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

9/11事件发生15年后，许多世界贸易中心(WTC)的响应人员继续遭受着标志性的WTC- 相关的身体和精神障碍。这些疾病之间普遍和持久的共病 挑战传统疗法。本提案旨在解释#年脆弱性和复原力因素 WTC响应者，并利用这一知识开发以人为中心的护理模式，以应对并存的医疗和 精神疾病。该提案的重点是个性，在初步的横断面研究中 WTC响应者群体是身体和精神障碍的最强预测因素之一， 症状、社会和职业损害以及治疗利用率，即使在控制WTC时也是如此- 相关诊断。这与文献中证实人格是最强大的 应对灾害的脆弱性和恢复力的预测因子，导致疾病病程的巨大差异 和治疗反应，这是以人为中心的医学可以识别和解决的。然而，纵向的 研究是必要的，以确定人格预测结果和阐明具体机制 它会影响疾病的进程。此外，个性化知情护理模式的可行性 除了身体和精神障碍外，人格的脆弱性还有待评估。海流 这项研究将从WTC健康计划的长岛地点招募并跟踪400名WTC应答者，因为他们 出席年度监测。在研究的观察部分，参与者将完成一项最先进的 在基线访问期间进行个性评估。届时及其后的两次年度访问，他们将 在一周内完成对症状、肺功能、认知过程、应激源和 我们还将获得他们的诊断和服务信息。这些分析将 确定哪些个性弱点会导致更严重的病程、功能和 处理利用，并阐明托换机理。此外，这些信息将允许 建立预测模型，并将确定可作为治疗目标的关键脆弱性。这个 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 使用由构建的模型通知的方法的漏洞。我们将针对最重要的 这些漏洞出现在一项概念验证随机临床试验(RCT)中，其中60名患者患有 具有易感性的障碍将被随机分为个性知情治疗(PT)和对照组。 治疗(CT)。我们假设PT将更有效地更改此漏洞和相关 机制比CT强。综上所述，这项拟议的研究将是第一个严格调查个性的研究 评估作为人格信息医学预测和治疗心身并存疾病的工具 世界贸易中心的应答者。这将为WTC应急者提供医疗保健服务，并将与 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.