The World Trade Center Health Program (WTCHP) General Responder Cohort (the cohort) consists of workers and volunteers who were part of the rescue and recovery effort that followed the 11 September 2001 attack on the World Trade Center towers. Fire Department of New York (FDNY) and Pentagon and Shanksville responders are not included in this cohort but are covered by other similar programmes. This self-selected, open, de facto cohort began to form within a month of 9/11when the rescue and recovery workers began presenting with a variety of respiratory complaints at Mount Sinai's Irving J. Selikoff Center for Occupational and Environmental Medicine. 1-4 In 2002, the National Institute for Occupational Safety and Health (NIOSH) provided funds to provide a one-time medical evaluation, and support for physical and mental health treatment came from philanthropic sources. NIOSH also provided funding, in 2004, for additional medical evaluations and, in 2006, for treatment of both physical and mental health conditions. With the passing of the James Zadroga 9/11 Health and Compensation Act of 2010, 5 more years of medical monitoring and treatment were provided. Who is in the cohort? Estimates of how many rescue and recovery workers and volunteers worked on the WTC effort vary and may never be known, but the City of New York estimate is 91 000. 5,6 As of 31 March 2014, the WTCHP had information on 48 389 potential enrollees (Figure 1), 34 225 of whom were eligible because of their participation in earlier programmes and 3056 more of whom were subsequently deemed eligible. Eligibility criteria are: (i) the person worked or volunteered on the WTC effort for either 4 h

This study examined the associations of individual coexisting illnesses, septicaemia, intra-abdominal abscess, marital status, smoking and alcohol use, with mortality following perforation of peptic ulcer without pre-operative evidence of haemorrhage. Patients who died in hospital following ulcer perforation (cases; n = 300) were compared with patients who survived following ulcer perforation (controls; n = 276). The controls were frequency-matched to the cases on age, sex and perforation site. Data were analysed by logistic regression. Cardiac, respiratory, cerebrovascular, renal, liver and malignant diseases, and septicaemia and intra-abdominal abscess were associated with mortality and the coexisting illnesses were significantly increased in cases compared to controls both on admission and at the end of hospital stay. During hospitalization, the odds of pneumonia decreased in cases, otherwise there was little change in strengths of associations over this period. Being widowed or never married was positively associated with mortality, and moderate alcohol use was negatively associated. In conclusion, this study identifies several coexisting illnesses, septicaemia and intra-abdominal abscess as risk factors for mortality following ulcer perforation. The results suggest that, with little exception, the same level of mortality risk is associated with coexisting illnesses whether the beginning or end of hospital stay is used as the index time point.

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