دانلود رایگان مقاله انگلیسی توسعه یک شاخص فیزیولوژیک نامطلوب برای گروه پاسخ دهنده مرکز تجارت جهانی - هینداوی 2018

Responders to the 9/11/2001 WTC attacks were exposed to multiple toxic pollutants. Since 2002, the health of the responder cohort has been continuously tracked by the WTC Health Monitoring Program. However, no assessments have been made of frailty, an important health metric given the current average age of the WTC responder cohort (55 years). In this study, we use laboratory test results and other physiological parameters to construct a physiological frailty index (FI-Lab) for this cohort. The study sample comprised responders aged 40 years or older who completed a health monitoring visit at Mount Sinai Center within the past 5 years. For each subject, FI-Lab was computed as the proportion of 20 physiological parameters (lab tests, pulmonary function, and blood pressure) on which the subject had abnormal values. Using negative binomial regression models, we tested FI-Lab’s association with the SF-12 wellbeing score and various demographic characteristics. FI-Lab showed strong associations with the physical and mental components of the SF-12 as well as age, race, and smoking status. Using a cutoff of 0.25 to define presence of physiological/preclinical frailty, we found frailty prevalence in the study sample to be approximately 12%. This study demonstrates the feasibility of assessing preclinical frailty in the WTC responder cohort.

4. Discussion

In this study, we developed and tested a frailty index constructed from physiological parameters (routine laboratory tests and anthropometric measures). This class of frailty indices is gaining popularity as an alternative to clinical FIs. The key distinction between clinical FI and FI-Lab is that the latter is based entirely on biochemical markers/physiological parameters; hence it is believed to represent the burden of preclinical or subclinical deficits [18]. Subclinical deficits can be thought of as systemic, organ-level dysregulation that occurs as a direct result of molecular or cellular level damage (e.g., oxidative stress and telomere attrition) and in turn leads to “macroscopic” (clinically evident) functional deficits and impairments such as disease, weakness, limited mobility, cognitive changes, and sensory loss [4]. In some sense, the subclinical dysregulation measured by FI-Lab provides an intermediate link within cellular-level damage that eventually scales up to clinically detectable impairments/deficits [17]. We therefore believe that WTC FI-Lab has the potential to identify frailty in its early stages among our cohort. In accordance with this, we used a relatively low age cutoff in the selection of the sample for this study. As a result, our study cohort is younger (median age of 51) than those in other frailty studies, which often focus on the elderly. The rationale behind this sample selection choice is that the development of WTC FI-Lab and other biomarker-based tools for biological age assessment will allow screening of those at risk of advanced frailty endpoints. There is a growing evidence that frailty may be modifiable/reversible, especially in the early stages [38] preceding the onset of more advanced symptoms. This calls for the development of valid tools for screening at-risk individuals.