Health care and social issues of immigrant rescue and recovery workers at the World Trade Center site.

This article reviews the experience of a unique occupational group of World Trade Center (WTC) workers: immigrant workers. This group is comprised largely of men, laborers, who are first-generation immigrants. The majority of these workers are from Latin America (predominantly from Ecuador and Colombia) or from Eastern Europe (predominantly from Poland). Our data shows that the disease profile observed in these workers was what we have previously reported for WTC working population as a whole. Recent reports have begun to document the disproportionate burden of occupational hazards, injuries, and illnesses experienced by immigrant workers in the United States. The WTC experience of immigrants exemplified this burden but, additionally, highlighted that this burden is exacerbated by limitations in access to appropriate health care, disability and compensation benefits, and vocational rehabilitation services. A clinical program that was designed to address the complex medical and psychosocial needs of these workers in a comprehensive manner was successfully established. Full justice for these workers depends on larger societal changes.

Case report: silicatosis in a carpet installer.

CONTEXT: Chronic exposure to talc in the course of carpet installation can result in pneumoconiosis. CASE PRESENTATION: We present a case of a young carpet installer who was diagnosed with silicatosis of the lung. Review of occupational history revealed that the patient had been working as a carpet installer for approximately 15 years, since he was 15 years of age. The patient was exposed to talc in the course of his work. DISCUSSION: Exposure to talc in the course of carpet installation has not been reported as a possible cause of pneumoconiosis. In this article we review different causes of silicatosis and discuss chronic exposure in the course of carpet installation and development of pneumoconiosis. In addition, we also review the relevance of mycobacterial infection in cases of silicosis and silicatosis. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE: Exposure to talc in the course of carpet installation should be added to conditions that can cause pneumoconioses, specifically silicatosis of the lung.

Diagnostic evaluation for Creutzfeldt-Jakob disease in Massachusetts, 1991-2001.

BACKGROUND: Surveillance for Creutzfeldt-Jakob disease (CJD) in the United States has become a focus of public health attention due to concerns about disease acquired through exposure to transmissible spongiform encephalopathy in other species. A definitive diagnosis requires neuropathologic examination, yet concerns about the invasiveness of procedures and infection control may be barriers to brain biopsy or autopsy in patients with suspected CJD. METHODS: We reviewed medical records of 50 of the 97 patients identified through the Massachusetts Department of Public Health CJD surveillance system for 1991-2001 and of an additional 21 patients in whom CJD was suspected but later ruled out. RESULTS: Of the 50 patients, brain biopsy was performed on 14 (28%), brain biopsy or autopsy was performed on 27 (54%), and brain biopsy and autopsy were performed on 4 (8%). Brain biopsy or autopsy was declined for an additional 7 patients (14%) by family or health care proxy. The proportion of patients on whom brain biopsy was performed was inversely correlated with age, with only 9 (21%) of the 43 patients >60 years old having brain tissue diagnosis. Brain biopsy was performed on patients in whom CJD was suspected but ruled out somewhat less often than it was for patients with confirmed CJD (4 [19%] of 21 patients vs. 7 [23%] of 30 patients, respectively; P=.71). CONCLUSION: The majority of patients with CJD-related death whose medical records were available had a brain biopsy or autopsy performed or requested (34 [68%] of 50 patients).