Maternal and Child Health Library
This and past issues of the MCH Alert are online available at http://www.mchlibrary.info/alert/archives.html.
September 28, 2007
1. Issue Brief Focuses on Use of Telemedicine in
California to Meet Children's Health Care Needs
2. Fact Sheet Identifies Most Supportive Neighborhoods
for Children
3. E-Journal Highlights Progress Against Poverty and
Cost-Effective Policies to Reduce Poverty
4. Authors Review Achievements, Issues, and Challenges in
the Prevention of Mother-to-Child HIV Transmission
5. Report Assesses Impact of Medicaid Managed Care on
Coordination of WIC and Primary Care Services
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1. ISSUE BRIEF FOCUSES ON USE OF TELEMEDICINE IN CALIFORNIA TO MEET
CHILDREN'S HEALTH CARE NEEDS
Meeting the Health Care Needs of California’s Children: The Role of
Telemedicine informs leaders and the public of how telemedicine, when
applied appropriately, can address the health care needs of children in
California, particularly children from families with low incomes who
live in medically underserved areas. The issue brief is the third in
the Digital Opportunity for Youth series produced by The Children's
Partnership. Content includes (1) an overview of the benefits of
telemedicine for children and families, health systems, and
communities; (2) the challenges associated with the successful adoption
of telemedicine; and (3) recommendations for ensuring that telemedicine
reaches its full potential in meeting the health care needs of
California's most vulnerable children. The use of telemedicine is
specifically illustrated in the following areas: emergency and critical
care, oral health, vision screening, mental health, children with
special health care needs, home health care, telepharmacy, child abuse
evaluations, educating families, supporting families, supporting rural
health professionals, providing medical education, disease management,
caring for children where they are located, and language translation.
Information on the history of telemedicine and additional resources
from the Children's Partnership are included. The issue brief is
available at http://www.childrenspartnership.org/AM/Template.cfm?Section=Home&Template=/CM/ContentDisplay.cfm&ContentID=11343.
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2. FACT SHEET IDENTIFIES MOST SUPPORTIVE NEIGHBORHOODS FOR CHILDREN
Neighborhood Support Index explores the connection between neighborhood
quality and child well-being. The fact sheet, published by Child Trends
with support from the Annie E. Casey Foundation, is based on parents'
responses to six questions included in the 2003 National Survey of
Children's Health. The questions, which were designed to assess
parents' perceptions of support from neighbors, were used to create the
Neighborhood Support Index, a tool designed to assess neighborhoods as
an important context for children and their families. The authors
present findings on neighborhood support for all children, neighborhood
support for children from families with low incomes, most supportive
neighborhoods by state, and most supportive neighborhoods for children
from families with low incomes. A table with data on the proportions of
children living in the most supportive neighborhoods by state is
included. The brief is available at http://www.childtrends.org/Files/Child_Trends-2007_09_18_FS_NeighborhoodIndex.pdf.
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3. E-JOURNAL HIGHLIGHTS PROGRESS AGAINST POVERTY AND COST-EFFECTIVE
POLICIES TO REDUCE POVERTY
The fall 2007 issue of The Future of Children, titled The Next
Generation of Antipoverty Policies, presents and explains several
specific public policies to achieve further reductions in poverty. The
e-journal, published by Princeton University's Woodrow Wilson School of
Public and International Affairs and the Brookings Institution, briefly
surveys historical trends in poverty in the United States and examines
factors that shaped them. The articles that follow review
poverty-reduction policies involving incentives and work mandates for
men; improvements in the work support system; and the creation of
longer-term strategies such as reducing the number of births to single
mothers and strengthening marriage, improving preschool education, and
helping the most disadvantaged mothers. The full text issue, executive
summary, and policy brief are available at
http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=521579.
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4. AUTHORS REVIEW ACHIEVEMENTS, ISSUES, AND CHALLENGES IN THE
PREVENTION OF MOTHER-TO-CHILD HIV TRANSMISSION
"Much progress has been made in PMTCT [prevention of mother-to-child
transmission] of HIV both in the United States and internationally.
However, the challenges of complete elimination of new perinatal HIV
infections will depend on not only PMTCT interventions worldwide but
also effective primary HIV prevention interventions among adolescents
and young adults," state the authors of an article published in the
September 2007 supplement to the American Journal of Obstetrics and
Gynecology. PMTCT in the United States and Europe has been a major
success story. However, translation of findings from research studies
into successful national PMTCT programs and health policies has not
been optimal. The supplement focuses on achievements, issues, and
challenges in PMTCT in the United States and in settings where
resources are limited. The article presents information on the
experience and on remaining gaps and challenges in perinatal HIV
prevention efforts in the United States, international experience in
PMTCT, international trials aimed at reducing transmission among women
with HIV who breastfeed, and current challenges and program gaps
internationally. A table of the chronology of events in perinatal HIV
prevention in the United States and PMTCT in international settings and
future directions for PMTCT in the United States and internationally
are also presented.
Future directions include the following:
- Efforts that led to the declines in perinatal HIV transmission
need to continue, and ongoing surveillance of the scope and breadth of
perinatal transmission in the United States needs to be strengthened.
[Note: The Centers for Disease Control and Prevention (CDC) recently
expanded recommendations for routine HIV testing to include all adults
and adolescents in health care facilities as well as pregnant women in
all antenatal settings and those women at labor and delivery with
unknown HIV status. More information is available at
http://www.cdc.gov/mmwR/preview/mmwrhtml/rr5514a1.htm.]
- All women should be offered testing early in prenatal care for
every pregnancy. [Note: The CDC is launching the One Test, Two Lives
campaign in the United States to encourage obstetrical professionals in
all settings to offer early HIV testing as a routine, opt-out practice
for their pregnant clients and to counsel clients who decline testing
to accept an HIV test. More information is available at
http://www.cdc.gov/1test2lives.]
- Ongoing and expanded education and resources for obstetric
clinicians are needed, especially as rapid HIV testing for women in
labor with unknown HIV status becomes the standard of care. [Note: The
Health Resources and Services Administration and CDC jointly support
the National Perinatal HIV Consultation and Referral Service's
Perinatal Hotline at (888) 448-8765].
- In international settings, there is an urgent need for effective
strategies to make breastfeeding safer for HIV-exposed infants through
the first year of life. The authors assert that an infant HIV vaccine,
if proven efficacious, would be an optimal approach to both reducing
the risk of HIV transmission during the first year of life and
providing the infant with adequate nutrition and the continued
protection breastmilk provides against other infectious causes of
morbidity and mortality.
Fowler MG, Lampe MA, Jamieson DJ, et al. 2007. Reducing the risk of
mother-to-child human immunodeficiency virus transmission: Past
successes, current progress and challenges, and future directions.
American Journal of Obstetrics and Gynecology 197(3, suppl. 1):S3-S9.
Available at http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937807008241.pdf.
(The supplement is open to the public.)
Readers: More information is available from the following MCH Library
resources:
- AIDS/HIV in Pregnancy (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_aidspreg.html&-MaxRecords=all&-DoScript=auto_search_aidspreg&-search
- AIDS/HIV (organizations resource list) at
http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_aids.html&-MaxRecords=all&-DoScript=auto_search_aids&-search
- Breastfeeding: Selected Resources at
http://www.mchlibrary.info/guides/breastfeeding.html
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5. REPORT ASSESSES IMPACT OF MEDICAID MANAGED CARE ON COORDINATION OF
WIC AND PRIMARY CARE SERVICES
"The impact of Medicaid managed care seems to be either neutral or
positive with regard to WIC services," state the authors of a report
conducted by Health Systems Research, Inc. for the United States
Department of Agriculture's Economic Research Service. The Supplemental
Nutrition Program for Women, Infants, and Children (WIC) is one of the
cornerstones of the federal government's efforts to promote healthy
diets for Americans with low incomes. Coordinating WIC services with
primary care provided under Medicaid has significant benefits for both
programs and is required by both Centers for Medicare and Medicaid and
Food and Nutrition Service regulations. The study's objectives were to
(1) identify and describe state-level efforts to establish policies to
coordinate WIC and Medicaid managed care, (2) examine the method used
by WIC and Medicaid officials to implement program coordination, (3)
assess best practices used to implement coordination efforts among
different models of WIC service delivery and primary care services
supported by Medicaid, and (4) identify outcome indicators and data
sources that can be used to track and measure the impact of managed
care on local efforts to coordinate WIC and primary care.
The authors interviewed 24 state Medicaid officials to examine current
practices where managed care has been implemented and coordination
efforts have taken place. The study also included a content analysis of
agreements developed to support coordination, as well as detailed case
studies of the referral and service coordination relationships between
local and WIC agencies and Medicaid managed care organizations in six
states. The case studies included semi-structured interviews with
selected local WIC directors, managed care organization officials, and
their staff responsible for coordination efforts.
The authors found that
- There must be a shared interest level between WIC and Medicaid
officials to ensure that successful coordination efforts are initiated
and maintained.
- Successful models of WIC and Medicaid managed care coordination
exist and should be promoted.
- Coordination between WIC and Medicaid managed care can improve
delivery of services to clients in areas outside direct WIC services,
such as immunization referral and lead screening.
- Issues related to information and data sharing should be dealt
with at the state or national level.
In addition, the authors offer the following recommendations:
- Strengthen communication efforts to improve coordination.
- Develop outcome findings that support coordination.
The authors conclude that "local coordination efforts that were
examined for this study appear to be both innovative and successful.
However, for more widespread coordination to take place, both for the
benefit of WIC and Medicaid programs, additional states and local
agencies need to become involved."
Bell L, Ledsky R, Silva S, et al. 2007. An assessment of the impact of
Medicaid managed care on WIC program coordination with primary
services. Washington, DC: Economic Research Service, U.S. Department of
Agriculture. Available at http://www.ers.usda.gov/publications/ccr33/ccr33.pdf.
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and
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