Personality-informed care model for 9/11-related comorbid conditions

在9/11事件发生15年后，许多世界贸易中心（WTC）的反应人员继续遭受标志性的WTC- 相关的身体和精神障碍。这些疾病之间的流行性和持续性共病 挑战传统治疗方法。本提案旨在阐明脆弱性和复原力因素， WTC反应，并使用这些知识来开发一个以人为本的护理模式，共病的医疗和 精神状况该提案的重点是个性，在初步的横断面研究中， WTC应答者人群是身体和精神障碍的最强预测因子之一， 症状，社会和职业障碍，治疗利用，即使在控制WTC- 相关诊断这与证实人格是最强大的因素之一的文献是一致的 预测脆弱性和应对灾害的复原力，导致疾病进程的巨大差异 和治疗反应，以人为本的医学可以识别和解决。然而，纵向 研究是必要的，以建立人格预测结果和阐明具体的机制 从而影响疾病进程。此外，人格知情护理模式的可行性，目标 除身心障碍外，人格脆弱性仍有待评估。当前 这项研究将从世贸中心卫生计划的长岛站点招募并跟踪400名世贸中心响应者，因为他们 进行年度监测。在研究的观察部分，参与者将完成一项最先进的 在基线访视期间进行人格评估。在这次访问和随后的两次年度访问中，他们将 在1周内完成症状、肺功能、认知过程、压力源的每日测量， 我们亦会取得他们的诊断及服务资料。这些分析将 确定哪些人格弱点独特地导致更严重的疾病过程，功能和 治疗利用，并澄清基础机制。此外，这些信息将允许 我们正在建立一个预测模型，并将确定可作为治疗目标的关键脆弱性。的 该研究的治疗部分将测试通过治疗个性来改善健康结果的可行性 使用由构建的模型告知的方法来评估漏洞。我们将针对最重要的 在一项概念验证随机临床试验（RCT）中，60例共病患者 具有易感性的疾病将被随机分配到个性知情治疗（PT）与对照组 治疗（CT）。我们假设，PT将更有效地改变这种脆弱性和相关的 机制比CT。综上所述，这项拟议中的研究将是第一个严格调查人格的研究 评估作为人格信息医学的工具，用于预测和治疗精神和身体共病 世贸中心的反应。这将为WTC响应者提供医疗保健服务，也将与 其他医疗保健系统。

Fifteen years after 9/11, many World Trade Center (WTC) responders continue to suffer from signature WTC- related physical and mental disorders. Prevalent and persistent comorbidity between these disorders challenges traditional treatments. The present proposal aims to explicate vulnerability and resilience factors in WTC responders, and use this knowledge to develop a person-focused care model for comorbid medical and psychiatric conditions. The proposal focuses on personality, which in preliminary cross-sectional studies of WTC responder population was among the strongest predictors of physical and mental disorders, persistence of symptoms, social and occupational impairment, and treatment utilization, even when controlling for WTC- related diagnoses. This is in line with the literature confirming that personality is one of the most powerful predictors of vulnerability and resilience in response to disasters, leading to large differences in illness course and treatment response, which person-focused medicine can recognize and address. However, longitudinal investigation is necessary to establish that personality predicts outcomes and elucidate specific mechanisms by which it affects illness course. Furthermore, the feasibility of personality-informed care model that targets personality vulnerability in addition to physical and mental disorders remains to be evaluated. The current study will recruit and follow 400 WTC responders from Long Island site of the WTC Health Program as they present for annual monitoring. In the observational part of the study, participants will complete a state-of-the-art personality assessment during the baseline visit. At that and at two subsequent annual visits, they will complete, during 1 week, daily measures of symptoms, lung function, cognitive processes, stressors, and functional impairment, and we will also obtain their diagnostic and services information. These analyses will determine which personality vulnerabilities uniquely contribute to worse illness course, functioning and treatment utilization, and clarify the underpinning mechanisms. Furthermore, this information will allow a construction of a predictive model and will identify key vulnerabilities that can be targets of treatment. The treatment part of the study will test the feasibility of improving health outcomes by treating personality vulnerabilities using an approach informed by the constructed model. We will target the most significant of these vulnerabilities in a proof-of-concept randomized clinical trial (RCT), where 60 patients with comorbid disorders who have the vulnerability will be randomized to personality-informed treatment (PT) vs. control treatment (CT). We hypothesize that PT will be more effective in changing this vulnerability and related mechanisms than CT. Taken together, the proposed study will be the first to rigorously investigate personality assessment as a tool of personality-informed medicine to predict and treat mental and physical comorbidity in WTC responders. This will inform the healthcare provision for WTC responders and will also be relevant to other health care systems.