Maternal and Child Health Library

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

November 4, 2005

1. MCH LIBRARY RELEASES NEW KNOWLEDGE PATH ON AUTISM SPECTRUM DISORDERS

Knowledge Path: Autism Spectrum Disorders offers a selection of current, high-quality resources about autism spectrum disorders (ASD) identification and intervention. The knowledge path, produced by the MCH Library, includes information on (and links to) Web sites, electronic and print publications, and databases containing resources about biomedical research into the causes of ASD; resources that address the communication, education, and vocational challenges associated with ASD; and resources about ASD's impact on family life. Separate sections identify resources about ASD and environmental health research as well as those that address concerns about vaccines. The knowledge path is intended for use by health professionals, educators, researchers, policymakers, and families. It is available at http://www.mchlibrary.info/KnowledgePaths/kp_autism.html.

MCH Library knowledge paths on other maternal and child health topics are available at http://www.mchlibrary.info/KnowledgePaths/index.html. The MCH Library welcomes feedback on the usefulness and value of these knowledge paths. A feedback form is available at http://www.mchlibrary.info/KnowledgePaths/feedback.html.

• Physician Education -- Physician education increases the number of diagnosed and treated depressed patients with accompanying reductions in suicide, although booster programs appear necessary. Education programs targeting primary care physicians should include instruction on the use of antidepressants.
• Gatekeeper Education -- Where the role of gatekeepers are formalized and pathways to treatment are readily available, educating gatekeepers helps reduce suicidal behavior.
• Means Restriction -- Restricting access to lethal methods decreases suicide by those methods.

• Pharmacotherapy -- Randomized controlled trials are needed to prove that selective serotonin reuptake inhibitors decrease suicide rates. The relationship between antidepressant use and emergent suicidal ideation and behavior in depressed children and adolescents needs further study.
• Screening -- Further consideration needs to be given to determining the cost-effectiveness of screening general populations vs. identified at-risk populations for reducing suicide rates, the predictive validity and reliability of specific screening instruments, and the appropriateness of standard suicide screening instruments across different cultures.
• Psychotherapy -- More needs to be known about the combinations of psychotherapeutic and pharmacologic interventions for short- and long-term outcomes for suicidal patients.
• Chain of Care -- Essential elements of postsuicide attempt interventions are yet to be identified.
• Media -- Strategies for influencing how the media reports suicide need to be implemented and evaluated.

• The percentage of families with CSHCN who had no insurance was 5.2%. An additional 6.4% were uninsured during a period in the last year, and about one-third (32.3%) were underinsured. The remaining 60% were considered to have both continuous and adequate coverage.
• The prevalence of underinsurance among families with CSHCN varied across different groups: Hispanics, families living in poverty, and those with children most affected by their conditions were most likely to be underinsured.
• Families with CSHCN who were underinsured were more likely than those who were uninsured to report difficulties receiving referrals for needed specialty care.
• Families with CSHCN who were underinsured were more likely than those who were uninsured to report that the child's condition caused them to reduce or stop work.