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What health risks do 9/11 first responders face?

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When the planes hit the World Trade Center on September 11, 2001, Federal Police Officer Raymond Gauvin followed his training without hesitation. His office at 26 Federal Plaza was less than a mile from the construction site. He came to rescue people from the rubble in minutes.

“I never thought that there would be medical consequences later,” says Gauvin.

Twenty years later, Gauvin suffered from bladder cancer, inflammation of the nose, acid reflux, and post-traumatic stress disorder (PTSD). All of these health effects – along with other cancers, respiratory diseases, and mental illnesses – are particularly common among first responders and survivors who worked at the World Trade Center site on September 11 and the months that followed.

By treating and studying these patients for two decades, clinicians have identified previously unknown associations between environmental pollution and numerous health conditions. Continuous research will advance scientific understanding of these conditions and help others affected by pollution.

Associating pollution with health effects

Like Gauvin, most first responders never anticipated the medical consequences of responding to the attacks. But New York Fire Department (FDNY) doctors and other labor groups soon noticed a lingering symptom among rescuers. They called it the “World Trade Center Cough”. It was just the first physical manifestation of the intense pollution they had inhaled on the spot.

“Those 110-story towers were essentially pulverized into small fragments,” said John Howard, a doctor and public health expert who serves as the administrator of the World Trade Center Health Program. These included particulate matter – a dangerous form of pollution often released from fossil fuel burning and forest fires – as well as asbestos fibers and more than 200 other carcinogens. Tiny particles are especially dangerous to lung health because they are small enough to be breathed in easily but large enough to damage the airways.

In addition to the 9/11 rescue and recovery efforts, many first responders worked at Ground Zero for months – which meant they continued to breathe this toxic pollution. Some worked there for ten months until July 2002.

[Related: This chart shows how far we’ve come in fighting cancer]

Initially, survivors and first responders faced respiratory ailments: the World Trade Center cough, along with swelling in the nose and head, a condition known as chronic sinusitis. Many responders also developed asthma, while some had gastroesophageal reflux disease (also called acid reflux) because the air pollution irritated their throats. Doctors working with first responders developed treatments for the cough and other common symptoms that resulted in significant improvements for patients. For example, in 2001 more than half of FDNY first responders had persistent coughs; this had fallen to 9 percent by 2021.

Some patients did not conform to the “classic asthma phenotype” but lost lung function over time, “similar to a smoker,” says Anna Nolan, professor at New York University’s medical school who works with FDNY first responders. This lung damage led to other respiratory diseases such as chronic obstructive pulmonary disease (or COPD), which blocks airflow from the lungs. Before 2001, scientists had little understanding of the risks (other than smoking) that cause asthma and COPD; Studies of first responders with these conditions highlighted key processes in the body and led to new treatments such as: B. Medicines for eosinophils, a type of white blood cell.

Respiratory illnesses aren’t the only problem for first responders. When someone inhales toxic pollutants like the particles released in the World Trade Center attacks, many of those toxins stay in the body permanently. Some become embedded and enter the bloodstream, from the lungs to other organs. In the long term, these carcinogens can increase the risk of various types of cancer; Studies have shown that first responders may be twice as likely to develop cancer than those who weren’t at ground zero. Nolan has seen skin cancer, lung cancer, bone cancer, breast cancer, thyroid cancer, and others among her patients. Pollution was unknown as a cause of cancer (besides lung cancer) until researchers at the World Trade Center showed a link in the early 2010s.

Research at the World Trade Center continues

In the fall of 2001, the Centers for Disease Control and Prevention (CDC) and local authorities began screening first responders for health problems. During the 2000s, this health screening program grew into the World Trade Center Health Program (or WTC Health Program), a national organization that provides research and treatment for first responders and survivors. The program was officially introduced with the 2010 Zadroga Act, named after James Zadroga, a police officer who died of a respiratory disease on September 11th. In 2015, Congress renewed the law and funded the health program through 2090.

“It looks like another federal health plan,” says Howard, the program’s administrator. But unlike Medicare or Medicaid, the WTC health program only covers conditions that can be directly linked to pollution on September 11th. And to take into account how little we know about the health effects of first responders, members can request the program to investigate conditions not already on that cover list. These inquiries are an important driver for ongoing research. Current areas of study include autoimmune diseases and cognitive effects, as recent reports have linked pollution exposure to Alzheimer’s and other forms of dementia.

Unraveling the effects of the September 11, 2001 pollution on a survivor’s underlying disease risk only gets more complicated as you get older. The average first responder is now over 50, says Nolan. “They develop a lot of things that most of us get as we age, but the question is, will they develop it more in this population?”

[Related: In Louisiana’s ‘Cancer Alley,’ a Black community battles an industry that threatens its health—and history]

In Gauvin’s case, his bladder cancer developed years after the 9/11 attacks. The police officer was diagnosed in 2013 after suffering severe pain in his lower abdomen while on vacation. After he reported his diagnosis to the WTC health program, the organization immediately took over all of his care; Bladder cancer has been linked to exposure to air pollution by World Trade Center researchers and other studies. Gauvin had access to the latest cancer treatments with no excess or deductible – including an intensive surgery that allowed him to keep working.

According to an analysis by FDNY researchers, cancer patients enrolled in the WTC health program are far more likely to survive their treatment than others in New York state. The health program’s cancer screening and case management protocols – which provide patients with much broader surveillance than the average physical surveillance – can provide a model for other health care providers who care for polluted patients, and perhaps even for cancer treatment as a whole.

Gauvin is now retired and lives in Delaware, but he still travels to Rutgers University’s WTC Health Clinic in New Jersey for physical exams, cancer tests, and other medical procedures. “As long as I can drive the two hours,” he says, “I’ll do what I have to do to get up there.”

The WTC health program also supports first responders and survivors with PTSD, anxiety, depression and substance use disorders. The program gives these patients access to free psychiatric care tailored specifically to their experience.

Health teachings from 9/11

More than 300 firefighters and 60 police officers and police officers died on September 11 in response to the attacks. Twenty years later, 81,000 first responders are participating in the WTC health program – along with 30,000 survivors who lived and worked near the World Trade Center.

By researching the health effects of this tragedy and mentoring first responders, scientists have learned valuable lessons for current and future victims of toxic pollution – such as those who live on the west coast devastated by forest fires. September 11th was the first “long-lasting disaster in which respiratory protection was important,” says Howard. First responders found that their respirators, for example, couldn’t withstand 8-12 hour shifts, so companies needed to improve these devices. Now wildland firefighters and other rescue workers have access to better breathing apparatus.

The Sept. 11 response also taught federal health officials to keep a list of people present at a disaster site so researchers can track them down later. And Howard says he’s learned the importance of taking pollutant measurements at different locations in a disaster area so that researchers can determine the individual exposure levels of different responders.

For Guavin, the main lesson is simple, “If you are familiar with any type of [pollution], you must have PPE immediately, ”he says. Guavin often urges his son-in-law, a state trooper in Delaware, and other first responders to remember their masks and get regular health checks.

“We consider ourselves invincible,” he says. But sometimes relying on instinct in the event of a disaster can have unforeseen consequences – as it did 20 years ago. “Entering a building is not always a good thing,” he says. “We have to think a little bit before we do it.”

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Communication disorders can have lifelong health impacts – where is the commensurate response? – Croakey Health Media

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According to Tricia McCabe, professor of speech pathology at Sydney University, communication disorders have far-reaching health implications and greater efforts are required to help children, families and others.

“Imagine paying for more and better services for children and young people with communication disabilities,” said McCabe when he recently ran Croakey’s rotating Twitter account @WePublicHealth. Below is a summary of their tweets, including links to many helpful resources.

Tricia McCabe writes:

I’m going to cover the interface between communication disorder and public health using the hashtag #CommSDoH, starting with sharing some information about what we mean by a communication disorder and jumping from there.

Communication disorders (impairments, limitations) occur when people have difficulty receiving a message from others. This may be due to a sensory impairment (hearing loss, deafness, visual impairment) as they have difficulty interpreting the message.

The difficulty in interpreting someone else’s message can arise for a number of reasons including illness, injury, development, or the environment. Understanding what you are being told depends on understanding the content, structure, and purpose of the message.

To understand content, you need to know the vocabulary and sounds of the language. We also need to understand the order of words and the structure (grammar) of what is being said.

Finally, we need to understand the tone, pitch, tempo, and volume of speech that give us the emotion and purpose of what is being said (or written). This is a simple explanation of the understanding as we shall see.

Human communication involves not only understanding, but also the ability to construct a message that others can easily interpret. This may require an effective use of voice, language, language (vocabulary, grammar, etc.), facial expressions, gestures, signs or writing.

To be an effective communicator, we also need to understand how others interpret our message. These skills of understanding and expression develop over the course of our lives and are an integral part of our social and economic success (more on this later).

After all, a person’s environment must enable them to communicate and interpret their communication as meaningful and important.

Thought experiment

So let’s do a thought experiment: what happens in your life when you cannot communicate effectively?

Children with speech and language delay (for whatever reason) hear fewer words spoken to them; hear more instructions and have fewer opportunities to start conversations. The words and phrases they hear are simpler, often “dumbfounded”.

If you start out in life with a communication delay or disorder, you are often at a higher risk of lower literacy and are therefore more likely to drop out of school.

The combination of not understanding instructions in the classroom or being teased or bullied for not understanding them or not communicating in the same way as their classmates can cause it to have an impact in class and lead to exclusion from school.

Children and adolescents with communication disabilities are more often involved in juvenile justice than their peers.

Children and adolescents with communication disabilities are also at higher risk for mental health problems than their peers.

In recent years, health economists like Dr. Paula Cronin from UTS showed that mothers of children with speech delay earn less than parents of children with typical development. I should note that this is the case when all other variables are taken into account.

Back to our thought experiment: what happens in your life when you have a communication disability?

In my own work with people with severe language disabilities, they report as adults:

  • Earn less than their friends
  • They are less educated and less literate than their siblings
  • Adults with a history of lifelong language disorder are more likely to have clinical anxiety, and the worse their language is than adults, the worse the anxiety they report.

Injustices

Above I described a communication disability that has many faces. One of these is the difficulty of understanding the intent of a person’s communication and drawing conclusions from their choice of words, tone of voice, and facial expressions. This is a kind of pragmatic obstruction to communication.

And pragmatic communication disabilities do not interact well with the legal system.

For people with communication disabilities, there are a number of additional factors that make their ability to participate in society even more difficult.

  1. Self-advocacy can be a challenge. If you have difficulty communicating, understanding how to present your case can be problematic.
  2. People with communication disabilities find it difficult to interpret forms, bureaucratic language, or the language of the legal system.
  3. If you are a parent with a communication disability, you may find it difficult to stand up for your children. This can be a double blow when dealing with organizations like the NDIS.
  4. Unfortunately, services for people with communication disabilities, such as speech pathology, are unevenly distributed with a well-known “zip code lottery”.
  5. This is where the Matthew effect comes into play. Families in more affluent areas have better access to services and there the effects of communication disabilities can be mitigated compared to families in poorer areas who share fewer resources and benefit less from limited services.
  6. Speech pathologists use service rationing as a strategy to handle large numbers of cases. The effect in richer communities is a migration to private services, the effect in poorer communities is a long delay before aid is provided.
  7. The cumulative effect is delayed access to services in the early years, resulting in lower academic success and a lifelong increased risk of socio-economic precariousness.
  8. Hearing health is affected by overcrowded or unstable housing, access to clean water and sanitation. Poverty causes ear diseases. Ear diseases cause poor understanding, attention, and participation in school.
  9. And like a language disorder, poor ear health leads to decreased literacy, early school leaving, and greater interaction with the justice system. #CommSDoH not understand = disadvantage.

  1. It is estimated that one in three people in the justice system has a communication disability (see: https://aic.gov.au/publications/tandi/tandi435)
  2. Imagine paying for more and better services for children and young people with communication disabilities.

Another useful resource is the @ orygen_aus Guide to Mental Health and Communication Disorders.

And @SpeechPathAus has a number of fact sheets on these topics for download.

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Anne Hailes: We need to talk about our mental health

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I have encountered suicide several times DURING my life. The first time was when I was a teenager and involved the lady across the street.

Then I remember the day, years later, when I went to Banbridge to meet a mother who had called me in distress; her son had committed suicide.

We met in a quiet corner of a roadside hotel. Her son was 19 and happened to be mine, and we were two mothers who shared something unfathomable.

On another occasion, one evening after my TV show, the security guard stopped me at the door: “There’s a woman who wants to talk to you, she sounds very upset.”

That’s how she was, she told me she felt that there was nothing to live with. We talked for almost two hours. At the end of our conversation, she assured me that she would not do anything.

That was over 20 years ago when suicide was less common and even recognized. Today there are a number of end-of-the-phone or even online supports and services including Samaritans, Lifeline, and Pips.

September 10th was World Suicide Day – did you notice? – but that is a topic that one should be aware of every day.

In a research paper from the NI Assembly Research and Information Service dated April 14, 2021, Dr. Lesley-Ann Black on the complex subject of suicide.

For example: “Research shows that one in eight children in Northern Ireland has suicidal ideation or attempted suicide. Men are more likely to die from suicide than women, although more women attempt suicide. The suicide rate in the most deprived areas is three times “higher than in the least deprived areas.”

Northern Ireland is also believed to have particular problems: “The strong link between suicide and mental illness is well established. Mental illness is a leading cause of disability in Northern Ireland.

“In addition, research suggests that Northern Ireland, a post-conflict society, is 20-25 percent more likely to be mentally ill than the rest of the UK, with approximately one in five adults having a diagnosable mental illness at any given time.

“Northern Ireland also has significantly higher rates of depression than the rest of the UK, higher antidepressant prescribing rates, higher incidences and presentations of self-harm (although, in many cases, people who harm themselves do not see a doctor) attention and are for healthcare professionals not visible) and high rates of post-traumatic stress disorder. “

Elsewhere, the report notes that alcohol and drug abuse may be a factor: “A significantly higher percentage of young people who have died of suicide in Northern Ireland had a history of alcohol and / or alcohol compared to the rest of the UK Substance abuse. “

The Department of Health’s suicide strategy, Protect Life 2, aims to reduce the suicide rate in Northern Ireland by 10 percent by 2024 and to “ensure that adequate suicide prevention services and support are provided in deprived areas where suicide and self-harm rates occur will”. are the highest “.

Online publication

Author Declan Henry published his online brochure Suicide: Reasons To Live earlier this month. He interviewed people from the UK and Ireland, including survivors, suicide attempt survivors and those who had strong suicidal thoughts at some point in their lives.

He discovered that there is one suicide death roughly every 40 seconds in the world, while there is an average of 19 people a day in the UK and Ireland – likely a conservative figure given the effects of Covid-19 and the effects of lockdown on the psychological People’s wellbeing has yet to be calculated.

His research highlights the complexities that lead to suicide or attempted suicide.

He writes of young people who talk more openly than previous generations.

“Children need to be educated about emotional health and given vocabulary that will enable them to describe their feelings,” he says.

“Society often wrongly feels that the life of the current generation of young people is much simpler compared to their predecessors. Young people have many things, so it’s easy to see why their mental health is being affected.

“They are constantly fed negativity by the media and confronted with graphic and violent images through online games. Many young people hardly speak at home anymore because they are busy with their ‘virtual life’ on their cell phones.

“Is it therefore surprising that some of them develop a sense of hopelessness for the future?”

Where is the help?

In general, Declan underlines the fact that the mental health system is in a state of disorder.

“Patients often feel like they are being pushed aside. GPs have limited time and the patient is usually given an antidepressant prescription and says to come back in a few weeks. Physical needs are met, but psychological needs are not.”

One interviewee named Frank says to Declan, “If someone tells you they feel suicidal, they ask for help. Some people post on Facebook saying they intend to kill themselves because they have no other place to talk.

“Many such people wear masks in public, including at home – where there is no sign that anything is wrong.”

Covering a wide range of suicide prevention strategies, Declan emphasizes the importance of speaking out loud and starting a discussion in general but specific and empathetic with the person you suspect is having suicidal thoughts.

You can download Declan’s brochure for free from declanhenry.co.uk

When life is difficult, Samaritans are here – day and night, 365 days a year. You can call them on 028 9066 4422 or 116 123, email jo@samaritans.org, or visit www.samaritans.org to find your nearest branch and local support groups.

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Over 90% surveyed with depressive disorders in China fail to seek treatment: study

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Depressive Disorders Photo: VCG

More than 90 percent of people with depressive disorder surveyed in China are untreatable, and only 0.5 percent have received adequate treatment, according to a new mental health survey of Chinese citizens.

The results of the study on Mental Disorder Exposure and Health Service Use in China, also known as the China Mental Health Survey, were announced at a conference and expert forum in Beijing on Sunday. The study, which lasted three years, examined the prevalence of mental disorders and their distribution characteristics among adults in the Chinese community, highlighting the current situation of low use of health services and poor access to adequate treatment for people with depressive disorders in China.

The study found that in China, the prevalence of depressive disorder is higher in women than in men; higher among housewives, pensioners and the unemployed than among the employed; higher for separated, widowed or divorced persons than for married or cohabiting persons; and more common in older age groups, in a cross-sectional epidemiological study of mental disorders in Chinese adults of 28,140 respondents (12,537 men and 15,603 women) completed at 157 nationally representative disease surveillance centers in 31 provincial-level regions in China.

The lifetime prevalence of depressive disorder in Chinese adults was 6.8 percent below that of the world, including 3.4 percent for depression, 1.4 percent for dysphoric disorders, and 3.2 percent for unspecified depressive disorders. The 12-month prevalence of depressive disorder was 3.6 percent, including 2.1 percent for depression, 1.0 percent for premenstrual dysphoric disorder, and 1.4 percent for unspecified depressive disorder, the research shows.

The study provided the first nationwide representative epidemiological data on depressive disorders in China and is expected to play an important role in formulating and adapting national mental health policies and in advancing the treatment of patients with depressive disorders. The results were published in the leading international medical journal The Lancet.

This study is groundbreaking research as it provides the first national data on the epidemiological prevalence, distribution characteristics, and access to treatment status of depressive disorder in adults in China, which is an important reference for determining mental health strategies from clinical health service use is perspective, Wang Yu, former director of the China Center for Disease Control and Prevention, told the forum.

Lu Jin, lead author of the paper, told the Global Times during the forum that the prevalence of depressive disorder in China is low by global standards, due to many factors.

“The fact that many Chinese people have difficulty expressing emotions (alexithymia) could be one of the causes of this status,” said Lu. “There is also a link between socio-economic development and depressive disorders, a condition associated with psychosocial disorders.”

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