The World Trade Center Health Program: Obstructive sleep apnea best practices.

The events of September 11, 2001 exposed nearly half a million community residents and workers engaged in rescue and recovery and clean-up to dust, debris and toxic chemicals, as well as psychologic and physical stressors. Early studies showed an excess of aerodigestive diseases including rhinosinusitis and gastroesophageal reflux. Several studies of World Trade Center (WTC) responders report an excess of obstructive sleep apnea among patients who developed new onset or worsening chronic rhinosinusitis.

World Trade Center psychological exposures and trauma related disorders: PTSD and adjustment disorders.

The relationship between exposure to the World Trade Center (WTC) disaster and elevated rates of trauma related psychiatric illnesses in 9/11 responders and survivors has been well documented. This paper is part of a series to promote the practice of evidence-based medicine when managing persons with WTC-related conditions and focuses on "Trauma and Stressor Related Disorders," a diagnostic category that includes posttraumatic stress disorder (PTSD) and adjustment disorder. It offers background on 9/11-related trauma exposure, a summary of research findings from this cohort, and is followed by brief diagnostic and treatment information from selected clinical practice guidelines.

World Trade Center Health Program best practices for the diagnosis and treatment of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is one of the most common health conditions reported among persons exposed to the dust, debris and chemicals after the September 11, 2001 attacks in the United States. In the 9/11-exposed population, GERD is often found to be co-morbid with other conditions, such as asthma, post-traumatic stress disorder, and obesity. High-quality clinical practice guidelines for GERD are available from the American College of Gastroenterology.

The World Trade Center Health Program: an introduction to best practices.

More than 20 years have elapsed since the September 11, 2001 (9/11) terrorist attacks on the World Trade Center (WTC), Pentagon and at Shanksville, PA. Many persons continue to suffer a variety of physical and mental health conditions following their exposures to a mixture of incompletely characterized toxicants and psychological stressors at the terrorist attack sites. Primary care and specialized clinicians should ask patients who may have been present at any of the 9/11 sites about their 9/11 exposures, especially patients with cancer, respiratory symptoms, chronic rhinosinusitis, gastroesophageal reflux disease, psychiatric symptoms, and substance use disorders.

Autoimmune conditions in the World Trade Center general responder cohort: A nested case-control and standardized incidence ratio analysis.

Background: The World Trade Center (WTC) general responder cohort (GRC) was exposed to environmental toxins possibly associated with increased risk of developing autoimmune conditions.

Objectives: Two study designs were used to assess incidence and risks of autoimmune conditions in the GRC.

Methods: Three clinically trained professionals established the status of possible GRC cases of autoimmune disorders adhering to diagnostic criteria, supplemented, as needed, by specialists' review of consenting responders' medical records.

Development and Validation of a Clinical Frailty Index for the World Trade Center General Responder Cohort.

To develop and validate a clinical frailty index to characterize aging among responders to the 9/11 World Trade Center (WTC) attacks. This study was conducted on health monitoring data on a sample of 6197 responders. A clinical frailty index, WTC FI-Clinical, was developed according to the cumulative deficit model of frailty.

An Assessment of Healthcare Access and Utilization in the World Trade Center Health Program.

Objective: Access to healthcare, a national priority, may be better understood through medical surveillance programs like the World Trade Center Health Program (WTCHP).

Methods: Measures of healthcare access and utilization for 1159 9/11 rescue and recovery workers ("responders") at the Rutgers Clinical Center of Excellence (CCE) were assessed using negative binomial modeling of the Benefits Eligibility Assessment Screening Tool and compared with 174 9/11 responders in the 2017 New York City Community Health Survey (NYCCHS) using z-testing.

Results: Approximately 10.

Strategies for Clinical Discussions About Climate Change.

This commentary links the climate crisis with the pandemic in how both are the subject of campaigns to doubt the science. The authors discuss how clinicians have a clear role to play in countering misinformation.

Cardiovascular disease in the World Trade Center Health Program General Responder Cohort.

Background: Over 90,000 rescue and recovery responders to the September 2001 World Trade Center (WTC) attacks were exposed to toxic materials that can impair cardiac function and increase cardiovascular disease (CVD) risk. We examined WTC-related exposures association with annual and cumulative CVD incidence and risk over 17 years in the WTC Health Program (HP) General Responder Cohort (GRC).

Methods: Post 9/11 first occurrence of CVD was assessed in 37,725 responders from self-reported physician diagnosis of, or current treatment for, coronary artery disease, myocardial infarction, stroke and/or congestive heart failure from WTCHP GRC monitoring visits.

Cancer in General Responders Participating in World Trade Center Health Programs, 2003-2013.

Background: Following the September 11, 2001, attacks on the World Trade Center (WTC), thousands of workers were exposed to an array of toxins known to cause adverse health effects, including cancer. This study evaluates cancer incidence in the WTC Health Program General Responder Cohort occurring within 12 years post exposure.

Methods: The study population consisted of 28 729 members of the General Responder Cohort enrolled from cohort inception, July 2002 to December 31, 2013.

Adapting meaning-centered psychotherapy for World Trade Center responders.

Objective: To date, nearly 10,000 World Trade Center (WTC) responders have been diagnosed with at least one type of WTC-related cancer, and over 70 types of cancer have been related to WTC occupational exposure. Due to the observed latency period for malignancies, the WTC Health Program anticipates increases in rates of new cancer diagnoses. Given the growing number of cancer diagnoses in this population, there is an urgent need to develop a novel intervention to address the psychosocial needs of WTC responders with cancer.

Assessment of Environmental Sustainability and Corporate Social Responsibility Reporting by Large Health Care Organizations.

Importance: Sustainability practices by large corporations are increasingly important to reduce the environmental and social impacts of the business enterprise. The health care industry represents 18% of the US economy, employs more people than any other economic sector, and is responsible for 10% of US carbon emissions. The engagement of large health care delivery organizations in reporting sustainability efforts has not been previously assessed.

Sudden gains and deteriorations in the treatment of posttraumatic stress disorder in World Trade Center responders.

This study sought to examine the prevalence of sudden gains and deteriorations (i.e., symptom reduction/improvement during treatment) and their influence on treatment outcomes among World Trade Center responders with probable posttraumatic stress disorder.

Lessons from the World Trade Center disaster: airway disease presenting as restrictive dysfunction.

Background: The present study (1) characterizes a physiologic phenotype of restrictive dysfunction due to airway injury and (2) compares this phenotype to the phenotype of interstitial lung disease (ILD).

Methods: This is a retrospective study of 54 persistently symptomatic subjects following World Trade Center (WTC) dust exposure. Inclusion criteria were reduced vital capacity (VC), FEV1/VC>77%, and normal chest roentgenogram.