Faculty Bibliography

Tens of thousands of workers participated in rescue, recovery, and cleanup activities at the World Trade Center (WTC) site in lower Manhattan after the terrorist attacks on September 11, 2001 (9/11). The collapse of the WTC resulted in the release of a variety of airborne toxicants. To date, respiratory symptoms and diseases have been among the most examined health outcomes in studies of WTC disaster workers. A systematic review of the literature on respiratory health outcomes was undertaken to describe the available information on new onset of respiratory symptoms and diseases among WTC disaster workers after September 11, 2001. Independent risk factors for respiratory health outcomes included being caught in the dust and debris cloud, early arrival at the WTC site, longer duration of work, and delaying mask and respirator use. Methodological challenges in epidemiologic studies of WTC disaster workers involved study design, exposure misclassification, and limited information on potential confounders and effect modifiers. In the 10 years after 9/11, epidemiologic studies of WTC disaster workers have been essential in investigating the respiratory health consequences of WTC exposure. Longitudinal studies along with continued medical surveillance will be vital in understanding the long-term respiratory burden associated with occupational WTC exposure

OBJECTIVES: We used an interviewer-administered questionnaire to investigate workplace exacerbation of asthma symptoms (WEAS) among low-income, minority, working asthmatics admitted Bellevue Hospital Center in New York City from 2001 to 2002. We hypothesized that a high prevalence of WEAS would be found in this population among all jobs held and a subset of individual occupational classifications. MEASUREMENTS AND MAIN RESULTS: Of 301 subjects, 51% reported WEAS in their current or most recent job; 71% reported WEAS in any job. Prevalences (95% confidence intervals) of WEAS in common job classifications were 61% (49-73%) in janitorial jobs, 50% (33-67%) in garment and textile manufacturing jobs, and 38% (23-55%) in construction jobs. CONCLUSION: WEAS is prevalent in this urban minority population

The endothelin pathway plays a critical role in melanoma tumor progression by a variety of mechanisms that enhance tumor cell growth, invasion, and metastasis. Here, we investigate the effect of this pathway on CXC chemokine expression in human melanoma cells and melanocytes. As determined by ELISA, endothelin-1 (ET-1) induces CXCL1 and CXCL8 secretion in three human melanoma cell lines in a concentration-dependent fashion. These responses are mediated by the endothelin-B receptor and are sustained over a 40 h time course. ET-1 does not induce CXCL1 secretion in primary human melanocytes but ET-3, an endothelin isoform, induces a low level of CXCL1 secretion in certain cultures. Neither ET-1 nor ET-3 induces secretion of CXCL8 in primary human melanocytes; thus, this response may be specific for melanocytic cells that have undergone malignant transformation. We have previously demonstrated that ET-1 induces changes in the expression of adhesion molecules in melanoma cells such that invasion and metastasis are favored. This study demonstrates that ET-1 additionally induces secretion of CXC chemokines critical for melanoma metastasis and tumor progression

Evidence suggests that Latino workers, along with other minority and low-income workers, face a higher risk for occupational disease than do other workers. Targeted surveillance and primary prevention interventions have been lacking or inadequate. The authors estimate the number of occupational disease deaths and new cases in Latino workers in the United States. Then, using data from New York City, they find that Latino workers are disproportionately employed in more hazardous occupations and underrepresented in less hazardous jobs. They suggest a comprehensive approach to address workplace disease in Latino workers, which involves primary prevention interventions, clinical services, educational approaches, research and surveillance, unionization and organization of workers, and legislation and regulation

Frequency dependence of compliance (FDC) reflects non-homogeneous ventilatory distribution and, in the presence of a normal measured airway resistance, suggests peripheral airways dysfunction. This study evaluated peripheral airway function and bronchial reactivity in irritant exposed or non-exposed individuals with normal routine pulmonary function tests (PFTs) who had persistent unexplained lower respiratory symptoms. Twenty-two patients were identified with persistent respiratory symptoms and with normal chest X-ray and PFTs. Twenty were non-smokers; two had stopped smoking more than 10 years before evaluation. Twelve patients had been exposed to irritants in their workplaces or at home. Non-specific bronchial hyper-reactivity (nsBHR) and FDC, pre- and post-bronchodilator, were measured in all patients. Studies were repeated in 6/12 irritant-exposed subjects after exposure removal and inhaled corticosteroid treatment. Whereas 12/22 patients had nsBHR, all 22 subjects demonstrated FDC [dynamic lung compliance/static lung compliance Cdyn,l/Cst,l at respiratory frequency 60 min(-1) (f60), mean 46%, range 27-67%]. After bronchodilator administration, a 15% improvement Cdyn,l was observed most consistently at f60 (mean% improvement 26%, 95% CI 14-38%) and in subjects without nsBHR. However, Cdyn,l at f60 did not return to normal after inhaled bronchodilator. Irritant-exposed and unexposed individuals appeared similar in results of testing for FDC and nsBHR. FDC and its response to bronchodilators provide objective physiological measures of an airway abnormality which may provide a basis for clinical symptoms in patients with normal routine pulmonary function studies. The presence of persistently abnormal FDC after bronchodilator (BD) and on follow up studies may reflect chronic inflammatory and/or structural changes in the airways in addition to bronchoconstriction

Work-related asthma (WRA) is asthma that is attributable to, or is made worse by, environmental exposures in the workplace. WRA has become the most prevalent occupational lung disease in developed countries, is more common than is generally recognized, and can be severe and disabling. Identification of workplace exposures causing and/or aggravating the asthma, and appropriate control or cessation of these exposures can often lead to reduction or even complete elimination of symptoms and disability. This depends on timely recognition and diagnosis of WRA. In this review, the diagnostic evaluation has been organized in a stepwise fashion to make it more practical for primary care physicians as well as physicians specializing in occupational diseases and asthma. WRA merits more widespread attention among clinicians, labor and management health and safety specialists, researchers, health care organizations, public health policy makers, industrial hygienists, and others interested in disease prevention.