Maternal & Child Newsletter 5/13/05

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Maternal & Child Newsletter 5/13/05

Postby denise » Fri May 13, 2005 12:40 am

MCH Alert
Tomorrow's Policy Today

Maternal and Child Health Library

This and past issues of the MCH Alert are available at

May 13, 2005

1. Report Higlights Gaps in the Provision of Early Childhood Developmental
2. Fact Sheets Describe Maternal and Child Health Program Expertise in
Meeting the Needs of Children with Special Health Care Needs and
3. Article Reviews Maternal Outcomes of Routine vs. Restrictive Episiotomy
4. Authors Assess the Extent to Which Children with Special Health Care
Needs Have Access to Adequate Health Insurance
5. Study Assesses Vaccine Beliefs of Parents Opposed to Compulsory



Quality of Preventive Health Care for Young Children: Strategies for
Improvement provides a broad picture of the provision of early childhood
developmental services. The report, published by the Commonwealth Fund,
examines gaps in services by comparing data from two national surveys: (1)
the 2000 National Survey of Early Childhood Health, which contains
information regarding parents' and guardians' concerns about their
children's development and (2) the American Academy of Pediatrics'
Periodic Survey of Fellows #46, which collected information from
pediatricians regarding the kind of services they provide to children from
birth to age 35 months. The report presents findings on defining
developmental services, parents' concerns regarding child development,
identifying and evaluating developmental issues, gaps in provision of
development assessment, disparities in guidance on child development and
health promotion, and pediatricians' perspectives on barriers to assessing
development. Strategies, recommendations, and a conclusion are also
presented. The report is available at ... _id=275484 or ... ildren.pdf.



The Association of Maternal and Child Health Programs (AMCHP) has produced
two fact sheets about the organization's role in supporting health
professionals at the state level to ensure the health and well-being of
infants, children, adolescents, women, and families. The first fact sheet,
titled Adolescent and School Health, discusses AMCPH's role in working
with adolescent health coordinators and other maternal and child health
professionals in each state to (1) increase awareness of adolescent health
within Title V programs; (2) address adolescent health from a
resiliency/asset approach; and (3) strengthen the capacity of Title V
programs in state health agencies to partner with schools and other
organizations to prevent behaviors that place adolescents at risk for HIV,
STDs, unintended pregnancy, and other significant health problems. The
fact sheet is available at ... health.pdf. The
second fact sheet, titled Children with Special Health Care Needs (CSHCN),
provides information about AMCHP's role in assisting families and state
programs with creating and sustaining systems of care for CSHCN and their
families through policy and legislative analysis, research, coordination
of national meetings, and publications. The fact sheet is available at



"Our systematic review finds no benefits from episiotomy," write the
authors of an article published in the May 4, 2005, issue of JAMA, The
Journal of the American Medical Association. Episiotomy is among the most
common surgical procedures experienced by women in the United States.
Despite decades of research, which many interpret as definitive evidence
against routine episiotomy, little professional consensus has developed
about the appropriateness of routine use. Lack of consensus is illustrated
by variation in use. The study described in this article reviewed the best
evidence available about the maternal outcomes of routine vs. restrictive
use of episiotomy. The literature included in the study employs varied
definitions of "restrictive use," including (1) to avoid episiotomy unless
indicated for fetal well-being, (2) to avoid episiotomy, (3) to use only
when medically necessary, and (4) not to perform an episiotomy for the
purpose of avoiding a laceration. Specifically, the authors sought to
describe short-term outcomes such as degree of perineal injury and pain
close to the time of birth, as well as long-term outcomes such as urinary
and fecal incontinence, pelvic floor defects, and sexual dysfunction.

The authors searched MEDLINE, Cochrane Collaboration resources, and the
Cumulative Index to Nursing and Allied Health Literature and also hand
searched reference lists of materials from 1950 through May 2004. They
included randomized clinical trials and prospective cohorts of long-term
outcomes and randomized clinical trials only of short-term outcomes. Of
327 articles reviewed, 26 met inclusion criteria.

The authors found that

* Fair to good evidence from clinical trials suggests that short-term
maternal outcomes of routine episiotomy, including severity of perineal
laceration, pain, and pain medication use, are not better than those with
restrictive use.

* Evidence is insufficient to provide guidance on choice of midline vs.
mediolateral episiotomy.

* Evidence regarding long-term sequelae is fair to poor; incontinence and
pelvic floor outcomes have not been followed up into the age range in
which women are most likely to have sequelae.

* Relevant studies are consistent in demonstrating no benefit from
episiotomy for prevention of fecal and urinary incontinence or pelvic
floor relaxation.

* No evidence suggests that episiotomy reduces impaired sexual function.

* Pain with intercourse was more common among women with episiotomy.

The authors conclude that "the time has come to take on the professional
responsibility of setting and achieving goals for reducing episiotomy

Hartmann K, Viswanathan M, Palmieri R. 2005. Outcomes of routine
episiotomy: A systematic review. JAMA, The Journal of the American Medical
Association 293(17):2141-2148. Abstract available at ... 93/17/2141.



"Although the majority of CSHCN [children with special health care needs]
currently have adequate health insurance, additional work is still needed
to eliminate disparities among our nation's most vulnerable children,"
state the authors of an article published in the May 2005 issue of
Pediatrics. Adequate health insurance is one of six core outcomes for
CSHCN under objectives 16-23 of Healthy People 2010. The article reports
the findings of the National Survey of Children with Special Health Care
Needs regarding the extent to which CSHCN have met the health insurance
core outcome.

Questionnaire items were included in the 2001 National Survey of Children
with Special Health Care Needs specifically to measure attainment of the
health insurance core outcome by CSHCN. For a child to be counted as
meeting the health insurance goal, coverage must have been present at the
time of the interview, the child must have been covered continuously for
the previous 12 months, and the coverage must have been adequate from the
family's perspective.

The authors found that

* Almost two thirds (59.6%) of CSHCN met the health insurance core outcome
using the three components of presence of coverage, continuity of
coverage, and adequacy of coverage.

* Less than half (45.2%) of Hispanic CSHCN and 57.6% of non-Hispanic black
CSHCN met the core outcome, compared with more than 60% of their
non-Hispanic white counterparts.

* Only 50% of CSHCN living at less than or equal to 200% of the federal
poverty level (FPL) met the core outcome, compared with 70% of those
living at greater than or equal to 400% of the FPL.

* Less than half (48.5%) of CSHCN with limited functional ability met the
core outcome, compared with 68.1% of those whose condition has no impact
on their activity.

* More than one quarter (28.8%) of CSHCN who did not meet the core outcome
had one or more unmet needs, compared with 1 in 10 (9.5%) of those who met
the core outcome.

The authors conclude that "assuring adequate health insurance to all CSHCN
will require a strong and committed partnership that involves numerous
stakeholders in the public and private sectors, including federal, state,
and local agencies, purchasers, insurers, employers, providers, and

Honberg L, McPherson M, Strickland B, et al. 2005. Assuring adequate
health insurance: Results of the National Survey of Children with Special
Health Care Needs. Pediatrics 115(5):1233-1239. Abstract available at ... 115/5/1233.

Readers: More information is available from the MCH Library's knowledge
path, Children and Adolescents with Special Health Care Needs, at ... #financing.



"A parent's opposition to compulsory vaccination is associated with
negative attitudes and beliefs about the safety and utility of vaccines,"
state the authors of an article published in the May 2005 issue of Public
Health Reports. Although all 50 states legislate that children must be up
to date in their required vaccinations before starting school, all states
also allow exemptions from this requirement. As of the 2004-2005 school
year, 19 states allowed for a philosophical exemption (distinct from a
religious exemption) in which parents who oppose vaccination for
philosophical reasons may claim exemption for their child. The article
describes the sociodemographic factors, vaccine beliefs, and behaviors
associated with a parent's opposition to compulsory vaccination. The
authors also discuss the association between the availability of a
philosophical exemption in a parent's state of residence and parental
objection to compulsory vaccination.

Data from the 2002 HealthStyles survey were used for the analysis. Parents
were asked about their level of agreement (on a five-point Likert scale)
with allowing their children to go to public school even if they are not
vaccinated. Parents who strongly agreed or agreed that children should be
allowed to go to public school even if they are not vaccinated were
categorized as opposed to compulsory vaccination (opposed parents).
Parents who were neutral, disagreed, or strongly disagreed with the
statement were categorized as supportive of compulsory vaccination
(supportive parents). Sociodemographic characteristics and parental
attitude, beliefs, and behavior were used to predict the outcome variable.

The final study sample included 1,527 parents with at least one child ages
18 or younger living in the household.

The authors found that 12% (N=188) of the parents were opposed to
compulsory vaccination for school entry. Opposed parents were more likely
than supportive parents

* to be from the lowest income category surveyed

* to agree that the body can protect itself from vaccine-preventable
disease without vaccines

* to disagree that vaccines are necessary to prevent certain diseases

* to believe that vaccines are not important or only somewhat important to
children's health

* to indicate that they did not plan to have their youngest child receive
all recommended vaccines

* to live in a state where philosophical exemption to vaccination was

The authors conclude that "effective risk communication between providers
and parents, as well as provision of basic vaccine information to parents
regarding (1) the diseases vaccines prevent, (2) what could happen if
their children are not vaccinated, (3) how vaccines work, and (4) the
concept of herd immunity, are important first steps in building a better
understanding of the importance of routine childhood vaccinations."

Kennedy A, Brown CJ, Gust DA. 2005. Vaccine beliefs of parents who oppose
compulsory vaccination. Public Health Reports 120(3):252-258. Available at ... 120252.pdf.

Readers: More information is available from the following articles
published in May 2005 issues of peer-reviewed journals:

Salmon DA, Moulton LH, Omer SB, et al. 2005. Factors associated with
refusal of childhood vaccines among parents of school-aged children: A
case-control study. Archives of Pediatrics and Adolescent Medicine
159(5):470-476. Abstract available at ... /159/5/470.

Diekema DS, and the American Academy of Pediatrics, Committee on
Bioethics. 2005. Responding to parental refusals of immunization of
children. Pediatrics 115(5):1428-1431. Available to subscribers at ... 115/5/1428.


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MCH Alert
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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

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