing radiation on the endocrine system in persons affected by theChornobyl NPP accident (n = 224) and their descendants (n = 146), compared with the general population sample(n = 70) were the study object. All patients underwent the ultrasound thyroid and parathyroid examination. Thegenerally recognized clinical, anthropometric (body weight, height, thigh volume, body mass index), instrumental(ultrasound examination of thyroid and parathyroid glands), laboratory (biochemical, hormonal), and statisticalmethods were applied. Parametric and nonparametric statistical methods were used in data processing. The value ofp < 0.05 was considered a statistically significant. RESULTS No significant difference was found in the incidence of carbohydrate metabolic disorders in the ChornobylNPP (ChNPP) accident consequences clean-up workers (ACCUW), evacuees from the NPP 30-km exclusion zone, res-idents of radiologically contaminated areas and in the control group in whom the parathyroid hyperplasia wasdetected. There was a significant increase in the incidence of arterial hypertension among ACCUW who had parathy-roid hyperplasia (76.9%) vs. the control group (51.2%). In cases of parathyoid hyperplasia the vitamin D levels weresignificantly lower than without it. Vitamin D insufficiency/deficiency was found in 94% of the surveyed subjects.The average level of parathyroid hormone in blood serum was significantly higher in the ACCUW of «iodine» period withdiagnosed parathyroid hyperplasia than in the control group: (57.2 ± 2.87) pg / ml against (32.74 ± 3.58) pg / ml,p < 0.05. Results of multivariative analysis indicated a strong association of vitamin 25(OH)D insufficiency/defi-ciency with development of thyroid disease, carbohydrate metabolic disorders, cardiovascular disease, osteo-penia/osteoporosis. parathyroid ultrasound scan was at that an effective diagnostic method for primary screeningfor parathyroid hyperplasia and regular monitoring of the treatment efficiency. When examining children bornto parents irradiated after the ChNPPA the parathyroid hyperplasia (58%) and low serum content of vitamin D(11.6 ± 3.5) nmol / l were most often found in children living on radiologically contaminated territories (RCT).A strong correlation was established between the HOMA insulin resistance index and serum content of vitamin D(r = 0.65), parathyroid hormone (r = 0.60), and free thyroxine (r = 0.68) in the group of children born to parents irra-diated after the ChNPPA, having got chronic autoimmune thyroiditis, which indicated a relationship between thy-roid function, impaired carbohydrate and fat metabolism and the state of parathyroids. CONCLUSIONS No difference in the incidence of carbohydrate metabolic disorders was found in the ChNPP ACCUW,evacuees from the 30-km exclusion zone, and residents of radiologically contaminated territories in whom parathy-roid hyperplasia was detected vs. the control group. Patients with parathyroid hyperplasia were found to be defi-cient in vitamin D in 94% of cases, and level of latter was significantly lower than under the normal parathyroid size.There was a significant increase in the incidence of diagnosed arterial hypertension among ACCUW who had parathy-roid hyperplasia vs. the control group: (76.9 ± 3.5)% vs. (51.2 ± 3.7)%. According to multivariate analysis a strongassociation between the vitamin 25(OH)D insufficiency/deficiency and development of thyroid disease, carbohydratemetabolic disorders, cardiovascular disease, and osteopenia/osteoporosis was established. The average level of pa-rathyroid hormone in the blood serum of the ChNPP ACCUW of the «iodine» period with diagnosed parathyroid hyper-plasia was significantly higher (57.2 ± 2.87) pg / ml against (32.74 ± 3.58) pg / ml; p <0,05) in the control group.
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Affiliation(s)
- O V Kaminskyi
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - O V Kopylova
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - D E Afanasyev
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - I M Muraviova
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - I G Chikalova
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - N S Dombrovska
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
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Golyarnik NA, Ilienko IN, Zvarych LM, Vorobyov MO, Bazyka DA. СHARACTERISTICS OF CYCLIN D1-MEDIATED REGULATION OF CELL CYCLE OF PERIPHERAL BLOOD LIMPHOCYTES OF CHORNOBYL CLEAN-UP WORKERS AND PERSONS WITH MALIGNANT NEOPLASMS OF THE ORAL CAVITY, OROPHARYNX AND LARYNGOPHARYNX. Probl Radiac Med Radiobiol 2021; 26:357-370. [PMID: 34965560 DOI: 10.33145/2304-8336-2021-26-357-370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE to explore proliferative potential of peripheral blood lymphocytes of Chornobyl clean-up workers and persons with malignant neoplasms of the oral cavity, oropharynx and laryngopharynx by level of expression of cyclin D1 and quantitative parameters of cell cycle. MATERIALS AND METHODS A total of 294 men aged (58.47 ± 7.32) were surveyed, 215 of them were Chornobyl clean"up workers (1986-1987), exposed at the dose range 10.43-3623.31 mSv; 49 persons of the control group and 30persons with malignant neoplasms of the oral cavity, oropharynx and laryngopharynx at III, IVА and IVВ stages ofthe disease. The analysis of parameters of cell cycle and proliferative activity of peripheral blood (PB) lymphocyteswas performed using the flow cytometry. The evaluation of distribution of cells by G0/G1, S, G2/M cell cycle phaseswas done in vivo and in in vitro. Proliferative potential was analyzed by level of expression of cytoplasmic protein ofcyclin D1. RESULTS Proliferative potential of PB lymphocytes of Chornobyl clean"up workers and persons with malignant neo"plasms of the oral cavity, oropharynx and laryngopharynx was assessed. An increase in the level of spontaneousсyclin D1 expression and disturbance of сyclin D1-dependent regulation of cell cycle of PB lymphocytes after mito"gen activation were determined in the Chornobyl clean-up workers. An increase in pool of cells in the S" and G2/M"phases of cell cycle was detected, which characterizes high proliferative potential of PB lymphocytes. These changesare most pronounced in the subgroup of persons with a radiation dose of D > 500 mSv, and in persons with oncolo"gical pathology. CONCLUSIONS A positive linear dependence has been established between the radiation dose and the number of cellsin the S"phase of cell cycle in the subgroup of Chornobyl clean"up workers with a radiation dose of D > 500 mSv. The detected changes of cyclin D1-dependent regulation of cell cycle and proliferative status of lymphocytes depend on the radiation dose, can be a manifestation of genome instability and be a cause for risks of oncogenesis, in a remote period after radiation exposure.
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Affiliation(s)
- N A Golyarnik
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - I N Ilienko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - L M Zvarych
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - M O Vorobyov
- Municipal non-profit enterprise «Zaporizhzhia Regional Antitumor Center» Zaporizhzhia Regional Council, 177-a Kulturna Str., Zaporizhzhia, 69040, Ukraine
| | - D A Bazyka
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
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Voronko AA, Seliuk OV, Bohomolets OV. COMORBID INTERNAL DISEASES IN MILITARY SERVANTS WHO HAVE SENSED THE EXPOSURE OF EXTREME FACTORS OF MILITARY SERVICE. Probl Radiac Med Radiobiol 2021; 26:339-356. [PMID: 34965559 DOI: 10.33145/2304-8336-2021-26-339-356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE to analyze comorbid pathology by methods of its quantitative assessment in servicemen exposed toextreme factors of military service (a set of factors of radiation accidents, the influence of modern armed conflictsand modern combat trauma without blood loss). MATERIALS AND METHODS Studies of comorbid pathology were performed in 613 servicemen who were treated at theclinical base of the Ukrainian Military Medical Academy (UMMA) in National Military Medical Clinical Center «MainMilitary Clinical Hospital» NMMCC «MMCH» during 1989-2018 years. Soldiers who suffered from acute radiation sick-ness (ARS) in 1961 (n = 34), participants in the liquidation of the consequences of the Chornobyl catastrophe(PLCChC) 15 years after participating in the elimination of its consequences and in a later period (respectivelyPLCChC 1st group (n = 59) and the 2nd group (n = 337)). Soldiers are participants in the anti-terrorist operation(ATO)/Combined Forces (CFO) operation who did not receive modern combat injuries with blood loss (participants inthe ATO/CFO, n = 183). All servicemen did not have any diseases limiting their fitness capabilities for military serv-ice before being exposed to extreme factors of military service. A cumulative CIRS scale was used to comprehensive-ly assess comorbidity. RESULTS With increasing time after participation in the elimination of the consequences of radiation accidents, thecourse of arterial hypertension (AH) is aggravated, but the dose-dependence of the severity of AH on the receivedradiation dose has not been established. The easier course of hypertension in ATO/CFO servicemen compared to ARSremote servicemen and group 2 PLCChC servicemen can be explained by their younger age at the time of the surveyand less time after exposure to extreme military service factors. In the military in the remote period after exposureto a complex of factors of radiation accidents, the frequency of diagnosing diseases by individual organs and bodysystem increases comparing to non-irradiated servicemen. The total number of disease severity scores on the cumu-lative scale of CIRS diseases is also higher. However, a dose-dependent effect of the severity of comorbid patholo-gy was also not found. These data indicate a higher prevalence of comorbid pathology in servicemen affected by acomplex of factors of radiation accf5idents, compared with participants in the anti-terrorist operation / environ-mental protection. However, the lower severity of comorbid pathology in ATO/CFO participants can also be explainedby their younger age at the time of the survey and less time after exposure to extreme factors of military service. CONCLUSIONS For servicemen, with increasing time after participation in the elimination of the consequences ofradiation accidents, the course of hypertension without its dose dependence becomes more difficult. The total num-ber of disease severity scores on the cumulative scale of CIRS diseases in servicemen in the remote period after participation in the elimination of the consequences of radiation accidents is higher than in non-irradiated service-men. However, a dose-dependent effect of the severity of comorbid pathology was also not found.
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Affiliation(s)
- A A Voronko
- Ukrainian Military Medical Academy, 45/1, building 33, Moskovskaya Str., Kyiv, 01015, Ukraine
| | - O V Seliuk
- Ukrainian Military Medical Academy, 45/1, building 33, Moskovskaya Str., Kyiv, 01015, Ukraine
| | - O V Bohomolets
- Ukrainian Military Medical Academy, 45/1, building 33, Moskovskaya Str., Kyiv, 01015, Ukraine
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Nosach OV, Sarkissova EO, Alyokhina SM, Pleskach OY, Litvinets OM, Ovsyannikova LM, Chumak AA. SUBCLINICAL INFLAMMATION IN NON/ALCOHOLIC FATTY LIVER DISEASE AT THE REMOTE PERIOD AFTER THE CHORNOBYL ACCIDENT. Probl Radiac Med Radiobiol 2021; 26:437-448. [PMID: 34965565 DOI: 10.33145/2304-8336-2021-26-437-448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE to evaluate the parameters of inflammatory reaction and oxidative stress in patients with non-alcoholicfatty liver disease (NAFLD) in the remote period after the influence of the Chornobyl accident factors. MATERIALS AND METHODS Eighty two patients with NAFLD who had been exposed to ionizing radiation as a result ofthe Chornobyl accident and have concomitant cardiovascular pathology were examined. Hematological parametersand the level of highly sensitive C-reactive protein (hsCRP) were determined, and the content of products of oxida-tive modification of lipids and proteins was evaluated. RESULTS Activation of the processes of oxidative modification of lipids and proteins was observed in most patientswith NAFLD. According to the level of hsCRP, the presence of subclinical inflammation and the risk of developingcomplicated cardiovascular pathology was found in 58 % of patients with NAFLD. The neutrophil / lymphocyte ratiocorrelates positively with hsCRP and can be used as an available routine clinical marker for selection among patientswith NAFLD persons with increased risk of cardiovascular complications. CONCLUSIONS HsCRP, oxidative modification products of lipids and proteins, ESR, and leukograms should be used toassess the degree of systemic inflammation in people affected by the Chornobyl accident, suffering NAFLD with con-comitant cardiovascular disease.
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Affiliation(s)
- O V Nosach
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - E O Sarkissova
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - S M Alyokhina
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - O Ya Pleskach
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - O M Litvinets
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - L M Ovsyannikova
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - A A Chumak
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
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Belyi DO, Ilyenko I, Nastina O, Sydorenko G, Gabulavichene Z, Kursina N, Bazyka O, Bilaya V, Kovaliov O, Bazyka D. RELATIVE TELOMERE LENGTH OF PERIPHERAL BLOOD LYMPHOCYTES AND STRUCTURAL AND FUNCTIONAL STATE OF THE LEFT VENTRICLE MYOCARDIUM IN CLEAN-UP WORKERS OF THE CHORNOBYL ACCIDENT WHO SUFFERED FROM STENOTIC CORONARY ATHEROSCLEROSIS. Probl Radiac Med Radiobiol 2021; 26:319-338. [PMID: 34965558 DOI: 10.33145/2304-8336-2021-26-319-338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Indexed: 06/14/2023]
Abstract
UNLABELLED The objective was to analyze the relative telomere length (RTL) of peripheral blood lymphocytes depending onmyocardium structural and functional state in emergency workers (EW) of the Chornobyl accident who suffered fromcoronary arteries stenotic atherosclerosis. MATERIALS AND METHODS There were examined 60 male EW who operated at the Chornobyl nuclear power plant at1986 and 25 male non-irradiated persons (control group - CG) with coronary heart disease (CHD). Everyone EW andCG patients were almost healthy before the accident. During the period 2016-2021, they underwent a comprehen-sive clinical and laboratory examination, echodopplercardiographic examination and determination of RTL by fluo-rescent hybridization in situ using laser flow cytometry. RESULTS EW almost did not differ from CG according to its clinical characteristics, the presence of risk factors,indices of systolic and diastolic heart functions, as well as RTL. The analysis of variance showed that RTL was influ-enced by the fact of irradiation in combination with obesity (p = 0.020). At normal body weight, RTL average valuein CG was significantly higher than in EW (p = 0.023). According to the results of hierarchical cluster analysis of twovariables as RTL and end-diastolic volume normalized by body surface area (EDV/BSA), EW and CG patients togeth-er were divided into two subgroups. The first subgroup (1st cluster) differed from the second (2nd cluster) by signi-ficantly larger average values of left ventricle (LV) EDV and end-systolic volume (ESV) as well as EDV/BSA andESV/BSA, LV myocardial mass (MM) and MM/BSA, reduced ejection fraction (EF). In patients of the 1st cluster telom-eres were significantly shorter than in the 2nd one (10,3 ± 1.7 vs. 14.3 ± 2.0 at p = 0.000). The increase of myocar-dial mass and LV wall thickness caused the development of its hypertrophy. The number of people with hypertrophyLV was significantly higher among patients of the 1st cluster (91.6 vs. 67.2 %, p < 0.001) due to eccentric hypertro-phy LV. Accordingly, concentric hypertrophy LV was more common among patients in the 2nd cluster (24.6 vs. 4.2 %at p < 0.01). Patients of the 1st cluster was characterized by a more severe course of heart failure. CONCLUSIONS In patients who suffered from CHD with stenotic atherosclerosis of the coronary arteries and wereexposed to radiation 30-35 years earlier, having normal body weight, there was a reduction in telomere. Hierarchicalcluster analysis proved to be a good tool that allows by the value of RTL and EDV/BSA to separate the group ofpatients with the most severe clinical course of CHD and LV systolic dysfunction among patients with the samepathology.
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Affiliation(s)
- D O Belyi
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - I Ilyenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - O Nastina
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - G Sydorenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - Z Gabulavichene
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - N Kursina
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - O Bazyka
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - V Bilaya
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - O Kovaliov
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - D Bazyka
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
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9
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Abstract
UNLABELLED The objective of the study was to improve the biological dosimetry approach among patients with acute radiationsickness of various degrees based on the analysis of radiation-induced chromosome aberrations in peripheral bloodlymphocytes of the victims. MATERIALS AND METHODS The study was based on primary cytogenetic data obtained in May 1986 within examina-tion of the 30 clean-up workers («liquidators») having got stage I-III acute radiation sickness. Dose verificationwas performed using the cytogenetic dosimetry based on a culture of peripheral blood lymphocytes with metaphaseanalysis of chromosome aberrations. RESULTS A new method of evaluating the results of patients' cytogenetic examination at the beginning of specifictherapy has been developed. Procedure was performed using a model of multiple linear regression (complex of cyto-genetic parameters) and provided a satisfactory diagnostic level (featuring a compliance with initially definedclinical and laboratory diagnoses). Overall frequency of the aberrant cells and radiation markers increased in high-er disease stages. There was a trend of the frequency growth of chromatid-type aberrations with increasing of radi-ation burden. Adequacy of the proposed method based on the regression analysis of cytogenetic results was con-firmed through the preservation of group differences in estimates of disease stage in subjects with verified diagnosis. CONCLUSION Cytogenetic dosimetry in the scope of examination of persons exposed to ionizing radiation is an oblig-atory component of radiation sickness stage verification. The recommended method of cytogenetic data evaluationbefore and at the beginning of detoxification therapy provides a satisfactory level of diagnostics.
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Affiliation(s)
- E A Djomina
- R. E. Kavetsky Institute Experimental Pathology, Oncology and Radiobiology of National Academy Science of Ukraine, 45 Vasylkivska Str., Kyiv, 03022, Ukraine
| | - V V Talko
- SI «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine» (NRCRM), 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
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10
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Goldfarb DG, Zeig-Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Webber MP, Dasaro CR, Shapiro M, Todd AC, Prezant DJ, Boffetta P, Hall CB. Temporal association of prostate cancer incidence with World Trade Center rescue/recovery work. Occup Environ Med 2021; 78:699-706. [PMID: 34507966 PMCID: PMC8458078 DOI: 10.1136/oemed-2021-107405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/20/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The World Trade Center (WTC) attacks on 11 September 2001 created a hazardous environment with known and suspected carcinogens. Previous studies have identified an increased risk of prostate cancer in responder cohorts compared with the general male population. OBJECTIVES To estimate the length of time to prostate cancer among WTC rescue/recovery workers by determining specific time periods during which the risk was significantly elevated. METHODS Person-time accruals began 6 months after enrolment into a WTC cohort and ended at death or 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. New York State was the comparison population. We used Poisson regression to estimate hazard ratios and 95% CIs; change points in rate ratios were estimated using profile likelihood. RESULTS The analytic cohort included 54 394 male rescue/recovery workers. We observed 1120 incident prostate cancer cases. During 2002-2006, no association with WTC exposure was detected. Beginning in 2007, a 24% increased risk (HR: 1.24, 95% CI 1.16 to 1.32) was observed among WTC rescue/recovery workers when compared with New York State. Comparing those who arrived earliest at the disaster site on the morning of 11 September 2001 or any time on 12 September 2001 to those who first arrived later, we observed a positive, monotonic, dose-response association in the early (2002-2006) and late (2007-2015) periods. CONCLUSIONS Risk of prostate cancer was significantly elevated beginning in 2007 in the WTC combined rescue/recovery cohort. While unique exposures at the disaster site might have contributed to the observed effect, screening practices including routine prostate specific antigen screening cannot be discounted.
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Affiliation(s)
- David G Goldfarb
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Mark R Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Janette Yung
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Amy R Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Maria J Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Mayris P Webber
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Montefiore Medical Center, Bronx, New York, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moshe Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David J Prezant
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Charles B Hall
- Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA
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11
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Abstract
PROBLEM/CONDITION After the September 11, 2001, terrorist attacks on the United States, approximately 400,000 persons were exposed to toxic contaminants and other factors that increased their risk for certain physical and mental health conditions. Shortly thereafter, both federal and nonfederal funds were provided to support various postdisaster activities, including medical monitoring and treatment. In 2011, as authorized by the James Zadroga 9/11 Health and Compensation Act of 2010, the CDC World Trade Center (WTC) Health Program began providing medical screening, monitoring, and treatment of 9/11-related health conditions for WTC responders (i.e., persons who were involved in rescue, response, recovery, cleanup, and related support activities after the September 11, 2001, terrorist attacks) and affected WTC survivors (i.e., persons who were present in the dust or dust cloud on 9/11 or who worked, lived, or attended school, child care centers, or adult day care centers in the New York City disaster area). REPORTING PERIOD COVERED 2012-2020. DESCRIPTION OF SYSTEM The U.S. Department of Health and Human Services WTC Health Program is administered by the director of CDC's National Institute for Occupational Safety and Health. The WTC Health Program uses a multilayer administrative claims system to process members' authorized program health benefits. Administrative claims data are primarily generated by clinical providers in New York and New Jersey at the Clinical Centers of Excellence and outside those states by clinical providers in the Nationwide Provider Network. This report describes WTC Health Program trends for selected indicators during 2012-2020. RESULTS In 2020, a total of 104,223 members were enrolled in the WTC Health Program, of which 73.4% (n = 76,543) were responders and 26.6% (n = 27,680) were survivors. WTC Health Program members are predominantly male (78.5%). The median age of members was 51 years (interquartile range [IQR]: 44-57) in 2012 and 59 years (IQR: 52-66) in 2020. During 2012-2020, enrollment and number of certifications of WTC-related health conditions increased among members, with the greatest changes observed among survivors. Overall, at enrollment, most WTC Health Program members lived in New York (71.7%), New Jersey (9.3%), and Florida (5.7%). In 2020, the total numbers of cancer and noncancer WTC-related certifications among members were 20,612 and 50,611, respectively. Skin cancer, male genital system cancers, and in situ neoplasms (e.g., skin and breast) are the most common WTC-related certified cancer conditions. The most commonly certified noncancer conditions are in the aerodigestive and mental health categories. The average number of WTC-related certified conditions per certified member is 2.7. In 2020, a total of 40,666 WTC Health Program members received annual monitoring and screening examinations (with an annual average per calendar year of 35,245). In 2020, the total number of WTC Health Program members who received treatment was 41,387 (with an annual average per calendar year of 32,458). INTERPRETATION Since 2011, the WTC Health Program has provided health care for a limited number of 9/11-related health conditions both for responders and survivors of the terrorist attacks. Over the study period, program enrollment and WTC certification increased, particularly among survivors. As the members age, increased use of health services and costs within the WTC Health Program are expected; chronic diseases, comorbidities, and other health-related conditions unrelated to WTC exposures are more common in older populations, which might complicate the clinical management of WTC-related health conditions. PUBLIC HEALTH ACTION Analysis of administrative claims data in the context of WTC research findings can better clarify the health care use patterns of WTC Health Program members. This information guides programmatic decision-making and might also help guide future disaster preparedness and response health care efforts. Strengthening the WTC Health Program health informatics infrastructure is warranted for timely programmatic and research decision-making.
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12
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Fowlkes A, Gaglani M, Groover K, Thiese MS, Tyner H, Ellingson K. Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance - Eight U.S. Locations, December 2020-August 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1167-1169. [PMID: 34437521 PMCID: PMC8389394 DOI: 10.15585/mmwr.mm7034e4] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
During December 14, 2020-April 10, 2021, data from the HEROES-RECOVER Cohorts,* a network of prospective cohorts among frontline workers, showed that the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines were approximately 90% effective in preventing symptomatic and asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19, in real-world conditions (1,2). This report updates vaccine effectiveness (VE) estimates including all COVID-19 vaccines available through August 14, 2021, and examines whether VE differs for adults with increasing time since completion of all recommended vaccine doses. VE before and during SARS-CoV-2 B.1.617.2 (Delta) variant predominance, which coincided with an increase in reported COVID-19 vaccine breakthrough infections, were compared (3,4).
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Affiliation(s)
| | | | | | | | | | | | - HEROES-RECOVER Cohorts
- CDC COVID-19 Response Team; Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas; Abt Associates, Inc., Rockville, Maryland; University of Utah, Salt Lake City, Utah; St. Luke’s Regional Health Care System, Duluth, Minnesota; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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13
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Vilendrer S, Amano A, Brown Johnson CG, Favet M, Safaeinili N, Villasenor J, Shaw JG, Hertelendy AJ, Asch SM, Mahoney M. An App-Based Intervention to Support First Responders and Essential Workers During the COVID-19 Pandemic: Needs Assessment and Mixed Methods Implementation Study. J Med Internet Res 2021; 23:e26573. [PMID: 33878023 PMCID: PMC8139393 DOI: 10.2196/26573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/09/2021] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has created unprecedented challenges for first responders (eg, police, fire, and emergency medical services) and nonmedical essential workers (eg, workers in food, transportation, and other industries). Health systems may be uniquely suited to support these workers given their medical expertise, and mobile apps can reach local communities despite social distancing requirements. Formal evaluation of real-world mobile app-based interventions is lacking. OBJECTIVE We aimed to evaluate the adoption, acceptability, and appropriateness of an academic medical center-sponsored app-based intervention (COVID-19 Guide App) designed to support access of first responders and essential workers to COVID-19 information and testing services. We also sought to better understand the COVID-19-related needs of these workers early in the pandemic. METHODS To understand overall community adoption, views and download data of the COVID-19 Guide App were described. To understand the adoption, appropriateness, and acceptability of the app and the unmet needs of workers, semistructured qualitative interviews were conducted by telephone, by video, and in person with first responders and essential workers in the San Francisco Bay Area who were recruited through purposive, convenience, and snowball sampling. Interview transcripts and field notes were qualitatively analyzed and presented using an implementation outcomes framework. RESULTS From its launch in April 2020 to September 2020, the app received 8262 views from unique devices and 6640 downloads (80.4% conversion rate, 0.61% adoption rate across the Bay Area). App acceptability was mixed among the 17 first responders interviewed and high among the 10 essential workers interviewed. Select themes included the need for personalized and accurate information, access to testing, and securing personal safety. First responders faced additional challenges related to interprofessional coordination and a "culture of heroism" that could both protect against and exacerbate health vulnerability. CONCLUSIONS First responders and essential workers both reported challenges related to obtaining accurate information, testing services, and other resources. A mobile app intervention has the potential to combat these challenges through the provision of disease-specific information and access to testing services but may be most effective if delivered as part of a larger ecosystem of support. Differentiated interventions that acknowledge and address the divergent needs between first responders and non-first responder essential workers may optimize acceptance and adoption.
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Affiliation(s)
- Stacie Vilendrer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexis Amano
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Cati G Brown Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Marissa Favet
- College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, United States
| | - Nadia Safaeinili
- Health Policy and Management, University of California, Berkeley, Berkeley, CA, United States
| | | | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Attila J Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
- Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Steven M Asch
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
- Center for Innovation to Implementation, Veterans Affairs, Menlo Park, CA, United States
| | - Megan Mahoney
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
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14
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Thompson MG, Burgess JL, Naleway AL, Tyner HL, Yoon SK, Meece J, Olsho LEW, Caban-Martinez AJ, Fowlkes A, Lutrick K, Kuntz JL, Dunnigan K, Odean MJ, Hegmann KT, Stefanski E, Edwards LJ, Schaefer-Solle N, Grant L, Ellingson K, Groom HC, Zunie T, Thiese MS, Ivacic L, Wesley MG, Lamberte JM, Sun X, Smith ME, Phillips AL, Groover KD, Yoo YM, Gerald J, Brown RT, Herring MK, Joseph G, Beitel S, Morrill TC, Mak J, Rivers P, Harris KM, Hunt DR, Arvay ML, Kutty P, Fry AM, Gaglani M. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:495-500. [PMID: 33793460 DOI: 10.15585/mmwr.mm7013e3externalicon] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.
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15
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Thompson MG, Burgess JL, Naleway AL, Tyner HL, Yoon SK, Meece J, Olsho LE, Caban-Martinez AJ, Fowlkes A, Lutrick K, Kuntz JL, Dunnigan K, Odean MJ, Hegmann KT, Stefanski E, Edwards LJ, Schaefer-Solle N, Grant L, Ellingson K, Groom HC, Zunie T, Thiese MS, Ivacic L, Wesley MG, Lamberte JM, Sun X, Smith ME, Phillips AL, Groover KD, Yoo YM, Gerald J, Brown RT, Herring MK, Joseph G, Beitel S, Morrill TC, Mak J, Rivers P, Harris KM, Hunt DR, Arvay ML, Kutty P, Fry AM, Gaglani M. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:495-500. [PMID: 33793460 PMCID: PMC8022879 DOI: 10.15585/mmwr.mm7013e3] [Citation(s) in RCA: 488] [Impact Index Per Article: 162.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.
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16
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Bornstein SL, Elton LG, Kennedy F, Sosefo M, Daniel P, Sanau E, Nason R, Mitchell RD. Rising to the challenge: The emergency nursing response to COVID-19 in the Pacific. Australas Emerg Care 2021; 24:1-3. [PMID: 33547001 PMCID: PMC7528973 DOI: 10.1016/j.auec.2020.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Leigh G Elton
- Emergency Department, Vila Central Hospital, Port Vila, Vanuatu
| | - Frances Kennedy
- Emergency Department, National Referral Hospital, Honiara, Solomon Islands
| | | | - Peter Daniel
- Emergency Department, Vila Central Hospital, Port Vila, Vanuatu
| | - Elizabeth Sanau
- Emergency Department, National Referral Hospital, Honiara, Solomon Islands
| | - Regina Nason
- Emergency Department, Mount Hagen Provincial Hospital, Mount Hagen, Papua New Guinea
| | - Rob D Mitchell
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia; School of Public Health & Preventive Medicine, Melbourne, Australia
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17
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Abstract
ABSTRACT Objective: The risk for aid workers to develop posttraumatic mental problems highlights the importance of reducing the harm of posttraumatic stress symptoms (PTSS) and promoting the benefits of posttraumatic growth (PTG). This study examined the negative relationship between mindfulness and PTSS, and the positive relationship between mindfulness and PTG, and further explored the mediating roles of self-acceptance, intrusive rumination, and deliberate rumination. Methods: Aid workers from the Red Cross Organization (N = 298) were recruited in the study. They completed a series of questionnaires assessing mindfulness, self-acceptance, rumination, posttraumatic stress disorder (PTSD), and PTG. Results: Results showed that mindfulness was significantly and negatively associated with PTSD through positively predicting self-acceptance and negatively predicting intrusive rumination. Mindfulness was significantly and positively associated with PTG, although the mediating effect did not exist because the path between self-acceptance and deliberate rumination was impassable. Conclusion: The mechanisms between mindfulness, PTSD, and PTG were further explored. Limitations and implications for trauma intervention and future research were discussed.
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Affiliation(s)
- Xue Wen
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Yuyang Zhou
- College of Business, Florida International University, Miami, Florida
| | - Jiaxuan Du
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Wei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing
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18
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Sabourin KR, Schultz J, Romero J, Lamb MM, Larremore D, Morrison TE, Frazer-Abel A, Zimmer S, Kedl RM, Jaenisch T, Rochford R. Risk Factors of SARS-CoV-2 Antibodies in Arapahoe County First Responders-The COVID-19 Arapahoe SErosurveillance Study (CASES) Project. J Occup Environ Med 2021; 63:191-198. [PMID: 33298759 PMCID: PMC7934329 DOI: 10.1097/jom.0000000000002099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Define the seroprevalence and risk factors for SARS-CoV-2 antibodies in Arapahoe County, Colorado first responders (eg, law enforcement, human services, fire departments). METHODS Two hundred sixty four first responders were enrolled June to July 2020. SARS-CoV-2 seropositivity was defined as detection of immunoglobulin G (IgG) antibodies to both spike receptor binding domain and nucleocapsid in venous blood by validated enzyme-linked immunosorbent assay. We compared risk factors for being seropositive versus seronegative. RESULTS 4% (11/264) were SARS-CoV-2 seropositive. Seropositive participants were significantly more likely to have lung disease (% seropositive, % seronegative; P-value) (36%, 8%; P = 0.01), prior SARS-CoV-2/COVID-19 testing (36%, 8%; P ≤ 0.01), a prior positive result (18%, less than 1%), and to believe they previously had COVID-19 (64%, 15%; P < 0.01). Only 15% of those believing they had COVID-19 had anti-SARS-CoV-2 antibodies. CONCLUSIONS Human services employees and individuals with lung disease are at SARS-CoV-2 exposure risk. Few individuals believed they had COVID-19 had prior exposure.
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Affiliation(s)
- Katherine R Sabourin
- Department of Immunology and Microbiology (Dr Sabourin, Dr Schultz, Dr Morrison, Dr Kedl, Dr Rochford); Department of Epidemiology, Colorado School of Public Health (Dr Lamb, Dr Jaenisch); Department of Computer Science, College of Engineering and Applied Science (Dr Larremore); BioFrontiers Institute (Dr Larremore), University of Colorado Boulder; Department of Rheumatology (Dr Frazer-Abel); Department of Infectious Disease (Mr Romero, Dr Zimmer), School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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19
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Sami S, Akinbami LJ, Petersen LR, Crawley A, Lukacs SL, Weiss D, Henseler RA, Vuong N, Mackey L, Patel A, Grohskopf LA, Morgenthau BM, Daskalakis D, Pathela P. Prevalence of SARS-CoV-2 Antibodies in First Responders and Public Safety Personnel, New York City, New York, USA, May-July 2020. Emerg Infect Dis 2021; 27:796-804. [PMID: 33493106 PMCID: PMC7920688 DOI: 10.3201/eid2703.204340] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We conducted a serologic survey in public service agencies in New York City, New York, USA, during May–July 2020 to determine prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among first responders. Of 22,647 participants, 22.5% tested positive for SARS-CoV-2–specific antibodies. Seroprevalence for police and firefighters was similar to overall seroprevalence; seroprevalence was highest in correctional staff (39.2%) and emergency medical technicians (38.3%) and lowest in laboratory technicians (10.1%) and medicolegal death investigators (10.8%). Adjusted analyses demonstrated association between seropositivity and exposure to SARS-CoV-2–positive household members (adjusted odds ratio [aOR] 3.52 [95% CI 3.19–3.87]), non-Hispanic Black race or ethnicity (aOR 1.50 [95% CI 1.33–1.68]), and severe obesity (aOR 1.31 [95% CI 1.05–1.65]). Consistent glove use (aOR 1.19 [95% CI 1.06–1.33]) increased likelihood of seropositivity; use of other personal protective equipment had no association. Infection control measures, including vaccination, should be prioritized for frontline workers.
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Akinbami LJ, Vuong N, Petersen LR, Sami S, Patel A, Lukacs SL, Mackey L, Grohskopf LA, Shehu A, Atas J. SARS-CoV-2 Seroprevalence among Healthcare, First Response, and Public Safety Personnel, Detroit Metropolitan Area, Michigan, USA, May-June 2020. Emerg Infect Dis 2020; 26:2863-2871. [PMID: 32956614 PMCID: PMC7706918 DOI: 10.3201/eid2612.203764] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To estimate seroprevalence of severe acute respiratory syndrome 2 (SARS-CoV-2) among healthcare, first response, and public safety personnel, antibody testing was conducted in emergency medical service agencies and 27 hospitals in the Detroit, Michigan, USA, metropolitan area during May-June 2020. Of 16,403 participants, 6.9% had SARS-CoV-2 antibodies. In adjusted analyses, seropositivity was associated with exposure to SARS-CoV-2-positive household members (adjusted odds ratio [aOR] 6.18, 95% CI 4.81-7.93) and working within 15 km of Detroit (aOR 5.60, 95% CI 3.98-7.89). Nurse assistants (aOR 1.88, 95% CI 1.24-2.83) and nurses (aOR 1.52, 95% CI 1.18-1.95) had higher likelihood of seropositivity than physicians. Working in a hospital emergency department increased the likelihood of seropositivity (aOR 1.16, 95% CI 1.002-1.35). Consistently using N95 respirators (aOR 0.83, 95% CI 0.72-0.95) and surgical facemasks (aOR 0.86, 95% CI 0.75-0.98) decreased the likelihood of seropositivity.
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Affiliation(s)
- Michele Heisler
- Physicians for Human Rights, New York, NY 10018, USA; Department of Internal Medicine, University of Michigan Medical School and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | | | - Donna McKay
- Physicians for Human Rights, New York, NY 10018, USA
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Nagamine M, Giltay EJ, Shigemura J, van der Wee NJ, Yamamoto T, Takahashi Y, Saito T, Tanichi M, Koga M, Toda H, Shimizu K, Yoshino A, Vermetten E. Assessment of Factors Associated With Long-term Posttraumatic Stress Symptoms Among 56 388 First Responders After the 2011 Great East Japan Earthquake. JAMA Netw Open 2020; 3:e2018339. [PMID: 32990742 PMCID: PMC7525349 DOI: 10.1001/jamanetworkopen.2020.18339] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE First responders are at risk for developing symptoms of posttraumatic stress disorder (PTSD). Little is known about the risk factors for developing PTSD during a years-long period after complex mass disasters. OBJECTIVE To explore the long-term course of PTSD symptoms and to identify risk factors and their relative association with PTSD among first responders dispatched to the 2011 Japanese earthquake, tsunami, and nuclear disaster. DESIGN, SETTING, AND PARTICIPANTS This 6-year, large, prospective cohort study was part of a continuous longitudinal study of Japan Ground Self-Defense Force first responders. The data were collected at 1, 6, 12, 24, 36, 48, 60, and 72 months after mission completion from 2011 to 2017. Of approximately 70 000 eligible participants, 56 388 were enrolled in this study. Data were analyzed from 2017 to 2020. EXPOSURES Stress exposures owing to personal or professional disaster experience (eg, duties with body recovery or radiation exposure risk) and working conditions (eg, deployment length, postdeployment overtime work). MAIN OUTCOMES AND MEASURES The Impact of Event Scale-Revised score assessed PTSD symptoms; scores of at least 25 were defined as probable PTSD. Cox proportional hazards regression models assessed the risk factors for incidence of probable PTSD. RESULTS Among the 56 388 participants, 97.1% were men, and the median age at enrollment was 34 (range, 18-63) years. A probable PTSD rate was 2.7% at 1 month and showed a downward trend in the first year and a subsequent plateau. The cumulative incidence of probable PTSD was 6.75%. The severity of PTSD symptoms demonstrated a high degree of rank-order stability over time. Rather than professional disaster experience, sociodemographic factors and working conditions were independently associated with the incidence of probable PTSD: personal experience of the disaster (hazard ratio [HR], 1.96; 95% CI, 1.72-2.24), deployment length of at least 3 months (HR vs <1 month, 1.75; 95% CI, 1.52-2.02), increased age (HR for ≥46 vs ≤25 years, 2.28; 95% CI, 1.79-2.92), and postdeployment overtime work of at least 3 months (HR vs little to none, 1.61; 95% CI, 1.39-1.87). CONCLUSIONS AND RELEVANCE Given these findings, in the future, first responders' PTSD symptoms might be mitigated by shortening deployment length, avoiding postdeployment overtime work, and paying special attention to the needs of personnel with personal experience of the disaster or older age. Efforts to alleviate responders' initial symptoms will be required.
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Affiliation(s)
- Masanori Nagamine
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa City, Japan
| | - Erik J. Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Jun Shigemura
- Department of Psychiatry, School of Medicine, National Defense Medical College, Saitama, Japan
| | - Nic J. van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Taisuke Yamamoto
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa City, Japan
| | - Yoshitomo Takahashi
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa City, Japan
| | - Taku Saito
- Department of Psychiatry, School of Medicine, National Defense Medical College, Saitama, Japan
| | - Masaaki Tanichi
- Department of Psychiatry, School of Medicine, National Defense Medical College, Saitama, Japan
| | - Minori Koga
- Department of Psychiatry, School of Medicine, National Defense Medical College, Saitama, Japan
| | - Hiroyuki Toda
- Department of Psychiatry, School of Medicine, National Defense Medical College, Saitama, Japan
| | - Kunio Shimizu
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa City, Japan
| | - Aihide Yoshino
- Department of Psychiatry, School of Medicine, National Defense Medical College, Saitama, Japan
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- ARQ National Psychotrauma Center, Diemen, the Netherlands
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Kshtriya S, Kobezak HM, Popok P, Lawrence J, Lowe SR. Social support as a mediator of occupational stressors and mental health outcomes in first responders. J Community Psychol 2020; 48:2252-2263. [PMID: 32841385 DOI: 10.1002/jcop.22403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
This cross-sectional study aimed to address whether occupational stressors are associated with adverse mental health outcomes in first responders via lower social support. A total of 895 first responders including emergency medical technicians, paramedics, and firefighters from 50 US States and the Virgin Islands (mean = 37.32, standard deviation = 12.09, 59.2% male, and 91.3% White) completed an online survey. Bivariate analyses indicated that occupational stressors were positively correlated with posttraumatic stress disorder (PTSD), major depression (MD), and generalized anxiety disorder (GAD) symptoms, and negatively correlated with social support, whereas social support was negatively correlated with PTSD, MD, and GAD symptoms. Mediation analyses revealed significant indirect effects of occupational stressors on PTSD, MD, and GAD symptoms via social support, after controlling for covariates. Although longitudinal research is needed for a more robust examination of this pathway, the results highlight the importance of social support in first responders. Efforts to augment the support systems of first responders are recommended.
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Affiliation(s)
- Sowmya Kshtriya
- Department of Psychology, Montclair State University, Montclair, New Jersey
| | - Holly M Kobezak
- Department of Psychology, Binghamton University, Binghamton, New York
| | - Paula Popok
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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24
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Winograd RP, Phillips S, Wood CA, Green L, Costerison B, Goulka J, Beletsky L. Training to reduce emergency responders' perceived overdose risk from contact with fentanyl: early evidence of success. Harm Reduct J 2020; 17:58. [PMID: 32831088 PMCID: PMC7443848 DOI: 10.1186/s12954-020-00402-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA.
| | - Sarah Phillips
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | - Lauren Green
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | | | | | - Leo Beletsky
- Northeastern University, Boston, Massachusetts, USA
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Brite J, Alper HE, Friedman S, Takemoto E, Cone J. Association Between Socioeconomic Status and Asthma-Related Emergency Department Visits Among World Trade Center Rescue and Recovery Workers and Survivors. JAMA Netw Open 2020; 3:e201600. [PMID: 32202645 PMCID: PMC7090833 DOI: 10.1001/jamanetworkopen.2020.1600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Although the association between poor economic or social standing and health is well established, few studies have attempted to examine the mediational pathways that produce adverse outcomes in disadvantaged populations. OBJECTIVE To determine whether barriers to care mediate the association between socioeconomic status (SES) and asthma-related emergency department (ED) visits. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the World Trade Center Health Registry, which comprises rescue and recovery workers and community members who worked, lived, studied or were otherwise present in downtown Manhattan, New York, during or immediately after the September 11, 2001, disaster. Data were matched to an administrative database of ED visits. Those who experienced an asthma-related ED visit and those who did not were compared in bivariate analysis. A mediation analysis was conducted to determine the role of barriers to care in the association between number of ED visits and SES. EXPOSURES Education, income, and race/ethnicity, which were collected at first survey in 2003 to 2004. MAIN OUTCOMES AND MEASURES Asthma-related ED visits that occurred after survey responses regarding barriers to care were collected (2006-2007) but before 2016, the latest date that data were available. RESULTS The analytic sample included 30 452 enrollees (18 585 [61%] male; median [interquartile range] age, 42.0 [35.0-50.0] years; 20 180 [66%] white, 3834 [13%] African American, and 3961 [13%] Hispanic or Latino [any race]). Approximately half (49%) had less than a bachelor's degree, and 15% had an annual income less than $35 000. Those of lower SES were more likely to experience an asthma-related ED visit. Although number of barriers to care mediated this association, they explained only a small percentage of the overall health disparity (ranging from 3.0% [95% CI, 2.3%-3.9%]) of the differences between African American and white individuals to 9.8% [95% CI, 7.7%-11.9%]) comparing those with less than a high school diploma to those with at least a bachelor's degree. However, the association varied by specific barrier to care. Lack of money, insurance, and transportation mediated up to 11.8% (95% CI, 8.1%-15.9%), 12.5% (95% CI, 8.5%-17.4%), and 4.3% (95% CI, 1.7%-8.4%), respectively, of the association between SES and number of ED visits. Lack of childcare, not knowing where to go for care, and inability to find a health care professional mediated a smaller or no percentage of the association. CONCLUSIONS AND RELEVANCE The identification of vulnerable subpopulations is an important goal to reduce the burden of asthma-related hospital care. More research is needed to fully understand all of the pathways that lead disaster survivors of lower SES to disproportionately experience ED visits due to asthma.
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Affiliation(s)
- Jennifer Brite
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York
| | - Howard E. Alper
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York
| | - Stephen Friedman
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York
| | - Erin Takemoto
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York
| | - James Cone
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York
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Kritikos M, Gandy S, Meliker JR, Luft BJ, Clouston SAP. Acute versus Chronic Exposures to Inhaled Particulate Matter and Neurocognitive Dysfunction: Pathways to Alzheimer's Disease or a Related Dementia. J Alzheimers Dis 2020; 78:871-886. [PMID: 33074229 PMCID: PMC7704925 DOI: 10.3233/jad-200679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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
An estimated 92% of the world's population live in regions where people are regularly exposed to high levels of anthropogenic air pollution. Historically, research on the effects of air pollution have focused extensively on cardiovascular and pulmonary health. However, emerging evidence from animal and human studies has suggested that chronic exposures to air pollution detrimentally change the functioning of the central nervous system with the result being proteinopathy, neurocognitive impairment, and neurodegenerative disease. Case analyses of aging World Trade Center responders suggests that a single severe exposure may also induce a neuropathologic response. The goal of this report was to explore the neuroscientific support for the hypothesis that inhaled particulate matter might cause an Alzheimer's-like neurodegenerative disease, in order to consider proposed mechanisms and latency periods linking inhaled particulate matter and neurodegeneration, and to propose new directions in this line of research.
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Affiliation(s)
- Minos Kritikos
- Department of Family, Population and Preventive Medicine, Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA
| | - Samuel Gandy
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaymie R. Meliker
- Department of Family, Population and Preventive Medicine, Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA
| | - Benjamin J. Luft
- World Trade Center Health and Wellness Program, Department of Medicine, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA
| | - Sean A. P. Clouston
- Department of Family, Population and Preventive Medicine, Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA
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Scott CK, Dennis ML, Grella CE, Nicholson L, Sumpter J, Kurz R, Funk R. Findings from the recovery initiation and management after overdose (RIMO) pilot study experiment. J Subst Abuse Treat 2020; 108:65-74. [PMID: 31493942 PMCID: PMC6893133 DOI: 10.1016/j.jsat.2019.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Received: 02/12/2019] [Revised: 07/17/2019] [Accepted: 08/06/2019] [Indexed: 01/24/2023]
Abstract
This pilot study evaluated the feasibility of the Recovery Initiation and Management after Overdose (RIMO) intervention to link individuals to medication-assisted treatment (MAT) following an opioid overdose. The study team worked with the Chicago Fire Department to train Emergency Medical Service (EMS) teams to request permission from individuals after an opioid overdose reversal to release their contact information; individuals were subsequently contacted by the study team for participation. A mixed-methods study design comprised: (1) an experimental pilot study that examined participation at each stage of the intervention and compared the odds of treatment received for individuals who were randomly assigned to either the RIMO intervention (n = 16) or a passive referral control (n = 17); and (2) a focus group that was subsequently conducted with participants in the RIMO group to obtain their feedback on the intervention components. Quantitative data was collected on participant characteristics at study intake and treatment received was based on self-report at a 30-day follow-up. The RIMO group had higher odds of receiving any treatment for opioid use (OR = 7.94) and any MAT (OR = 20.2), and received significantly more days of opioid treatment (Ms=15.2 vs. 3.4) and more days of MAT in the 30 days post-randomization (Ms=11.2 vs. 0.76), relative to the control group (all p < .05). Qualitative data illustrated that participants valued the assertive outreach, engagement, and persistent follow-up components of RIMO, which differed from their prior experiences. The pilot study suggests that the RIMO intervention is able to address the challenges of linking and engaging individuals into MAT after an opioid overdose.
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Affiliation(s)
- Christy K Scott
- Lighthouse Institute, Chestnut Health Systems, Chicago, IL 221 W. Walton, Chicago, IL 60610, United States of America.
| | - Michael L Dennis
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
| | - Christine E Grella
- Chestnut Health Systems, Chicago, IL 221 W. Walton, Chicago, IL 60610, United States of America.
| | - Lisa Nicholson
- Chestnut Health Systems, Chicago, IL 221 W. Walton, Chicago, IL 60610, United States of America.
| | - Jamie Sumpter
- Chestnut Health Systems, Chicago, IL 221 W. Walton, Chicago, IL 60610, United States of America.
| | - Rachel Kurz
- Chestnut Health Systems, Chicago, IL 221 W. Walton, Chicago, IL 60610, United States of America.
| | - Rod Funk
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
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28
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Ma G, Tan S, Shang S. The Evaluation of Building Fire Emergency Response Capability Based on the CMM. Int J Environ Res Public Health 2019; 16:ijerph16111962. [PMID: 31163571 PMCID: PMC6603904 DOI: 10.3390/ijerph16111962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/17/2022]
Abstract
The construction of smart cities is a theme of urban development, and building fires greatly threaten public safety and urban environmental governance, in which fire emergency management is one of the key factors. However, most studies on the evaluation of emergency response capacity ignore the process of improvement, as well as the intelligence and practicality of the results. The evaluation system of building fire emergency response capability maturity (FE-CMM) was innovatively proposed based on the capability maturity model (CMM), including the evaluation index, evaluation grade, evaluation method, and evaluation process. At the same time, a plug-in for evaluating fire emergency response capability was developed based on the building information modeling (BIM) platform. Finally, an empirical study was carried out in combination with the case of a district fire center. The research demonstrates that the evaluation system can effectively judge the maturity of fire emergency response capability, and the established plug-in can preliminarily realize the intelligent evaluation of building fire emergency response capability, which improves the practice and intelligence of the fire emergency response capability evaluation system when fully considering the process of improvement. It has guiding significance for ex ante control and refined management of building fires, thus providing support for urban public safety and environmental governance.
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Affiliation(s)
- Guofeng Ma
- School of Economics and Management, Tongji University, Shanghai 200092, China.
| | - Sheng Tan
- School of Economics and Management, Tongji University, Shanghai 200092, China.
| | - Shanshan Shang
- School of International Business Management, Shanghai International Studies University, Shanghai 201620, China.
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29
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van Gerwen MAG, Tuminello S, Riggins GJ, Mendes TB, Donovan M, Benn EKT, Genden E, Cerutti JM, Taioli E. Molecular Study of Thyroid Cancer in World Trade Center Responders. Int J Environ Res Public Health 2019; 16:E1600. [PMID: 31067756 PMCID: PMC6539993 DOI: 10.3390/ijerph16091600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Maaike A G van Gerwen
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Stephanie Tuminello
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Gregory J Riggins
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA.
| | - Thais B Mendes
- Division of Genetics, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil.
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Emma K T Benn
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Eric Genden
- Department of Otolaryngology- Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Janete M Cerutti
- Division of Genetics, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil.
| | - Emanuela Taioli
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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30
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van Reemst L, Fischer TFC. Experiencing External Workplace Violence: Differences in Indicators Between Three Types of Emergency Responders. J Interpers Violence 2019; 34:1864-1889. [PMID: 27413089 DOI: 10.1177/0886260516657913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Police officers, firefighters, and emergency medical workers are at a relatively high risk of experiencing external workplace violence (EWPV), that is, violence initiated by people outside the organization. Based on criminal opportunities theories, the aim of this research was to study to what extent socio-demographic and work characteristics are related to experiencing EWPV. In addition, the aim was to explore how these relations differ between the three types of emergency responders. Data from a workplace violence survey of the Ministry of the Interior and Kingdom Relations of the Netherlands was used, from which emergency medical workers ( n = 264), firefighters ( n = 255), and police officers ( n = 296) were selected. Results indicated that police officers experienced most and firefighters experienced least EWPV. Younger professionals and professionals who have more frequent and risky contact experienced more EWPV. The expectations that males and those with less skills or experience to avoid EWPV experience more EWPV were not convincingly supported. The relationships between characteristics and EWPV, and the explanatory power of the models, differed between types of emergency responders. The studied characteristics best explained variations in EWPV of police officers, and therefore prevention of EWPV by addressing these characteristics will be most successful for police officers. The prediction of EWPV should be improved, for example, by studying the relationship with "attractiveness" or "vulnerability" of the possible victim, such as psychological characteristics of professionals. The study showed that research about indicators and prevention of EWPV should be aimed at separate professions.
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31
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Bellehsen M, Moline J, Rasul R, Bevilacqua K, Schneider S, Kornrich J, Schwartz RM. A Quality Improvement Assessment of the Delivery of Mental Health Services among WTC Responders Treated in the Community. Int J Environ Res Public Health 2019; 16:E1536. [PMID: 31052246 PMCID: PMC6540212 DOI: 10.3390/ijerph16091536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Mayer Bellehsen
- Department of Psychiatry, Unified Behavioral Health Center and World Trade Center Health Program, Northwell Health, 132 East Main Street, Bay Shore, NY 11706, USA.
| | - Jacqueline Moline
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, 175 Community Drive, Great Neck, NY 11021, USA.
| | - Rehana Rasul
- Department of Biostatistics and Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, 175 Community Drive, Great Neck, NY 11021, USA.
| | - Kristin Bevilacqua
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, 175 Community Drive, Great Neck, NY 11021, USA.
| | - Samantha Schneider
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, 175 Community Drive, Great Neck, NY 11021, USA.
| | - Jason Kornrich
- World Trade Center Health Center, Northwell Health, 97-77 Queens Blvd, Rego Park, NY 11374, USA.
| | - Rebecca M Schwartz
- Feinstein Institute for Medical Research, Department of Occupational Medicine, Epidemiology and Prevention and Northwell Health and Joint Center for Trauma, Disaster Health and Resilience at Mount Sinai, Stony Brook University, and Northwell Health, 175 Community Drive, Great Neck, NY 11021, USA.
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Lewis-Schroeder NF, Kieran K, Murphy BL, Wolff JD, Robinson MA, Kaufman ML. Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues. Harv Rev Psychiatry 2019; 26:216-227. [PMID: 29975339 PMCID: PMC6624844 DOI: 10.1097/hrp.0000000000000176] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
First responders are regularly confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians. Evidence indicates that the prevalence of posttraumatic stress disorder (PTSD) is substantially higher among first responders than the general population. This article provides information about the outpatient trauma services at McLean Hospital's LEADER (Law Enforcement, Active Duty, Emergency Responder) program to assist clinicians who encounter these first responders in their practices or who are specifically interested in working with this patient population. We begin by synthesizing the literature on the prevalence of PTSD in first responders following work-related exposure to traumatic stress, and by addressing the occupation-specific risk factors and the third-variable risk factors that may contribute to potentiated risk. We then discuss assessment strategies and treatment options used in our program, which is tailored for individuals who are dealing with mental health issues stemming from occupation-specific traumatic-stress exposure. We also address the unique challenges of treating traumatized first responders with more complex issues such as traumatic stress exposure across the lifespan and safety issues, including acute suicidality. We conclude by discussing notable gaps in the literature, including the need to investigate why and how women present with different PTSD symptoms than men and how these differences need to be taken into account in determining appropriate treatment for women.
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Affiliation(s)
- Nina F Lewis-Schroeder
- From Harvard Medical School (Drs. Lewis-Schroeder, Murphy, Robinson, and Kaufman) and McLean Hospital, Belmont, MA (all)
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Tuminello S, van Gerwen MAG, Genden E, Crane M, Lieberman-Cribbin W, Taioli E. Increased Incidence of Thyroid Cancer among World Trade Center First Responders: A Descriptive Epidemiological Assessment. Int J Environ Res Public Health 2019; 16:E1258. [PMID: 30970543 PMCID: PMC6479621 DOI: 10.3390/ijerph16071258] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/20/2019] [Accepted: 04/04/2019] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Stephanie Tuminello
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Maaike A G van Gerwen
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Eric Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Michael Crane
- Division of Occupational and Environmental Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Wil Lieberman-Cribbin
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Emanuela Taioli
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Rojano B, West E, Goodman E, Weiss JJ, de la Hoz RE, Crane M, Crowley L, Harrison D, Markowitz S, Wisnivesky JP. Self-management behaviors in World Trade Center rescue and recovery workers with asthma. J Asthma 2019; 56:411-421. [PMID: 29985718 PMCID: PMC7553201 DOI: 10.1080/02770903.2018.1462377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 10/19/2017] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Asthma is a major source of morbidity among World Trade Center (WTC) rescue and recovery workers. While physical and mental health comorbidities have been associated with poor asthma control, the potential role and determinants of adherence to self-management behaviors (SMB) among WTC rescue and recovery workers is unknown. OBJECTIVES To identify modifiable determinants of adherence to asthma self-management behaviors in WTC rescue and recovery worker that could be potential targets for future interventions. METHODS We enrolled a cohort of 381 WTC rescue and recovery workers with asthma. Sociodemographic data and asthma history were collected during in-person interviews. Based on the framework of the Model of Self-regulation, we measured beliefs about asthma and controller medications. Outcomes included medication adherence, inhaler technique, use of action plans, and trigger avoidance. RESULTS Medication adherence, adequate inhaler technique, use of action plans, and trigger avoidance were reported by 44%, 78%, 83%, and 47% of participants, respectively. Adjusted analyses showed that WTC rescue and recovery workers who believe that they had asthma all the time (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.38-4.08), that WTC-related asthma is more severe (OR: 1.73; 95% CI: 1.02-2.93), that medications are important (OR: 12.76; 95% CI: 5.51-29.53), and that present health depends on medications (OR: 2.39; 95% CI: 1.39-4.13) were more likely to be adherent to their asthma medications. Illness beliefs were also associated with higher adherence to other SMB. CONCLUSIONS Low adherence to SMB likely contributes to uncontrolled asthma in WTC rescue and recovery workers. Specific modifiable beliefs about asthma chronicity, the importance of controller medications, and the severity of WTC-related asthma are independent predictors of SMB in this population. Cognitive behavioral interventions targeting these beliefs may improve asthma self-management and outcomes in WTC rescue and recovery workers. Key message: This study identified modifiable beliefs associated with low adherence to self-management behaviors among World Trade Center rescue and recovery rescue and recovery workers with asthma which could be the target for future interventions. CAPSULE SUMMARY Improving World Trade Center-related asthma outcomes will require multifactorial approaches such as supporting adherence to controller medications and other self-management behaviors. This study identified several modifiable beliefs that may be the target of future efforts to support self-management in this patient population.
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Affiliation(s)
- Belen Rojano
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin West
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Goodman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey J. Weiss
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rafael E. de la Hoz
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Occupational and Environmental Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Crane
- Division of Occupational and Environmental Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura Crowley
- Division of Occupational and Environmental Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Denise Harrison
- Department of Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY, USA
| | - Steven Markowitz
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY, USA
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Li J, Cone JE, Brackbill RM, Giesinger I, Yung J, Farfel MR. Pulmonary Fibrosis among World Trade Center Responders: Results from the WTC Health Registry Cohort. Int J Environ Res Public Health 2019; 16:ijerph16050825. [PMID: 30866415 PMCID: PMC6427469 DOI: 10.3390/ijerph16050825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - Ingrid Giesinger
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
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Abstract
Background Terrorist attacks induce various responses in emergency responders. Addressing this range of responses in individual workers is of central interest. Aims To assess the gender- and occupation-specific effects of a terrorist attack, particularly in emergency responders. Methods This was a pilot study. Emergency responders present during the 2016 terrorist attack at Breitscheidplatz in Berlin were asked to participate. Measures for crisis management had been previously implemented. Stress (Patient Health Questionnaire [PHQ]), quality of life (The World Health Organization Quality of Life [WHOQOL-BREF]), post-traumatic stress disorder (PTSD Checklist for DSM-5 [PCL-5]) and current psychological symptoms (Brief Symptom Inventory [BSI]) were assessed. Results Thirty-seven subjects were included, 11 female and 26 male. The occupational groups included 16 firefighters, six police officers, five psychosocial health care personnel and nine members of aid organizations. Three months after the attack, female workers showed higher scores in stress and paranoid ideation, police officers showed higher scores in hostility and firefighters scored lower quality of life in environment and physical health. Conclusions The mental health burden identified in this study plays an important role for emergency responders after terrorist attacks. Differences between occupational groups may be attributable to differences in tasks that responders perform during acute incidents. The presence of these differences 3 months after the incident suggests that these are at least medium-term conditions. This study may inform the development of treatments and policies and it thus recommended to develop a multi-level assessment and treatment programme that is gender- and occupation-specific.
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Affiliation(s)
- U Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany
| | - P Zimmermann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany
| | - M Mahnke
- Department of Psychiatry, Psychotherapy and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany
- Fire Department of Berlin, Volunteer Fire Department of Wedding, Berlin, Germany
| | - O Butler
- Max Planck Institute for Human Development, Berlin, Germany
| | - S Polk
- Max Planck Institute for Human Development, Berlin, Germany
| | - G Willmund
- Department of Psychiatry, Psychotherapy and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany
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Abstract
OBJECTIVE The aim of this study was to report on cases of head and neck cancer (HNC) among World Trade Center (WTC) responders participating in the WTC Health Program and seen at Rutgers WTC Center of Clinical Excellence. METHODS Medical records were abstracted by two clinical reviewers and discrepancies resolved. Cases were defined as WTC responders diagnosed with HNC between December 9, 2005, and December 31, 2016. RESULTS Sixteen HNC patients met the case definition, most (13) arrived at the WTC location on 9/11 or within the following 2 days, and half worked in law enforcement during the 9/1 response. CONCLUSION An association between HNC and WTC exposure is biologically plausible and should be further investigated. Research to enumerate the risk factor profile for these cancers may contribute to understanding mechanisms by which WTC exposure can contribute to carcinogenesis and to prevention and early detection strategies.
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Affiliation(s)
- Judith M Graber
- Rutgers, The State University of New Jersey, School of Public Health, Department of Epidemiology, Piscataway, New Jersey (Dr Graber); Rutgers, The State University of New Jersey, School of Public Health, Department of Environmental and Occupational Health, Piscataway, New Jersey (Dr Chuang); Rutgers Robert Wood Johnson Medical School, Department of Medicine, Piscataway, New Jersey (Dr Ward); Rutgers The State University of New Jersey, Environmental and Occupational Health Sciences Institute (EOHSI), Clinical Research and Occupational Medicine, Piscataway, New Jersey (Dr Black); Rutgers The State University of New Jersey, School of Public Health, Department of Environmental and Occupational Health, EOHSI Clinical Center, Piscataway, New Jersey (Dr Udasin)
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Bezabh YH, Abebe SM, Fanta T, Tadese A, Tulu M. Prevalence and associated factors of post-traumatic stress disorder among emergency responders of Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia: institution-based, cross-sectional study. BMJ Open 2018; 8:e020705. [PMID: 30049692 PMCID: PMC6067328 DOI: 10.1136/bmjopen-2017-020705] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the prevalence and associated factors of post-traumatic stress disorder (PTSD) among emergency responders at Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia. DESIGN Institution-based, cross-sectional design. SETTING The study was conducted at the Fire and Emergency Control and Prevention Service Authority, Addis Ababa, Ethiopia. PARTICIPANTS 603 emergency responders who worked in the Fire and Emergency Control and Prevention Authority during the study period. MEASUREMENT Data were collected using a self-administered questionnaire: an adaptation of the standardised PTSD Checklist-Civilian Version. The questionnaire was administered to subjects on duty. Social support was measured using the Oslo 3-Item Social Support Scale, while other stressful life events were measured using the List of Threatening Experiences, that is, experiencing one or more stressful life events in the last 6 months. Reliability and construct validity were verified. To be diagnosed with PTSD, a subject must display at least three different types of symptoms at once. Coded variables were entered into Epi Info V.3.5.1 and then exported to SPSS V.20 for analysis. Descriptive and bivariate and multivariate logistic regressions and 95% CI were employed to establish and test statistically significant associations. RESULTS A total of 603 subjects participated in the study, with 19.9% prevalence rate of PTSD (95% CI 16.9 to 23.1). The study found family history of mental illness (adjusted OR (AOR)=2.82; 95% CI 1.65 to 4.84), longer years of service (AOR=2.67; 95% CI 1.54 to 4.63), as well as prolonged exposure to emergency situations (AOR=0.44; 95% CI 0.24 to 0.84) and road traffic accidents (AOR=2.71; 95% CI 1.67 to 4.42) as significant predictors of PTSD among emergency responders. CONCLUSION The prevalence of PTSD was high among the study population. Family history of mental illness, length of service, duration of exposure and type of exposure were found to be associated with PTSD. Mental health education and linking emergency responders with available mental health services/facilities should be prioritised to mitigate the problem.
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Affiliation(s)
| | - Solomon Mekonnen Abebe
- College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tolesa Fanta
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Agitu Tadese
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Mikiyas Tulu
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
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Goh CE, Mooney SJ, Siscovick DS, Lemaitre RN, Hurvitz P, Sotoodehnia N, Kaufman TK, Zulaika G, Lovasi GS. Medical facilities in the neighborhood and incidence of sudden cardiac arrest. Resuscitation 2018; 130:118-123. [PMID: 30057353 DOI: 10.1016/j.resuscitation.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Received: 10/21/2017] [Revised: 07/01/2018] [Accepted: 07/05/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Medical establishments in the neighborhood, such as pharmacies and primary care clinics, may play a role in improving access to preventive care and treatment and could explain previously reported neighborhood variations in sudden cardiac arrest (SCA) incidence and survival. METHODS The Cardiac Arrest Blood Study Repository is a population-based repository of data from adult cardiac arrest patients and population-based controls residing in King County, Washington. We examined the association between the availability of medical facilities near home with SCA risk, using adult (age 18-80) Seattle residents experiencing cardiac arrest (n = 446) and matched controls (n = 208) without a history of heart disease. We also analyzed the association of major medical centers near the event location with emergency medical service (EMS) response time and survival among adult cases (age 18+) presenting with ventricular fibrillation from throughout King County (n = 1537). The number of medical facilities per census tract was determined by geocoding business locations from the National Establishment Time-Series longitudinal database 1990-2010. RESULTS More pharmacies in the home census tract was unexpectedly associated with higher odds of SCA (OR:1.28, 95% CI: 1.03, 1.59), and similar associations were observed for other medical facility types. The presence of a major medical center in the event census tract was associated with a faster EMS response time (-53 s, 95% CI: -84, -22), but not with short-term survival. CONCLUSIONS We did not observe a protective association between medical facilities in the home census tract and SCA risk, orbetween major medical centers in the event census tract and survival.
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Affiliation(s)
- Charlene E Goh
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - Stephen J Mooney
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, United States
| | | | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Philip Hurvitz
- Department of Urban Design & Planning, College of Built Environments, University of Washington, Seattle, WA, United States
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Tanya K Kaufman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Garazi Zulaika
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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Hughes HE, Colón-González FJ, Fouillet A, Elliot AJ, Caserio-Schonemann C, Hughes TC, Gallagher N, Morbey RA, Smith GE, Thomas DR, Lake IR. The influence of a major sporting event upon emergency department attendances; A retrospective cross-national European study. PLoS One 2018; 13:e0198665. [PMID: 29898000 PMCID: PMC5999282 DOI: 10.1371/journal.pone.0198665] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/23/2018] [Indexed: 12/04/2022] Open
Abstract
Major sporting events may influence attendance levels at hospital emergency departments (ED). Previous research has focussed on the impact of single games, or wins/losses for specific teams/countries, limiting wider generalisations. Here we explore the impact of the Euro 2016 football championships on ED attendances across four participating nations (England, France, Northern Ireland, Wales), using a single methodology. Match days were found to have no significant impact upon daily ED attendances levels. Focussing upon hourly attendances, ED attendances across all countries in the four hour pre-match period were statistically significantly lower than would be expected (OR 0.97, 95% CI 0.94-0.99) and further reduced during matches (OR 0.94, 95% CI 0.91-0.97). In the 4 hour post-match period there was no significant increase in attendances (OR 1.01, 95% CI 0.99-1.04). However, these impacts were highly variable between individual matches: for example in the 4 hour period following the final, involving France, the number of ED attendances in France increased significantly (OR 1.27, 95% CI 1.13-1.42). Overall our results indicate relatively small impacts of major sporting events upon ED attendances. The heterogeneity observed makes it difficult for health providers to predict how major sporting events may affect ED attendances but supports the future development of compatible systems in different countries to support cross-border public health surveillance.
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Affiliation(s)
- Helen E. Hughes
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham, United Kingdom
- Farr Institute at HeRC, Liverpool University, Liverpool, United Kingdom
- NIHR HPRU in Gastrointestinal Infections, Liverpool, United Kingdom
| | - Felipe J. Colón-González
- NIHR HPRU in Emergency Preparedness and Response, London, United Kingdom
- School of Environmental Sciences, University of East Anglia, Norwich, United Kingdom
| | - Anne Fouillet
- Syndromic Surveillance Unit, Santé publique France, the national public health agency, Saint-Maurice, France
| | - Alex J. Elliot
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham, United Kingdom
- NIHR HPRU in Emergency Preparedness and Response, London, United Kingdom
| | - Céline Caserio-Schonemann
- Syndromic Surveillance Unit, Santé publique France, the national public health agency, Saint-Maurice, France
| | - Thomas C. Hughes
- Emergency Department, John Radcliffe Hospital, Oxford, United Kingdom
| | - Naomh Gallagher
- Health Protection, Public Health Agency, Northern Ireland, Belfast, United Kingdom
| | - Roger A. Morbey
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham, United Kingdom
- NIHR HPRU in Emergency Preparedness and Response, London, United Kingdom
| | - Gillian E. Smith
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham, United Kingdom
- NIHR HPRU in Emergency Preparedness and Response, London, United Kingdom
| | - Daniel Rh. Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - Iain R. Lake
- NIHR HPRU in Gastrointestinal Infections, Liverpool, United Kingdom
- NIHR HPRU in Emergency Preparedness and Response, London, United Kingdom
- School of Environmental Sciences, University of East Anglia, Norwich, United Kingdom
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Kim H, Baidwan NK, Kriebel D, Cifuentes M, Baron S. Asthma among World Trade Center First Responders: A Qualitative Synthesis and Bias Assessment. Int J Environ Res Public Health 2018; 15:ijerph15061053. [PMID: 29882850 PMCID: PMC6025114 DOI: 10.3390/ijerph15061053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/15/2022]
Abstract
The World Trade Center (WTC) disaster exposed the responders to several hazards. Three cohorts i.e., the Fire Department of New York (FDNY), the General Responder Cohort (GRC), and the WTC Health Registry (WTCHR) surveyed the exposed responder population. We searched Pubmed and Web of Science for literature on a well-published association between the WTC exposures and asthma, focusing on new-onset self-reported physician-diagnosed asthma. The resulting five articles were qualitatively assessed for potential biases. These papers were independently reviewed by the co-authors, and conclusions were derived after discussions. While, the cohorts had well-defined eligibility criteria, they lacked information about the entire exposed population. We conclude that selection and surveillance biases may have occurred in the GRC and WTCHR cohorts, but were likely to have been minimal in the FDNY cohort. Health care benefits available to responders may have increased the reporting of both exposure and outcome in the former, and decreased outcome reporting in the FDNY cohort. Irrespective of the biases, the studies showed similar findings, confirming the association between WTC exposure and self-reported physician-diagnosed asthma among responders. This suggests that health data gathered under great duress and for purposes other than epidemiology can yield sound conclusions. Potential biases can, however, be minimized by having validated survey instruments and worker registries in place before events occur.
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Affiliation(s)
- Hyun Kim
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Navneet Kaur Baidwan
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN 55455, USA.
| | - David Kriebel
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA 01854, USA.
| | - Manuel Cifuentes
- Department of Public Health, Regis College, Weston, MA 02493, USA.
| | - Sherry Baron
- Barry Commoner Center for Health & the Environment, Queens College, New York, NY 11367, USA.
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Hall EM, Patel K, Victory KR, Calvert GM, Nogueira LM, Bojes HK. Phosphine Exposure Among Emergency Responders - Amarillo, Texas, January 2017. MMWR Morb Mortal Wkly Rep 2018; 67:387-389. [PMID: 29621206 PMCID: PMC5889246 DOI: 10.15585/mmwr.mm6713a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Missikpode C, Peek-Asa C, Young T, Hamann C. Does crash risk increase when emergency vehicles are driving with lights and sirens? Accid Anal Prev 2018; 113:257-262. [PMID: 29444480 DOI: 10.1016/j.aap.2018.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Emergency vehicles, such as police, ambulances, and fire vehicles, need to arrive at the scene of emergencies as quickly as possible, and thus they often travel in emergency mode - using their lights and sirens and often bypassing traffic signals. We examined whether travelling in emergency mode increased crash risk among police, ambulance and fire vehicles. METHODS We conducted a quasi-induced exposure analysis using data from the Iowa Crash Database for the period of 2005 through 2013. The data are maintained by the Iowa Department of Transportation (IADOT), Office of Driver Services (ODS) and includes all investigating police officer's reports of motor vehicle crashes. The quasi-induced exposure method is an approach to calculate crash risk in the absence of exposure data using vehicles without a contributing cause (did not contribute to the crash) as a proxy for the baseline driving population. RESULTS From 2005 - 2013, police vehicles were involved in 2406 crashes and ambulances and fire vehicles were involved in 528 crashes. Police vehicles were 1.8 times more likely to crash while driving in emergency mode than usual mode; this was a statistically significant increase. Ambulance and fire vehicles were not more likely to crash in emergency mode compared with usual mode. For police, other factors that contributed to crash risk included gender, age, icy/snowy roads, unpaved roads, and intersections. For ambulances and fire vehicles, other factors that contributed to crash risk included gender, age, weekends, icy/snowy roads and urban locations. CONCLUSION Crash risk increased when police vehicles drove with lights and sirens but did not increase for ambulance and fire vehicles. Further research is necessary to develop and evaluate strategies to mitigate crash risk among police vehicles. Cultural approaches which prioritize transportation safety in conjunction with reaching the scene as quickly as possible may be warranted.
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Affiliation(s)
- Celestin Missikpode
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA; Injury Prevention and Research Center, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Corinne Peek-Asa
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA; Injury Prevention and Research Center, College of Public Health, University of Iowa, Iowa City, IA, USA.
| | - Tracy Young
- Injury Prevention and Research Center, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Cara Hamann
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA; Injury Prevention and Research Center, College of Public Health, University of Iowa, Iowa City, IA, USA
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Dufayet L, Médernach C, Bassi C, Garnier R, Langrand J. [Outbreak of carbon monoxide poisoning in the Ile-de-France region during the spring 2016 Seine flooding]. Sante Publique 2017; 29:803-809. [PMID: 29473394 DOI: 10.3917/spub.176.0803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Heavy rainfall in May 2016 caused large-scale flooding of the Seine and its tributaries. Analysis of this unusual event showed that it could recur on an even larger scale. The sanitary consequences were less frequently assessed in this analysis, particularly the risk of accidental collective carbon monoxide (CO) poisoning caused by the use of combustion engine drainage pumps. METHODS We retrospectively reviewed all cases of acute accidental carbon monoxide exposure observed in the Ile-de-France region, related to the use of drainage pumps in spring and summer 2016 and notified to the Ile-de-France CO poisoning surveillance network. RESULTS Five events were identified, including 45 people exposed to carbon monoxide. Thirty-four of these people were poisoned, 5 were not poisoned and insufficient data were available for 6 people. Three people showed signs of severity and 2 were treated by hyperbaric oxygen therapy. The other poisoned individuals were managed in hospital and treated by oxygen therapy. All were cured. DISCUSSION Collective CO poisonings are common sanitary events during flooding and can be potentially severe. They can occur during the event or over the following days. Preventive measures may help to reduce the risk of CO poisoning, such as increased awareness among professionals, better information of individuals who rent these types of devices or even the use of CO detectors during their use.
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Schenk EJ, Yuan J, Martel LD, Shi GQ, Han K, Gao X. Risk factors for long-term post-traumatic stress disorder among medical rescue workers appointed to the 2008 Wenchuan earthquake response in China. Disasters 2017; 41:788-802. [PMID: 27982458 DOI: 10.1111/disa.12222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study aims to determine the risk factors for clinically-significant post-traumatic stress disorder (PTSD) among Chinese medical rescue workers one year after the response to the Wenchuan earthquake on 12 May 2008. A sample of 337 medical workers who performed response work within the first three months of the event completed an online questionnaire, which included information on demographics, social support, the management and organisation of the disaster response, and an assessment of PTSD. Symptoms consistent with PTSD were prevalent in 17 per cent of the rescue workers. Those who developed PTSD symptoms were more likely to have been injured, experienced a water shortage, been disconnected from family and friends during the response, and have passive coping styles and neurotic personalities. Factors that cannot be changed easily, such as personality traits, should be evaluated prior to deployment to ensure that rescue workers at higher risk of PTSD are provided with adequate support before and during deployment.
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Affiliation(s)
- Ellen J Schenk
- MPH was a graduate student at the Department of Global Health, Rollins School of Public Health, Emory University, United States at the time when most of the work on this manuscript was conducted and is currently a doctoral student at the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Jun Yuan
- MA.Sc is a trainee with the Chinese Field Epidemiology Training Program and an epidemiologist at the Guangzhou Center for Disease Control and Prevention, China
| | - Lise D Martel
- PhD is the Guinea Country Director at the Center for Global Health, Centers for Disease Control and Prevention, United States
| | - Guo-Qing Shi
- MPH is a mentor with the Chinese Field Epidemiology Training Program, China
| | - Ke Han
- MPH is a trainee with the Chinese Field Epidemiology Training Program, China
| | - Xing Gao
- MD PhD is a Representative (in China) with the China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases, Centers for Disease Control and Prevention, United States
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Hong KJ, Song KJ, Shin SD, Song SW, Ro YS, Jeong J, Kim TH, Lee YJ, Kim M, Jo SN, Kim MY. Rapid Health Needs Assessment after Typhoons Bolaven and Tembin Using the Public Health Assessment for Emergency Response Toolkit in Paju and Jeju, Korea 2012. J Korean Med Sci 2017; 32:1367-1373. [PMID: 28665075 PMCID: PMC5494338 DOI: 10.3346/jkms.2017.32.8.1367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 05/28/2017] [Indexed: 11/20/2022] Open
Abstract
Following natural disasters, rapid health needs assessments are required to quickly assess health status and help decision making during the recovery phase. The Korean Centers for Disease Control and Prevention (KCDC) developed the Public Health Assessment for Emergency Response (PHASER) Toolkit which was optimized for a weather disaster in Korea. The goal of this study is to assess public health needs following the 2012 typhoons Bolaven and Tembin in both urban and rural areas in Korea. We conducted pilot trials using the PHASER toolkit to assess health needs following typhoons Bolaven and Tembin in Paju and Jeju during summer 2012. We sampled 400 households in Jeju and 200 households in Paju using a multistage cluster sampling design method. We used a standardized household tracking sheet and household survey sheet to collect data on the availability of resource for daily life, required health needs, clinical results and accessibility of medical services. The primary outcomes were clinical results and accessibility of medical service after the typhoons. We completed surveys for 190 households in Paju and 386 households in Jeju. Sleeping disorders were identified in 6.8% (95% confidence interval [CI], 2.8%-10.8%) surveyed in Paju and 17.4% (95% CI, 12.8%-22.0%) in Jeju. We used the PHASER toolkit to assess healthcare needs rapidly after 2 typhoons in Korea. Sleeping disorders were frequently identified in both Paju and Jeju following the 2 typhoons.
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Affiliation(s)
- Ki Jeong Hong
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Sung Wook Song
- Department of Emergency Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Han Kim
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Yu Jin Lee
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Minsook Kim
- Gangbuk-gu Community Health Center, Seoul, Korea
| | - Soo Nam Jo
- Gyeonggi Infectious Disease Control Center, Seongnam, Korea
| | - Min Young Kim
- Jeju National University College of Nursing, Jeju, Korea
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Abstract
INTRODUCTION Patient aggression affects healthcare quality and, in extreme situations, may even lead to medical malpractice. Little is known, however, about the specific distribution of health care professionals' exposure to patient aggression in various countries. OBJECTIVE The aim of this study was to assess the exposure of various professional groups of healthcare personnel to patient aggression, and to identify potential determinants (medical profession, age, gender, professional experience and employment at outpatient/inpatient healthcare units) of this exposure. METHODS The study was performed between January 2008 - December 2009 in northeastern Poland, and included 1,624 healthcare workers (493 nurses, 504 midwives, 501 physicians and 126 medical rescue workers). Exposure to eight forms of patient aggression was assessed using the MDM Mobbing Questionnaire. RESULTS Using a raised voice was the most frequently observed form of aggression in all groups, whereas the least frequent form of aggression encountered was the use of direct physical violence. In inpatient healthcare units, the intensity of patient aggression was encountered most by nurses and medical rescue workers, followed by physicians and midwives. In outpatient healthcare units, medical rescue workers experienced significantly higher levels of aggression when compared to other professional groups. Significant differences in mean aggression intensity experienced in inpatient and outpatient healthcare units were observed only in nurses and physicians. Furthermore, no significant effects of gender were observed on the intensity of patient aggression. CONCLUSION Nurses are most exposed to different forms of patient aggression, with verbal attacks being most prevalent. Nurses employed at inpatient healthcare units experienced aggression more frequently than those working in outpatient healthcare units.
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Affiliation(s)
- Krystyna Kowalczuk
- Department of Integrated Medical Care, Medical University of Bialystok, Poland
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Abstract
The cleanup effort following the destruction of the World Trade Center (WTC) was unprecedented and involved removal of 1.8 million tons of rubble over a nine-month period. Work at the site occurred 24 hr a day, 7 days a week and involved thousands of workers during the process. The Occupational Safety and Health Administration (OSHA) conducted personal and area exposure sampling during the cleanup of the site. Secondary data analysis was performed on OSHA air sampling data for respirable dust and silica from September 2001 to June 2002 at the WTC recovery site to characterize workers' exposure. Results for silica and respirable particulate were stratified by area and personal samples as well as job task for analysis. Of 1108 samples included in the analysis, 693 were personal and 415 were area. The mean result for personal silica samples was 42 μg/m3 (Range: 4.2-1800 μg/m3). Workers identified as drillers had the highest mean silica exposure (72 μg/m3; range: 5.8-800 μg/m3) followed by workers identified as dock builders (67 μg/m3; range: 5.8-670 μg/m3). The mean result for personal samples for respirable particulate was 0.44 mg/m3 (range: 0.00010-13 mg/m3). There were no discernable trends in personal respirable dust and silica concentrations with date.
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Affiliation(s)
- Brian T Pavilonis
- a Department of Environmental, Occupational, and Geospatial Health Sciences , CUNY Graduate School of Public Health and Health Policy , New York , New York
| | - Franklin E Mirer
- a Department of Environmental, Occupational, and Geospatial Health Sciences , CUNY Graduate School of Public Health and Health Policy , New York , New York
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Bromet EJ, Hobbs MJ, Clouston SAP, Gonzalez A, Kotov R, Luft BJ. DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11). Psychol Med 2016; 46:771-783. [PMID: 26603700 PMCID: PMC4754831 DOI: 10.1017/s0033291715002184] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11-13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being. METHOD Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit. RESULTS In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life. CONCLUSIONS This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.
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Affiliation(s)
- E. J. Bromet
- Department of Psychiatry,
Putnam Hall-South Campus, Stony Brook
University, Stony Brook, NY,
USA
| | - M. J. Hobbs
- Department of Psychiatry,
Putnam Hall-South Campus, Stony Brook
University, Stony Brook, NY,
USA
| | - S. A. P. Clouston
- Program in Public Health and Department of
Preventive Medicine, Stony Brook University,
Stony Brook, NY, USA
| | - A. Gonzalez
- Department of Psychiatry,
Putnam Hall-South Campus, Stony Brook
University, Stony Brook, NY,
USA
| | - R. Kotov
- Department of Psychiatry,
Putnam Hall-South Campus, Stony Brook
University, Stony Brook, NY,
USA
| | - B. J. Luft
- Department of Medicine,
Stony Brook University, Stony Brook,
NY, USA
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