World Trade Center Non-Responder Program.

摘要

The New York City Health and Hospitals Corporation (HHC) received NIOSH funding to provide screening, monitoring, and clinical services to a group of individuals experiencing health symptoms because of exposures to the World Trade Center disaster. Characterized as "Non-Responders," this group included local residents, workers, and students as well as clean-up workers. The main difference between "Non-Responders" and "Responders" is their exposures generally resulted not from their job responsibilities, but from their presence in the disaster area due to living, working, attending school, or transiting the area at the time. This include exposures from the collapsing buildings (dust cloud), as well as chronic exposures that resulted from resuspended dust and fumes, and gasses from the prolonged fires that community members were exposed to as they returned to their work or homes, or participated in clean-up activities. "Non-Responders" also differ from "Responders" with the inclusion of pediatric patients and in that around half of the patients were women. These services were offered at three HHC sites: Bellevue Hospital Center, which originated health care for uninsured community residents affected by the disaster; Gouverneur Healthcare Services, which is located in Lower Manhattan amid the affected neighborhoods; and Elmhurst Hospital Center, where many clean-up workers lived. As of the project end date, the WTC EHC had treated 5,820 individuals with symptoms related to WTC exposures, including 89 pediatric patients. The majority of treated health problems included respiratory illnesses, gastroesophageal reflux, and mental health problems including PTSD, depression, and anxiety. The WTC EHC expanded its ability to provide medical and mental health treatment through recruitment of personnel and development of training for both medical and mental health WTC-focused treatment. The WTC EHC enhanced the infrastructure to allow data management and analysis to address utilization and financial reporting requirements, and to enable evaluation of adverse health effects and long-term treatment outcomes and needs. In addition to collaborating with community groups, the WTC EHC worked with the NYC Department of Health and Mental Hygiene (DOHMH) World Trade Center Health Registry (WTCHR) through its Treatment Referral Program (TRP) to contact WTCHR members who reported symptoms and offer them the opportunity to be screened for unmet health needs and to enroll in care. HHC conducted outreach initiatives through public information campaigns, including subway advertising, television and radio spots, and multi-language ads in targeted neighborhood ethnic newspapers to reach potential patients from the Chinese, Hispanic, Polish, and other linguistic minorities. Other accomplishments include assessing data about WTC EHC patients related to clinical understanding of lung function, longitudinal analysis of lung function, inflammatory biomarkers associated with WTC pulmonary symptoms and lung function, association of persistent mental health symptoms and physical symptoms, identification and confirmation of cancer cases, and prevalence of other symptoms such as headaches. This resulted in publications documenting the presence of upper and lower respiratory symptoms in the WTC EHC population, pathologic findings, co-existence of medical and mental health illness in the community population, adverse health effects in children, and longitudinal improvement in lung function in WTC EHC participants.