Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
June 16, 2006
1. Web Site Provides Online Learning Opportunity for
Understanding Sex and Gender Differences
2. Policy Brief Addresses the How, What, Where, and Who
of Family Supports for Children with Special Health Care Needs
3. Report Highlights Achievements and Barriers in the
Elimination of Perinatal Transmission of HIV Infection
4. Article Assesses Effectiveness of an Oral Health
Educational Intervention for Pediatric Residents
5. Authors Discuss Boyfriends, Girlfriends, and
Adolescents' Risk of Sexual Involvement
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1. WEB SITE PROVIDES ONLINE LEARNING OPPORTUNITY FOR UNDERSTANDING
SEX AND GENDER DIFFERENCES
The Science of Sex and Gender in Human Health Online Course Web site
was developed to help students, educators, health professionals, and
researchers gain a basic scientific understanding of the major
physiological differences between the sexes; the influences these
differences have on illness and health outcomes; and the implications
for policy, medical research, and health care. The Web site was
developed as a collaborative effort between the National Institute of
Health's Office of Research on Women's Health and the Food and Drug
Administration's Office of Women's Health. The Web site currently
offers one course titled Basic Science and the Biological Basis for
Sex- and Gender-Related Differences. The course, which is free of
charge and self-paced, consists of six lessons that cover definitions
of sex and gender, the development and implementation of applicable
federal guidelines and regulations, cell physiology, developmental
biology, pharmacodynamics and pharmacokinetics, and clinical
applications of genomics. Continuing-education credit can be awarded
for successful completion of the course. A second course, which will
apply the basic concepts presented in this course to specific
conditions and organ systems where sex differences play a significant
role, is in development. The Web site is available at http://sexandgendercourse.od.nih.gov.
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2. POLICY BRIEF ADDRESSES THE HOW, WHAT, WHERE, AND WHO OF FAMILY
SUPPORTS FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
Cultural and Linguistic Competence in Family Supports discusses the
cultural factors that may impact the resources, services, and other
assistance provided to families of children with special health care
needs and the policy implications of promoting and sustaining cultural
and linguistic competence in the provision of family supports. The
policy brief, produced by the National Center for Cultural Competence
at Georgetown University with support from the Health Resources and
Services Administration's Maternal and Child Health Bureau, addresses
the need for family supports, definitions of family supports, and the
rationale for cultural and linguistic competence in family supports.
The brief also provides information on the need to align policies,
structures, and practices in the following areas: (1) providing a
family-driven support system, (2) supporting cross-cultural encounters,
(3) ensuring language access, (4) addressing bias and discrimination,
(5) supporting self-reliance, (6) involving fathers, and (7) adapting
service delivery. The brief is intended for use by organizations in
assessing policies and determining directions for future policy
development and implementation that advance and sustain cultural and
linguistic competence. The brief is available at http://gucchd.georgetown.edu/nccc/documents/final%20pdf%20fspb.pdf.
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3. REPORT HIGHLIGHTS ACHIEVEMENTS AND BARRIERS IN THE ELIMINATION OF
PERINATAL TRANSMISSION OF HIV INFECTION
"The decreases in perinatal HIV infections and perinatally acquired
AIDS cases in the United States represent an important achievement in
public health," state the authors of a report published in the June 2,
2006, issue of MMWR Weekly. The report presents information on trends
in perinatal AIDS and HIV, milestones in the reduction of perinatal HIV
transmission, and current challenges.
The authors report the following trends in AIDS and HIV cases and
milestones in the reduction of perinatal HIV transmission:
- The estimated number of perinatally acquired AIDS cases in the
United States peaked at 945 in 1992. In 2004, an estimated 48
perinatally acquired cases of AIDS were reported, a decrease of
approximately 95% from 1992.
- The estimated number of HIV-infected infants peaked at 1,650 in
1991. In 2002, an estimated range of 144 to 236 HIV-infected infants
were born in the United States (although estimating procedures for the
two time points differed).
- Implementation of recommendations for universal HIV testing,
antiretroviral use, avoidance of breastfeeding, and scheduled cesarean
delivery among women with HIV infection has resulted in a 95% decrease
in the number of perinatal AIDS cases in the United States since 1992
and a decline in the risk for perinatal HIV transmission from an
HIV-infected mother to less than 2%.
Challenges cited by the authors include the following:
- Females ages 13 and older accounted for only 7% of reported new
AIDS cases in 1985 but for 27% of reported cases in 2004.
- Data from the HIV and AIDS Reporting System for births during
2001-2004 indicate that 16% of mothers with HIV-infected infants had no
documented prenatal care, and 26% were not recognized as infected with
HIV before delivery; 41% of HIV-infected infants had not received
appropriate prophylactic interventions during labor and delivery; and
25% of HIV-infected infants had not received appropriate postnatal
treatment.
The authors conclude that "continued success in the United States . . .
will require sustained commitment to prevention of HIV infection among
women and to treatment for women infected with HIV [and] AIDS."
Mofenson L, Taylor AW, Rogers M, et al. 2006. Achievements in Public
Health: Reduction in perinatal transmission of HIV infection -- United
States, 1985-2005. MMWR Weekly 55(21):592-597. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5521a3.htm?s_cid=mm5521a3_e.
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4. ARTICLE ASSESSES EFFECTIVENESS OF AN ORAL HEALTH EDUCATIONAL
INTERVENTION FOR PEDIATRIC RESIDENTS
"Multifaceted instruction in oral health was effective in improving
pediatric residents' knowledge of oral health and increasing the
reported delivery of these services in their ambulatory care
practices," write the authors of an article published in the May-June
2006 issue of Ambulatory Pediatrics. Physicians with sufficient
knowledge about the fundamentals of oral health can play an important
role in improving pediatric oral health through the early detection of
dental disease, identification of children who are at risk for disease,
and preventive counseling. However, evidence to support any particular
type of educational intervention for medical students or residents is
lacking. The purpose of the study described in this article was to
evaluate the effectiveness of an educational intervention in oral
health for pediatric residents.
For the study, pediatric residents at the University of North Carolina
at Chapel Hill (UNC) were enrolled in a trial with a nonequivalent
control group design and pretest and posttest assessment of outcomes.
The residents took part in a multifaceted intervention to address
barriers to the use of oral health prevention in practice. Strategies
included didactic expository sessions, hands-on instruction
incorporated into patient care, preventive oral health service
reminders embedded in the tools used routinely during provision of
care, and a training program in systems change aimed at accelerating
adoption of oral health into clinical practice. East Carolina
University (ECU) and Wake Forest University (WFU) served as comparison
schools. As at UNC, residents at these two schools provide substantial
clinical care in ambulatory care settings. Residents at ECU had a short
practicum in oral health, and residents at WFU had no specific oral
health instruction. The residents completed questionnaires that
assessed knowledge, opinions, confidence, and practices in areas
highlighted by the U.S. Preventive Services Task Force.
The authors found that
- In total, 70 of 143 residents completed both baseline and
follow-up questionnaires, for a 55% response rate. Response rates were
distributed unevenly among schools, with 20 (40%) out of 50 responders
at ECU, 16 (43%) out of 37 at WFU, and 43 (76%) out of 56 at UNC.
- Changes between baseline and follow-up scores at UNC were 17.7%
for knowledge, 17.9% for confidence, and 65.1% for practices.
- Except for changes in practices at ECU (18.3%) changes at WFU and
ECU were small.
The authors conclude that "studies are needed to devise new, more
effective interventions targeting more difficult areas such as
appropriate prescription of fluoride supplements and risk assessment
for dental disease."
Schaff-Blass E, Rozier G, Chattopadhyay A. 2006. Effectiveness of an
educational intervention in oral health for pediatric residents.
Ambulatory Pediatrics 6(3):157-164. Abstract available at http://www.ambulatorypediatrics.org/article/PIIS1530156706000633/abstract.
Readers: More information is available from the Bright Futures Web site
at http://www.brightfutures.org/oralhealth/about.html and from the MCH Library's knowledge path, Oral Health and Children and
Adolescents, at http://www.mchlibrary.info/KnowledgePaths/kp_oralhealth.html.
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5. AUTHORS DISCUSS BOYFRIENDS, GIRLFRIENDS, AND ADOLESCENTS' RISK OF
SEXUAL INVOLVEMENT
"We have found that having had a boyfriend or girlfriend by seventh
grade is both a predictor of having sex in the ninth grade and a marker
of prior risks for sex," state the authors of an article published in
the June 2006 issue of Perspectives on Sexual and Reproductive Health.
While having a boyfriend or girlfriend, particularly an older one, is
associated with sexual initiation, relatively little is known about how
or why this happens. The article presents findings from a longitudinal
study to examine the impact of having an early romantic relationship on
subsequent sexual behavior.
Data for the study were drawn from a randomized controlled trial
testing the effects of a middle school intervention to reduce sexual
risk behaviors. The initial study involved 19 predominantly Hispanic
middle schools (10 treatment and 9 control) in Northern California.
Surveys were administered in school each spring from 1997 to 2000,
beginning when participants were in sixth grade. Measures included
seventh-grade relationship status, ninth-grade sexual behavior,
sixth-grade and eighth-grade psychosocial variables (unwanted sexual
advances, peer norms favoring sex, situations that could lead to sexual
behavior, sexual limits), and ethnicity. Females in sixth grade were
asked whether they had had their first period or menstruation.
The analyses (performed separately for each gender) explored
associations between seventh-grade relationship status and ninth-grade
sexual behavior, controlling for sixth-grade and eighth-grade
characteristics. The sample for the present analysis included 1,070
males and 1,199 females who indicated in seventh grade that they had
never had sex.
The authors found that
- Males who reported a girlfriend by seventh grade were more likely
than those who had not to be sexually active in ninth grade.
- Females who reported a same-age boyfriend in seventh grade were
more likely than those reporting no boyfriend in seventh grade to be
sexually active in ninth grade, and those reporting an older boyfriend
in seventh grade were more likely than those reporting a same-age
boyfriend to be sexually active in ninth grade.
After controlling for sixth-grade and eighth-grade characteristics, the
authors found that
- For males, sixth-grade peer norms favoring sex, Hispanic
ethnicity, and eighth-grade situations that could lead to sex predicted
ninth-grade reports of sexual activity.
- For females, menarche in sixth grade was associated with
ninth-grade reports of sexual activity, as were peer norms favoring sex
and situations that could lead to sex in eighth grade.
"Helping girls to handle the social changes related to early pubertal
development, deemphasizing social activities that may pave the way for
risky behavior and encouraging parental supervision may help reduce
early involvement with a boyfriend or girlfriend," conclude the authors.
Marin BV, Kirby DB, Hudes ES, et al. 2006. Boyfriends, girlfriends and
teenagers' risk of sexual involvement. Perspectives on Sexual and
Reproductive Health 38(2):76-83. Abstract available at http://www.guttmacher.org/pubs/journals/3806606.pdf.
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and
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