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Epidemiologic research on man-made disasters: strategies and implications of cohort definition for World Trade Center worker and volunteer surveillance program.

Authors
Savitz-DA; Oxman-RT; Metzger-KB; Wallenstein-S; Stein-D; Moline-JM; Herbert-R
Source
Mt Sinai J Med 2008 Mar-Apr; 75(2):77-87
NIOSHTIC No.
20034598
Abstract
Studies of long-term health consequences of disasters face unique methodologic challenges. The authors focused on studies of the health of cleanup and recovery workers, who are often poorly enumerated at the outset and difficult to follow over time. Comparison of the experience at the World Trade Center disaster with 4 past incidents of chemical and radiation releases at Seveso, Italy; Bhopal, India; Chernobyl, Ukraine; and Three Mile Island, USA, provided useful contrasts. Each event had methodologic advantages and disadvantages that depended on the nature of the disaster and the availability of records on area residents, and the emergency-response and cleanup protocol. The World Trade Center Worker Monitoring Program has well-defined eligibility criteria but lacks information on the universe of eligible workers to characterize response proportions or the potential for distortion of reported health effects. Nonparticipation may result from lack of interest, lack of awareness of the program, availability of another source of medical care, medical conditions precluding participation, inability to take time off from work, moving out of the area, death, or shift from initially ineligible to eligible status. Some of these considerations suggest selective participation by the sickest individuals, whereas others favor participation by the healthiest. The greatest concern with the validity of inferences regarding elevated health risks relative to external populations is the potential for selective enrollment among those who are affected. If there were a large pool of nonparticipating workers and those who suffered ill health were most motivated to enroll, the rates of disease among participants would be substantially higher than among all those eligible for the program. Future disaster follow-up studies would benefit substantially by having access to accurate estimates of the number of workers and information on the individuals who contributed to the cleanup and recovery effort.
Keywords
Psychological-responses; Psychological-stress; Mental-health; Mental-stress; Stress; Occupational-exposure; Occupational-hazards; Occupational-psychology; Health-care-personnel; Health-services; Disaster-planning; Work-analysis; Work-environment; Work-operations; Worker-health; Workplace-studies; Epidemiology
Contact
David A. Savitz, Department of Community and Preventive Medicine Mount Sinai School of Medicine New York, NY
CODEN
MSJMAZ
Publication Date
20080301
Document Type
Journal Article
Email Address
david.savitz@mssm.edu
Funding Type
Cooperative Agreement
Fiscal Year
2008
NTIS Accession No.
NTIS Price
Identifying No.
Cooperative-Agreement-Number-U10-OH-008225; Cooperative-Agreement-Number-U10-OH-008232
Issue of Publication
2
ISSN
0027-2507
Priority Area
Services
Source Name
Mount Sinai Journal of Medicine
State
NY
Performing Organization
Mount Sinai School of Medicine of New York University
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