Implications of the World Trade Center attack for the public health and health care infrastructures.
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The September 11, 2001, attack on the World Trade Center had profound effects on the well-being of New York City. The authors describe and assess the strengths and weaknesses of the city's response to the public health, environmental/ occupational health, and mental health dimensions of the attack in the first 6 months after the event. They also examine the impact on the city's health care and social service system. The authors suggest lessons that can inform the development of a post-September 11th agenda for strengthening urban health infrastructures. (+info)
Adherence to HIV medications in a cohort of men who have sex with men: impact of September 11th.
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Adherence to highly active antiretroviral therapy (HAART) regimens remains a challenge for people living with human immunodeficiency virus (HIV). Severe traumas like that of September 11, 2001, can exacerbate the difficulties already associated with adherence. A community-based sample of 68 HIV-seropositive men who have sex with men (MSM) living in New York City who were on protease inhibitor HAART regimens completed quantitative assessments to examine adherence in the aftermath of September 11th. Data were drawn from a larger study of drug use and HIV medication adherence. Assessments conducted from September 24, 2001 to October 24, 2001 were compared to assessments taken 2-4 months prior to September 11th. Repeated measures analyses of variance were used to analyze the number of missed and suboptimal doses (doses taken outside the prescribed time by +/-4 hours) reported in the 2 weeks prior to each respective assessment. The results indicated a significant increase in the number of missed doses and the number of suboptimal doses immediately after the events of September 11th. Differences in adherence were not influenced, however, by sociodemographic characteristics. These results suggest that the events of September 11th had an impact on adherence to HIV medications among MSM in New York City and provide further support for the notion that the events of September 11th may have adversely impacted the lives of seropositive individuals. Attention should be paid by clinicians working with HIV-positive individuals on how this event has been incorporated into lives of individuals already burdened by a chronic and demanding disease. (+info)
Potential exposures to airborne and settled surface dust in residential areas of lower Manhattan following the collapse of the World Trade Center--New York City, November 4-December 11, 2001.
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Following the terrorist attacks of September 11, 2001, which destroyed the World Trade Center (WTC) in lower Manhattan, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and the Agency for Toxic Substances and Disease Registry (ATSDR), with assistance from the U.S. Public Health Service (PHS) Commissioned Corps Readiness Force and the WTC Environmental Assessment Working Group, assessed the composition of outdoor and indoor settled surface and airborne dust in residential areas around the WTC and in comparison areas. This report summarizes the results of the investigation, which found 1) similar levels of airborne total fibers in lower and in upper Manhattan, 2) greater percentage levels of synthetic vitreous fibers (SVF) and mineral components of concrete and building wallboard in settled dust of residential areas in lower Manhattan than in upper Manhattan, and 3) low levels of asbestos in some settled surface dust in lower Manhattan residential areas. Based in part on the results of this investigation, the U.S. Environmental Protection Agency (EPA) is cleaning and sampling residential areas as requested by lower Manhattan residents. In addition, to assess any short- or long-term health effects of smoke, dust, and airborne substances around the WTC site, DOHMH and ATSDR are developing a registry that will track the health of persons who were most highly exposed to these materials. (+info)
Deaths: preliminary data for 2001.
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OBJECTIVES: This report presents preliminary data on deaths for the year 2001 in the United States. U.S. data on deaths are shown by age, sex, race, and Hispanic origin. Death rates for 2001 are based on population estimates consistent with the April 1, 2000, census. Data on life expectancy, leading causes of death, infant mortality, and deaths resulting from September 11, 2001, terrorist attacks are also presented. For comparison, this report also presents revised final death rates for 2000, based on populations consistent with the April 1, 2000, census. METHODS: Data in this report are based on a large number of deaths comprising approximately 98 percent of the demographic file and 92 percent of the medical file for all deaths in the United States in 2001. The records are weighted to independent control counts of infant deaths and deaths 1 year and over received in State vital statistics offices for 2001. Unless otherwise indicated, comparisons are made with final data for 2000. For certain causes of death, preliminary data differ from final data because of the truncated nature of the preliminary file. These are, in particular, accidents, homicides, suicides, and respiratory diseases. Populations were produced for the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) under a collaborative arrangement with the U.S. Census Bureau. The populations reflect the results of the 2000 census. This census allowed people to report more than one race for themselves and their household members and also separated the category for Asian or Pacific Islander persons into two groups (Asian and Native Hawaiian or Other Pacific Islander). These changes reflect the Office of Management and Budget's (OMB) 1997 revisions to the standards for the classification of Federal data on race and ethnicity. Because only one race is currently reported in death certificate data, the 2000 census populations were "bridged" to the single race categories specified in OMB's 1977 guidelines for race and ethnic statistics in Federal reporting, which are still in use in the collection of vital statistics data. RESULTS: The age-adjusted death rate in 2001 for the United States decreased slightly from 869.0 deaths per 100,000 population in 2000 to 855.0 in 2001. For causes of death, declines in age-adjusted death rates occurred for Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Accidents (unintentional injuries), and Influenza and pneumonia. Age-adjusted death rates also declined for drug-induced deaths between 2000 and 2001. Age-adjusted death rates increased between 2000 and 2001 for the following causes: Alzheimer's disease, Nephritis, nephrotic syndrome and nephrosis, Essential (primary) hypertension and hypertensive renal disease, and Assault (homicide). The increase in homicide was a direct result of the terrorist attacks of September 11, 2001. The infant mortality rate did not change between 2000 and 2001. Life expectancy at birth rose by 0.2 years to a record high of 77.2 years. (+info)
Chemical weapon functional exercise--Cincinnati: observations and lessons learned from a "typical medium-sized" city's response to simulated terrorism utilizing Weapons of Mass Destruction.
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In the wake of the September 11, 2001, attacks and the subsequent anthrax scare, there is growing concern about the United States' vulnerability to terrorist use of Weapons of Mass Destruction (WMD). As part of ongoing preparation for this terrible reality, many jurisdictions have been conducting simulated terrorist incidents to provide training for the public safety community, hospitals, and public health departments. As an example of this national effort to improve domestic preparedness for such events, a large scale, multi-jurisdictional chemical weapons drill was conducted in Cincinnati, Ohio, on May 20, 2000. This drill depicted the components of the early warning system for hospitals and public health departments, the prehospital medical response to terrorism. Over the course of the exercise, emergency medical services personnel decontaminated, triaged, treated, and transported eighty-five patients. Several important lessons were learned that day that have widespread applicability to health care delivery systems nationwide, especially in the areas of decontamination, triage, on-scene medical care, and victim transportation. As this training exercise helped Cincinnati to prepare for dealing with future large scale WMD incidents, such drills are invaluable preparation for all communities in a world increasingly at risk from terrorist attacks. (+info)
World Trade Center fine particulate matter--chemistry and toxic respiratory effects: an overview.
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The 11 September 2001 terrorist attack on New York City's World Trade Center (WTC) caused an unprecedented environmental emergency. The collapse of the towers sent a tremendous cloud of crushed building materials and other pollutants into the air of lower Manhattan. In response to the calamity, federal, state, and city environmental authorities and research institutes devoted enormous resources to evaluate the impact of WTC-derived air pollution on public health. Unfortunately, on the day of the disaster, no air-sampling monitors were operating close to the WTC site to characterize and quantify pollutants in the dust cloud. However, analysis of fallen dust samples collected 5 and 6 days after the attack showed that 1-4% by weight consisted of particles small enough to be respirable (Lioy et al. 2002). These particles included fine particulate matter, or PM(subscript)2.5(/subscript) [PM < 2.5 micro m mass median aerodynamic diameter (MMAD)], which can be inhaled deep into the lung and is associated with cardiovascular and respiratory health effects. Because of the extremely high concentrations of dust immediately after the collapse of the towers, even a relatively small proportion of PM(subscript)2.5(/subscript) in the dust clouds could have contributed to breathing problems in rescue workers and others who were not wearing protective masks. (+info)
Chemical analysis of World Trade Center fine particulate matter for use in toxicologic assessment.
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The catastrophic destruction of the World Trade Center (WTC) on 11 September 2001 caused the release of high levels of airborne pollutants into the local environment. To assess the toxicity of fine particulate matter [particulate matter with a mass median aerodynamic diameter < 2.5 microm (PM2.5)], which may adversely affect the health of workers and residents in the area, we collected fallen dust samples on 12 and 13 September 2001 from sites within a half-mile of Ground Zero. Samples of WTC dust were sieved, aerosolized, and size-separated, and the PM2.5 fraction was isolated on filters. Here we report the chemical and physical properties of PM2.5 derived from these samples and compare them with PM2.5 fractions of three reference materials that range in toxicity from relatively inert to acutely toxic (Mt. St. Helens PM; Washington, DC, ambient air PM; and residual oil fly ash). X-ray diffraction of very coarse sieved WTC PM (< 53 microm) identified calcium sulfate (gypsum) and calcium carbonate (calcite) as major components. Scanning electron microscopy confirmed that calcium-sulfur and calcium-carbon particles were also present in the WTC PM2.5 fraction. Analysis of WTC PM2.5 using X-ray fluorescence, neutron activation analysis, and inductively coupled plasma spectrometry showed high levels of calcium (range, 22-33%) and sulfur (37-43% as sulfate) and much lower levels of transition metals and other elements. Aqueous extracts of WTC PM2.5 were basic (pH range, 8.9-10.0) and had no evidence of significant bacterial contamination. Levels of carbon were relatively low, suggesting that combustion-derived particles did not form a significant fraction of these samples recovered in the immediate aftermath of the destruction of the towers. Because gypsum and calcite are known to cause irritation of the mucus membranes of the eyes and respiratory tract, inhalation of high doses of WTC PM2.5 could potentially cause toxic respiratory effects. (+info)
World Trade Center fine particulate matter causes respiratory tract hyperresponsiveness in mice.
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Pollutants originating from the destruction of the World Trade Center (WTC) in New York City on 11 September 2001 have been reported to cause adverse respiratory responses in rescue workers and nearby residents. We examined whether WTC-derived fine particulate matter [particulate matter with a mass median aerodynamic diameter < 2.5 microm (PM2.5)] has detrimental respiratory effects in mice to contribute to the risk assessment of WTC-derived pollutants. Samples of WTC PM2.5 were derived from settled dust collected at several locations around Ground Zero on 12 and 13 September 2001. Aspirated samples of WTC PM2.5 induced mild to moderate degrees of pulmonary inflammation 1 day after exposure but only at a relatively high dose (100 microg). This response was not as great as that caused by 100 microg PM2.5 derived from residual oil fly ash (ROFA) or Washington, DC, ambient air PM [National Institute of Standards and Technology, Standard Reference Material (SRM) 1649a]. However, this same dose of WTC PM2.5 caused airway hyperresponsiveness to methacholine aerosol comparable to that from SRM 1649a and to a greater degree than that from ROFA. Mice exposed to lower doses by aspiration or inhalation exposure did not develop significant inflammation or hyperresponsiveness. These results show that exposure to high levels of WTC PM2.5 can promote mechanisms of airflow obstruction in mice. Airborne concentrations of WTC PM2.5 that would cause comparable doses in people are high (approximately 425 microg/m3 for 8 hr) but conceivable in the aftermath of the collapse of the towers when rescue and salvage efforts were in effect. We conclude that a high-level exposure to WTC PM2.5 could cause pulmonary inflammation and airway hyperresponsiveness in people. The effects of chronic exposures to lower levels of WTC PM2.5, the persistence of any respiratory effects, and the effects of coarser WTC PM are unknown and were not examined in these studies. Degree of exposure and respiratory protection, individual differences in sensitivity to WTC PM2.5, and species differences in responses must be considered in assessing the risks of exposure to WTC PM2.5. (+info)