Early Identification of World Trade Center Conditions in Adolescents

描述（由申请人提供）：纽约大学医学院和辛辛那提儿童医院医学中心响应PAR-12-126，提议评估早期接触世界贸易中心（WTC）灾难的长期潜在心脏代谢和肺部影响，并确定早期识别WTC相关健康后果的机会。仅有的调查人员定期为在世贸中心遗址附近居住/上学的儿童提供临床护理，他们的初步数据表明，肺活量的下降与尘云暴露有关，心脏代谢危险因素的频率也非常高。这一临床、自我选择的人群的发现不能推断到暴露于灾难的整个儿童群体，但仍然表明，有必要进一步研究WTC暴露可能造成的代谢和心血管后果。如果在更大、更有代表性的样本中与WTC暴露相关，两种新的创新技术，振荡测定法和脉搏波速度评估，对早期检测WTC相关的肺部和心脏代谢疾病有很大的希望，对他们来说，饮食、环境和药物干预可能会预防疾病在以后的生活中进展。因此，合作者建议招募225名对WTC健康登记处（WTCHR）有反应的青少年，这是最具代表性的儿科人群，从环境暴露的角度来看是最具特征的。将该研究与WTCHR联系起来，也提高了联邦资源利用的效率，提供了更客观的临床数据，以支持WTCHR捕获的持续呼吸道症状增加的自我报告结果，从而提高了登记数据的可靠性。我们将比较来自纽约大学医学院附属初级保健中心（私人和公共诊所）的肺部和心脏代谢结果，仔细匹配（年龄、种族/民族、性别、当前居住地和社会经济地位）和未暴露对照（2001年9月11日不在休斯顿街以南居住/上学）人群。研究小组受益于与社区组织的牢固伙伴关系，这些组织自2001年以来向受影响社区提供了外联和支持，这将加强招聘和成果交流。总之，调查人员在研究受世贸中心破坏影响的成年人方面有丰富的经验，在开展呼吸健康和精神健康的流行病学研究方面也有丰富的经验。除了在饮食、环境和医疗方面对与接触世贸组织物质有关的心脏代谢和呼吸疾病进行干预的机会之外，如果发现暴露于世贸中心袭击的心理后遗症与早期生活暴露于世贸中心灾难的心脏代谢和肺部影响有关（可能作为中介或调节者），这将表明平行筛查心理后遗症的重要性，作为保护年轻时暴露者的自信反应的一部分。

DESCRIPTION (provided by applicant): NYU School of Medicine and Cincinnati Children's Hospital Medical Center respond to PAR-12-126, proposing to assess the potential for longer-latency cardiometabolic and pulmonary effects of early life exposure to the World Trade Center (WTC) disaster, and to identify opportunities for early identification of WTC-related health consequences. Preliminary data from the only investigators who regularly provide clinical care to children who lived/attended school near the WTC site identified decrements in spirometry associated with dust cloud exposure, and a remarkably high frequency of cardiometabolic risk factors. Findings from this clinically, self- selected population cannot be extrapolated to the entire population of children who were exposed to the disaster but nonetheless suggest that further study is warranted of the possible metabolic and cardiovascular consequences of WTC exposures. If associated with WTC exposures in a larger, more representative sample, two new and innovative techniques, oscillometry and pulse wave velocity assessment, hold great promise for earlier detection of WTC-related pulmonary and cardiometabolic disease, for whom dietary, environmental and medication interventions may prevent disease progression in later life. The collaborators therefore propose to recruit 225 adolescents who respond to the WTC Health Registry (WTCHR), the most representative pediatric population and best-characterized from an environmental exposure standpoint. Connecting the study to the WTCHR also presents efficiency of federal resource utilization, providing more objective clinical data to support self-reported findings of increased persistent respiratory symptoms captured by the WTCHR, thereby improving reliability of the registry data. We will compare pulmonary and cardiometabolic outcomes to carefully matched (age, race/ethnicity, gender, current borough of residence and socioeconomic status) and unexposed control (not resident/attending school south of Houston Street on September 11, 2001) populations from NYU School of Medicine affiliated primary care (private and public clinics). The research team benefits from strong partnerships with community-based organizations which have provided outreach and support to affected communities since 2001, which will enhance recruitment and communication of results. Together, the investigators have outstanding experience with adults exposed to the WTC destruction and considerable experience in the conduct of epidemiologic research on respiratory health and mental health. Besides the opportunities for dietary, environmental and medical interventions for cardiometabolic and respiratory conditions related to WTC exposure, if the psychological sequelae of exposure to the WTC attacks are found to be associated (perhaps as mediators or moderators) with cardiometabolic and pulmonary effects of early life exposure to the WTC disaster this would suggest the importance of parallel screening for psychological sequelae as part of an assertive response to protect those exposed when young.