MCH Alert


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
2. Study Assesses MCH Workforce Competencies and Training Needs
3. Article Examines Effect of Medicaid and SCHIP Expansions on Child Mortality
4. Research Determines Risk of Severe Obesity in Adulthood by Adolescent Weight Status
5. Authors Investigate Subsequent Care Received by Children Who Are Nonadherent with Their Next Preventive Visit

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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

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2. STUDY ASSESSES MCH WORKFORCE COMPETENCIES AND TRAINING NEEDS

"The top training needs identified by state MCH and CYSHCN directors in the 2008 AMCHP workforce survey fall into a global category reflecting a variety of skills related to critical thinking that cut across competency domains," state the authors of an article published in the Maternal and Child Health Journal (online) ahead of print on November 5, 2010. Over the years, there have been a number of efforts to document and address MCH work force needs. The article reports on results of a 2008 assessment of work force competencies and training needs at the state level. The authors examine reported needs, preferences, and barriers in the context of currently funded education and training opportunities. Implications for needed adjustments to current graduate and continuing education and opportunities to improve "alignment" between work force needs and resources are also discussed.

The 2008 MCH work force assessment was conducted through an interorganizational partnership. The assessment was designed to elicit standardized information about the specific programmatic and functional foci of the state Title V MCH and Children and Youth with Special Health Care Needs programs, leadership tenure and staffing vacancies, and staff needs with respect to competencies in core knowledge and skill areas. Several assessment items were drawn from the 1992 and 2000 studies to document temporal trends. A paper version of the assessment was piloted with four states in January and February 2008. The assessment was distributed as a web-based document -- also available in print format -- in May 2008.

The authors found that
"Given the changing needs expressed by state MCH leaders as well as their preferences for receiving additional training, it is important that current and future [graduate education] and [continuing education] approaches (both content and structure) be appropriately aligned to meet these needs," conclude the authors.

Grason H, Kavanagh L, Dooley S, et al. 2010. Findings from an assessment of state Title V workforce development needs. Maternal and Child Health Journal [published online ahead of print on November 5, 2010]. Abstract available at http://www.springerlink.com/content/1h59wx376380m780

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3. ARTICLE EXAMINES EFFECT OF MEDICAID AND SCHIP EXPANSIONS ON CHILD MORTALITY

Medicaid and State Children's Health Insurance Program (SCHIP) "expansions worked equally well in improving the health of Black children and White children. At the same time, the Medicaid and SCHIP expansions do not appear to have reduced relative racial disparities in child mortality, which remained unchanged in this time period," state the authors of an article published in the December 2010 issue of the American Journal of Public Health. Most research on the impact of the expansions of coverage has focused on improvements in access to care and use of services. The article examines the association between child mortality and those expansions and the effect of the expansions on racial disparities in child mortality.

The researchers (1) obtained the complete National Center for Health Statistics individual-level multiple-cause-of-death mortality data from 1985 through 2004 from a public use data archive; (2) extracted records for children ages 1-17, along with the cause of death, year of death, state of residence, and child demographic characteristics (age and race); and (3) tabulated the number of deaths from natural (disease-related) and external (injuries, homicide, and suicide) causes, by state, year, three racial categories (black, white, and "other"), and three age categories (ages 1-4, 6-11, and 12-17). They analyzed data for the broad categories of natural and external causes of mortality, developed descriptive trends in mortality rates by age and race, and studied the relationship between Medicaid and SCHIP eligibility and child mortality.

The authors found that
"It is not evident from this study that expanded health insurance coverage for children was a successful strategy for reducing relative racial disparities in child mortality through 2003," conclude the authors. They add, "reducing racial disparities may require many different types of changes at the national and community level, of which improved health insurance coverage is just one such change."

Howell E, Decker S, Hogan S, et al. 2010. Declining child mortality and continuing racial disparities in the era of the Medicaid and SCHIP insurance coverage expansions. American Journal of Public Health 100(12):2500-2506. Abstract available at http://ajph.aphapublications.org/cgi/content/abstract/100/12/2500.

Readers: More information is available from the following MCH Library resources:

- Health Insurance and Access to Care for Children and Adolescents: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_insurance.html

- Health Insurance and Access to Care for Kids and Teens: Resources for Families at
http://mchlibrary.info/families/frb_insurance.html

- Racial and Ethnic Disparities in Health: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_race.html

- Racial and Ethnic Disparities in Health: Resources for Families at
http://www.mchlibrary.info/families/frb_race.html

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4. RESEARCH DETERMINES RISK OF SEVERE OBESITY IN ADULTHOOD BY ADOLESCENT WEIGHT STATUS

"Taking advantage of a nationally representative longitudinal data set, we observed high rates of incident severe obesity in adulthood among individuals who were obese earlier in life," state the authors of an article published in the November 10, 2010, issue of JAMA, The Journal of the American Medical Association. Few national studies track individuals over time to understand the progression from obesity to severe obesity. Given the lack of successful treatment options, risks associated with treatment, and numerous health consequences of severe obesity, primary prevention is critical. Understanding which individuals are at risk for severe obesity is essential for determining when interventions would need to be implemented to prevent obese individuals from becoming severely obese. The article presents findings from a study to determine the incidence of and risk for severe obesity in adulthood among individuals who were obese during adolescence.

Data for the study were drawn from the National Longitudinal Study of Adolescent Health (AddHealth). All results are nationally representative of adolescents who were enrolled in grades 7 through 12 in 1994 and were followed into adulthood. Weight and height were measured in waves II (1996) through IV (2007-2009) during in-home surveys using standardized procedures. Body mass index (BMI) and BMI percentiles from measured height and weight were derived for age and sex and categorized using recommended definitions for comparability across adolescence and adulthood. Race and ethnicity were also recorded. The final sample included 8,834 individuals.

The authors found that
The NS, Suchindran C, North KE, et al. 2010. Association of adolescent obesity with risk of severe obesity in adulthood. JAMA, The Journal of the American Medical Association 304(18):2042-2047. Abstract available at http://jama.ama-assn.org/cgi/content/short/304/18/2042.

Readers: More information is available from the following MCH Library resources:

- Overweight and Obesity in Children and Adolescents: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_overweight.html

- Overweight and Obesity in Kids and Teens: Resources for Families at
http://mchlibrary.info/families/frb_overweight.html

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5. AUTHORS INVESTIGATE SUBSEQUENT CARE RECEIVED BY CHILDREN WHO ARE NONADHERENT WITH THEIR NEXT PREVENTIVE VISIT

"Children who missed their preventive visits, particularly those identified as having behavioral health issues, were likely to return for acute or ED care," write the authors of an article published in the Journal of Pediatrics online (ahead of print) on November 11, 2010. Behavioral health screening at the annual preventive care visit is currently recommended by the American Academy of Pediatrics and mandated as part of Medicaid's Early and Periodic Screening, Diagnostic, and Treatment program requirements. However, little information is available about whether the preventive visit is the best time to screen. Studies have shown high variability in preventive care adherence. Risk factors associated with poor adherence include low socioeconomic status, adolescent age, lack of insurance, parental mental health problems, and being a racial or ethnic minority. The study described in this article sought to (1) determine whether nonadherent children maintained their relationships with their medical homes and returned for acute or emergency department (ED) care, thus offering additional opportunities for mental health follow-up; (2) determine what demographic and behavioral health factors characterized children who returned for either acute or ED services; and (3) assess the need for mental health screening and follow-up at acute and ED visits.

The authors used a longitudinal sample of children ages 4 years, 11 months, to 16 years, 11 months from an urban pediatric clinic within the Cambridge Health Alliance (CHA) that was using the Pediatric Symptom Checklist (PSC) and the Youth PSC for mental health screening at preventive care visits. The authors examined a subset of children who were screened at an initial preventive care visit between December 1, 2003, and July 31, 2003, but were nonadherent with subsequent preventive care visits (10-18 months later). The dependent variable of interest was the location to which nonadherent children first returned for care after a missed preventive care visit. Children who were nonadherent were monitored from the point of the missed visit (18 months after the baseline visit) until their next contact with their medical home or other CHA primary care site for either acute or preventive care, or within the CHA system for ED care (until June 30, 2008). Independent variables included both demographic and behavioral characteristics.

The authors found that
The authors conclude that "[children's] return visits [for acute or ED care] represent opportunities for follow-up, intervention, and review of behavioral health screening."

Hacker KA, Arsenault LN, Williams S, et al. 2010. Mental and behavioral health screening at preventive visits: Opportunities for follow-up of patients who are nonadherent with the next preventive visit. Journal of Pediatrics [published online ahead of print on November 11, 2010]. Abstract available at
http://www.jpeds.com/article/S0022-3476%2810%2900819-X/abstract

Readers: More information is available from the following MCH Library resources:

- Emotional, Behavioral, and Mental Health Challenges in Children and Adolescents: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html

- Emotional, Behavioral, and Mental Health Challenges in Kids and Teens: Resources for Families at
http://mchlibrary.info/families/frb_Mental_Conditions.html

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MCH Alert © 1998-2010 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02MC00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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The editors welcome your submissions, suggestions, and questions. Please contact us at the address below.

EDITOR/ADMINISTRATOR: Jolene Bertness, M.Ed.
CO-EDITOR: Tracy Lopez, M.S.L.S.
COPYEDITOR/WRITER: Ruth Barzel, M.A.
WRITER: Beth DeFrancis, M.L.S.

MCH Alert
Maternal and Child Health Library
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Phone: (202) 784-9770
Fax: (202) 784-9777
E-mail: mchalert@ncemch.org
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