Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
August 17, 2007
1. Toolkit Released to Aid Application of Privacy
Requirements to Public-Health-Sector Activities
2. Report Highlights the Importance of High-Value
Preventive Care
3. Task Force Releases Statement on Counseling for Motor
Vehicle Occupant Restraint
4. Report Presents Evidence on the Impact of Universal,
School-Based Programs in Decreasing Rates of Violence Among Children
and Adolescents
5. Article Looks at the Relationship Between Birth
Defects and Low Birthweight and Preterm Birth
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1. TOOLKIT RELEASED TO AID APPLICATION OF PRIVACY REQUIREMENTS TO
PUBLIC-HEALTH-SECTOR ACTIVITIES
PRISM -- A Privacy Toolkit for Public Health Professionals is designed
to provide direction for government health entities in applying Health
Insurance Portability and Accountability Act (HIPAA) privacy
regulations to their programs and functions and also in complying with
all state and federal requirements. The electronic toolkit was released
by the Public Health Data Standards Consortium to complement an
existing series of guidance documents produced by the Department of
Health and Human Services Office of Civil Rights to aid compliance by
providing information that directly addresses public-health-sector
activities. The toolkit identifies and defines the baseline conditions
and requirements that a state or local government health program must
follow when using and disclosing specific types of health information.
A series of tables outlines different types and purposes of information
use and disclosure and the general legal requirements relevant to each
type of use or disclosure. An introduction to the PRISM privacy tool; a
glossary containing key definitions and terms related to the disclosure
of privacy information; and additional federal government, association,
nonprofit organization, and academic resources are provided. The
toolkit is available at http://www.phdsc.org/prism/introduction.htm.
More information about the Public Health Data Standards Consortium is
available at http://www.phdsc.org/prism/introduction.htm.
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2. REPORT HIGHLIGHTS THE IMPORTANCE OF HIGH-VALUE PREVENTIVE CARE
"[Thirty thousand] cases of pelvic inflammatory disease would be
prevented annually if we increased to 90 percent the portion of
sexually active young women who have been screened in the past year for
chlamydial infection. Today, 40 percent of young women are being
screened annually," state the authors of the report Preventive Care: A
National Profile on Use, Disparities, and Health Benefits. In 2006,
Partnership for Prevention and HealthPartners Research Foundation,
under the guidance of the National Commission on Prevention Priorities,
published a study that ranked 25 evidence-based clinical preventive
services recommended by the U.S. Preventive Services Task Force and
Advisory Committee on Immunization Practices on the basis of each
service's health benefits and economic value. The current report brings
attention to high-impact, cost-effective preventive services that have
the lowest utilization rates and that have the greatest potential to
save lives if utilization rates were to improve. The authors document
the use of preventive care; estimate the health benefits; and quantify
disparities in use of preventive care. Special attention is given to
cancer screenings. The report is intended for use by health
professionals, policymakers, and others in ensuring that evidence-based
preventive services are a front-and-center goal of efforts to reform
the nation's health system. The report is available at http://www.prevent.org/content/view/129/72.
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3. TASK FORCE RELEASES STATEMENT ON COUNSELING FOR MOTOR VEHICLE
OCCUPANT RESTRAINTS
The U.S. Preventive Services Task Force has issued a new statement on
the independent role of primary care interventions to increase the
proper use of child safety seats, booster seats, and lap-and-shoulder
belts to prevent motor vehicle occupant injuries (MVOIs) and to prevent
alcohol-related MVOIs in adolescents and adults. The statement,
published by the Agency for Healthcare Research and Quality and also in
the August 7, 2007, issue of the Annals of Internal Medicine, updates
the task force's 1996 recommendation for primary care interventions to
increase the use of child safety seats and safety belts and comprises
an introduction, summary of recommendations and evidence, clinical and
other considerations, and a discussion.
The task force concluded that
- The current evidence is insufficient to assess the incremental
benefit (beyond the efficacy of legislation and community-based
interventions) of counseling in the primary care setting in improving
rates of proper use of motor vehicle occupant restraints (child safety
seats, booster seats, and lap-and-shoulder belts).
- The current evidence is insufficient to assess the balance of
benefits and harms of routine counseling of all patients in the primary
care setting to reduce driving while under the influence of alcohol or
riding with drivers who are alcohol-impaired.
The summary statement and supporting documents are available at http://www.ahrq.gov/clinic/uspstf/uspsmvin.htm.
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4. REPORT PRESENTS EVIDENCE ON THE IMPACT OF UNIVERSAL, SCHOOL-BASED
PROGRAMS IN DECREASING RATES OF VIOLENCE AMONG CHILDREN AND ADOLESCENTS
"On the basis of this evidence, the Task Force on Community Preventive
Services recommends the implementation of universal, school-based
programs to prevent violent behavior," state the authors of a report
published in a supplement to the August 2007 issue of the American
Journal of Preventive Medicine. Violence is widespread and causes
considerable morbidity and mortality in the United States. Research has
shown that childhood violence is predictive of later violent pathways.
The report summarizes the findings of a systematic review of the
effects of universal, school-based programs intended to prevent violent
behavior. Information on interpreting and using the recommendation are
provided. The report, accompanying systematic review, and a recently
updated meta-analysis of school-based programs are available at http://www.ajpm-online.net/issues/contents?issue_key=S0749-3797(07)X0126-0.
The other systematic reviews of the effectiveness of selected
population-based interventions designed to reduce or prevent violence
by and against children and adolescents are available from the Guide to
Community Preventive Service at http://www.thecommunityguide.org/violence/default.htm.
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5. ARTICLE LOOKS AT THE RELATIONSHIP BETWEEN BIRTH DEFECTS AND LOW
BIRTHWEIGHT AND PRETERM BIRTH
"This study demonstrates that birth defects are associated with preterm
birth and low birth weight when controlling for multiple confounding
factors, including shared risk factors and pregnancy complications,"
state the authors of an article published in the August 2007 issue of
Obstetrics and Gynecology. Although preterm and low-birthweight infants
are more likely to have birth defects, compared with infants who are
born at term and at a normal weight, the effect of birth defects on
birthweight has been difficult to study because of confounding by
multiple shared risk factors. (A birth defect is defined as an
abnormality in the structure, function, or body metabolism that is
present at birth and affects how the body looks, works, or both.) To
better understand the relationship between birth defects and preterm
birth, the authors proposed the application of propensity scoring to
control for confounding by multiple shared risk factors.
The authors examined data from a large, prospective multi-center
population-based database, the First and Second Trimester Evaluation of
Risk Trial. All live births after more than 24 weeks with complete data
on outcome and confounders were divided into two comparison groups: (1)
those with a chromosomal or structural abnormality (birth defect) and
(2) those with no such abnormality. Propensity scores were developed by
using multiple logistic regression analysis relating presence or
absence of birth defects to an array of characteristics that were
hypothesized to differ between these two groups. The technique was used
to promote a fair and unbiased comparison of the association between
birth defects and preterm birth and low birthweight, controlling for
the multiple shared risk factors that can confound this association.
The number of women included in the analysis was 33,020.
The authors found that
- Compared with singleton liveborns with no birth defects, those
with a birth defect were 2.7 times more likely to deliver preterm at
less than 37 weeks, 7.0 times more likely to deliver preterm at less
than 34 weeks, and 11.5 times more likely to deliver very preterm at
less than 32 weeks.
- Compared with singleton liveborns with no birth defects, those
with a birth defect were 3.6 times more likely to be low birthweight at
less than 2,500 g and 11.3 times more likely to be very low birthweight
at less than 1,500 g.
The authors conclude that "with rates of preterm birth rising in this
country, this study adds emphasis to the importance of preconception
care and birth defect prevention as shared mechanisms for improving
birth outcomes."
Dolan SM, Gross SJ, Merkatz IR, et al. 2007. The contribution of birth
defects to preterm birth and low birth weight. Obstetrics and
Gynecology 110 (no. 2, pt. 1):318-324. Abstract available at http://www.greenjournal.org/cgi/content/abstract/110/2/318.
Readers: More information is available from the MCH Library's knowledge
path, Preconception and Pregnancy, at http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html.
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MCH Alert © 1998-2007 by National Center for Education in Maternal
and
Child Health and Georgetown University. MCH Alert is produced by
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