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Background and aims Prescription opioid overdose is a leading cause of injury-related morbidity and mortality in the United States. We aimed to identify characteristics associated with clinical severity in emergency department patients with prescription opioid overdose. Design This was a secondary data analysis of adult prescription opioid overdoses from a large prospective cohort of acute overdoses. We examined elements of a typical emergency department evaluation using a multivariable model to determine which characteristics were associated with clinical severity, specifically severe respiratory depression (SRD). Setting This study was conducted at two urban academic emergency departments in New York City, USA. Participants Adult patients who presented with acute prescription opioid overdose between 2009 and 2013 were included in the current study. We analyzed 307 patients (mean age = 44.7, 42% female, 2.0% mortality). Measurements Patient demographics, reported substances ingested, suspected intent for ingesting the substance, vital signs, laboratory data, treatments including antidotes and intubation and outcome of death were recorded by trained research assistants. Intent was categorized into four mutually exclusive categories: suicide, misuse, therapeutic error and undetermined. The primary outcome was SRD, defined as administration of either (a) naloxone or (b) endotracheal intubation (ETI). Findings A total of 109 patients suffered SRD with 90 patients receiving naloxone alone, nine ETI alone and 10 both naloxone and ETI. The most common opioids were oxycodone ( n = 124) and methadone ( n = 116). Mean age was higher in patients with SRD (51.1 versus 41.1, P < 0.001). Opioid misuse was associated with SRD in the multivariable analysis [odds ratio (OR) = 2.07, 95% confidence interval (CI) = 1.21-3.55]. The unadjusted relative risk of SRD was high for fentanyl (83.3% SRD) and lowest for codeine (3.6% SRD). Conclusion In emergency department patients in the United States with prescription opioid overdose, worse clinical severity was associated with opioid misuse, increased with age and was widely variable, depending on the specific opioid medication involved. [ABSTRACT FROM AUTHOR]

The article presents a cohort study which examines the 9-year incidence and prevalence of physical and mental health disorders of the rescue and recovery workers in the September 11, 2001 (9/11) terrorist attacks on the World Trade Center (WTC) in New York City. The study explores the incidence rates of multiple health problems and their associations with occupational risk exposures. Findings show incidences of physical disorders such as asthma and sinusitis and mental disorders like depression.

The article presents an epidemiological study that aims to conduct an evaluation of health effects in New York State personnel who responded to the World Trade Center disaster on September 11, 2001. Results show that one half of the respondents showed lower and upper respiratory symptoms and one third reported psychological symptoms. Health effects such as respiratory and suggestive post-traumatic stress disorder were associated with having been caught in the cloud of dust. The study concludes that some respondents directly involved in the rescue operations experienced new or worsening health effects because of their exposures.

There are continuing concerns regarding the respiratory health effects of airborne particulate matter (PM) after the destruction of the World Trade Center (WTC). We examined cytokine (interleukin [IL]-8, IL-6, tumor necrosis factor-α) release by primary human lung alveolar macrophages (AM) and type II epithelial cells after exposure to WTC PM2.5 (indoor and outdoor), PM10–2.5 (indoor), and PM53–10 (outdoor), fractionated from settled dusts within 2 months of the incident. There was an increase in AM cytokine/chemokine release at 5 and/or 50 μg/well WTC PM, which fell at 500 μg/well. Type II cells did not release tumor necrosis factor-α, and the increase in IL-8 and IL-6, although significant, was lower than that of AM. Respirable PM generated by the WTC collapse stimulates inflammatory mediator release by lung cells, which may contribute to the increased incidence of respiratory illness since September 11th 2001. [ABSTRACT FROM AUTHOR]

Examines the effects of exposure to the environment around the World Trade Center after the terrorist attacks of September 11, 2001. Evaluation of police first-responders; Occurrence of respiratory symptoms; Independent risk factors for abnormal spirometry; Finding that officers with dyspnea, chest discomfort, or wheeze were more likely to have abnormal spirometry.

Rates of developmental and respiratory diseases are disproportionately high in underserved, minority populations such as those in New York City's Washington Heights, Harlem, and the South Bronx. Blacks and Latinos in these neighborhoods represent high risk groups for asthma, adverse birth outcomes, impaired development, and some types of cancer. The Columbia Center for Children's Environmental Health in Washington Heights uses molecular epidemiologic methods to study the health effects of urban indoor and outdoor air pollutants on children, prenatally and postnatally, in a cohort of over 500 African-American and Dominican (originally from the Dominican Republic) mothers and newborns. Extensive data are collected to determine exposures to paniculate matter < 2.5 µm in aerodynamic diameter (PM[sub2.5]), polycyclic aromatic hydrocarbons (PAHs), diesel exhaust paniculate (DEP), nitrogen oxide, nonpersistent pesticides, home allergens (dust mite, mouse, cockroach), environmental tobacco smoke (ETS), and lead and other metals. Biomarkers, air sampling, and clinical assessments are used to study the effects of these exposures on children's increased risk for allergic sensitization, asthma and other respiratory disorders, impairment of neurocognitive and behavioral development, and potential cancer risk. The center conducts its research and community education in collaboration with 10 community-based health and environmental advocacy organizations. This unique academic-community partnership helps to guide the center's research so that it is most relevant to the context of the low-income, minority neighborhoods in which the cohort resides, and information is delivered back to these communities in meaningful ways. In turn, communities become better equipped to relay environmental health concerns to policy makers. In this paper we describe the center's research and its academic-community partnership and present some preliminary findings. Key words: asthma, cancer... [ABSTRACT FROM AUTHOR]

Background. Little is known about the impact of providing health insurance to uninsured children who have asthma or other chronic diseases. Objectives. To evaluate the association between health insurance and the utilization of health care and the quality of care among children who have asthma. Design. Before-and-during study of children for a 1-year period before and a 1-year period immediately after enrollment in a state-funded health insurance plan. Intervention. In 1991 New York State implemented Child Health Plus (CHPlus), a health insurance program providing ambulatory and ED (ED), but not hospitalization coverage for children 0 to 12.99 years old whose family incomes were below 222% of the federal poverty level and who were not enrolled in Medicaid. Subjects. A total of 187 children (2-12.99 years old) who had asthma and enrolled in CHPlus between November 1, 1991 and August 1, 1993. Main Outcome Measures. Rates of primary care visits (preventive, acute, asthma-specific), ED visits, hospitalizations, number of specialists seen, and quality of care measures (parent reports of the effect of CHPlus on quality of asthma care, and rates of recommended asthma therapies). The effect of CHPlus was assessed by comparing outcome measures for each child for the year before versus the year after CHPlus enrollment, controlling for age, insurance coverage before CHPlus, and asthma severity. Data Ascertainment. Parent telephone interviews and medical chart reviews at primary care offices, EDs, and public health clinics. Main Results. Visit rates to primary care providers were significantly higher during CHPlus compared with before CHPlus for... [ABSTRACT FROM AUTHOR]

Presents a time-series analysis of acidic particulate matter and daily mortality and morbidity in the region of Buffalo, New York. Consideration of daily aerosol acidity and sulfate measurements from May 1988 to October 1990; Associations with respiratory hospital admissions.

Studies the incidence and severity of acute respiratory disease in families exposed to different air pollution levels in the New York Metropolitan Area. Disease rates among family members; Sources of indoor air pollution; Differences in incidence in three different communities.

Focuses on the study released by the U.S. National Institute of Environmental Health Sciences, which found respiratory difficulties plague rescuers and others who worked at the World Trade Center since September 11, 2001. Connections between pollutants and adverse health effects, according to Philip Landrigan, chairman of the Department of Community and Preventive Medicine, Mount Sinai School of Medicine; Distress caused by highly alkaline pulverized cement particles and microscopic glass shards; Symptoms of the firefighters and ironworkers who were evaluated; Impact of pollution on residents who lived within a ten-block radius of the site; The risk of asbestos-linked mesothelioma.

Examines the acute respiratory effects of short-term exposures to nitrogen dioxide in New York, New York. Sensitivity of asthmatics to bronchoconstrictor; Assessment of chronic health effects; Utilization of a portable Breon Spirometer.

Examines the feed-associated respiratory illness in farmers of Ostego County, New York, New York. List of criteria for diagnosing lung diseases of farmers; Occurrence of silo filler's disease when workers inhale toxic oxides of nitrogen; Accounts on the educational efforts of physicians in reducing the incidence of disorders.