Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
August 11, 2006
1. Paper Examines Efforts to Address Unique Health Issues
and Health Care Coverage Requirements of Young Adults
2. Report Presents Examples of State Action to Address
the Needs of Children Under Age 3
3. AAP Encourages Implementation of New Shopping Cart
Standards to Prevent Child Injury
4. Randomized Trial Assesses Approaches to Screening for
Intimate Partner Violence in Health Care Settings
5. Article Investigates Role of Subthreshold Symptoms on
Major Depressive Disorder in Adolescence
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1. PAPER EXAMINES EFFORTS TO ADDRESS UNIQUE HEALTH ISSUES AND HEALTH
CARE COVERAGE REQUIREMENTS OF YOUNG ADULTS
Young People's Health Care: A National Imperative examines young adult
(ages 19-24) health status, with an emphasis on health care access and
utilization. The issue paper, published by the National Institute for
Health Care Management Research and Educational Foundation, contains a
short introduction on why the young adult population merits more
attention; the introduction is followed by a discussion of young adult
health issues. Section one presents an overview of young adult health
issues and social influences, and section two discusses implications
for the delivery and financing of health care for young adults.
Innovative efforts to address health care coverage of young adults and
selected resources on young adult health are included in the
appendices. The paper is intended to inform policymakers, health
professionals, health insurance purchasers, beneficiaries, and young
adults and their families about the health status and coverage issues
young adults face as they strive to reach self-sufficiency. The paper
is available at http://www.nihcm.org/finalweb/YoungPeoplesHCFINAL.pdf.
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2. REPORT PRESENTS EXAMPLES OF STATE ACTION TO ADDRESS THE NEEDS OF
CHILDREN UNDER AGE 3
Starting Off Right: Promoting Child Development from Birth in State
Early Care and Education Initiatives seeks to support state leaders who
endeavor to develop early care and education policies that support
child development from birth. The report, published by the Center for
Law and Social Policy, provides background data on infants and toddlers
and their participation in early care and education; outlines a
framework and highlights state examples of both policy initiatives to
promote child development from birth to age 3 and state governance and
funding strategies to support birth-to-3 policies; suggests key steps
and considerations for state leaders; and discusses emerging themes
that cut across birth-to-3 early care and education policy issues. A
list of primary contacts for state examples is also included. The full
report, an executive summary, and additional resources are available at
http://www.clasp.org/publications/startingoffright.htm.
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3. AAP ENCOURAGES IMPLEMENTATION OF NEW SHOPPING CART STANDARDS TO
PREVENT CHILD INJURY
"The current US standard for shopping carts should be revised to
include clear and effective performance criteria for shopping cart
child-restraint systems and cart stability to prevent falls from carts
and cart tip-overs," state the authors of an American Academy of
Pediatrics' (AAP) policy statement published in the August 2006 issue
of Pediatrics. Injuries associated with shopping carts are an important
cause of pediatric morbidity, especially among children under age 5.
The policy statement presents background information and
recommendations from AAP's Committee on Injury, Violence, and Poison
Prevention about prevention of shopping-cart-related injuries.
AAP recommendations outlined in the policy statement include the
following:
- Incorporate an effective performance standard in existing and
future state and federal laws on shopping cart safety; transport
children only in carts that meet this minimum safety standard.
- Encourage businesses that provide customers with shopping carts
to adopt safety strategies to help prevent shopping-cart-related
injuries to children.
- Educate families about the risks of transporting children in
shopping carts.
- Inform the public through the media about shopping cart hazards.
- Evaluate the effectiveness of education programs and
public-awareness initiatives focused on shopping cart safety.
- Until an effective revised performance standard for shopping cart
safety is implemented in the United States, seek alternatives to
transporting children in shopping carts.
American Academy of Pediatrics Committee on Injury, Violence, and
Poison Prevention. 2006. Shopping cart-related injuries to children.
Pediatrics 118(2):825-827. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/pediatrics;118/2/825.
Readers: A related technical report and AAP Parent Page are also
available to Pediatrics subscribers at http://pediatrics.aappublications.org/cgi/content/abstract/118/2/739
and http://pediatrics.aappublications.org/cgi/content/extract/pediatrics;118/2/e545.
More information is available from the MCH Library's organizations
resource lists, Child Safety, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_childsafe.html&-MaxRecords=all&-DoScript=auto_search_childsafe&-search
and Injury Prevention, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_injury.html&-MaxRecords=all&-DoScript=auto_search_injury&-search.
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4. RANDOMIZED TRIAL ASSESSES APPROACHES TO SCREENING FOR INTIMATE
PARTNER VIOLENCE IN HEALTH CARE SETTINGS
"The findings from this study examining 3 approaches to IPV [intimate
partner violence] screening in health care settings suggest that the
face-to-face approach is the least preferred by women, irrespective of
instrument," state the authors of an article published in the August 2,
2006, issue of JAMA, The Journal of the American Medical Association.
Many national medical organizations, government agencies, and advocacy
groups have recommended universal or routine IPV screening. However,
few studies have compared methods of administration. The article
presents findings from a randomized trial, which compared three methods
of IPV screening using two instruments on IPV detection, extent of
missing data, and acceptability of screening approach.
Study participants were recruited from primary, acute, and specialty
health care settings in Ontario, Canada, (N=2,461). All participants
provided written informed consent before study enrollment, and health
professionals received specialized training in responding to IPV
screening.
After obtaining consent, participants were screened by their health
professional with one of two screening instruments, randomly
determined: (1) the Partner Violence Screen (PVS) or (2) the Woman
Abuse Screening Tool (WAST). The screening was implemented using one of
three methods, again randomly determined: (1) computer-based
self-completed method, (2) written self-completed method, or (3)
face-to-face method with verbal questioning by the health professional.
Following each screen, participants completed a written version of the
standard demographic questions, the questions used to evaluate
participant preference of screening approach, and the Composite Abuse
Scale used to examine agreement between the screening instruments.
The authors found that
- Twelve-month prevalence of IPV ranged from 4.1% to 17.7%,
depending on screening method, instrument, and health care setting.
- Prevalence was significantly lower on the written WAST than on
the PVS.
- Lower levels of missing data occurred for the WAST vs. the PVS
and for the written method vs. the face-to-face and computer-based
methods combined.
- On all three evaluation indicators (easy, preferred, private),
women chose computerized and written methods over face-to-face
questioning.
- The positive predictive value of the WAST was minimally higher
than that of the PVS, and the negative predictive values were almost
the same, leading to very similar accuracies.
"Prevalence, missing data, and preference are all important
considerations for both clinical and research efforts in IPV
screening," the authors conclude.
MacMillan HL, Wathen CN, Jamieson E, et al. 2006. Approaches to
screening for intimate partner violence in health care settings: A
randomized trial. JAMA, The Journal of the American Medical Association
296(5):530-536. Abstract available at http://jama.ama-assn.org/cgi/content/abstract/296/5/530?etoc.
Readers: More information is available from the MCH Library's knowledge
path, Domestic Violence, at http://www.mchlibrary.info/KnowledgePaths/kp_domviolence.html,
and bibliography, Mental Health in Primary Care, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_mental.html&-MaxRecords=all&-DoScript=auto_search_mental&-search.
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5. ARTICLE INVESTIGATES ROLE OF SUBTHRESHOLD SYMPTOMS ON MAJOR
DEPRESSIVE DISORDER IN ADOLESCENCE
"Results indicate that the presence of subthreshhold symptoms increases
risk for onset of MDD [major depressive disorder], with disturbances in
mood contributing unique variance over and above all of the other
symptoms of depression," state the authors of an article published in
the August 2006 issue of the Journal of the American Academy of Child
and Adolescent Psychiatry. Compared to early childhood, early
adolescence is associated with significant increases in reports of
depressed mood as well as increases in MDD. Recently, there has been
growing interest in the theoretical and clinical significance of
subthreshold depression (i.e., the presence of clinically significant
depressive symptoms, but below the required number to warrant a
diagnosis of MDD). The objective of the study described in this article
was to evaluate the prospective association between individual
subthreshold symptoms of depression and onset of MDD in a large
epidemiologic sample of adolescents.
Adolescents participating in the study were randomly selected from nine
senior high schools representative of urban and rural districts in
western Oregon. The total number of participants was 1,456. The
adolescents completed an initial (T1) assessment (diagnostic interviews
and questionnaire) and returned for re-administration of the interviews
and questionnaire approximately 1 year later.
The authors found that
- After controlling for gender and history of depression, seven of
the nine DSM-III-R symptoms (depressed mood, anhedonia, weight/appetite
disturbance, sleep disturbance, motor disturbance, loss of
energy/fatigue, worthlessness/guilt, thinking difficulties, and
thoughts of death/suicide) contributed significantly to the prediction
of MDD when tested in separate models.
- Endorsement of each symptom increased the likelihood of MDD onset
over a 1-year interval.
- In a summary model that included all of the significant symptoms
identified in the separate models and that controlled for gender,
history of depression, and all significant symptoms, sad mood was the
only symptom that contributed unique variance to the prediction of MDD
onset.
The authors conclude that "a symptom-level approach to research on
adolescent depression may help guide the identification of adolescents
at risk by focusing on the endorsement of particular subthreshold
symptoms . . . either before or after an episode of depression or
subsequent to an episode in the form of residual symptomology." They
continue, "such an approach may also help clarify some of the
underlying causal mechanisms involved in the development of this
disorder and have implications for etiologic models of depression."
Georgiades K, Lewinsohn PM, Monroe SM, et al. 2006. Major depressive
disorder in adolescence: The role of subthreshold symptoms. Journal of
the American Academy of Child and Adolescent Psychiatry 45(8):936-944.
Abstract available at http://www.jaacap.com/pt/re/jaacap/abstract.00004583-200608000-00007.htm;jsessionid=GhQQvZbZ1LtVJmQh2kyBMyL23BDyfpHPtbxQTbzTSGTtfkyNx1Yv!-1082563917!-949856145!8091!-1.
Readers: More information is available from the Bright Futures Web site
at http://www.brightfutures.org/mentalhealth/index.html;
and from the MCH Library's knowledge path, Mental Health in Children
and Adolescents, at http://www.mchlibrary.info/KnowledgePaths/kp_mentalhealth.html
and bibliography, Adolescent Mental Health, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_adolmenhlth.html&-MaxRecords=all&-DoScript=auto_search_adolmenhlth&-search.
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MCH Alert © 1998-2006 by National Center for Education in Maternal
and
Child Health and Georgetown University. MCH Alert is produced by
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