Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html

November 19, 2010

1.MCH LIBRARY RELEASES NEW ASTHMA RESOURCE GUIDES
 
The Maternal and Child Health Library at Georgetown University released a new edition of a knowledge path about asthma in children and adolescents, its prevalence, and its impact on homes, schools, and communities. The knowledge path includes tools for improving asthma management and care and staying abreast of new developments in pediatric asthma research. The knowledge path can be used by health professionals, program administrators, policymakers, researchers, and community advocates to learn more about the topic, for program development, and to locate training resources and information to answer specific questions. Separate sections point to resources about environmental triggers, medications and monitoring, and asthma management in school. The knowledge path is available at http://www.mchlibrary.info/KnowledgePaths/kp_asthma.html. A resource brief for families accompanies the knowledge path and is available at http://www.mchlibrary.info/families/frb_asthma.html
 
MCH Library knowledge paths on other topics are available at http://www.mchlibrary.info/KnowledgePaths/index.html. The MCH Library welcomes feedback on the usefulness and value of these knowledge paths. A feedback form is available at http://www.mchlibrary.info/feedback/index.html

• One hundred and twelve Title V program leaders received the request to assist with the survey, and all 50 states and the District of Columbia provided at least one program response.
• Improvement of critical thinking skills was reported to be the greatest training need. Such skills included translating data into viable information, synthesizing and translating MCH data for a variety of audiences, designing and conducting program evaluations, and systems thinking skills. In addition, there is a strong need to enhance personal as opposed to organizational skills.
• Blended (both distance and onsite) learning approaches for graduate education and national conferences with skill-building workshops for continuing education were identified as the preferred training modalities.
• Barriers related to time, cost, and travel are very similar to those identified in the previous needs-assessment surveys.

• Mortality declined across the time period among all age and racial groups.
• The absolute difference between black and white mortality rates also declined over the period. However, the black-white mortality ratio, reflecting relative racial disparities in child mortality, remained unchanged for all children.
• The degree of Medicaid expansion (represented by the proportion of children in a particular age group who would be eligible for Medicaid or SCHIP) was significantly related to the natural-case mortality rate, suggesting that a 10-percentage-point increase in eligibility results in a 3.73 percent decline in child mortality. However, the decline in child mortality was not linear, suggesting that there were factors affecting mortality that were greater in some years than in others.
• Medicaid and SCHIP expansions were associated with declines in child mortality due to external causes.
• The coefficient for black race was virtually identical in models with and without the Medicaid and SCHIP eligibility indicator -- for both natural-cause and external-cause mortality. Similarly, an interaction effect between black race and the eligibility indicator was nonsignificant.

• Over the 13-year period between adolescence (1996) and adulthood (2007-2009), a total of 703 incident cases of severe obesity in adulthood were observed, indicating a total incidence rate of 7.9 percent.
• A substantial proportion of obese adolescents became severely obese by their early 30s, with significant variation by sex.
• Incident severe obesity was highest among black women, at 52.4 percent.
• Obese adolescents were significantly more likely to develop severe obesity than normal-weight or overweight adolescents (hazard ratio, 16.0), with variation across race/ethnicity and sex.

• The final sample consisted of 1,703 children. More than 72 percent returned for an annual preventive visit within the next 10 to 18 months; 27.1 percent were nonadherent. Most nonadherent children return for acute, ED, or delayed preventive care after missing their preventive visit. Most return visits (preventive, delayed preventive, and acute care) occurred in the medical home (99 percent for adherent and delayed preventive care and 86 percent for acute care).
• Nonadherent children generally differed from adherent children in age distribution (mean age was significantly older), race (less often white), and insurance category (more often public or self-pay).
• Non-returners and delayed returners did not differ significantly in any of the behavioral health indicators.
• Among acute and ED care users, nonadherent children were significantly more likely to have had positive PSC scores, have been referred for mental health care, have been in counseling, and have had "any behavioral problem" at their screening visit. Behavior problems were particularly high among ED care users.