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疗中心对PAR-12-126做出回应，建议评估早期暴露于世界贸易中心(WTC)灾难中潜伏期更长的心脏代谢和肺影响的可能性，并确定及早确定WTC相关健康后果的机会。来自唯一定期为在WTC地点附近居住/就读于学校的儿童提供临床护理的调查人员的初步数据发现，与灰尘云暴露相关的肺活量测定下降，心脏代谢风险因素的频率非常高。这一临床自选人群的研究结果不能推断为暴露在灾难中的整个儿童群体，但仍表明有必要对WTC暴露可能造成的新陈代谢和心血管后果进行进一步研究。如果在更大、更具代表性的样本中与WTC接触有关，两项新的创新技术--振荡法和脉搏波速度评估--将为WTC相关的肺病和心脏代谢性疾病的早期检测带来巨大希望，对这些疾病来说，饮食、环境和药物干预可能会阻止疾病在以后的生活中发展。因此，合作者建议招募225名响应WTC健康注册(WTCHR)的青少年，WTC健康注册是最具代表性的儿科人口，从环境暴露的角度来看是最具特征的。将这项研究与世界呼吸道疾病研究中心联系起来，还展示了联邦资源利用的效率，提供了更客观的临床数据，以支持世界烟草控制中心捕获的持续性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(私立和公立诊所)的经过仔细匹配的(年龄、种族/民族、性别、当前居住地和社会经济地位)和未暴露的对照(2001年9月11日休斯顿街以南的非居民/在校学生)人群的肺和心脏代谢结果。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年以来一直向受影响的社区提供外联和支助，这将加强招聘和成果的传播。总之，调查人员在处理暴露在WTC破坏中的成年人方面拥有出色的经验，并在进行呼吸健康和精神健康的流行病学研究方面拥有相当多的经验。除了与WTC接触有关的心脏代谢和呼吸系统疾病的饮食、环境和医学干预机会外，如果WTC袭击的心理后遗症被发现与WTC灾难的早期生命暴露对心脏和肺部的影响有关(可能作为调解人或调节者)，这将表明同时筛查心理后遗症的重要性，作为保护年轻时暴露于WTC的人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.