
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
- 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.
"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
- 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.
"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
- 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 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 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.
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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and
Child Health and Georgetown University. MCH Alert is produced by
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