Aim: There is limited information regarding asthma triggers in World Trade Center (WTC) rescue and recovery workers (RRW) or how mental health conditions affect the perception of triggers. Methods: We included 372 WTC workers with asthma. The Asthma Trigger Inventory (ATI) assessed triggers along five domains: psychological, allergens, physical activity, infection, and pollution. We administered the Structured Clinical Interview to diagnose post-traumatic stress disorder (PTSD), major depression and panic disorder (PD). The Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ) measured asthma control and quality of life, respectively. Linear regression models were fitted to examine the association of ATI total and subdomain scores with mental health conditions as well as the percent of ACQ and AQLQ variance explained by ATI subscales. Results: The most common triggers were air pollution (75%) and general allergens (68%). PTSD was significantly associated with psychological triggers (partial r(2)=0.05, p < 0.01), physical activity (partial r(2)=0.03, p < 0.01) and air pollution (partial r(2)=0.02, p = 0.04) subscales while PD was significantly associated with air pollution (partial r(2)=0.03, p = 0.03) and general allergens (partial r(2)=0.02, p = 0.03). ATI subscales explained a large percentage of variance in asthma control (r(2)=0.37, p < 0.01) and quality of life scores (r(2)=0.40, p < 0.01). Psychological subscale scores explained the largest portion of the total variability in ACQ (partial r(2)= 0.11, p = 0.72) and AQLQ (partial r(2)=0.14, p = 0.64) scores. Conclusion: RRW with mental health conditions reported more asthma triggers and these triggers were associated with asthma morbidity. These data can help support interventions in RRW with asthma.

Objective: Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity. Methods: Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures. Results: Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons). Conclusions: There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.

OBJECTIVES:To estimate the medical costs of work-attributable diseases (WAD) treated by the public health care system for one of the Spanish Autonomous Communities, the Basque Country, in 2008.METHODS:We calculated the burden of disease attributable to work for each category of diseases according to ICD-9-CM by using estimates of attributable fractions. Hospital and specialized outpatient care cost data were derived from the Spanish National Health System analytical accountability system. Secondary sources of information were used to estimate primary health care and drug prescriptions.RESULTS:Direct costs of work-attributable diseases borne by the Basque Regional Health Service totalled 106 million Euros in 2008, representing 3.3% of Basque public expenditures on health and 0.16% of Basque GDP in 2008. Specialized care, including hospitalizations, absorbed the highest proportion of costs (52%), followed by drug prescriptions and primary health care (27% and 21%, respectively). Diseases of the musculoskeletal system and connective tissues accounted for 47.3% of total costs, followed by cardiovascular diseases (19.6%) and cancer (15%).CONCLUSIONS:Occupational diseases and accidents are costly in the Basque Region of Spain, generating a severe deviation of public expenditures and overburdening of the Public Health System because they should really be the responsibility of the Social Security System. Proper identification and assignment of costs of work-related diseases would result in significant savings for the National Health System (Spanish and European), would provide an incentive for the prevention of these avoidable causes of illness and thus contribute to the sustainability of social systems.

ISEE-879 Objective: To identify the proportion of cases of malignant pleural mesothelioma (MPM), that can be attributed to occupational exposure to asbestos. Material and Methods: A MPM case-control study was performed on workers from 2 IMSS hospitals, which concentrate on oncology patients in the Valley of Mexico, during 2004–2005. An occupational and environmental exposure questionnaire was applied, and occupational history was assessed by an industrial hygiene experts’ panel, which featured exposure in qualitative and quantitative way. With it, was calculated a total accumulated exposure dose (TAED). The odds ratios OR and the attributable risk was calculated with a no conditional logistic regression model. Results: Analysis involved 69 case incidents of MPM and 161 controls. The mean age of the cases was 62 years (SD = 11.5; range = 39–84) and controls was 66 years. Of the total cases, 78.2% and the 47.8% of controls were exposed occupational to the asbestos. The OR were adjusted by age and sex for each quartile of the TAED; in upper quartile >2629.1 f/cc asbestos obtained an OR crude 7.05(2.8–17.4) and OR adjusted 11.3(3.8–33.2); the attributable risk in the exposed was 80.4%. Conclusions: Our results show widely that the industrial use of all forms of asbestos is cancerigenic, it generates disease and death among the Mexican workers. Therefore Mexico must apply the prohibition of the asbestos use, as a priority of public health to prevent the epidemic that is shown in this study.