Preterm delivery in Boston before and after September 11th, 2001

BACKGROUND: We hypothesized that stress induced by the terrorist attacks of September 11, 2001 might shorten pregnancy. To test this hypothesis, we compared gestational duration and risk of preterm delivery among women who were pregnant on September 11 with women who had delivered before that date. STUDY DESIGN: We conducted a matched cohort study among pregnant women enrolled in the Boston-based cohort study Project Viva between 1999 and 2001. Each of 606 participants, pregnant on September 11, 2001, was matched to 1 or 2 participants who delivered before that date. RESULTS: Compared with women who delivered before September 11th, women who were pregnant on September 11th had mean gestation length that was 0.13 weeks longer (95% confidence interval = -0.05 to 0.30) and an odds ratio for preterm delivery before 37 weeks' gestation of 0.60 (0.36 to 0.98). Only women exposed in the first trimester had longer gestation. CONCLUSIONS: Contrary to expectation, Boston-area women who were pregnant on September 11th had a lower risk of preterm delivery than women who delivered before that date. Although the interpretation of this finding is difficult, it is clear that the acute psychologic stress documented nationwide after the terrorist attacks did not increase the risk of preterm delivery in this population at some distance from the attacks.     

All-hazards preparedness in an era of bioterrorism funding.

OBJECTIVES: All-hazards preparedness was evaluated in North Carolina's 85 local health departments (LHDs). METHODS: In regional meetings, data were collected from LHD teams from North Carolina's LHDs using an instrument constructed from Centers for Disease Control and Prevention's preparedness indicators and from the Local Public Health Preparedness and Response Capacity Inventory. RESULTS AND CONCLUSIONS: Levels of preparedness differ widely by disaster types. LHDs reported higher levels of preparedness for natural disasters, outbreaks, and bioterrorist events than for chemical, radiation, or mass trauma disasters. LHDs face challenges to achieving all-hazards preparedness since preparation for one type of disaster does not lead to preparedness for all types of disasters. LHDs in this survey were more prepared for disasters for which they were funded (bioterrorism) and for events they faced regularly (natural disasters, outbreaks) than they were for other types of disasters.     

Emergency preparedness among people living near US army chemical weapons sites after September 11, 2001

We examined trust in the army and perceptions of emergency preparedness among residents living near the Anniston, Ala, and Richmond, Ky, US Army chemical weapons stockpile sites shortly after September 11, 2001. Residents (n = 655) living near the 2 sites who participated in a cross-sectional population were relatively unprepared in the event of a chemical emergency. The events of September 11 gave rise to concerns regarding the security of stored chemical weapons and the sites' vulnerability to terrorist attacks. Although residents expressed trust in the army to manage chemical weapons safely, only a few expressed a desire to actively participate in site decisions. Compliance with procedures during emergencies could be seriously limited, putting residents in these sites at higher levels of risk of exposure to chemical hazards than nonresidents.     

The public health dashboard: a surveillance model for bioterrorism preparedness.

The City of Milwaukee Health Department piloted a short-term, near real-time syndromic surveillance and communication tool by using an existing secure regional Internet infrastructure. Voluntary, active syndromic case reporting by hospital Emergency Departments was combined with other data streams, including clinical laboratory reports of communicable disease, hospital emergency room diversions, ambulance runs, medical examiner reports of unusual or suspicious deaths, poison control and nursing hotline call volumes, and pharmacy over-the-counter sales. These data were aggregated into a "Surveillance Dashboard" format that was used to communicate community syndromic health trends to hospitals, Emergency Departments, and other providers using a secure Internet technology. Emergency Departments at 8 area hospitals reported a total of 314 cases meeting syndromic criteria from 26,888 patient encounters. Participants were satisfied with data entry and communications. All participating Emergency Departments received e-mail and text pager alerts sent by the Milwaukee Health Department. No unexplained findings or suggestions of an early outbreak were reported through syndrome surveillance for the 4-week duration of the project. Similar surveillance and communications systems could provide multiple benefits to Emergency Department workflow and management, as well as to public health and emergency response.     

CDC's strategic plan for bioterrorism preparedness and response

The Department of Health and Human Services (DHHS) has played a critical lead role over the past two years in fostering activities associated with the medical and public health response to bioterrorism. Based on a charge from Secretary Donna Shalala in 1998, the Centers for Disease Control and Prevention (CDC) is leading public health efforts to strengthen the nation's capacity to detect and respond to a bioterrorist event. As a result of our efforts, federal, state, and local communities are improving their public health capacities to respond to these types of emergencies. For many of us in public health, developing plans and capacities to respond to acts of bioterrorism is an extension of our long-standing roles and responsibilities. These are stated in the CDC Mission Statement: to promote health and quality of life by preventing and controlling disease, injury, and disability, and the Bioterrorism Mission: to lead the public health effort in enhancing readiness to detect and respond to bioterrorism. CDC's infectious diseases control efforts are summarized below: --Initially formed to address malaria control in 1946; --Established the epidemic Intelligence Service in 1951; --Participated in global smallpox eradication and other immunization programs; --Estimated 800-1,000 + field investigations/year since late 1990s; --New diseases: Legionnaire's Disease, toxic shock syndrome, Lyme disease, HIV, hantavirus pulmonary syndrome, West Nile, etc. -- Today: focus on emerging infections and bioterrorism. Over the past 50 years, CDC has seen a decline in the incidence of some infectious diseases and an increase in some, whereas others continue to present on a more unpredictable basis (i.e., hantavirus). Outbreak identification, investigation, and control have been an integral part of what we do for more than 50 years. We estimate that 800 to 1,000 field investigations have occurred every year since the late 1990s. Today, however, we have a new focus on emerging infectious diseases and bioterrorism.     

The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences

Bioterrorism preparedness programs have contributed to death, illness, and waste of public health resources without evidence of benefit. Several deaths and many serious illnesses have resulted from the smallpox vaccination program; yet there is no clear evidence that a threat of smallpox exposure ever existed. The anthrax spores released in 2001 have been linked to secret US military laboratories-the resultant illnesses and deaths might not have occurred if those laboratories were not in operation.The present expansion of bioterrorism preparedness programs will continue to squander health resources, increase the dangers of accidental or purposeful release of dangerous pathogens, and further undermine efforts to enforce international treaties to ban biological and chemical weapons. The public health community should acknowledge the substantial harm that bioterrorism preparedness has already caused and develop mechanisms to increase our public health resources and to allocate them to address the world's real health needs.     

On the front lines: family physicians' preparedness for bioterrorism

OBJECTIVE: The events of September 11, 2001, and the nation's recent experience with anthrax assaults made bioterrorism preparedness a national priority. Because primary care physicians are among the sentinel responders to bioterrorist attacks, we sought to determine family physicians' beliefs about their preparedness for such an attack. STUDY DESIGN: In October 2001 we conducted a national survey of 976 family physicians randomly selected from the American Academy of Family Physicians' active membership directory. POPULATION: 614 (63%) family physicians responded to the survey. OUTCOMES MEASURED: Physicians' self-reported ability to "know what to do as a doctor in the event of a suspected bioterrorist attack, recognize signs and symptoms of an illness due to bioterrorism, and know where to call to report a suspected bioterrorist attack." RESULTS: Ninety-five percent of physicians agreed that a bioterrorist attack is a real threat within the United States. However, only 27% of family physicians believed that the US health care system could respond effectively to a bioterrorist attack; fewer (17%) thought that their local medical communities could respond effectively. Twenty-six percent of physicians reported that they would know what to do as a doctor in the event of a bioterrorist attack. Only 18% had previous training in bioterrorism preparedness. In a multivariate analysis, physicians reported that preparedness for a bioterrorist attack was significantly associated with previous bioterrorism preparedness training (OR 3.9 [95% CI 2.4-6.3]) and knowing how to obtain information in the event of a bioterrorist attack (OR 6.4 [95% CI 3.9-10.6]). CONCLUSIONS: Only one quarter of family physicians felt prepared to respond to a bioterrorist event. However, training in bioterrorism preparedness was significantly associated with physicians' perceived ability to respond effectively to an attack. Primary care physicians need more training in bioterrorism preparedness and easy access to public health and medical information in the event of a bioterrorist attack.     

Fear of bioterrorism and implications for public health preparedness

After the human anthrax cases and exposures in 2001, the Illinois Department of Public Health received an increasing number of environmental and human samples (1,496 environmental submissions, all negative for Bacillus anthracis). These data demonstrate increased volume of submissions to a public health laboratory resulting from fear of bioterrorism.     

Assessing and improving bioterrorism preparedness among first responders: a pilot study

Following the September 11 terrorist attacks, the vulnerability of the United States became apparent. It also became evident that there was a need for respiratory protection. The purpose of this study was to determine the prior knowledge and perceptions of emergency medical technicians with respect to bioterrorism and to enhance their current knowledge to better prepare them for possible future events. The study was also designed to create a certified pool of trainers who would be capable of fit-testing all squad members with N-100 respirators. Representatives were recruited from each of the Hunterdon County, New Jersey, rescue squads. Participants attended a train-the-trainer session. Before the session and after, they were tested on knowledge and perceptions about relevant bioterrorism issues and were given an educational presentation on bioterrorism, threatening agents, respiratory health, and proper protection, along with being introduced to the fit-test steps for N-100 respirator masks. The response rate for the training was 94 percent. The authors measured and compared responses on the pre-test and the post-test with respect to knowledge, behaviors, and perceptions, and the results indicated a change following the training. The study thus provided evidence that the train-the-trainer program is an effective method of providing public health preparedness training to members of community organizations and agencies.     

Anthrax in New Jersey: a health education experience in bioterrorism response and preparedness

The anthrax attack in 2001 created new challenges to health educators working on the response effort in New Jersey. Never before had there been a need for educating a group of people who had been exposed to a biological weapon. Coming on the heels of the catastrophic World Trade Center collapse on September 11, 2001, the New Jersey Department of Health and Senior Services was entrenched in the response to, and management of, the anthrax attack that placed a heavy emphasis on educating the postal workers of the United States Postal Service Trenton Processing and Distribution Center. This article provides an account of the preparation and delivery of educational materials and activities in the midst of a biological emergency, emphasizes the role health educators play in responding to bioterrorism events, and encourages health educators to become involved in bioterrorism preparedness efforts.     

The strategic plan for preparedness and response to bioterrorism in Korea

Following the Anthrax bioterrorism attacks in the US in 2001, the Korean government established comprehensive countermeasures against bioterrorism. These measures included the government assuming management of all infectious agents that cause diseases, including smallpox, anthrax, plaque, botulism, and the causative agents of viral hemorrhagic fevers (ebola fever, marburg fever, and lassa fever) for national security. In addition, the Korean government is reinforcing the ability to prepare and respond to bioterrorism. Some of the measures being implemented include revising the laws and guidelines that apply to the use of infectious agents, the construction and operation of dual surveillance systems for bioterrorism, stockpiling and managing products necessary to respond to an emergency (smallpox vaccine, antibiotics, etc.) and vigorously training emergency room staff and heath workers to ensure they can respond appropriately. In addition, the government's measures include improved public relations, building and maintaining international cooperation, and developing new vaccines and drugs for treatments of infectious agents used to create bioweapons.     

Bioterrorism risk perceptions and educational needs of public health professionals before and after September 11, 2001: a national needs assessment survey.

The study objectives were to compare local public health professionals' bioterrorism risk perceptions, the extent of bioterrorism preparedness training, and to describe preferred methods for delivery of preparedness education in the United States. National needs assessments were conducted via a mailed survey to 3,074 local public health departments in October 2000 and November 2001. Compared to a survey conducted in October 2000, the perceived risk of a bioterrorism attack in the United States increased dramatically after September 11 (p < 0.0001); however, 57% of respondents believed one was unlikely to occur within their own community. Public health professionals perceive their own communities to be at low risk for a bioterrorism event. Ongoing, updated, standardized bioterrorism preparedness education is needed.     

After 9/11: priority focus areas for bioterrorism preparedness in hospitals

Following the terrorist attacks of September 11, 2001, bioterrorism preparedness was a priority in hospitals, but it did not remain a priority. As a result, hospitals are still unprepared to deal with the effects of a bioterrorist attack. The government has provided initial funding to state and local governments for bioterrorism preparedness; however, much of this money has yet to reach hospitals. With the inadequate funding available to hospitals, four initial measures must be focused on. These focus areas are community involvement, hospital staff education, information technology and disease surveillance improvement, and additional equipment and staff acquisition. Hospitals should also make bioterrorism-preparedness planning a regional effort.     

Public health and terrorism preparedness: cross-border issues

On December 15, 2003, the Centers for Public Health Preparedness at the University of Minnesota and the University of Iowa convened the "Public Health and Terrorism Preparedness: Cross-Border Issues Roundtable." The purpose of the roundtable was to gather public health professionals and government agency representatives at the state, provincial, and local levels to identify unmet cross-border emergency preparedness and response needs and develop strategies for addressing these needs. Representatives from six state and local public health departments and three provincial governments were invited to identify cross-border needs and issues using a nominal group process. The result of the roundtable was identification of the needs considered most important and most doable across all the focus groups. The need to collaborate on and exchange plans and protocols among agencies was identified as most important and most doable across all groups. Development of contact protocols and creation and maintenance of a contact database was also considered important and doable for a majority of groups. Other needs ranked important across the majority of groups included specific isolation and quarantine protocols for multi-state responses; a system for rapid and secure exchange of information; specific protocols for sharing human resources across borders, including emergency credentials for physicians and health care workers; and a specific protocol to coordinate Strategic National Stockpile mechanisms across border communities.