The Mount Sinai journal of medicine, New York
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Spirometry is the most commonly used pulmonary function test to screen individuals for suspected lung disease. It is also used for screening workers with exposures to agents associated with pulmonary diseases. Although the American Thoracic Society (ATS) provides guidelines for spirometers and spirometry techniques, many factors are not standardized, so that results from individual pulmonary function laboratories vary substantially. These differences can create substantial difficulties in using data pooled from multiple sites to understand health consequences of disasters that involve exposures to pulmonary toxins. This article describes the approach used to minimize these differences for a consortium of institutions who are providing medical monitoring examinations to World Trade Center (WTC) responders. The protocol improved upon the minimal ATS guidelines. ⋯ The program allowed standardization of the performance and interpretation of spirometry results across multiple institutions. This facilitated reliable and rapid diagnosis of lung disease in the large number of WTC responders screened. We recommend this approach for postdisaster pulmonary evaluations in other settings.
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Respiratory consequences from occupational and environmental disasters are the result of inhalation exposures to chemicals, particulate matter (dusts and fibers) and/or the incomplete products of combustion that are often liberated during disasters such as fires, building collapses, explosions and volcanoes. Unfortunately, experience has shown that environmental controls and effective respiratory protection are often unavailable during the first days to week after a large-scale disaster. ⋯ Respiratory health consequences after aerosolized exposures to high-concentrations of particulates and chemicals can be grouped into 4 major categories: 1) upper respiratory disease (chronic rhinosinusitis and reactive upper airways dysfunction syndrome), 2) lower respiratory diseases (reactive [lower] airways dysfunction syndrome, irritant-induced asthma, and chronic obstructive airways diseases), 3) parenchymal or interstitial lung diseases (sarcoidosis, pulmonary fibrosis, and bronchiolitis obliterans, and 4) cancers of the lung and pleura. This review describes several respiratory consequences of occupational and environmental disasters and uses the World Trade Center disaster to illustrate in detail the consequences of chronic upper and lower respiratory inflammation.
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Effective adjuvant treatments proven to prolong survival for breast cancer exist, yet many women, particularly minority women, do not receive them. Little work has focused on improving the quality of, and reducing racial disparities in, cancer treatment. We describe the application of a conceptual model to direct, design, and implement trials to reduce underuse of effective adjuvant breast cancer treatments. ⋯ Identifying reasons for underuse by interviewing patients, physicians, physician office staff, and allied care providers about episodes in which needed care failed to occur helps engage key individuals, and can inform the design and implementation of interventions targeting barriers to delivering high quality breast cancer care to all.
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Diabetes prevalence and mortality are increasing, with minority populations disproportionately affected. Despite evidence that weight loss due to improved nutrition and increased physical activity can prevent or control diabetes, there is often a disconnect between this evidence and individuals' lifestyles. ⋯ This type of collaboration and the model may be useful tools to help communities identify and address the deficits that prevent their residents from enjoying the health benefits of improved nutrition and increased physical activity, and that also lead to racial and ethnic disparities in health.
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Substantial racial and ethnic disparities in health and health care exist in the United States. The Department of Health Policy at the Mount Sinai School of Medicine has developed a strategy for reducing those disparities that builds upon its quality improvement experience. ⋯ Parallels between our disparities research strategy and six sigma quality improvement methods are described. Finally, the article provides an example of how we have been able to successfully implement proven-effective health improvement programs in the Harlem community even after grant funding has ended.