George Friedman-Jimenez, M.D.

Epidemiology of Respiratory Health Outcomes Among World Trade Center Disaster Workers: Review of the Literature 10 Years After the September 11, 2001 Terrorist Attacks
Ekenga, Christine C.; Friedman-Jimenez, George
2011 SEP ;5 2 2(5):S189-S196, Disaster medicine & public health preparedness
Tens of thousands of workers participated in rescue, recovery, and cleanup activities at the World Trade Center (WTC) site in lower Manhattan after the terrorist attacks on September 11, 2001 (9/11). The collapse of the WTC resulted in the release of a variety of airborne toxicants. To date, respiratory symptoms and diseases have been among the most examined health outcomes in studies of WTC disaster workers. A systematic review of the literature on respiratory health outcomes was undertaken to describe the available information on new onset of respiratory symptoms and diseases among WTC disaster workers after September 11, 2001. Independent risk factors for respiratory health outcomes included being caught in the dust and debris cloud, early arrival at the WTC site, longer duration of work, and delaying mask and respirator use. Methodological challenges in epidemiologic studies of WTC disaster workers involved study design, exposure misclassification, and limited information on potential confounders and effect modifiers. In the 10 years after 9/11, epidemiologic studies of WTC disaster workers have been essential in investigating the respiratory health consequences of WTC exposure. Longitudinal studies along with continued medical surveillance will be vital in understanding the long-term respiratory burden associated with occupational WTC exposure. (Disaster Med Public Health Preparedness. 2011;5:S189-S196)
— id: 137809, year: 2011, vol: 5 2 2, page: S189, stat: Journal Article,

Epidemiology of respiratory health outcomes among world trade center disaster workers: review of the literature 10 years after the september 11, 2001 terrorist attacks
Ekenga, Christine C; Friedman-Jimenez, George
2011 Sep;5 Suppl 2:S189-S196, Disaster medicine & public health preparedness
Tens of thousands of workers participated in rescue, recovery, and cleanup activities at the World Trade Center (WTC) site in lower Manhattan after the terrorist attacks on September 11, 2001 (9/11). The collapse of the WTC resulted in the release of a variety of airborne toxicants. To date, respiratory symptoms and diseases have been among the most examined health outcomes in studies of WTC disaster workers. A systematic review of the literature on respiratory health outcomes was undertaken to describe the available information on new onset of respiratory symptoms and diseases among WTC disaster workers after September 11, 2001. Independent risk factors for respiratory health outcomes included being caught in the dust and debris cloud, early arrival at the WTC site, longer duration of work, and delaying mask and respirator use. Methodological challenges in epidemiologic studies of WTC disaster workers involved study design, exposure misclassification, and limited information on potential confounders and effect modifiers. In the 10 years after 9/11, epidemiologic studies of WTC disaster workers have been essential in investigating the respiratory health consequences of WTC exposure. Longitudinal studies along with continued medical surveillance will be vital in understanding the long-term respiratory burden associated with occupational WTC exposure
— id: 137452, year: 2011, vol: 5 Suppl 2, page: S189, stat: Journal Article,

Disparities in environmental and occupational health
Friedman-Jimenez, George; Claudio, Luz
Environmental and occupational medicine Philadelphia : Wolters Kluwer/Lippincott Williams & Wilkins, 2007,
— id: 5379, year: 2007, vol: , page: ?, stat: Chapter,

Prevalence of workplace exacerbation of asthma symptoms in an urban working population of asthmatics
Berger, Zackary; Rom, W N; Reibman, J; Kim, M; Zhang, S; Luo, L; Friedman-Jimenez, George
2006 Aug;48(8):833-839, Journal of occupational & environmental medicine
OBJECTIVES: We used an interviewer-administered questionnaire to investigate workplace exacerbation of asthma symptoms (WEAS) among low-income, minority, working asthmatics admitted Bellevue Hospital Center in New York City from 2001 to 2002. We hypothesized that a high prevalence of WEAS would be found in this population among all jobs held and a subset of individual occupational classifications. MEASUREMENTS AND MAIN RESULTS: Of 301 subjects, 51% reported WEAS in their current or most recent job; 71% reported WEAS in any job. Prevalences (95% confidence intervals) of WEAS in common job classifications were 61% (49-73%) in janitorial jobs, 50% (33-67%) in garment and textile manufacturing jobs, and 38% (23-55%) in construction jobs. CONCLUSION: WEAS is prevalent in this urban minority population
— id: 69582, year: 2006, vol: 48, page: 833, stat: Journal Article,

Endothelin-1 induces CXCL1 and CXCL8 secretion in human melanoma cells
Mangahas, Catherine R; dela Cruz, Gelo V; Friedman-Jimenez, George; Jamal, Sumayah
2005 Aug;125(2):307-311, Journal of investigative dermatology
The endothelin pathway plays a critical role in melanoma tumor progression by a variety of mechanisms that enhance tumor cell growth, invasion, and metastasis. Here, we investigate the effect of this pathway on CXC chemokine expression in human melanoma cells and melanocytes. As determined by ELISA, endothelin-1 (ET-1) induces CXCL1 and CXCL8 secretion in three human melanoma cell lines in a concentration-dependent fashion. These responses are mediated by the endothelin-B receptor and are sustained over a 40 h time course. ET-1 does not induce CXCL1 secretion in primary human melanocytes but ET-3, an endothelin isoform, induces a low level of CXCL1 secretion in certain cultures. Neither ET-1 nor ET-3 induces secretion of CXCL8 in primary human melanocytes; thus, this response may be specific for melanocytic cells that have undergone malignant transformation. We have previously demonstrated that ET-1 induces changes in the expression of adhesion molecules in melanoma cells such that invasion and metastasis are favored. This study demonstrates that ET-1 additionally induces secretion of CXC chemokines critical for melanoma metastasis and tumor progression
— id: 57870, year: 2005, vol: 125, page: 307, stat: Journal Article,

A case-control study of workplace exacerbation of asthma symptoms
Berger, Z; Kim, M; Reibman, J; Shore, R; Friedman-Jimenez, G
2004 JUN 1 ;159(11):S78-S78, American journal of epidemiology
— id: 46558, year: 2004, vol: 159, page: S78, stat: Journal Article,

Occupational health among Latino workers: a needs assessment and recommended interventions
Moure-Eraso, Rafael; Friedman-Jimenez, George
2004 ;14(4):319-347, New solutions : a journal of environmental & occupational health policy : NS
Evidence suggests that Latino workers, along with other minority and low-income workers, face a higher risk for occupational disease than do other workers. Targeted surveillance and primary prevention interventions have been lacking or inadequate. The authors estimate the number of occupational disease deaths and new cases in Latino workers in the United States. Then, using data from New York City, they find that Latino workers are disproportionately employed in more hazardous occupations and underrepresented in less hazardous jobs. They suggest a comprehensive approach to address workplace disease in Latino workers, which involves primary prevention interventions, clinical services, educational approaches, research and surveillance, unionization and organization of workers, and legislation and regulation
— id: 96455, year: 2004, vol: 14, page: 319, stat: Journal Article,

Mortality of nuclear submariners in the US Navy
Friedman-Jimenez, G; Kato, I; Afanasyeva, Y; Shore, R
2003 JUN 1 ;157(11):S80-S80, American journal of epidemiology
— id: 55531, year: 2003, vol: 157, page: S80, stat: Journal Article,

Relationship between low doses of ionizing radiation and mortality of nuclear submariners in the US Navy
Friedman-Jimenez, G; Kato, I; Afanasyeva, Y; Shore, R
2003 JUN 1 ;157(11):S10-S10, American journal of epidemiology
— id: 55530, year: 2003, vol: 157, page: S10, stat: Journal Article,

Frequency dependence of compliance in the evaluation of patients with unexplained respiratory symptoms [In Process Citation]
de la Hoz RE; Berger KI; Klugh TT; Friedman-Jimenez G; Goldring RM
2000 Mar;94(3):221-227, Respiratory medicine
Frequency dependence of compliance (FDC) reflects non-homogeneous ventilatory distribution and, in the presence of a normal measured airway resistance, suggests peripheral airways dysfunction. This study evaluated peripheral airway function and bronchial reactivity in irritant exposed or non-exposed individuals with normal routine pulmonary function tests (PFTs) who had persistent unexplained lower respiratory symptoms. Twenty-two patients were identified with persistent respiratory symptoms and with normal chest X-ray and PFTs. Twenty were non-smokers; two had stopped smoking more than 10 years before evaluation. Twelve patients had been exposed to irritants in their workplaces or at home. Non-specific bronchial hyper-reactivity (nsBHR) and FDC, pre- and post-bronchodilator, were measured in all patients. Studies were repeated in 6/12 irritant-exposed subjects after exposure removal and inhaled corticosteroid treatment. Whereas 12/22 patients had nsBHR, all 22 subjects demonstrated FDC [dynamic lung compliance/static lung compliance Cdyn,l/Cst,l at respiratory frequency 60 min(-1) (f60), mean 46%, range 27-67%]. After bronchodilator administration, a 15% improvement Cdyn,l was observed most consistently at f60 (mean% improvement 26%, 95% CI 14-38%) and in subjects without nsBHR. However, Cdyn,l at f60 did not return to normal after inhaled bronchodilator. Irritant-exposed and unexposed individuals appeared similar in results of testing for FDC and nsBHR. FDC and its response to bronchodilators provide objective physiological measures of an airway abnormality which may provide a basis for clinical symptoms in patients with normal routine pulmonary function studies. The presence of persistently abnormal FDC after bronchodilator (BD) and on follow up studies may reflect chronic inflammatory and/or structural changes in the airways in addition to bronchoconstriction
— id: 11733, year: 2000, vol: 94, page: 221, stat: Journal Article,

Clinical evaluation, management, and prevention of work-related asthma
Friedman-Jimenez G; Beckett WS; Szeinuk J; Petsonk EL
2000 Jan;37(1):121-141, American journal of industrial medicine
Work-related asthma (WRA) is asthma that is attributable to, or is made worse by, environmental exposures in the workplace. WRA has become the most prevalent occupational lung disease in developed countries, is more common than is generally recognized, and can be severe and disabling. Identification of workplace exposures causing and/or aggravating the asthma, and appropriate control or cessation of these exposures can often lead to reduction or even complete elimination of symptoms and disability. This depends on timely recognition and diagnosis of WRA. In this review, the diagnostic evaluation has been organized in a stepwise fashion to make it more practical for primary care physicians as well as physicians specializing in occupational diseases and asthma. WRA merits more widespread attention among clinicians, labor and management health and safety specialists, researchers, health care organizations, public health policy makers, industrial hygienists, and others interested in disease prevention.
— id: 11925, year: 2000, vol: 37, page: 121, stat: Journal Article,

Minority workers and communities
Frumkin H; Walker ED; Friedman-Jimenez G
1999 Jul-Sep;14(3):495-517, Occupational medicine
Environmental and occupational hazards do not affect all communities equally. Members of ethnic and racial minorities, whether as working people or as community residents, sustain disproportionate risks from chemical, physical, and biological hazards. This paper reviews the nature of these disproportionate risks, focusing primarily on the workplace, but considering general environmental exposures as well. It discusses three principal mechanisms of increased risk: excessive hazardous exposures in both the workplace and the general environment, increased susceptibility, and inferior healthcare. It presents evidence that, as the result of these factors, members of minority groups display elevated rates of work-related illness, injury, fatality, and disability. Finally, it offers recommendations with regard to research, primary prevention, minority recruitment into the occupational health professions, and treatment and compensation for injured and ill minority workers
— id: 63063, year: 1999, vol: 14, page: 495, stat: Journal Article,

Occupational and environmental medicine in New York State
de la Hoz RE; London M; Friedman-Jimenez G; Rom WN
1997 ;70(1):1-8, International archives of occupational & environmental health
New York State (NYS) is home to 7.2% of the population and producer of 8.4% of the gross domestic product of the United States. The history and the current status of occupational and environmental medicine (OEM) research, educational resources, clinical practice patterns, and regulatory framework in NYS are reviewed. Changes anticipated or already taking place in health care financing, clinical practice patterns, occupational safety and health regulations and enforcement, and funding for research and medical education at the national level, are already having an impact in OEM activities in NYS
— id: 12405, year: 1997, vol: 70, page: 1, stat: Journal Article,

Serum growth factors and oncoproteins in firefighters
Ford J; Smith S; Luo JC; Friedman-Jimenez G; Brandt-Rauf P; Markowitz S; Garibaldi K; Niman H
1992 Feb;42(1):39-42, Occupational medicine (Oxford, UK)
Firefighters are potentially at increased risk for cancer and non-malignant respiratory disease due to their toxic exposures on the job. Growth factors and oncogene proteins are thought to play a role in the development of various malignancies and pulmonary fibrotic diseases. Therefore, a cohort of firefighters and matched controls have been screened for the presence of nine different growth factors and oncoproteins using an immunoblotting assay. Fourteen of the firefighters were found to be positive for beta-transforming growth factor (beta-TGF) related proteins compared to no positives in the controls (P = 0.0017). These results suggest that beta-TGF may be a possible biomarker for monitoring firefighters and other exposed workers for the potential development of cancer or non-malignant respiratory disease
— id: 63064, year: 1992, vol: 42, page: 39, stat: Journal Article,

Using reproductive effect markers to observe subclinical events, reduce misclassification, and explore mechanism
Hatch MC; Friedman-Jimenez G
1991 Jan;90:255-259, Environmental health perspectives
Biological markers of effect, in general less widely available than exposure markers, do exist in the field of reproduction and increasingly are being used in epidemiological studies. Several such markers, including semen quality, menstrual hormones, early pregnancy loss, and placental abnormalities, are cited as examples. We argue the value of effect markers for detecting subclinical events that are critical for reproductive performance. Such studies can extend knowledge of the true frequency and determinates of reproductive disorders. A second portion of the paper deals with the role of effect markers in reducing disease misclassification. With a hypothetical early pregnancy study as a case in point, we illustrate the degree and direction of bias associated with several different protocols and encourage epidemiologists to weigh these quantitative considerations in deciding on study design. Finally, we discuss uses of biological markers to explore mechanisms, drawing on experience in an ongoing reproductive study that is testing a hypothetical pathway from maternal psychosocial stress to reduced fetal growth using urine catecholamine levels as a physiological marker of exposure and placental vascular abnormalities as a marker of effect
— id: 63065, year: 1991, vol: 90, page: 255, stat: Journal Article,

Occupational disease among minority workers: a common and preventable public health problem
Friedman-Jimenez G
1989 Feb;37(2):64-70, 84, AAOHN journal (American Association of Occupational Health Nurses)
1. Minority workers are overrepresented in the most hazardous jobs and, as a result, are at high risk of developing occupational diseases. 2. Due to various social and economic factors, minority workers with occupational diseases are less likely than white workers to come to health care attention and be correctly diagnosed as having an occupational disease. 3. Occupational health clinics and providers need to discuss options for treatment clearly with the client and, when appropriate, be persistent in negotiating with employers to reduce or eliminate harmful exposures, while remaining sensitive to the very real threat of job loss
— id: 63066, year: 1989, vol: 37, page: 64, stat: Journal Article,