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shtml A Message from Thomas Farley, MD, MPH, the Commissioner of the New York City Dep artment of Health and Mental Hygiene What We KnowWhat Additional Research Can Tell UsMonitoring and Treatment Millions of people were affected by the September 11 terrorist attacks from physic al and mental health problems to financial loss. This large and diverse populati on had different exposures after the collapse of the World Trade Center (WTC), a nd health effects have varied as a result. A decade after the attacks, we now know more about the health effects of 9/11. T he WTC Medical Working Group's 2011 Annual Report on 9/11 Health summarizes the research to date and includes a review of the latest scientific articles about the health impacts of 9/11. What We Know Large studies suggest that post-traumatic stress symptoms are the most common he alth effect of 9/11. Almost one in five (19%) adults enrolled in the Health Depa rtment's WTC Health Registry reported post-traumatic stress symptoms 5 to 6 year s after 9/11, roughly 4 times the rate typically found in the general population . Risk factors for probable PTSD included: intense dust cloud exposure or suffering an injury on 9/11 being on a high floor of the World Trade Center, evacuating late or working for an employer that sustained fatalities. witnessing horror or knowing someone killed or injured on 9/11 little or no social support after 9/11 Rescue and recovery workers who started rescue work on or soon after 9/11 or who worked at the WTC site for a long time were also more likely to develop PTSD. W orkers from non-emergency occupations also suffered high rates of PTSD. People who experienced trauma before or after 9/11, such as losing a job after t he attacks, or urban or domestic violence, were at increased risk for developing PTSD. Despite widespread evidence of PTSD among all exposed groups, studies have not s hown an increase in suicide in the four years after 9/11. Depression, anxiety and substance use disorders have not been as well studied as PTSD among WTC-exposed people. The studies to date, however, suggest that the p revalence of these conditions increased shortly after 9/11 and there is signific ant co-occurrence, or co-morbidity with PTSD in WTC-exposed groups. Those exposed to WTC-related dust were more likely to develop respiratory sympto ms, sinus problems, asthma or lung problems. One in 10 Registry enrollees develo ped new-onset asthma within 6 years of 9/11, 3 times the national rate. New case s were highest during the first 16 months after 9/11. Intense dust cloud exposure on 9/11 increased everyone's risk for developing ast hma. The risk was also increased among: rescue, recovery and clean-up workers who arrived early at the WTC site or worke d at the WTC site for long periods of time; Lower Manhattan residents who didn't evacuate their homes, and Lower Manhattan residents and office workers who returned to homes or workplaces covered with a thick coating of dust. Lower Manhattan residents and office workers who returned to homes or workplaces covered with a thick coating of dust. people who both lived and worked in lower Manhattan after 9/11 Steep declines in pulmonary function first detected among firefighters and emerg ency medical service (EMS) workers within a year of 9/11 have largely persisted even among those who never smoked. It is estimated that four times as many firef ighters and twice as many EMS workers had below-normal lung function for their a ges six to seven years after 9/11 as they did before the attacks. Among the few

active smokers, pulmonary function declines were even greater than for non-smoke rs. Recent studies also have identified persistent abnormal pulmonary function in ot her WTC rescue and recovery workers, including police, and in Lower Manhattan re sidents and area workers. Both epidemiologic and clinical studies demonstrate substantial comorbidity of m ental health conditions with respiratory illness in WTC-exposed groups. Many WTC-exposed people report heartburn, acid reflux or other gastroesophageal reflux sypmtoms, often with respiratory or mental health symptoms. Since these s ymptoms are common among the general population, more research is needed to dete rmine the connection between them and WTC exposure. Several studies have suggested that WTC exposure is associated with sarcoidosis (an inflammation that can affect any organ, but typically affects the lungs) amo ng rescue, recovery and clean-up workers who worked on the debris pile. However, these studies cannot rule out the possibility that increased medical attention and testing may be responsible for the detected increases in sarcoidosis rates a mong WTC workers. Findings have been inconsistent regarding the impact of WTC exposure on birth ou tcomes. Some studies suggest that reduced fetal growth found in some babies deli vered by women who were pregnant on 9/11 may be related to the stress caused by the attacks. Other studies, however, found no impact of WTC exposure on birth ou tcomes. Few studies have addressed the impact of WTC exposure on child and adolescent he alth, especially physical health, although data from the WTC Health Registry's b aseline survey of 3,000 children and adolescents indicate that very young childr en caught in the dust cloud on 9/11 were at increased risk for developing asthma . Research about cancer and mortality in WTC-exposed populations is in its initial stages because it takes a longer time for these potential health consequences t o become evident. The first WTC cancer risk study to be published found that firefighters with WTC exposure may be at greater risk for cancer than firefighters who weren t exposed. The first mortality study to be published showed that persons in the WTC Health Registry were less likely to die in the eight years of follow-up than in the gen eral New York City population. The study, however, also showed that among Lower Manhattan residents, area workers and passersby in the Registry, those with high er levels of WTC exposure may be at greater risk for all-cause mortality and car diac-related mortality in particular compared to those with intermediate or lowe r levels of WTC exposure. back to top What Additional Research Can Tell Us More about the prevalence and persistence of WTC-related conditions almost a dec ade after 9/11. The WTC Health Registry began its third health survey of more th an 71,000 enrollees in 2011. The extent to which people with potential WTC-related health conditions are rece iving treatment, and what coverage gaps remain The effectiveness of treatment for patients with WTC-related mental and physical health conditions Whether or not findings from the first cancer and mortality studies are replicat ed, if they are replicated in different populations with different exposure leve ls, and if they change over time. How prevalent WTC-related depression and substance use are among WTC-exposed pop ulations The impact of ongoing WTC-related physical health conditions on long-term mental health The impact of tobacco use on WTC-related respiratory and mental health condition s. The impact of 9/11 on children who went to school or who lived in the area, whos

e parents were part of the rescue and recovery effort or who lost family members back to top Monitoring and Treatment for 9/11-Related Health Conditions People affected by 9/11 are eligible for treatment and medication with no out-of -pocket costs at New York City's WTC Centers of Excellence. Representatives from the Centers also helped develop clinical guidelines for adu ltsand children exposed to 9/11. The guidelines can be used by health care provi ders nationwide to diagnose and treat WTC-related health problems. The Centers and the WTC Health Registry all funded by the federal government continue to provide clinicians, epidemiologists and other researchers with the kind of evid ence that will help answer some of the unknowns over the long term. Their ongoin g work will help better identify the people who are at greatest risk for becomin g ill and further refine treatment options for people who already are sick.

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