Investigation of a spontaneous abortion cluster: lessons learned

Terrorism-preparedness training for non-clinical hospital workers: tailoring content and presentation to meet workers' needs

Clinicians have been the primary focus of health care worker training in response to the 2001 terrorist and anthrax attacks. However, many nonclinical hospital workers also are critical in providing medical care during any large-scale emergency. We designed a training program, guided by focus groups, to provide them with information to recognize unusual events and to protect themselves. We compared four different training methods: workbook, video, lecture, and a small-group discussion. One hundred and ninety-one workers participated. After the training, they were more confident in their employer's preparedness to respond to a terrorist attack but specific knowledge did not change substantially. Fortunately, the self-directed workbook (the more economical and least disruptive method) was as effective as the other methods. Our experience may be useful to others who are planning terrorism-preparedness training programs.

Terrorism preparedness training for nonclinical hospital workers: empowering them to take action

While aspects of the national response to the last years' terrorist attacks have included preparedness training for health care institutions, much of the focus has been on clinician recognition of biologic exposures. However, many hospital workers have nonclinical responsibilities (such as housekeepers and mailroom workers) and many more, though active in clinical care, are para-professionals with limited medical training (such as nursing assistants). These workers are critical to the achievement of our institution's mission to provide competent and compassionate medical care, even during an emergency. In recognition of this, and to understand their attitudes and concerns, we conducted focus groups. The process provided a forum to receive immediate feedback from the workers, and will be used to design customized knowledge and skills training sessions that empower them to take proper responsive action should a terrorist attack occur. Our experience may be useful to others who are planning terrorism preparedness training programs.

Investigation of clusters of adverse reproductive outcomes, an overview

Clusters of adverse reproductive outcomes are reported with increasing frequency to public health services, but it is likely that only a minority of clusters are caused by a common environmental teratogen or mutagen. Many guidelines and protocols have been developed for the investigation and the management of chronic disease clusters and can be applied to the study of adverse reproductive outcomes. Cluster investigation normally follows four successive phases: (i) the generation of one or more etiologic hypotheses, (ii) the confirmation of the hypotheses, (iii) an intervention aimed at reducing any dangerous exposure, and (iv) the evaluation of the effect of the intervention. However, each situation is unique and there is no standard recipe for conducting the epidemiologic investigation at each successive phase, for choosing the appropriate statistical technique and for communicating with interested parties. In order to minimize both the risk of pursuing a worthless investigation and the risk of ignoring a real excess of cases caused by an adverse environmental factor, it is imperative to rely on a team of specialists with expertise in epidemiology, statistics, toxicology, embryology, and communication.

Intrauterine effects of electromagnetic fields--(low frequency, mid-frequency RF, and microwave): review of epidemiologic studies

Electromagnetic radiations are named according to frequency or to wavelength (which is inversely proportional to frequency) and create electromagnetic fields (EMFs). Frequencies widely vary according to sources: high-voltage power lines, electrically heated beds, MRI, VDTs, microwave ovens, satellite, and radio/TV transmissions or cellular phone transmitters/receivers. Public concern has increased about the potential health effects of EMFs. There are arguments in favour of EMFs being biologically active, but no mechanism has been identified that explains the link between EMFs and bioeffects. Human data reviewed concern the potential reproductive effects (mainly spontaneous abortions, low birthweight and congenital malformations) of exposure to sources of EMFs: maternal residence, electrically heated beds, occupational exposure (mainly video display terminals), and medical exposures. The available epidemiologic studies all have limitations that prevent to draw clearcut conclusions on the effects of EMFs on human reproduction. EMFs are ubiquitous and unavoidable exposures. The matter of possible effects cannot be considered closed, but until our understanding of the biologic important parameters of EMFs exposures is stronger,design of new studies will be difficult and small epidemiologic studies are unlikely to provide definitive answers and should not be given high priority. No conclusion can be drawn for radiofrequencies and microwaves because of lack of data. There is no convincing evidence today that EMFs of the sort pregnant women or potential fathers meet in occupational or daily life exposures does any harm to the human reproductive process.

Teratogen update: electromagnetic fields

Public concern is increasing about the potential health effects of extremely low frequency (ELF) electromagnetic fields (EMFs) naturally present or generated by electrical appliances and those of very low frequency (VLF) fields, like those generated by video display terminals (VDTs). There are arguments in favour of EMFs being biologically active but no mechanism has been identified that explains the link between EMFs and bioeffects. More than 50 studies on exposures of animals to EMFs have been performed within the last few years. Although there were a few statistically significant effects in the studies reviewed, no replicable results were found among laboratories. The extent of effects observed, if any, was always low, and deserves further investigation before relevance to humans can be considered. Human data reviewed concern the potential reproductive effects (mainly) spontaneous abortions, low birthweight, and congenital malformations) of exposure to various sources of EMFs: maternal residence, heated waterbeds, electric blankets, and ceiling heating coils, occupational exposure (mainly video display terminals), and magnetic resonance imaging. The totality of the evidence that is thus far available provides no convincing evidence to indicate that low frequency EMFs of the sort that might be met in occupational or daily life exposures does any harm to the human reproductive process. It is suggested that those counseling pregnant women follow the guidelines established by WHO in agreement with the International Non-ionizing Radiation Committee. This group does not consider that the results of published studies provide a basis for restricting human exposure to electromagnetic fields and radiation.

Investigation of a spontaneous abortion cluster: development of a risk communication plan

A risk communication plan was developed for a group of payroll office workers who were investigated for a possible cluster of spontaneous abortions (SABs). Survey and focus group methods were used to assess the workers' attitudes, beliefs, and information preferences. We found that four features of the workforce needed to be considered in developing an effective plan: 1) subgroups of workers varied on their levels of concern, awareness, involvement, and definitions of the problem; 2) workers did not have the necessary knowledge concerning SABs or the scientific method to participate in a two-way communication; 3) workers were highly stressed; and 4) workers were distrustful that they would be told the truth about the SABs. A multicomponent risk communication strategy was developed to overcome these barriers. Specifically, we recommended that background information on SABs and the scientific method be presented before the report of the study results and that follow-up sessions should be conducted on job stress and the emotional aspects of miscarriages.