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Maternal Child Health Newsletter 11/5/04

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Maternal Child Health Newsletter 11/5/04

Post by laura » Fri Nov 05, 2004 09:11 am

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MCH Alert
Tomorrow's Policy Today
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National Center for Education in Maternal and Child Health
Search past issues of the MCH Alert and other MCH Library resources at
http://www.MCHLibrary.info/databases/search.lasso

November 5, 2004

1. Maternal and Child Health Training Program Launches Web Site
2. Analysis Examines Rates of Chlamydia Screening Among Sexually Active
Females
3. Authors Explore Changes in U.S. Family Planning Services
4. Study Assesses Relationship Between Family Meal Patterns and Disordered
Eating in Adolescents
5. Article Provides Results of National Study of Vaginal Births After
Cesareans in Birth Centers

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1. MATERNAL AND CHILD HEALTH TRAINING PROGRAM LAUNCHES WEB SITE

The Maternal and Child Health (MCH) Training Program of the Maternal and
Child Health Bureau has launched a new Web site to support the education
and training of those working in the MCH professions. The MCH Training
Program supports trainees, faculty, continuing education, and technical
assistance. The new Web site provides information on new funding
opportunities, writing a grant proposal, currently funded projects, and
reporting requirements. The Web site also includes an events calendar,
conference archives, a glossary, a PDF file library, and other resources
relevant to the program. The Web site is available at
http://www.mchb.hrsa.gov/training.

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2. ANALYSIS EXAMINES RATES OF CHLAMYDIA SCREENING AMONG SEXUALLY ACTIVE
FEMALES

Chlamydia "screening rates were low despite slight increases in screening
covered both by commercial and Medicaid plans during 1999-2001," state the
authors of a report published in the October 29, 2004, issue of Morbidity
and Mortality Weekly Report. Because up to 70% of chlamydial infections in
women are asymptomatic, routine screening and treatment of infected
persons is essential to prevent pelvic inflammatory disease, infertility,
ectopic pregnancy, and perinatal infections. The U.S. Preventive Services
Task Force and several clinical organizations have recommended routine
screening for chlamydia infection for all sexually active women ages 26
and younger and for pregnant women of all ages. The report summarizes the
results of an analysis of chlamydia screening rates among young, sexually
active females.

Data for the analysis were drawn from the Health Plan Employer Data and
Information Set as reported by commercial and Medicaid health insurance
plans in 1999-2001. During the study period, a total of 335 commercial
health maintenance organizations (HMOs) and point-of-service (POS) plans
and 92 Medicaid HMOs and POS plans reported chlamydia screenings. Mean
chlamydia screening rates were assessed by calculating the number of
sexually active female enrollees ages 16-26 who were continuously enrolled
during the preceding calendar year and the number of eligible female
enrollees who had a claim for chlamydia tests. Being sexually active was
defined as receipt of a contraceptive prescription or submission of a
medical claim associated with pregnancy, contraceptives, STDs, or
Papanicolaou (Pap) test during the preceding year.

The authors found that

* Among sexually active female enrollees ages 16-26 in commercial plans,
20% were screened for chlamydia in 1999, 25% in 2000, and 26% in 2001.

* Among enrollees ages 16-26 in Medicaid plans, screening rates were 28%
in 1999, 36% in 2000, and 38% in 2001.

The authors conclude that "increased screening by health-care providers
and coverage of screening by health plans will be necessary to reduce
substantially the burden of chlamydial infection in the United States."

Shih S, Scholle S, Irwin K, et al. 2004. Chlamydia screening among
sexually active young female enrollees of health plans -- United States,
1999-2001. Morbidity and Mortality Weekly Report 53(42):983-985. Available
at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5342a1.htm or
http://www.cdc.gov/mmwr/PDF/wk/mm5342.pdf.

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3. AUTHORS EXPLORE CHANGES IN U.S. FAMILY PLANNING SERVICES

"Over time, the network of publicly funded family planning clinics has
proved its resiliency, adapting to shifts in health care delivery,
structure and financing, while continuing to meet the contraceptive needs
of millions of poor and low-income women," state the authors of an article
published in the September/October 2004 issue of Perspectives on Sexual
and Reproductive Health. The article examines the extent and distribution
of changes in the size and structure of the U.S. family planning clinic
network and assesses the impact of recent changes on the ability of
clinics to meet women's contraceptive service needs.

Researchers collected service data for calendar year 2001 for all agencies
and clinics providing subsidized family planning services in the 50
states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands,
and 6 Pacific U.S. territories.

The authors found that

* In all, 2,953 publicly funded agencies administered contraceptive
services at 7,683 clinics in the United States, Puerto Rico, and U.S.
territories in 2001. Between 1994 and 2001, the overall number of agencies
administering contraceptive services declined by 5%, and the number of
clinics increased by 8%.

* In 2001, a total of 6.7 million women, including 1.9 million
adolescents, received contraceptive services from publicly funded clinics.
Both numbers represent 2% increases since 1994.

* The number of community health centers and other clinics increased by
42% and 30%, respectively, while the number of health department and
Planned Parenthood clinics decreased by 8% and 5%, respectively. One-third
of all clients served in 2001 at publicly funded family planning clinics
received care from a health department clinic, and another third received
care from a Planned Parenthood clinic.

* In one-third of states, clinic capacity improved, with met need
increasing by 5% to 65%. However, in another one-third of states, clinic
capacity declined, with met need decreasing by 5% or more.

* States that had implemented income-based Medicaid waivers since 1994
experienced a 24% increase in the number of contraceptive clients served
by publicly funded providers, with met need increasing from 39% to 50%.

The authors conclude that "further investigation is needed to learn what
circumstances have led to declining clinic capacity, the impact it has had
on low-income women and the efforts that are needed to reverse it."

Frost JJ, Frohwirth L, Purcell A. 2004. The availability and use of
publicly funded family planning clinics: U.S. trends, 1994-2001.
Perspectives on Sexual and Reproductive Health 36(5):206-215.

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4. STUDY ASSESSES RELATIONSHIP BETWEEN FAMILY MEAL PATTERNS AND DISORDERED
EATING IN ADOLESCENTS

"Findings from the current study suggest that family meals have the
potential to play a role in the prevention of unhealthy weight control
behaviors among youth," state the authors of an article published in the
November 2004 issue of the Journal of Adolescent Health. Unhealthy weight
control practices and other disordered eating patterns are prevalent among
adolescents, and familial factors clearly contribute to the onset of
disordered eating practices in adolescence, but questions remain about the
identification of specific familial factors that can have an impact on
adolescents and are potentially amenable to change via brief
interventions. The current study examines associations between family meal
patterns and disordered eating practices among adolescent girls and boys.

The study population included 4,746 ethnically diverse adolescents from
urban and suburban school districts in the St. Paul/Minneapolis area of
Minnesota. The mean age of the study population was 14.9 years. Data were
collected in schools during the 1998-99 school year.

The authors found that

* For girls, after adjusting for Body Mass Index (BMI) and
sociodemographic characteristics, more frequent family meals were
protective against engaging in all forms of disordered eating (extreme and
less extreme unhealthy weight control behaviors, binge eating with loss of
control, and chronic dieting).

* For girls, after adjusting for BMI and sociodemographic characteristics,
a more structured family meal environment was protective against
unhealthy weight-control behaviors and chronic dieting, but associations
with binge eating were not statistically significant.

* For boys, after adjusting for BMI and sociodemographic characteristics,
more frequent family meals, high priority of family meals, and a positive
atmosphere at family meals were protective against unhealthy
weight-control behaviors but not against binge eating or chronic dieting.

* For girls, after also adjusting for family connectedness and
weight-specific pressures within the home, more frequent family meals and
high priority of family meals remained strongly associated with lower
levels of unhealthy weight-control behaviors and chronic dieting.
Increased structure of family meals was associated with lower levels of
unhealthy weight-control behaviors. A positive atmosphere at meals was
only protective against extreme unhealthy weight-control behaviors.

* For boys, high priority of family meals and a positive atmosphere at
meals were protective against unhealthy weight-control behaviors.

The authors conclude that "health providers working with youth and their
parents could take the time to discuss family meal patterns and explore
realistic strategies for increasing family meal frequency and improving
family meal environment."

Neumark-Sztainer D, Wall M, Story M, et al. 2004. Are family meal patterns
associated with disordered eating behaviors among adolescents? Journal of
Adolescent Health 35(5):350-359.

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5. ARTICLE PROVIDES RESULTS OF NATIONAL STUDY OF VAGINAL BIRTHS AFTER
CESAREANS IN BIRTH CENTERS

"On the basis of these findings, we advise both birth centers and women
with prior cesarean deliveries against attempting VBACs [vaginal births
after cesareans] in any nonhospital setting," state the authors of an
article published in the November 2004 issue of Obstetrics & Gynecology.
In 1990, the Standards Committee of the National Association of
Childbearing Centers recommended that VBACs could be offered in birth
centers under certain conditions. After reported increases in the number
of uterine ruptures during VBACs attempted in birth centers, in 1999 the
American College of Obstetricians and Gynecologists issued a new set of
guidelines recommending that VBACs should be attempted "only in
institutions equipped to respond to emergencies with physicians
immediately available to provide emergency care." This report presents the
findings of the National Association of Childbearing Centers' study of
VBACs in birth centers and evidence-based recommendations regarding the
advisability of performing trials of labor after cesarean delivery in
birth centers.

Data were collected for 1,453 women who presented at participating birth
centers for an attempted VBAC between 1990 and 2000.

The authors found that:

* Eighty percent of the women had a vaginal delivery.

* Having had a previous vaginal delivery was associated with an increased
chance of successful vaginal delivery in the current trial of labor
(94.4%, vs. 80.9% for women with no previous vaginal delivery).

* Nearly one-fourth (347) of the women were transferred to a hospital
before delivery. Thirty-seven of these transfers were coded as
emergencies.

* Of the 1,106 women who delivered in the birth centers, 42 (3.8%) were
transferred to a hospital after delivery, approximately half for maternal
indications and half for neonatal indications.

* There were 6 uterine ruptures, 7 perinatal deaths, 1 hysterectomy, and
15 liveborn infants with 5-minute Apgar scores <7.

* Women with more than one previous cesarean delivery were significantly
more likely than women with only one previous cesarean delivery to have a
uterine rupture.

* The occurrence of serious adverse outcomes, particularly perinatal
death, was increased among women who delivered at 42 or more weeks of
gestation.

The authors conclude that "because out-of-hospital birth is not a safe
choice for women with prior cesarean deliveries, hospitals should provide
the option of care by a midwife/obstetrician team for women seeking VBAC
within the hospital setting."

Lieberman E, Ernst EK, Rooks JP. 2004. Results of the National Study of
Vaginal Birth After Cesarean in Birth Centers. Obstetrics & Gynecology
104(5):933-942.

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MCH Alert © 2004 by National Center for Education in Maternal and Child
Health and Georgetown University. MCH Alert is produced by MCH Library
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under its cooperative agreement (6U02 MC 00001) with the Maternal and
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contact us at the address below.

EDITORS: Jolene Bertness, Tracy Lopez
COPYEDITOR: Ruth Barzel

National Center for Education in Maternal and Child Health
Georgetown University
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