MCH Alert


Maternal and Child Health Library

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


September 7, 2007

1. Expert Panel Updates Guidelines for Asthma Management
2. NIH Releases New Curriculum Supplement for Middle School
3. Authors Evaluate Efforts to Improve Management of Family Psychosocial Problems at Well-Child Care Visits
4. Analysis Examines Socioeconomic Disparities in U.S. Childhood Mortality

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1. EXPERT PANEL UPDATES GUIDELINES FOR ASTHMA MANAGEMENT

The Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma presents recommendations to help clinicians and consumers make appropriate decisions about asthma care. The report is the latest from the National Asthma Education and Prevention Program and updates reports issued in 1997 and 2002. The literature review and final guidelines in the report are organized around four essential components of asthma care including (1) assessment and monitoring, (2) consumer education, (3) control of factors contributing to asthma severity, and (4) pharmacologic treatment. Key points and key differences are presented at the beginning of each section and subsection to highlight major issues. The report is intended for use by the National Heart, Lung, and Blood Institute and its partners in developing clinical practice tools and educational materials for consumers. A prepublication copy of the report is available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.

Readers: The summary report is expected in December 2007.

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2. NIH RELEASES NEW CURRICULUM SUPPLEMENT FOR MIDDLE SCHOOL

The Science of Healthy Behaviors is a curriculum supplement designed for use by teachers in grades 7 and 8 to help students explore the scientific study of behavior and how behavioral and social factors influence health. The curriculum supplement was produced by the National Institutes of Health Office of Science Education and represents the latest in a series of interactive teaching units that combine science research discoveries from the National Institutes of Health (NIH) with instructional materials. Lesson topics include defining behavior, influences on behavior, tools of social and behavioral science, and behavioral specialists at work. The curriculum supplement, as well as all supplements in the NIH series, are free to science teachers and school administrators, are consistent with national science education standards, and incorporate scientific data. The Science of Healthy Behaviors' content summary, Web version, request for free supplements, teacher's guide, and aligned state standards are available at http://science.education.nih.gov/customers.nsf/middleschool.htm.

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3. AUTHORS EVALUATE EFFORTS TO IMPROVE MANAGEMENT OF FAMILY PSYCHOSOCIAL PROBLEMS AT WELL-CHILD CARE VISITS

"This study demonstrates the feasibility and effectiveness of addressing multiple family psychosocial problems during WCC [well child care] visits for low-income children," state the authors of an article published in the September 2007 issue of Pediatrics. Despite the existence of professional guidelines, few pediatricians routinely address families’ circumstances and well-being. To better understand how to incorporate these guidelines into pediatric practice, the American Academy of Pediatrics Task Force on the Family in 2003 emphasized the need for additional research on the "mechanics, content, and effectiveness of family-orientated pediatrics practice." This study evaluated the feasibility and impact of implementing the WE CARE (Well-Child Care Visit, Evaluation, Community Resources, Advocacy, Referral, Education) intervention at a medical home for children from families with low incomes.

The study was a randomized, controlled trial conducted in an urban, hospital-based pediatric clinic at a large academic institution. Participants included 45 pediatric residents and 200 parents of children (ages 2 months to 10 years) who presented for a WCC visit with an enrolled resident between April 11, 2006, and June 28, 2006. Parents in the intervention group (N=100) were given the WE CARE survey to complete before their child's encounter and were instructed to give the survey to their child's physician for review at the beginning of the visit. Residents in the intervention group (N=24) participated in a 20-minute teaching session before study implementation and in a 10-minute booster educational session 1 month following study initiation. During the sessions, they were instructed to review the WE CARE survey with the parent during the visit and to make a referral (tear out and hand the parent an information sheet from the WE CARE Family Resource Booklet). Parents in the intervention and control groups were interviewed immediately post-visit and were also interviewed via telephone 1 month after they had enrolled. Residents in both groups were asked to complete a survey at the end of the study. Medical charts were also reviewed at the end of the study.

The authors found that
"We believe that the WE CARE intervention can serve as a model for addressing family psychosocial problems for medical homes that care for low-income children" conclude the authors, adding that "additional research will be needed to assess the long-term impact of family psychosocial screening interventions on parental outcomes and child health, behavioral, and developmental outcomes."

Garg A, Butz AM, Dworkin P, et al. 2007. Improving the management of family psychosocial problems at low-income children's well-child care visits: The WE CARE project. Pediatrics 120(3):547-588. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/120/3/547.

Readers: More information is available from the Bright Futures Web site at http://www.brightfutures.org/tools/index.html and from the MCH Library's 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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4. ANALYSIS EXAMINES SOCIOECONOMIC DISPARITIES IN U.S. CHILDHOOD MORTALITY

"The data presented here underscore the increasingly important role of area socioeconomic deprivation in producing health disparities in US childhood mortality," state the authors of an article published in the September 2007 issue of the American Journal of Public Health. Because childhood mortality rates are the lowest of all age-specific mortality rates and because national mortality statistics lack relevant socioeconomic information, socioeconomic disparities in childhood mortality are rarely documented, particularly in a temporal fashion. The article presents an analysis of changing socioeconomic inequalities in U.S. childhood mortality in the past three decades.

Socioeconomic data from the 1990 decennial census were linked with data from the National Vital Statistics System to obtain county- and cause-specific childhood death data for the period 1969 through 2000. Each of 3,097 counties was assigned to one of five deprivation quintiles, ranging from the most socioeconomically deprived to the least socioeconomically deprived. Trends in childhood mortality by deprivation were computed annually and across different time periods, after adjusting for the effects of age, gender, and race and ethnicity.

The authors found that
"Narrowing the socioeconomic gap in child mortality may require designing strategies that are not only aimed at improving child health services but also aimed at mitigating the effects of inequalities in material and social living conditions," conclude the authors.

Singh GK, Kogan MD. 2007. Widening socioeconomic disparities in US childhood mortality. American Journal of Public Health 97(9):1658-1665. Abstract available at http://www.ajph.org/cgi/content/abstract/97/9/1658.

Readers: More information about child mortality is available from the MCH Library's organizations resource list at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_mortality.html&-MaxRecords=all&-DoScript=auto_search_mortality&-search.

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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 Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02MC00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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