To describe the development of and some of the early results from the World Trade Center Health Registry (WTCHR). Is the WTCHR a model for a nanomaterials exposure registry? What lessons may be learned from the WTCHR?
We describe the steps involved in creation of the WTCHR, from design through implementation.
The lessons learned from the WTCHR include thorough documentation of exposure early in the registry, using multimode surveys to maximize response rate, establishing an institutional home with sufficient resources for core as well as in-depth longitudinal and intervention studies, meeting with stakeholders regularly, making data accessible, and timely publication of findings, including wide dissemination of clinical guidelines.
The process of creating and maintaining the WTCHR provides important lessons for the possible creation of a nanomaterials exposure registry.
[Show abstract][Hide abstract] ABSTRACT: What are nanoparticles and why are they important in dermatology? These questions are addressed by highlighting recent developments in the nanotechnology field that have increased the potential for intentional and unintentional nanoparticle skin exposure. The role of environmental factors in the interaction of nanoparticles with skin and the potential mechanisms by which nanoparticles may influence skin response to environmental factors are discussed. Trends emerging from recent literature suggest that the positive benefit of engineered nanoparticles for use in cosmetics and as tools for understanding skin biology and curing skin disease outweigh potential toxicity concerns. Discoveries reported in this journal are highlighted. This review begins with a general introduction to the field of nanotechnology and nanomedicine. This is followed by a discussion of the current state of understanding of nanoparticle skin penetration and their use in three therapeutic applications. Challenges that must be overcome to derive clinical benefit from the application of nanotechnology to skin are discussed last, providing perspective on the significant opportunity that exists for future studies in investigative dermatology.
[Show abstract][Hide abstract] ABSTRACT: To highlight the important issues to consider in deciding whether to pursue and how to conduct medical surveillance for the emerging occupational and environmental respiratory diseases. It provides several recent examples illustrating implementation and usefulness of medical surveillance and the lessons learned from these experiences.
Medical surveillance conducted after sentinel outbreaks of constrictive bronchiolitis in microwave popcorn and flavoring production plants have shown the usefulness of this approach in documenting the burden of disease, identifying particular problem areas as targets for preventive interventions, and in tracking the progress. They have also identified the usefulness of longitudinal spirometry, which allows comparison of the individuals' results to their own previous tests. The importance of recognizing a sentinel outbreak needing greater investigation is demonstrated by the cluster of cases of constrictive bronchiolitis recognized in military veterans returning from Iraq and Afghanistan. The World Trade Center disaster has demonstrated the importance of having baseline lung function data for future comparison and the importance of rapidly identifying exposed populations at greatest risk for health effects, and thus potentially having the greatest benefit from medical surveillance.
When used appropriately, medical surveillance is a useful tool in addressing the emerging occupational and environmental respiratory diseases by facilitating improvements in primary prevention and enabling interventions to help individuals through secondary prevention.
Current Opinion in Allergy and Clinical Immunology 02/2014; 14(2). DOI:10.1097/ACI.0000000000000033 · 3.57 Impact Factor
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