Maternal Child Health Alert Newsletter Dec 03

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Maternal Child Health Alert Newsletter Dec 03

Postby annegarrett » Thu Dec 04, 2003 02:45 pm

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

December 5, 2003

1. Report Summarizes Role of Environmental Toxicants in Preterm Birth 2. Authors Examine Postpartum Counseling Perceptions and Practices 3. Study Assesses Effects of Expanded Newborn Screening 4. Article Examines Teaching Hospitals' Ability to Offer Specialty Care to the Uninsured

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1. REPORT SUMMARIZES ROLE OF ENVIRONMENTAL TOXICANTS IN PRETERM BIRTH

The Role of Environmental Hazards in Premature Birth: Workshop Summary looks at the issues surrounding the role of the environment as a risk factor for delivering a preterm infant. The newly published report summarizes main themes presented by the speakers and participants of the Institute of Medicine's Roundtable on the Environmental Health Sciences, Research, and Medicine workshop held on October 2-3, 2001, in Washington, DC. The purpose of the workshop was to understand the biological mechanism of normal labor and delivery, and how broadly defined environmental influences can interact with the processes of normal pregnancy to result in preterm birth. The report presents information on preterm birth and its consequences, labor and delivery, biological pathways, gene-environment interactions, social implications, and future directions. It is intended for use by policymakers, health professionals, researchers, and others in understanding and preventing preterm birth. The report is available at http://www.nap.edu/catalog/10842.html.

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2. AUTHORS EXAMINE POSTPARTUM COUNSELING PERCEPTIONS AND PRACTICES

"There is greater concordance today between pediatricians' and mothers' perceptions of educational priorities and actual counseling practices than there was a generation ago," state the authors of an article published in the November-December 2003 issue of Ambulatory Pediatrics. In 1979, Greenberg et al. studied mothers' and pediatricians' perceptions of postpartum education needs and compared pediatricians' perceptions with actual postpartum counseling practices. In 1999, a similar study was conducted at the same community hospital in suburban Washington, DC. This article describes the results of the 1999 study, which sought to determine how well pediatricians' perceptions of educational priorities for counseling about newborn care matched those of new mothers during postpartum hospitalization. Researchers also sought to determine whether pediatricians' counseling practices reflected mothers' priorities.

The study was conducted in three phases. First, a focus group of 10 pediatricians and a convenience sample of 61 postpartum mothers were asked to list their top 10 educational priorities. Second, all 147 staff pediatricians and a separate convenience sample of 53 postpartum mothers were asked to rate the items on their group's top 10 list. Mothers were also asked to indicate which information they felt their pediatrician (rather than another health professional) should discuss. Finally, 23 pediatricians were observed and audiotaped during counseling sessions. An 11-item template representing the items that mothers or pediatricians rated as important was used to score the number of items covered in each counseling session. Researchers compared the percentages of mothers and pediatricians rating a topic as very important and compared mothers' expectations and pediatricians' perceptions with actual practice.

The authors found that

* Mothers listed discussion of prevention of pain during circumcision as important, but pediatricians did not.
* Pediatricians listed discussion of safety and infant sleep position as very important, but mothers did not.
* Pediatricians rated discussion of health problems in the infant, diagnostic tests, general care, and infant behavior as significantly less important than mothers did.
* In general, most pediatricians discussed topics rated by the majority of mothers as very important (e.g., problems/illness, feeding issues), but were less likely to consistently discuss some of the topics they rated as very important (e.g., safety, sleep position).
* Pediatricians rarely discussed topics they did not rate as very important (e.g., newborn metabolic screening, infant behavior, circumcision issues), even though these topics were highly ranked by mothers.

The authors conclude that "given mothers' high interest in learning about newborn care in the postpartum period, complementary educational resources should be used to supplement the pediatricians' efforts prior to discharge."

Callaghan P, Greenberg L, Brasseaux C, et al. 2003. Postpartum counseling perceptions and practices: What's new? Ambulatory Pediatrics 3(6):284-287.

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3. STUDY ASSESSES EFFECTS OF EXPANDED NEWBORN SCREENING

"Despite expanded newborn screening's apparent positive impact on the health and well-being of infants with metabolic disorders and their families, questions remain," state the authors of an article published in the November 19, 2003, issue of JAMA, The Journal of the American Medical Association. Many states are now using tandem mass spectrometry, a new procedure that screens for many disorders with a single evaluation, to expand mandated newborn screening. The study described in this article was designed to assess the effects of expanded screening for biochemical genetic disorders on child outcomes and parental stress. The study compared newborn identification by expanded screening with clinical identification. The study also assessed the impact on parents of a false-positive screening result (compared with a normal result) in the expanded newborn screening program.

The study drew from a cohort of children who were identified as having any of 20 biochemical genetic disorders between February 1999 and June 2002, and who were evaluated by December 2002. The sample included 50 affected children identified by the New England Newborn Screening Program in Massachusetts and Maine or by a private screening lab in Pennsylvania and 33 affected children identified clinically from any New England state. In addition, 94 children who had a false-positive result in the expanded newborn screening program and 81 unaffected children who had normal newborn screening results were enrolled. The children received a standard medical examination. Their medical records were obtained, and measures of child functioning were assessed. A total of 254 mothers and 153 fathers were interviewed and completed the Parenting Stress Index (PSI).

The authors found that

* Twenty-eight percent of children identified by newborn screening required hospitalization at least once within the first 6 months of life, vs. 55% identified clinically.
* One child identified by newborn screening functioned in the range of mental retardation, vs. 8 children identified clinically.
* Mothers of children identified by newborn screening reported significantly lower overall stress on the PSI than mothers of children identified clinically; however, fathers of children identified by newborn screening and fathers of children identified clinically reported similar overall stress levels.
* Twenty-one percent of children in the false-positive group were hospitalized, vs. 10% in the comparison group.
* The PSI scores of mothers in the false-positive group were significantly higher than those of mothers in the comparison group; mothers in the false-positive group also scored higher on the parent-child dysfunction subscale than mothers in the comparison group.

"This study highlights some of the challenges to current newborn screening practices," the authors conclude. The findings demonstrate the need to educate parents about newborn screening before the birth of their child and the need to educate primary care and other health professionals about metabolic disorders.

Waisbren S, Albers S, Amata S, et al. 2003. Effect of expanded newborn screening for biochemical genetic disorders on child outcomes and parental stress. JAMA, The Journal of the American Medical Association 290(19):2564-2572.

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4. ARTICLE EXAMINES TEACHING HOSPITALS' ABILITY TO OFFER SPECIALTY CARE TO THE UNINSURED

"In this survey . . . we found large gaps in perceived access to referral services to specialists, high-tech care, outpatient mental health and substance abuse treatment, and even routine inpatient care," write the authors of an article published in the November/December 2003 issue of Health Affairs. The authors state that U.S. teaching hospitals have historically been associated with the care of people with low incomes. In the study described in this article, the authors sought to determine whether such hospitals function effectively as a safety net for low-income and uninsured persons.

The authors surveyed 2,295 clinicians at 121 U.S. academic health centers (AHCs) to determine their perception of access to care for the individuals they served, as well as limits placed on their ability to provide that care. The authors developed questions to (1) assess clinicians' ability to obtain care for the uninsured and (2) understand barriers to providing care. The authors also identified the ownership status of the parent medical school (public or private) and the ownership of the flagship or primary teaching hospital, if there was one (public vs. all others). In addition, the authors classified clinicians into high- and low- "safety-net status" depending on the proportion of individuals they cared for who were uninsured.

The authors found that

* Individuals without insurance or who were enrolled in Medicaid constituted 16% and 25%, respectively, of those served by AHCs.
* Clinicians in public medical schools and in medical schools affiliated primarily with public teaching hospitals saw significantly more uninsured persons than did clinicians in private medical schools and in medical schools affiliated primarily with private teaching hospitals.
* There were large and significant differences, by individuals' insurance status, in the percentages of clinicians reporting difficulty in obtaining care for the people they served. Relative rates (uninsured vs. privately insured) range from 2.1 for problems obtaining substance abuse services to 8.9 for referral to a specialist.
* Formal policies limiting care to the uninsured were reported by 13% of clinicians.
* The most common reason given for limited care to the uninsured was that the number of individuals referred was small, followed by inadequate reimbursement.
* Clinicians in the high-safety-net category were less likely than their low-safety-net counterparts to report lack of referrals, inadequate reimbursement, discouragement by their group practice or hospital, less-well-equipped facilities, or travel barriers.

The authors conclude that "the capacity of safety-net institutions, including AHCs, to provide equitable care to all patients needs to be reexamined."

Weissman JS, Moy E, Campbell EG, et al. 2003. Limits to the safety net: Teaching hospital faculty report on their patients' access to care. Health Affairs 22(6):156-166.

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MCH Alert © 2003 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by MCH Library Services at the National Center for Education in Maternal and Child Health under its cooperative agreement (6U02 MC 00001) 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.

Permission is given to forward MCH Alert to individual colleagues. For all other uses, requests for permission to duplicate and use all or part of the information contained in this publication should be sent to MCH Alert Editor, National Center for Education in Maternal and Child Health, at mchalert@ncemch.org.

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EDITORS: Jolene Bertness, Tracy Lopez
COPYEDITOR: Ruth Barzel

National Center for Education in Maternal and Child Health Georgetown University Mailing address: Box 571272, Washington, DC 20057-1272 Street address: 2115 Wisconsin Avenue, N.W., Suite 601, Washington, DC 20007-2292
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Anne Garrett
Executive Director
Preeclampsia Foundation
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Re : Maternal Child Health Alert Newsletter Dec 03

Postby angela » Sat Dec 06, 2003 09:02 am

Anne,

This is such in interesting article! I am a childbirth educator for a large hospital in Minneapolis and we regularly have Pediatrician come to our classes and talk about issues they think the families would be interested in. I have passed along this article to my supervisor who is making copies for all educators so that we can bring up some of the topics that the mothers thought were important. Education of new parents is so important!

I also talk to all my classes about pre-e/PIH, since my experience with it. I emphasize all the warning signs and the importance of early detection. My co-workers also are talking to their classes in more detail as well. I go to a lot of class reunions and it is amazing how many new mothers thank me for my information, it may have saved their life and their babies life!

Take Care and Thanks,
Angela Reinke
ds 5/8/01
dd 7/29/03 37 weeks due to PIH
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