Distinct characteristics of lymphoid and myeloid clonal hematopoiesis in World Trade Center first responders.

Clonal hematopoiesis of indeterminate potential (CHIP) represents the presence of clonal somatic mutations in blood cells in otherwise healthy individuals. While CHIP is known to increase risk for hematologic malignancies and cardiovascular disease, its association with airborne carcinogens remains largely unknown. We investigated CHIP mutations in 9/11 World Trade Center (WTC) disaster responders (n=350), who experienced substantial exposure to a complex mix of airborne carcinogens.

Increased Aβ40 in plasma is associated with severity of exposure to airborne pollutants at the World Trade Center: a cross-sectional study of neurological biomarkers.

World Trade Center (WTC) responders who were more severely exposed to the airborne pollution while working in rescue and recovery work would have heightened circulating levels of β-Amyloid (Aβ) levels in plasma. Plasma for 905 WTC responders was retrieved in 2019 and flash frozen and assayed using single molecule analysis to measure circulating levels of two subtypes of Aβ (Aβ40, Aβ42), alongside phosphorylated tau-181, glial fibrillary acidic protein (GFAP), and neurofilament-light. Plasma data were linked to demographics, blood volume, apolipoprotein-ε4 status, and medical outcomes as well as, in a subsample, with neuroimaging-based measures of cortical thickness.

Cognitive Impairment: A Novel Risk Factor for Rapid Kidney Function Decline and Incident CKD in Middle-Aged Adults.

Background: Emerging evidence suggests that better cognition is associated with a lower risk of chronic kidney disease (CKD). However, whether early-onset cognitive impairment (CI) at baseline is linked to rapid estimated glomerular filtration rate (eGFR) decline or incident CKD remains unclear.

Methods: We conducted a prospective cohort study of 5,761 World Trade Center (WTC) responders (mean age: 53.

Evaluating the Test-Negative Design for COVID-19 Vaccine Effectiveness Using Randomized Trial Data: A Secondary Cross-Protocol Analysis of 5 Randomized Clinical Trials.

Importance: The test-negative design (TND) has been widely used to assess postmarketing COVID-19 vaccine effectiveness but requires further evaluation for this application.

Objective: To determine whether the TND reliably evaluates vaccine effectiveness against symptomatic COVID-19 using placebo-controlled vaccine efficacy randomized clinical trials (RCTs).

Design, Setting, And Participants: This secondary cross-protocol analysis constructed TND study datasets from study sites in 16 countries across 5 continents using the blinded phase cohorts of 5 harmonized phase 3 COVID-19 Prevention Network RCTs: COVE (Coronavirus Vaccine Efficacy and Safety), AZD1222, ENSEMBLE, PREVENT-19 (Prefusion Protein Subunit Vaccine Efficacy Novavax Trial COVID-19), and VAT00008.

Is Posttraumatic Stress Disorder in a Class of Its Own? Longitudinal Comparison to Other Conditions Following Trauma and Life Stress Exposure.

Posttraumatic stress disorder (PTSD) is defined by the assumption that qualifying traumatic events lead to a syndrome distinct from other internalizing disorders, while stressful life events play a prominent role in etiologic theories of major depressive disorder (MDD). We examined whether the environmental etiology of PTSD and MDD are distinct by evaluating the relative contributions of traumatic and stressful life events to both conditions. Harmful alcohol use and physical limitations served as noninternalizing comparators expected to show weaker associations with environmental factors.

Stress dynamics that maintain posttraumatic stress disorder across 20 years.

Background: Posttraumatic stress disorder (PTSD) is often chronic and impairing. Mechanisms that maintain symptoms remain poorly understood because of heterogenous presentation. We parsed this heterogeneity by examining how individual differences in stress-symptom dynamics relate to the long-term maintenance of PTSD.

A Longitudinal Assessment of Hearing Loss in the World Trade Center General Responder Cohort.

Objective: In analyses without adjustment for World Trade Center (WTC) noise exposure, people with WTC and neighborhood exposures from the September 11, 2001, attacks have experienced slightly elevated risks of hearing loss. We investigated incident hearing loss in the WTC General Responder Cohort by their levels of WTC exposure, their WTC noise exposure and previous occupation.

Methods: Adjusted multivariable log binomial regression models assessed persistent (≥10 months) hearing loss associated with WTC exposures using 22 years of the monitoring visit data ( n = 45,537).

Gastroesophageal Reflux Disease in the World Trade Center Health Program General Responder Cohort.

Background: People participating in the rescue, recovery, and clean-up effort after the September 11, 2001 attack on the World Trade Center (WTC) were exposed to a complex mix of noxious substances and subsequently experienced elevated gastroesophageal reflux disease (GERD) incidence, the second-most-common WTC-related condition.

Methods: Longitudinal WTC Health Program data, collected between July 2002 and December 2022, were used to describe the sample characteristics, diagnostic procedures, and treatment of consenting cohort members with self-reported GERD who reported incident GERD for a year or longer (n = 19,067). Cross-tabulations and binomial logistic regression, adjusted for confounders including comorbidities, assessed the associations with intermittent and resolved, compared with unresolved, GERD.

Day-to-day dynamics of facial emotion expressions in posttraumatic stress disorder.

Facial expressions are an essential component of emotions that may reveal mechanisms maintaining posttraumatic stress disorder (PTSD). However, most research on emotions in PTSD has relied on self-reports, which only capture subjective affect. The few studies on outward emotion expressions have been hampered by methodological limitations, including low ecological validity and failure to capture the dynamic nature of emotions and symptoms.

World Trade Center response activities and cognitive health: A moderated mediation study of the role of surgical/nuisance dust mask usage.

Objective: This study explores the relationship between World Trade Center (WTC) response activities (WRAs) and cognitive impairment (CI) and uses a moderated-mediation model to examine the role of wearing a surgical/nuisance dust mask.

Methods: This study includes 3285 WTC responders. Responders were placed into eight WRA groups based on self-report structured responses and free-text descriptions of activities at the WTC.

Glial activation among individuals with neurological post-acute sequelae of coronavirus disease 2019: A positron emission tomography study of brain fog using [F]-FEPPA.

Background: This study examined the regional distribution of glial activation in essential workers with neurological post-acute sequelae of coronavirus disease 2019 (COVID-19) infections (N-PASC).

Methods: We injected ≤185 MBq of [F]-FEPPA as an intravenous bolus and positron-emission tomography over 2 h. To measure distribution volume (V) we recruited 24 essential workers (14 N-PASC, 10 Never-COVID-19 Controls, of whom 22 successfully placed arterial lines).

SARS-COV-2 re-infection and incidence of post-acute sequelae of COVID-19 (PASC) among essential workers in New York: a retrospective cohort study.

Background: After surviving Coronavirus Disease 2019 (COVID-19), some people develop symptoms known as post-acute sequelae of COVID-19 (PASC). PASC is an emerging phenomenon yet to be fully understood, and identifying risk factors has been challenging. This study investigated the association between the number of COVID-19 episodes and the incidence of PASC among essential workers.

Prevalence of Mild and Severe Cognitive Impairment in World Trade Center Exposed Fire Department of the City of New York (FDNY) and General Emergency Responders.

Background: The emergency personnel who responded to the World Trade Center (WTC) attacks endured severe occupational exposures, yet the prevalence of cognitive impairment remains unknown among WTC-exposed-FDNY-responders. The present study screened for mild and severe cognitive impairment in WTC-exposed FDNY responders using objective tests, compared prevalence rates to a cohort of non-FDNY WTC-exposed responders, and descriptively to meta-analytic estimates of MCI from global, community, and clinical populations.

Methods: A sample of WTC-exposed-FDNY responders (n = 343) was recruited to complete an extensive battery of cognitive, psychological, and physical tests.

Exposure duration and cerebral amyloidosis in the olfactory cortex of World Trade Center responders: A positron emission tomography and magnetic resonance imaging study.

Background: Amyloid-β proteins, a hallmark of Alzheimer's disease, are believed to play an adaptive role in the cerebral immune response.

Objective: Amyloid is believed to play a role in cerebral immune response and could play a similar role in response to air pollution exposures. In the present study, we examined whether WTC exposure duration was associated with cerebral amyloidosis in WTC responders.

Prevalence of Mild and Severe Cognitive Impairment in World Trade Center Exposed Fire Department of the City of New York (FDNY) and General Emergency Responders.

Background: The emergency personnel who responded to the World Trade Center (WTC) attacks endured severe occupational exposures, yet the prevalence of cognitive impairment remains unknown among WTC-exposed-FDNY-responders. The present study screened for mild and severe cognitive impairment in WTC-exposed FDNY responders using objective tests, compared prevalence rates to a cohort of non-FDNY WTC-exposed responders, and descriptively to meta-analytic estimates of MCI from global, community, and clinical populations.

Methods: A sample of WTC-exposed-FDNY responders ( = 343) was recruited to complete an extensive battery of cognitive, psychological, and physical tests.

Sleep disturbances across 2 weeks predict future mental healthcare utilization.

Study Objectives: Insufficient sleep costs the US economy over $411 billion per year. However, most studies investigating the economic costs of sleep rely on one-time measures of sleep, which may be prone to recall bias and cannot capture variability in sleep. To address these gaps, we examined how sleep metrics captured from daily sleep diaries predicted medical expenditures.

Cross-sectional association between posttraumatic stress and cognition is moderated by pulmonary functioning in world trade center responders.

Background: Posttraumatic stress disorder (PTSD) symptomatology and poorer pulmonary function are highly prevalent psychiatric and medical conditions. In the present study, we tested for the individual, additive, and modifying associations of PTSD symptomatology and pulmonary function with cognitive performance.

Methods: In this cross-sectional study, a total of 1,401 World Trade Center (WTC) responders (mean age = 53, SD = 8 years, 92% males) participated in the study.

Incidence of Dementia Before Age 65 Years Among World Trade Center Attack Responders.

Importance: Reports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected.

Objective: To assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe exposures to debris vs responders not exposed to building debris or who wore personalized protective equipment (PPE).

Design, Setting, And Participants: This prospective cohort study was conducted from November 1, 2014, to January 1, 2023, in an academic medical monitoring program available to verified WTC responders residing on Long Island, New York.