MCH Alert


National Center for Education in Maternal and Child Health

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May 7, 2004

1. Fact Sheet Highlights Relationship Between Oral Health and Health in Women
2. Report Examines the Role of Poison Prevention and Control Services
3. Expert Panel Evaluates Reproductive and Developmental Toxicity of Widely Prescribed Antidepressant in Women and Children
4. Data Briefs Address Trends, Barriers, and Policy Solutions in U.S. Health Insurance Coverage
5. Authors Assess Evidence of Effectiveness of Physician Interventions in Preventing and Managing Dental Caries in Preschool-Age Children

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1. FACT SHEET HIGHLIGHTS RELATIONSHIP BETWEEN ORAL HEALTH AND HEALTH IN WOMEN

In recognition of National Women's Health Week (May 9-15, 2004), the National Maternal and Child Oral Health Resource Center (OHRC) has released a new fact sheet, Oral Health and Health in Women: A Two-Way Relationship. OHRC produced the fact sheet in collaboration with health professionals, program administrators, educators, and researchers in the fields of oral health and women's health. The fact sheet provides general information and national data on women’s oral health. Topics include women’s oral health status, the relationship between oral health and general health in women, oral health care, and strategies for improving women’s oral health. The fact sheet is available at http://www.mchoralhealth.org/PDFs/WomensFactSheet.pdf.

Readers: National Women's Check-Up Day will be held on May 10 to encourage women to use the many high-quality preventive care services, including oral health care services, available to them through the nation's health centers. More information is available from the National Women's Health Week Web site at http://www.4woman.gov/whw/2004.

More information about women's health is available from the MCH Library's bibliographies, Women's Health and Women's Health: Consumer Education Materials, at http://www.mchlibrary.info/databases/bibmenu.html.

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2. REPORT EXAMINES THE ROLE OF POISON PREVENTION AND CONTROL SERVICES

Forging a Poison Prevention and Control System examines the future of poison prevention and control services in the United States. The Maternal and Child Health Bureau of the Health Resources and Services Administration asked the Institute of Medicine (IOM) to help develop a more systematic approach to understanding, stabilizing, and providing long-term support for poison prevention and control services. IOM examined the role of poison control services within the larger public health system, the injury prevention and control field, and the fields of general medical care and medical and clinical toxicology. IOM also looked at how poison control centers function relative to the functions performed by other health care agencies and government organizations. The report provides information on the magnitude of the problem; the historical context of poison control centers; center activities, personnel, and quality assurance; current costs, funding, and organizational structures; data and surveillance; and prevention and public education. Conclusions, recommendations, a list of contributors, and committee biographies are also included. The pre-publication version of the report is available at http://books.nap.edu/books/0309091942/html/index.html.

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3. EXPERT PANEL EVALUATES REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF WIDELY PRESCRIBED ANTIDEPRESSANT IN WOMEN AND CHILDREN

"The Expert Panel concluded that there is sufficient evidence in humans to determine that prenatal exposure to fluoxetine [Sarafem, Prozac] results in poor neonatal adaptation . . . at typical therapeutic exposures (20-80mg/day orally) during the third trimester of pregnancy," state the authors of a report published by the Center for the Evaluation of Risks to Human Reproduction. Fluoxetine is an antidepressant that is widely prescribed in the United States. The report evaluates evidence for adverse effects on reproduction (including development) caused by fluoxetine exposures among women of childbearing age and among children.

The Fluoxetine Expert Panel, a twelve-member panel of government and nongovernment scientists, conducted an evaluation to (1) interpret the strength of scientific evidence that fluoxetine is a reproductive or developmental toxicant, (2) assess the extent of human exposures, (3) assess the scientific evidence that adverse reproductive or developmental health effects may be associated with such exposures, and (4) identify knowledge gaps. The evaluation culminated in a public expert panel meeting held on March 3-5, 2004.

The panel found that

* Third trimester exposure to therapeutic doses of fluoxetine (20-80 mg/day orally) is associated with an increased incidence of poor neonatal adaptation (e.g., jitteriness, hypoglycemia, hypothermia, poor tone, respiratory distress, weak or absent cry, diminished pain reactivity, or desaturation with feeding).
* The evidence suggests that developmental toxicity can also occur in the form of shortened gestational duration and reduced birthweight at term.
* There is sufficient evidence that fluoxetine can produce reproductive toxicity in men and women as manifested by reversible, impaired sexual function, specifically orgasm.
* The mechanism by which fluoxetine can cause reproductive and developmental toxicity is unknown.
* There are insufficient data to draw conclusions about drug-induced toxicity in infants exposed to fluoxetine through breast milk or about children on fluoxetine therapy.

The authors note that a monograph on fluoxetine is forthcoming and will include a brief, this report, and all public comments on the report. The monograph will be made publicly available and will be transmitted to appropriate health and regulatory agencies.

CERHR Fluoxetine Expert Panel. 2004. NTP-CERHR Expert Panel Report on the Reproductive and Developmental Toxicity of Fluoxetine. NTP-CERHR-Fluoxetine-04. Research Triangle Park, NC: National Institute of Environmental Health Sciences. Available at http://cerhr.niehs.nih.gov/news/fluoxetine/index.html.

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4. DATA BRIEFS ADDRESS TRENDS, BARRIERS, AND POLICY SOLUTIONS IN U.S. HEALTH INSURANCE COVERAGE

"Overall, employer-provided health insurance coverage fell from 1999 to 2002, almost entirely because of falling dependent coverage, largely among children," state the authors of Improving Access to Health Insurance, a data brief published by the Center for Economic and Policy Research (CEPR). The brief is the first of a five-part series by CEPR on health insurance in the United States. The brief addresses access to health insurance and describes policy options available to expand coverage to Americans who did not have health insurance during 2002. Other briefs in the series examine health insurance coverage generally, employer-provided health insurance for employees, changes in the share of Americans receiving employer-provided health insurance as a dependent on another family member's plan, and interactions between the private and public health insurance systems.

The data used in the series comes from CEPR's analysis of the Survey of Income and Program Participation. The authors explored demographic trends and identified major problems. They also evaluated various policy solutions offered by Congress and major party presidential candidates.

The authors found that

* Access to employer-provided health insurance coverage fell from 64.0% in 1999 to 61.6% in 2002.
* Between 1999 and 2002, the share of workers with employer-provided health insurance who cover another family member fell from 56.0% to 51.6%. The decline was larger among children than among adults.
* Less than half (47.4%) of low-wage workers had any employer-provided health insurance during all of 2002.
* Between 1999 and 2002, the share of children covered for the whole year (by any source) fell from 74.9% to 71.4%.
* Latinos are less likely than other racial/ethnic groups to be covered.
* Among adults, young adults (ages 18 to 25) are the least likely to have health insurance.

"Increasing access to health coverage and ensuring equity in eligibility are two achievable goals," the authors conclude. They suggest that "future legislative solutions must focus on increasing access to health insurance as well as ensuring equity across age, race, and income levels."

Boushey H, Wright J. 2004. Improving access to health insurance. Washington, DC: Center for Economic and Policy Research. Available at http://www.cepr.net/health_insurance/hi_brief.htm.

Readers: More information is available from the Cover the Uninsured Week (May 10-16) Web site at http://www.CoverTheUninsuredWeek.org, and from the MCH Library's knowledge path, Child and Adolescent Health Insurance and Access to Care, available at http://www.mchlibrary.info/KnowledgePaths/kp_insurance.html.

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5. AUTHORS ASSESS EVIDENCE OF EFFECTIVENESS OF PHYSICIAN INTERVENTIONS IN PREVENTING AND MANAGING DENTAL CARIES IN PRESCHOOL-AGE CHILDREN

"The evidence base for recommendations to physicians about dental caries prevention in young children needs to be strengthened," state the authors of an article published in the April 2004 issue of the American Journal of Preventive Medicine. The article presents a summary of evidence for the U.S. Preventive Services Task Force (USPSTF) on the effectiveness of primary care clinician-based interventions for preventing dental caries in preschool-age children.

Researchers searched MEDLINE for the period 1966 to October 2001. The literature review focused on studies addressing the performance of primary care clinicians in five essentially dental roles: (1) screening and risk assessment, (2) referral, (3) provision of dietary fluoride supplementation, (4) application of fluoride varnish, and (5) counseling.

The authors found that

* The strength of the evidence assessing the effectiveness of screening and risk assessment, referral, and counseling is poor.
* The strength of the evidence assessing the appropriateness of primary care clinicians' prescription of supplemental fluoride is fair, but it suggests that physicians' decisions about fluoride supplements might not always be made with full knowledge of a child's other fluoride exposures.
* The strength of the evidence assessing the effectiveness of dietary fluoride supplementation and fluoride varnish is also fair; however, no studies on the effects of the most recently recommended regimen for fluoride supplementation are available.

The authors conclude that "evidence for the effectiveness of traditionally recommended primary care clinician interventions (screening, referral, counseling) to prevent dental caries in preschool children is lacking." They add that although there is fair evidence for the effectiveness of fluoride supplementation and fluoride varnish, "there is also evidence indicating that physicians' consideration of fluoride exposure is incomplete, thus increasing the risk for fluorosis among those prescribed supplements."

Bader JD, Rozier RG, Lohr KN, et al. 2004. Physicians' roles in preventing dental caries in preschool children. American Journal of Preventive Medicine 26(4):315-325.

Readers: The USPSTF concluded that the benefits of dietary fluoride supplementation outweigh the potential harm of fluorosis, which in the United States is primarily observed as a mild cosmetic discoloration of the teeth. The task force recommendations, based on this review, are available at http://www.ahrq.gov/clinic/3rduspstf/dentalchild/dentchrs.htm.

Additional information about the prevention and management of dental caries in infants and children from birth to age 5 can be found in the Early Childhood Caries Resource Guide (2nd ed.), available at http://www.mchoralhealth.org/PDFs/EarlyChildCaries.pdf. The resource guide was published by the National Maternal and Child Oral Health Resource Center and is designed to assist policymakers, program administrators, health professionals, and others in the prevention of early childhood caries. It is divided into three sections. The first section lists journal articles appearing in the literature between 2002 and 2004. The second section describes the following types of materials: books, curricula, manuals, modules, guidelines, pamphlets, brochures, and videotapes. The third section lists federal agencies and national organizations that may serve as resources.

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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 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.

The editors welcome your submissions, suggestions, and questions.  Please 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
Mailing address: Box 571272, Washington, DC  20057-1272
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