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Maternal & Child Newletter 5/20/05

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Maternal & Child Newletter 5/20/05

Postby denise » Tue May 24, 2005 08:04 pm

by denise (5480 Posts), Tue May 24, 2005 08:04 pm

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MCH Alert
Tomorrow's Policy Today
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Maternal and Child Health Library

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

May 20, 2005

1. Statistical Sourcebook Provides Key Facts About Obesity
2. National Survey Explores Women's Health Knowledge, Attitudes, and
Perceptions
3. Article Examines Effectiveness of Practice-Based Education to Improve
Delivery Systems for Anticipatory Guidance
4. Authors Assess Program's Effectiveness in Increasing Primary Care
Providers' Adherence to Asthma Guidelines
5. Study Investigates Follow-Up Testing Among Children with Elevated
Screening Blood Lead Levels

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1. STATISTICAL SOURCEBOOK PROVIDES KEY FACTS ABOUT OBESITY

A Nation at Risk: Obesity in the United States Statistical Sourcebook
shows how prevalent obesity has become and examines the factors that
contribute to the patterns of unhealthy eating and insufficient physical
activity that are at the heart of the epidemic. The sourcebook is a
collaborative effort of the American Heart Association and the Robert Wood
Johnson Foundation. The sourcebook presents information on (1) research
and statistics; (2) racial, ethnic, geographic, and economic disparities
and information on disparities in access to healthy foods, physical
activity opportunities, and physical activity facilities; (3) health and
financial consequences of obesity; and (4) causes of obesity. The appendix
includes tools for understanding and measuring body mass index in children
and adolescents as well as descriptions of and links to other resources.
The sourcebook is intended for use by media, policymakers, health
professionals, school officials, and others in raising public awareness
about obesity and getting information into the hands of those who will act
on it. The sourcebook is available at
http://www.americanheart.org/downloadable/heart/1114880987205NationAtRisk.pdf.

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2. NATIONAL SURVEY EXPLORES WOMEN'S HEALTH KNOWLEDGE, ATTITUDES, AND
PERCEPTIONS

First Annual Health Survey: Women Talk presents findings from a national
telephone survey of U.S. women ages 18 and older conducted in March 2005
to explore women's knowledge about, attitudes toward, and perceptions of
their health. The executive summary, published by the National Women's
Health Resource Center (NWHRC), presents key findings on women's roles as
health managers, their awareness of and attention to their own health,
health information resources, and health perceptions by race and
socioeconomic status. NWHRC is also launching an educational initiative
based on the survey findings called Take 10 to T.A.L.K. The campaign
features a wallet-size card (in English and Spanish) with four questions
that women should ask when visiting their health professionals. The press
release, executive summary, wallet card, and other information is
available at http://www.healthywomen.org/womentalk/index.html.

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3. ARTICLE EXAMINES EFFECTIVENESS OF PRACTICE-BASED EDUCATION TO IMPROVE
DELIVERY SYSTEMS FOR ANTICIPATORY GUIDANCE

"Our study demonstrates that parents perceived increased communication
when we implemented an intervention targeted to improve office systems to
achieve better results for prevention," state the authors of an article
published in the May 2005 issue of the Archives of Pediatrics and
Adolescent Medicine. According to the authors, although national physician
organizations advocate spending a significant proportion of the well-child
visit on anticipatory guidance, these expectations are often unmet in
practice. The objective of the study described in this article was to
evaluate the impact of an office-based intervention on parents' reports of
physician discussion of anticipatory guidance, parent knowledge related to
common anticipatory guidance topics, and parent behavior related to common
anticipatory guidance topics.

The authors performed a randomized, controlled study of 44 primary care
pediatric practices in North Carolina. In the 22 intervention practices,
project staff helped an improvement team of clerical, nursing, and
physician staff members (1) review data on immunization, tuberculosis,
lead, and anemia; (2) select performance goals, identify evidence-based
strategies for improvement, and consider how these strategies might be
adopted in their practices; and (3) implement changes in small samples of
patients. Interviews with parents of 1-month-olds and 6-month-olds were
then conducted. The control groups received only step 1 of the
intervention.

The authors found that

* The proportion of families of 1-month-olds who reported receiving four
of five age-appropriate anticipatory guidance items (smoke detectors,
owning a car seat, using a car seat, cigarette smoke exposure, and hot
water temperature) changed from 15.9% to 10.0% in control practices and
from 7.3% to 24.0% in intervention practices.

* The proportion of families of 6-month-olds who reported receiving four
of four age-appropriate anticipatory guidance items (owning a car seat,
using a car seat, cigarette smoke exposure, and using well water or city
water) changed from 8.2% to 5.4% in control practices and from 2.2% to
18.1% in intervention practices.

* Control and intervention parents did not differ in the proportion of
parents reporting knowledge about topics related to the 1-month-olds or to
the 6-month-olds.

* Control and intervention parents did not differ in the proportion of
parents reporting parent behavior regarding topics related to the
1-month-olds or to the 6-month-olds.

The authors conclude that "better communication may be construed as a step
in the process toward the ultimate goal of improved parent behavior." They
continue: "Future studies should delineate which aspects of the
interventions are most important for improvement and should determine how
to create an intervention robust enough to improve parents' knowledge and
behavior as well."

Rosenthal MS, Lannon CM, Stuart JM, et al. 2005. A randomized trial of
practice-based education to improve delivery systems for anticipatory
guidance. Archives of Pediatrics and Adolescent Medicine 159(5):456-463.
Abstract available at
http://archpedi.ama-assn.org/cgi/content/abstract/159/5/456.

Readers: The Spanish edition of Family Pocket Guide: Raising Healthy
Infants, Children, and Adolescents was recently posted to the Bright
Futures for Families Web site. The pocket guide, written especially for
families, reinforces partnership and important roles for families in their
children's good health. It provides information about choosing and working
with health professionals, what to expect as children grow, questions to
ask and what to expect at health visits, and other resources. The pocket
guide is available at
http://www.brightfuturesforfamilies.org/pocket_guidesp.shtml.

More information on anticipatory guidance is also available from the
Bright Futures at Georgetown University Web site at
http://www.brightfutures.org.

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4. AUTHORS ASSESS PROGRAM'S EFFECTIVENESS IN INCREASING PRIMARY CARE
PROVIDERS' ADHERENCE TO ASTHMA GUIDELINES

"This study demonstrates the effectiveness of a disease management program
based on the use of the NAEPP [National Asthma Education and Prevention
Program] guidelines in reducing asthma morbidity in a large group of
low-income, urban, minority children whose asthma is managed entirely by
PCPs [primary care providers]," state the authors of an article published
in the May 2005 issue of the Journal of Pediatrics. The article presents
findings from a study to determine whether a systematic, standardized,
asthma management program (Easy Breathing) increases PCPs' adherence to
the 1997 NAEPP guidelines for anti-inflammatory therapy and whether
greater adherence was associated with a decrease in hospitalizations and
emergency department (ED) visits in minority children from families with
low incomes who reside in Hartford, CT.

The study sample included 3,748 children with asthma who presented for
care at one of six primary care clinics in Hartford, CT, and who were
enrolled in Easy Breathing between June 1, 1998, and August 31, 2002. The
authors examined utilization of medical services (hospitalizations, ED
visits, outpatient visits, and prescriptions) through analysis of paid
Medicaid/SCHIP claims. The primary comparisons were both historical (using
each child's entire utilization experience after and before enrollment)
and contemporaneous (using the utilization of all children enrolled at a
given time along with the utilization of all children yet to be enrolled).

The authors found that

* Forty-eight percent (N=1,799) of the study children were diagnosed with
persistent asthma.

* After enrollment in Easy Breathing, there was a 25% overall decrease in
inhaled corticosteroid use.

* PCPs' adherence to the NAEPP recommendations for treatment of persistent
asthma increased from 38% before enrollment in Easy Breathing to 96% after
enrollment.

* The overall rate of hospitalization for all children with asthma
decreased by 35% after enrollment in Easy Breathing, and the decrease was
sustained for 3 years; the rate of ED visits for asthma decreased by 27%
for children overall, and the rate of outpatient visits decreased by 19%.

"We believe that Easy Breathing has been successful in changing provider
behavior because it focused almost exclusively on asthma diagnosis and
therapy, areas that were important to the provider," state the authors.
They conclude that "adherence to the guidelines resulted in a reduction in
hospitalizations, ED visits, and outpatient visits."

Cloutier MM, Hall CB, Wakefield DB, et al. 2005. Use of asthma guidelines
by primary care providers to reduce hospitalizations and emergency visits
in poor, minority, urban children. Journal of Pediatrics 146(5):591-597.
Abstract available at
http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=as0022347604011692&nav=abs.

Readers: More information is available from the MCH Library's knowledge
path, Asthma in Children and Adolescents, at
http://www.mchlibrary.info/KnowledgePaths/kp_asthma.html.

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5. STUDY INVESTIGATES FOLLOW-UP TESTING AMONG CHILDREN WITH ELEVATED
SCREENING BLOOD LEAD LEVELS

"In this first population-based study of the outcomes of screening, we
found that half of Medicaid-enrolled children with an elevated blood lead
level have no follow-up testing, and those children at greatest risk of
having an elevated blood lead level are less likely to receive follow-up
testing," state the authors of an article published in the May 11, 2005,
issue of JAMA, The Journal of the American Medical Association. Follow-up
testing is the cornerstone of lead poisoning management and an essential
component of secondary prevention. However, few studies have evaluated the
care that children with elevated screening blood lead levels receive. The
article describes a study to measure the proportion of Michigan
Medicaid-enrolled children ages 6 and younger with elevated screening
blood lead levels who have follow-up testing and to determine factors
associated with such follow-up testing.

The study sample included 3,682 children with elevated screening blood
lead levels (greater than or equal to 10 micrograms per deciliter) between
January 1, 2002, and June 30, 2003. (Children with elevated screening
blood lead levels prior to the study period were excluded from the
analysis.) The main outcome measures were the proportion of children who
had at least one follow-up test in the 6-month period after screening and
the number of missed opportunities among children who did not have any
follow-up testing. The relationship between screening blood lead levels
and results from the first follow-up test were also evaluated.

The authors found that

* Overall, 53.9% of the children had follow-up testing within 6 months of
their elevated blood lead screening; on follow-up testing, 47.5% of the
children still had elevated blood lead levels.

* Children who had higher screening blood lead levels were more likely to
have follow-up testing.

* Hispanic or non-white (vs. white) children, children with urban (vs.
rural) residence, and children living in high- (vs. low-) risk areas were
the least likely to have follow-up testing.

* Among children with elevated screening blood lead levels who did not
have follow-up testing, 58.6% had at least one medical encounter in the
6-month period after screening; the most common type of medical encounter
was for evaluation and management (39.3%), followed by emergency
department visit (26.7%), and preventive care (13.2%).

"These findings suggest a lack of connection between federal efforts to
eliminate childhood lead poisoning and current lead screening practices,"
state the authors. They conclude that "it is crucial to improve follow-up
and to understand and develop interventions to overcome these unexpected
disparities in care."

Kemper AR, Cohn LM, Fant KE, et al. 2005. Follow-up testing among children
with elevated screening blood lead levels. JAMA, The Journal of the
American Medical Association 293(18):2232-2237. Abstract available at
http://jama.ama-assn.org/cgi/content/abstract/293/18/2232.

Readers: A special selection of articles on lead poisoning in children was
published in the May/June 2005 issue of Public Health Reports. Topics
include the discovery of the impact of lead pigments on children's health,
screening housing to prevent lead toxicity in children, cost of child lead
poisoning, reducing lead exposure from drinking water, federal response to
childhood lead poisoning, and the lead industry. The articles are
available at http://www.publichealthreports.org.

Information is also available from the MCH Library's knowledge path, Early
and Periodic Screening, Diagnostic and Treatment (EPSDT) Services, at
http://www.mchlibrary.info/KnowledgePaths/kp_EPSDT.html.

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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
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and Child Health Bureau reserves a royalty-free, nonexclusive, and
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contact us at the address below.

MANAGING EDITOR: Jolene Bertness
CO-EDITOR: Tracy Lopez
COPYEDITOR/WRITER: Ruth Barzel

MCH Alert
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Georgetown University
Box 571272
Washington, DC 20057-1272
Phone: (202) 784-9770
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E-mail: MCHAlert@ncemch.org
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-------
Denise (29) Co-coordinator for WI
Jason (32)
Ariana (24 months)5/3/03-just shy of 35 weeks: Class 1 HELLP
http://hometown.aol.com/oneyodafan/DeniseHomePage.htm
denise
Registered User
 
Posts: 5480
Joined: Sat Dec 06, 2003 08:03 pm
Location: Central WI

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