Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
September 22, 2006
1. Chartbook Provides Data on Overweight and Physical
Activity Among Children and Adolescents
2. Policy Brief Examines Implications of Medicaid Reform
Initiatives
3. Report Highlights Findings from Assessment of Adult
Health Literacy
4. Article Reviews Efficacy of Child and Adolescent
Depression-Prevention Programs
5. Trial Assesses Wait-And-See Prescription for the
Treatment of Acute Otitis Media
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Special Notice: The MCH Library's knowledge path previously titled
Locating Community Services has a new name. The newly titled and
slightly revised path, Community Services Locator: Locating
Community-Based Services to Support Children and Families, is available
at http://www.mchlibrary.info/KnowledgePaths/kp_community.html.
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1. CHARTBOOK PROVIDES DATA ON OVERWEIGHT AND PHYSICAL ACTIVITY AMONG
CHILDREN AND ADOLESCENTS
Overweight and Physical Activity Among Children: A Portrait of States
and the Nation 2005 presents national and state-level data on the
prevalence of overweight in children and adolescents (ages 10-17)
within the context of family structure, poverty level, parental health
and habits, and community surroundings. The chartbook, produced by the
Maternal and Child Health Bureau, is based on parent reports from the
National Survey of Children's Health. Survey findings for each state
and the District of Columbia are presented in comparison with national
statistics and include (1) the percentage of children and adolescents
who are overweight, (2) the percentage of children and adolescents who
exercised or participated in physical activity for 20 minutes or more
per day during the past week, (3) the percentage of children and
adolescents who were on a sports team or took sports lessons during the
past 12 months, and (4) the percentage of children and adolescents who
have parents who exercise regularly. Several of the indicators are also
shown by one or more of the following: child's or adolescent's age,
family income, and child's or adolescent's sex. The chartbook is
intended for use by health professionals, program administrators,
educators, policymakers, and others in their efforts to promote healthy
weight and physical activity among children and adolescents. The
chartbook is available at http://nschdata.org/documents/OverweightChartBook.pdf.
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2. POLICY BRIEF EXAMINES IMPLICATIONS OF MEDICAID REFORM
INITIATIVES
Defined Contribution Plans and Limited Benefit Arrangements:
Implications for Medicaid Beneficiaries explores the implications of
state Medicaid reforms that limit benefits, coverage, and payments for
medically necessary health care. The 22-page policy brief, produced by
the George Washington University School of Public Health and Health
Services with support from America's Health Insurance Plans, presents a
background and overview and identifies a series of considerations that
come into play when states approach the issue of benefit redesign.
Topics include Medicaid's important safety net role, Medicaid's
evolution as a purchaser of health benefit plans, the economic and
health status of Medicaid beneficiaries, and potential benefit gaps and
the loss of coverage for critical health care needs. The importance of
attracting and maintaining a strong and competitive health plan market
for Medicaid beneficiaries, the importance of comprehensive benefits in
attracting and maintaining a strong provider network, and the
importance of purchasing arrangements that advance cross-plan
accountability for efficiency and patient safety and quality are also
discussed. The policy brief is available at http://www.gwumc.edu/sphhs/healthpolicy/chsrp/downloads/Rosenbaum_AHIP_FNL_091306.pdf.
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3. REPORT HIGHLIGHTS FINDINGS FROM ASSESSMENT OF ADULT HEALTH LITERACY
The Health Literacy of America's Adults: Results from the 2003 National
Assessment of Adult Literacy describes how health literacy varies
across the population and where adults with different levels of health
literacy obtain information about health issues. The report, produced
by the National Center for Education Statistics, contains analyses that
examine differences related to health literacy that are based on
self-reported background characteristics among groups in 2003. Topics
include health literacy levels, demographic characteristics and health
literacy, overall health, health insurance coverage, and sources of
information about health issues. The appendices contain sample
health-literacy-assessment question, definitions of all subpopulation
and background variables reported, technical notes, standard errors for
tables and figures, and additional analyses. References are also
included. The full report, executive summary, and appendices are
available at http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483.
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4. ARTICLE REVIEWS EFFICACY OF CHILD AND ADOLESCENT
DEPRESSION-PREVENTION PROGRAMS
"The present meta-analysis indicates that a growing number of
empirically tested programs aimed at preventing depression have shown
low to moderate effects, with most reducing rather than preventing
increases in levels of depressive symptoms," state the authors of an
article published in the June 2006 issue of the Journal of Consulting
and Clinical Psychology. Depression during childhood and adolescence is
a significant public health concern, affecting about 1%-2% of
prepubertal children and about 3%-8% of adolescents. The authors
assessed the efficacy of 30 studies aimed at preventing depressive
symptoms in children and adolescents and used meta-analysis to examine
these programs' relative effect sizes. In particular, the authors
compared differential efficacy among universal, selective, and
indicated prevention programs.
The authors used three methods for obtaining relevant studies: (1) a
computer search of PsycINFO for all years in the database was
conducted, (2) references from all located depression-prevention
studies and reviews were examined, and (3) a manual search was
conducted of any journal in which another study used had been
published, dating back to 1971.
The authors found that
- The majority of effect sizes at both post-intervention and
6-month follow-up represent small to moderate effects.
- At post-intervention, selective programs (those that target
individuals at elevated risk for depression) were more effective than
universal programs (those typically conducted in schools using
large-group presentations or curricular modifications and that do not
single out individuals for treatment).
- There was a non-significant trend for indicated prevention
programs (those conducted with individuals who already show subclinical
signs and symptoms of depression) to be more effective than universal
programs.
- Both selective and indicated prevention programs were
significantly more effective than universal programs at follow-up.
The authors provide five recommendations:
1. Studies testing the efficacy of programs for preventing depression
should examine whether certain risk factors moderate the relationship
between the intervention and depression.
2. Findings from basic research on the epidemiology, phenomenology,
course, and etiology of mood disorders that highlight differences
associated with developmental level, gender, and ethnicity should guide
modifications in programs aimed at preventing depression.
3. Studies of depression prevention should examine mechanisms by (1)
contrasting alternative interventions that experimentally manipulate
hypothesized mediators and (2) testing whether the hypothesized
mediators are affected by the intervention.
4. The development of prevention programs should be guided by theory.
5. Prevention studies should use basic findings about depression to
inform important methodological decisions.
Horowitz JL, Garber J. 2006. The prevention of depressive symptoms in
children and adolescents: A meta-analytic review. Journal of Consulting
and Clinical Psychology 74(3):401-415. Full text available at http://www.apa.org/journals/releases/ccp743401.pdf.
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 bibliographies, 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
and, Children's Mental Health, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_chldmenhlth.html&-MaxRecords=all&-DoScript=auto_search_chldmenhlth&-search.
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5. TRIAL ASSESSES WAIT-AND-SEE PRESCRIPTION FOR THE TREATMENT OF ACUTE
OTITIS MEDIA
"We demonstrated that the WASP [wait-and-see prescription] is a
successful treatment strategy for AOM [acute otitis media] when
patients may not have an established relationship with the clinician,"
state the authors of an article published in the September 13, 2006,
issue of JAMA, The Journal of the American Medical Association. Acute
AOM is the most common reason for prescribing an antibiotic to
children. The article presents the results of a randomized controlled
trial with a consecutive series of children diagnosed with AOM during a
1-year period in a pediatric emergency department using diagnostic
recommendations from evidence-based guidelines. The purpose of the
trial was to determine whether treatment of AOM using WASP
significantly reduced use of antibiotics compared with a standard
prescription (SP) in this setting. The trial also evaluated the effects
of the intervention on clinical symptoms and adverse outcomes related
to antibiotic use.
A consecutive sample of children (ages 6 months to 12 years) who were
diagnosed as having AOM in the pediatric emergency department of
Yale-New Haven Hospital in New Haven, CT, were enrolled in the study
from July 12, 2004, to July 11, 2005. The children's parents were asked
to complete a baseline questionnaire about associated symptoms. All
parents received a written prescription for an antibiotic, chosen and
dosed by the clinician. Parents of children randomized to the WASP
group received written and verbal instructions "not to fill the
antibiotic prescription unless your child either is not better or is
worse 48 hours after today's visit"; parents of children randomized to
the SP group received written and verbal instructions "to fill the
antibiotic prescription and give the antibiotic to your child after
today's visit." All parents received complimentary bottles of ibuprofen
suspension and otic analgesic drops. Standardized, structured telephone
interviews with parents were conducted at 4 to 6, 11 to 14, and 30 to
40 days after enrollment. The primary outcome was the proportion of
each group that filled the prescription for an antibiotic. Secondary
outcomes included clinical course of the illness, adverse effects of
medications, days of school or work missed, unscheduled medical visits,
and parents' comfort with managing future AOM episodes without
antibiotics.
The authors found that
- During the enrollment period, 776 children were diagnosed as
having AOM; 283 were randomized, 138 to the WASP group and 145 to the
SP group.
- Demographic and baseline symptoms of the two groups were similar.
- Prescriptions were not filled for 62% of children in the WASP
group and for 13% of children in the SP group.
- Children in the WASP group whose parents filled the prescription
were significantly more likely to report diarrhea, ear pain, or fever
than were those whose parents did not fill the prescription.
The authors conclude that the "WASP approach may interrupt the cycle of
antibiotic prescription, the expectation of parents to immediately
treat AOM with an antibiotic, and subsequent medical visits for this
illness."
Spiro DM, Khoon-Yen T, Arnold DH, et al. 2006. Wait-and-see
prescription for the treatment of acute otitis media: A randomized
controlled trial. JAMA, The Journal of the American Medical Association
296(10):1235-1241. Abstract available at http://jama.ama-assn.org/cgi/content/abstract/296/10/1235?etoc.
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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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