Recovery Workers Research Articles

Carers and co-production: enabling expertise through experience?

Purpose– The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration.Design/methodology/approach– The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice.Findings– Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care.Research limitations/implications– Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic.Practical implications– Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the “triangle of care” with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors.Social implications– The families of people with severe and enduring mental illness assume a major responsibility for the provision of care and support to their relatives over extended time periods (Roseet al., 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The “co-production of care” reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the “triangle of care” with carers bringing their own skills, resources and expertise.Originality/value– This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a “triangle of care”.

Проблемы и перспективы развития туризма в промышленном регионе (на примере Пермского края)

The development of domestic tourism - strategic goal of the state that is achieved by the implementation of the measures in various areas of tourism development, both at the federal level and regional. Of particular interest are industrial developed regions, among them the Perm region occupies a special place because has great natural resources and well-developed industrial infrastructure, unique monuments of history. The development plans of the region, the presence of a developed industry require special attention in the organization of rest and recovery workers in various industries. In the Region implementing the state program for development of infrastructure of the tourist complex with funding through public-private partnerships, promotion of tourism resources in foreign and domestic tourist markets, the creation of the scientific base for the tourism development, the introduction of innovations in tourism. Priority directions in development are conference and business tourism, active, cultural, educational and cultural event, primary wellness tourism, cruise tourism, which is confirmed by the research. The state program envisages measures to increase the attractiveness of the region as a tourist destination. The article analyses the problems and directions of tourism development on the basis of systematic approach. The analysis showed that the elements of the system approach in the program are not implemented, but the possibilities for their implementation are: the development of public-private partnership, development of selfregulation and the use of tourist information centers. Authors give the suggestions for the implementation of public-private partnerships, the strengthening of state control and attraction of public organizations in the sphere of tourism, evaluation, staff development, motivation of the travel industry in the field of quality assurance.

Trajectories of Scores on a Screening Instrument for PTSD Among World Trade Center Rescue, Recovery, and Clean-Up Workers.

The longitudinal course of posttraumatic stress disorder (PTSD) over 8-9 years was examined among 16,488 rescue and recovery workers who responded to the events of September 11, 2001 (9/11) at the World Trade Center (WTC; New York, NY), and were enrolled in the World Trade Center Health Registry. Latent class growth analysis identified 5 groups of rescue and recovery workers with similar score trajectories at 3 administrations of the PTSD Checklist (PCL): low-stable (53.3%), moderate- stable (28.7%), moderate-increasing (6.4%), high-decreasing (7.7%), and high-stable (4.0%). Relative to the low-stable group, membership in higher risk groups was associated with 9/11-related exposures including duration of WTC work, with adjusted odds ratios ranging from 1.3 to 2.0, witnessing of horrific events (range = 1.3 to 2.1), being injured (range = 1.4 to 2.3), perceiving threat to life or safety (range = 2.2 to 5.2), bereavement (range = 1.6 to 4.8), and job loss due to 9/11 (range = 2.4 to 15.8). Within groups, higher PCL scores were associated with adverse social circumstances including lower social support, with B coefficients ranging from 0.2 to 0.6, divorce, separation, or widowhood (range = 0.4-0.7), and unemployment (range = 0.4-0.5). Given baseline, exposure-related, and contextual influences that affect divergent PTSD trajectories, screening for both PTSD and adverse circumstances should occur immediately, and at regular intervals postdisaster.

Relationship between Persistent Post-traumatic Stress Disorder and Human Remains Exposure for Staten Island Barge and Landfill Recovery and Clean-up Workers After 9/11

After the September 11, 2001 World Trade Center (WTC) disaster, recovery and clean-up efforts were concentrated at the WTC site and the Staten Island (SI) Fresh Kills landfill and barges. Research is limited regarding the long-term health effects of human remains exposure during clean-up and recovery work at the SI landfill and barges. We studied 1,592 WTC Health Registry enrollees who worked at the SI landfill, loading piers and barges after the 9/11/01 attacks to assess the relationship between remains exposure and persistent posttraumatic stress disorder (PTSD) 10-11 years later. A dose-response relationship was found between frequency of human remains exposure and persistent PTSD (adjusted odds ratio (AOR): every day (AOR) = 4.77; 95% confidence interval (CI): 2.00-11.52, almost every day (AOR) = 4.35; 95% CI: 1.75-10.80), and some days (AOR) = 2.98; 95% CI: 1.43-6.22). When exposed to human remains, sanitation workers had higher odds of persistent PTSD, compared to firefighters and police. In addition, respondents who scored lower on a social support scale had higher odds of persistent PTSD. The findings highlight the need for strategies to reduce the risk of PTSD associated with exposure to human remains in future disasters.

Post-disaster stressful life events and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among responders to the World Trade Center disaster

BackgroundThe current study examined contributions of post-disaster stressful life events in relation to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning among rescue, recovery, and clean-up workers who responded to the September 11, 2001 World Trade Center (WTC) terrorist attacks. MethodsParticipants were 18,896 WTC responders, including 8466 police officers and 10,430 non-traditional responders (85.8% male; 86.4% Caucasian; Mage = 39.5, SD = 8.8) participating in the WTC Health Program who completed an initial examination between July, 2002 and April, 2010 and who were reassessed, on average, 2.5 years later. ResultsPath analyses were conducted to evaluate contributions of life events to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning. These analyses were stratified by police and non-traditional responder groups and adjusted for age, sex, time from 9/11 to initial visit, WTC exposures (three WTC contextual exposures: co-worker, friend, or a relative died in the disaster; co-worker, friend, or a relative injured in the disaster; and responder was exposed to the dust cloud on 9/11), and interval from initial to first follow-up visit. In both groups, WTC-related posttraumatic stress, depressive symptoms, and overall functioning were stable over the follow-up period. WTC exposures were related to these three outcomes at the initial assessment. WTC-related posttraumatic stress, depressive symptoms, and overall functioning, at the initial assessment each predicted the occurrence of post-disaster stressful life events, as measured by Disaster Supplement of the Diagnostic Interview Schedule. Post-disaster stressful life events, in turn, were associated with subsequent mental health, indicating partial mediation of the stability of observed mental health. ConclusionsThe present findings suggest a dynamic interplay between exposure, post-disaster stressful life events, and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among WTC disaster responders.

Abstract 280: Cancer risk in World Trade Center rescue and recovery workers

Abstract Objective: The purpose of this investigation was to evaluate cancer incidence in responders during the first 7 years after 11 September 2001. Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. The follow-up lasted until 2008. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure. Results: A total of 575 cancers were diagnosed in 552 individuals. Increases above registry-based expectations were noted for all cancer sites combined (SIR = 1.15; 95% CI: 1.06, 1.25), thyroid cancer (SIR = 2.39; 95% CI: 1.70, 3.27), prostate cancer (SIR = 1.21; 95% CI: 1.01, 1.44), combined hematopoietic and lymphoid cancers (SIR = 1.36; 95% CI: 1.07, 1.71), and soft tissue cancers (SIR = 2.26; 95% CI: 1.13, 4.05). When restricted to 302 cancers diagnosed ≥ 6 months after enrollment, the SIR for all cancers decreased to 1.06 (95% CI: 0.94, 1.18), but thyroid and prostate cancer diagnoses remained greater than expected. All cancers combined were increased in very highly exposed responders and among those exposed to significant amounts of dust, compared with responders who reported lower levels of exposure. Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow-up and surveillance of WTC responders. The follow-up of the cohort is currently being updated and efforts are being made to improve the assessment of exposure to carcinogens related to WTC experience. Citation Format: Paolo Boffetta, Samara Solan, Sylvan Wallenstein, Roberto Lucchini, Philip Landrigan. Cancer risk in World Trade Center rescue and recovery workers. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 280. doi:10.1158/1538-7445.AM2014-280

Protecting worker and public health during responses to catastrophic disasters-learning from the World Trade Center experience.

Despite incremental lessons learned since 9/11, responder and community health remain at unnecessary risk during responses to catastrophic disasters, as evidenced during the BP Deepwater Horizon spill and Hurricanes Katrina, Rita, and Sandy. Much of the health harm that occurs during disaster response, as distinct from during the disaster event itself, is avoidable. Protection of public health should be an integral component of disaster response, which should "do no additional harm." This commentary examines how challenges and gaps the World Trade Center response resulted in preventable occupational and environmental health harm. It proposes changes in disaster response policies to better protect the health of rescue and recovery workers, volunteers, and impacted worker and residential communities.

Telomere length in Chernobyl accident recovery workers in the late period after the disaster.

The outcome of the Chernobyl nuclear power plant (CNPP) accident was that a huge number of people were exposed to ionizing radiation. Previous studies of CNPP clean-up workers from Latvia revealed a high occurrence of age-associated degenerative diseases and cancer in young adults, as well as a high mortality as a result of cardiovascular disorders at age 45–54 years. DNA tandem repeats that cap chromosome ends, known as telomeres, are sensitive to oxidative damage and exposure to ionizing radiation. Telomeres are important in aging processes and carcinogenesis. The aim of this study was to investigate the long-term effect of protracted ionizing radiation exposure on telomere length in CNPP clean-up workers. Relative telomere length (RTL) was measured in peripheral blood leukocytes of 595 CNPP clean-up workers and 236 gender- and age-matched controls using real-time quantitative polymerase chain reaction (q-PCR). Close attention was paid to participation year and tasks performed during the worker's stay in Chernobyl, health status, and RTL differences between subgroups. Telomere shortening was not found in CNPP clean-up workers; on the contrary, their RTL was slightly greater than in controls (P = 0.001). Longer telomeres were found in people who worked during 1986, in those undertaking ‘dirty’ tasks (digging and deactivation), and in people with cancer. Shorter telomeres appeared frequently in those with cataract, osteoporosis, atherosclerosis, or coronary heart disease. We conclude that the longer telomeres revealed in people more heavily exposed to ionizing radiation probably indicate activation of telomerase as a chromosome healing mechanism following damage, and reflect defects in telomerase regulation that could potentiate carcinogenesis.

0073 PTSD and Cognitive Impairment among Rescue and Recovery Workers exposed to the 9/11 World Trade Centre Disaster

ObjectivesThe 9/11 World Trade Centre Disaster (WTCD) has resulted in many chronic health problems among survivors. Rescue/recovery workers (RRW), having the highest exposures, would likely be at the highest risk...

16. Information.

Effective disaster management requires systems for data acquisition and information management that enable responders to rapidly collect, process, interpret, distribute, and access the data and information required for disaster management. Effective information sharing depends on the types of users, the type of damage, alterations of the functional status of the affected society, and how the information is structured. Those in need of information should be provided with the information necessary for their tasks and not be overloaded with unnecessary information that could serve as a distraction. Such information systems must be designed and exercised. To disseminate and share data with the relevant users, all disaster responses must include effective and reliable information systems. This information includes that acquired from repeated assessments in terms of available and needed human and material resources, which resources no longer are needed, and the status of the relief and recovery workers. It is through this information system that vital decisions are made that are congruent with the overall picture as perceived by the most relevant coordination and control centre. It is essential that information systems be designed and tested regularly as part of preparedness. Such systems must have the capacity to acquire, classify, and present information in an organised and useful manner.

Chernobyl’s Legacy: Black Prophecies’ Bubble

On April 26, 1986, the Chernobyl nuclear accident occurred. Thirty people died within several weeks, while the accident's scale was unprecedented—and probably about the largest theoretically possible. Many predictions were then made, including rumors concerning up to million cancer deaths. Most of those predictions were a priori unobservable and therefore unscientific. The reality turned out to be absolutely different. According to solid scientific data gained over one quarter of a century, 15 cancer deaths at most may be directly attributed to fallout radiation. In particularly, no conclusion could be drawn concerning the presence or absence of a radiation-related excess of cancer—including leukemia—among Chernobyl accident recovery workers, who received rather high (and well-documented) radiation doses. The number of radiation-related mutations (congenital malformations) is zero. Two popular myths challenge the above scientific evidence: (a) the raw medical data is filtered by local governments; (b) the international agencies that summarize the data (like IAEA, UNSCEAR and WHO) are pro-nuclear biased. Both arguments are, speaking politically-correct, alternatively convincing. On the other hand it should be stressed that the myths and misperceptions about the threat of radiation themselves caused enormous human suffering. In addition to the socio-economic problems associated with relocation (mostly unjustified), people have suffered a paralyzing fatalism, which has contributed to a culture of chronic dependency. Mental health problems, leading to and coupled with smoking and alcohol abuse, proved to be a very much greater problem than radiation. Similar problems should be avoided in future accidents by means of proper transparency.

Review of health hazards and prevention measures for response and recovery workers and volunteers after natural disasters, flooding, and water damage: mold and dampness

Health problems and illnesses encountered by unprotected workers, first-responders, home-owners, and volunteers in recovery and restoration of moldy indoor environments after hurricanes, typhoons, tropical storms, and flooding damage are a growing concern for healthcare providers and disaster medicine throughout the world. Damp building materials, particularly cellulose-containing substrates, are prone to fungal (mold) and bacterial infestation. During remediation and demolition work, the airborne concentrations of such microbes and their by-products can rise significantly and result in an exposure risk. Symptoms reported by unprotected workers and volunteers may relate to reactions of the airways, skin, mucous membranes, or internal organs. Dampness-related fungi are primarily associated with allergies, respiratory symptoms or diseases such as dermatitis, rhinosinusitis, bronchitis, and asthma, as well as changes of the immunological system. Also, cognitive, endocrine, or rheumatological changes have been reported. Based on the consensus among experts at a recent scientific conference and a literature review, it is generally recommended to avoid and minimize unnecessary fungal exposure and use appropriate personal protective equipment (PPE) in disaster response and recovery work. Mycologists recommend addressing any moisture or water intrusion rapidly, since significant mold growth can occur within 48h. Systematic source removal, cleaning with "soap and water," and "bulk removal" followed by high-efficiency particulate air vacuuming is recommended in most cases; use of "biocides" should be avoided in occupied areas. Public health agencies recommend use of adequate respiratory, skin, and eye protection. Workers can be protected against these diseases by use of dust control measures and appropriate personal protective equipment. At a minimum, a facial dust mask such as the National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirator should be used for mold remediation jobs. For any large-scale projects, trained remediation workers who have medical clearance and use proper personal protection (PPE) should be employed.

Patient-Clinician Agreement on Treatment Type and Helpfulness: Results From a WTC Rescue and Recovery Worker Cohort

This study assessed patient and clinician agreement about treatment type and its association with treatment helpfulness among World Trade Center rescue and recovery workers. A total of 187 outpatients and 280 clinicians completed a survey, which gathered information on patient characteristics, treatment types, and treatment helpfulness. Kappa statistics and sensitivity and specificity analyses were used, and the association between patient-clinician agreement and reported treatment benefit was determined. Patient-clinician agreement was highest for group therapy, medication management, eye movement desensitization and reprocessing, and couples therapy. Agreement about medication management, individual psychotherapy, and workers' compensation evaluation was associated with higher reported treatment benefits. Findings support the hypothesis that agreement regarding treatment type is associated with higher reported benefit and extend findings of previous studies to a linguistically diverse, naturalistic sample exposed to a disaster trauma. Results also highlight the need for better understanding of eclectic therapies offered in real-world clinical practice.

209 After Hurricane Sandy, implementation of the expanded syndromic surveillance for recovery workers and residents

ObjectivesHurricane Sandy brought wide spread devastation in the region of New York and New Jersey in USA. To our knowledge, there have been no official reports of the health effects...

Letter to the Editor: On the Radiation-Leukemia Dose-Response Relationship among Recovery Workers after the Chernobyl Accident

This letter to the Editor continues the topic of the Chernobyl accident and probable overestimation of its consequences started in the journal Dose-Response (Jaworowski 2010; Jargin 2011) within a broader perspective: the dose-response relationship after low-dose low-rate exposures to ionizing radiation. UNSCEAR (2000) Report concluded that no increased risk of leukemia related to ionizing radiation has been found among recovery operation workers (liquidators) after the Chernobyl accident. According to the UNSCEAR (2008) Report, recent studies suggest an increase in the incidence of leukemia among the liquidators; however, limitations of those studies include low statistical power, uncertainties in dose reconstructions, and internal inconsistencies that suggest potential biases and confounding factors; evidence of the leukemia incidence increase among liquidators thus being “far from conclusive”. An association between a radiation exposure and leukemia incidence among liquidators was reported recently (Ivanov et al. 2012; Zablotska et al. 2013). Participation rates were higher among “cases” than among controls (Zablotska et al. 2013), a phenomenon noticed also by other researchers (Cardis et al. 2005; Kesminiene et al. 2008), being probably caused by higher motivation of the cases. The patients knowing their doses were probably on average more interested in further medical examinations if a dose estimate had been relatively high. In the health care system of the former Soviet Union, thoroughness of an examination sometimes depended on a patient’s initiative. In other words, individuals with higher dose estimates were probably given on average more attention, and cared more about their health themselves. “The dose-dependent participation of self-reported pre-screening cases” was pointed out by Zablotska et al. (2011), which probably can occur in Chernobyl-related research of different kind. Therefore, a probability of discovering a disease without specific local symptoms such as leukemia must be higher in people with higher dose estimates. Therefore, one of the reasons why no statistically significant radiation risks were observed for chronic lymphatic leukemia (CLL) by Ivanov et al. (2012) seems to be clear: this leukemia type is often accompanied by lymphadenopathy therefore probably remaining less frequently undiagnosed in the general population.

Cancer Incidence in World Trade Center Rescue and Recovery Workers, 2001–2008

Background: World Trade Center (WTC) rescue and recovery workers were exposed to a complex mix of pollutants and carcinogens.Objective: The purpose of this investigation was to evaluate cancer incidence in responders during the first 7 years after 11 September 2001.Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure.Results: A total of 575 cancers were diagnosed in 552 individuals. Increases above registry-based expectations were noted for all cancer sites combined (SIR = 1.15; 95% CI: 1.06, 1.25), thyroid cancer (SIR = 2.39; 95% CI: 1.70, 3.27), prostate cancer (SIR = 1.21; 95% CI: 1.01, 1.44), combined hematopoietic and lymphoid cancers (SIR = 1.36; 95% CI: 1.07, 1.71), and soft tissue cancers (SIR = 2.26; 95% CI: 1.13, 4.05). When restricted to 302 cancers diagnosed ≥ 6 months after enrollment, the SIR for all cancers decreased to 1.06 (95% CI: 0.94, 1.18), but thyroid and prostate cancer diagnoses remained greater than expected. All cancers combined were increased in very highly exposed responders and among those exposed to significant amounts of dust, compared with responders who reported lower levels of exposure.Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow-up and surveillance of WTC responders.

Phthalates and Childhood Asthma: Revealing an Association through Urinary Biomarkers

Exposure to phthalates, substances used as plasticizers in a large number of consumer goods, can occur by ingestion, inhalation, or skin contact. Children––who are uniquely vulnerable to adverse health effects of environmental exposures because of their still-developing neuro-logical, immunological, and respiratory systems—can receive particularly high exposures due to more frequent contact with phthalate-rich surfaces such as plastic toys and polyvinyl chloride (PVC) flooring, as well as house dust, which collects phthalates (and other chemicals). Researchers now report an association between phthalate exposure and asthma and allergic disease in a cohort of 10-year-old Norwegian children [EHP 121(2):251–256; Bertelsen et al.]. The research team conducted a cross-sectional analysis of urine sample data from 623 children participating in the 10-year followup to the prospective Environment and Childhood Asthma study in Oslo. The followup included structured interviews with parents and blood tests, lung function tests, clinical examinations, and skin prick tests for allergic sensitization for children. Samples of first-morning urine were collected and assessed for three metabolites of low-molecular-weight phthalates (commonly used in personal care products) and eight metabolites of high-molecular-weight phthalates (commonly used in PVC applications such as flooring, electrical cords, car interiors, and toys). The investigators used logistic regression modeling to estimate associations between current asthma and phthalate metabolite concentrations. Hand-to-mouth activity combined with phthalate-rich surfaces such as PVC toys and dusty floors can mean particularly high phthalate exposures for children. Previous animal studies have shown an association between high-molecular-weight phthalates and allergic disease development, while epidemiological studies have shown exposure to house dust containing several of these chemicals to be associated with asthma and allergic disease. The current analysis revealed an association between asthma in children and the highest quartiles of exposure to the metabolites mono-carboxyoctyl phthalate and mono-carboxynonyl phthalate. The parent compounds of these metabolites are high-molecular-weight phthalates used primarily as plasticizers in PVC items. No association was observed between asthma and the nine other metabolites, nor was any association detected between any metabolites and allergic sensitization. Limitations of the study include the cross-sectional design and measurements based on single urine samples, which do not reflect phthalate exposures over time. However, the findings do support the growing body of evidence showing an association between asthma and exposure to high-molecular-weight phthalates.

Social Work Training Curriculum in Disaster Management

This article describes training approaches in disaster recovery for social workers, allied workers, and volunteers. Recovery workers from diverse disciplines require specific training in the theoretical constructs, interventions, tasks, and policy to undertake their roles. The article links the knowledge and skills base of disaster recovery to core social work professional education. Current debates in disaster recovery practice are discussed. An undergraduate and postgraduate program developed for Singaporean social work students is outlined in detail. Other models of training are described, including interagency programs, ongoing professional development, workshops after impact, specific training for volunteers, and training for the community itself.

Использование магниторезонансной спектроскопии при системном анализе радиочувствительности/радиорезистентности животных и человека

The responses of deoxyribonucleotide (dNTP), DNA and protein synthesis systems in blood-forming organs of animals (dogs, mice) as well as changes in Fe(3+)-transferrin (Fe(3+)-TF) and Cu(2+)-ceruloplasmin (Cu(2+)-CP) pools in blood to gamma-irradiation and the administration of radioprotectors have been studied. It has been shown that changes in Fe(3+)-TF and Cu(2+)-CP pools in blood are indices of changes in the body radioresistance and are reliably controlled by the EPR technique. An increase in the Fe(3+)-TF pool promotes the activated synthesis of dNTP, DNA and Fe(3+)-containing proteins which are essential for the repair efficiency during the early post-irradiation time as well as for the development of compensatory and restorative reactions of cellular systems; i.e., they are responsible for the body resistance to DNA-damaging factors. It is important that the intensity of responses depends on the initial state of the organism. It has been shown, that changes in Fe(3+)-transferrin and Cu(2+)-ceruloplasmin pools, which are trust-worthy controlled by the EPR technique in whole blood, blood plasma, and serum, as well as the changes in the extracellular DNA content in blood plasma are the markers of the changes in the organism radioresistance. This has been proved during the medical examination of the Chernobyl accident recovery workers and civil population, including children, exposed to low-intensity radiation.

Elevated Peripheral Eosinophils Are Associated with New-Onset and Persistent Wheeze and Airflow Obstruction in World Trade Center-Exposed Individuals

Background. Exposure to World Trade Center (WTC) dust and fumes is associated with the onset of asthma-like respiratory symptoms in rescue and recovery workers and exposed community members. Eosinophilic inflammation with increased lung and peripheral eosinophils has been described in subpopulations with asthma. We hypothesized that persistent asthma-like symptoms in WTC-exposed individuals would be associated with systemic inflammation characterized by peripheral eosinophils. Methods. The WTC Environmental Health Center (WTC EHC) is a treatment program for local residents, local workers, and cleanup workers with presumed WTC-related symptoms. Patients undergo a standardized evaluation including questionnaires and complete blood count. Between September 2005 and March 2009, 2462 individuals enrolled in the program and were available for analysis. Individuals with preexisting respiratory symptoms or lung disease diagnoses prior to September 2001 and current or significant tobacco use were excluded, Results. One thousand five hundred and seventeen individuals met the inclusion criteria. Patients had a mean age of 47 years, were mostly female (51%), and had a diverse race/ethnicity. Respiratory symptoms that developed after WTC dust/fume exposure and remained persistent included dyspnea on exertion (68%), cough (57%), chest tightness (47%), and wheeze (33%). A larger percentage of patients with wheeze had elevated peripheral eosinophils compared with those without wheeze (21% vs. 13%, p < .0001). Individuals with elevated peripheral eosinophils were more likely to have airflow obstruction on spirometry (16% vs. 7%, p = .0003). Conclusion. Peripheral eosinophils were associated with wheeze and airflow obstruction in a diverse WTC-exposed population. These data suggest that eosinophils may participate in lung inflammation in this population with symptoms consistent with WTC-related asthma.