Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
December 21, 2007
1. Authors Review Research on Developmental Surveillance
and Screeening in Primary Care
2. Research Brief Explores Sexual Experience Among Young
Adolescents
3. Article Looks at Dilemmas Experienced by Childbirth
Educators in the Current Maternity Care Context
4. Study Evaluates Pediatric Autopsies Using
Family-Centered Criteria
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Readers: The next issue of the MCH Alert will be published on January
11, 2008. We wish you a joyous holiday season!
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1. AUTHORS REVIEW RESEARCH ON DEVELOPMENTAL SURVEILLANCE AND
SCREEENING IN PRIMARY CARE
Developmental Screening in Primary Care: The Effectiveness of Current
Practice and Recommendations for Improvement summarizes research on the
effectiveness of current efforts by primary care health professionals
to detect developmental delays in early childhood and considers ways to
improve outcomes for young children and families. The December 2007
report, published by the Commonwealth Fund, is based on a review of the
literature to (1) assess the effectiveness of primary care practices in
identifying developmental delays in young children, (2) describe
practices related to identifying developmental delays, and (3) identify
factors that affect practice. An executive summary provides key
findings from existing research and recommendations for future research
and policy development. The report also includes an introduction;
information about the study methods, results, and conclusions; and
notes. The report is available at http://www.commonwealthfund.org/usr_doc/1082_Sices_developmental_screening_primary_care.pdf?section=4039.
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2. RESEARCH BRIEF EXPLORES SEXUAL EXPERIENCE AMONG YOUNG ADOLESCENTS
Science Says: The Sexual Behavior of Young Adolescents provides new
data on the sexual behavior of adolescents ages 14 and younger and
offers recommendations to parents, policymakers, and those working with
young adolescents. The research brief, part of a series published by
the National Campaign to Prevent Teen Pregnancy's Putting What Works to
Work project, presents data and information on young adolescents'
sexual experience, pregnancy and births, contraceptive use, oral sex,
pressure, dating, number of partners, and parents. The authors also
present information on science-based programs to delay sexual
initiation and conclude with a discussion of the fol1owing topics: (1)
the proportion of young adolescents who report having sex before age
13; (2) reasons to be concerned about early sexual activity and dating:
(3) parent-adolescent communication about sex, love, relationships, and
values; (4) teaching young adolescents how to resist and manage sexual
pressure; (5) pregnancy-prevention programs for young adolescents; and
(6) future needs. The brief is available at http://www.teenpregnancy.org/works/pdf/Science_Says_3_behavioryoungadol.pdf.
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3. ARTICLE LOOKS AT DILEMMAS EXPERIENCED BY CHILDBIRTH EDUCATORS IN THE
CURRENT MATERNITY CARE CONTEXT
"Our study demonstrated that childbirth education is a cultural
phenomenon, with deeply embedded values held by childbirth educators
regarding the nature and importance of information, scientific
evidence, and consumer choice," state the authors of an article
published in the fall 2007 issue of the Journal of Perinatal Education.
Since the inception of childbirth education in the 1950s, childbirth
educators have endeavored to persuade pregnant women to view childbirth
education as an essential component of their preparation for labor and
birth. In the beginning, women who came to classes generally saw the
classes as a means to achieve their goal of being "awake and aware," or
having their husbands present during childbirth. Over the past decade,
technological and pharmaceutical interventions have been introduced
into routine maternity care, and this has been accepted by and even
desired by a majority of American birthing women. Recent findings show
a dramatic drop in childbirth-education attendance. The authors explore
possible reasons for this by looking at childbirth educators and the
various strategies, practices, and beliefs they present in their
classes. The authors focus on five key dilemmas that childbirth
educators have encountered as they make decisions about the format and
content of their classes.
Data were collected from observations of 11 childbirth class series.
These data were supplemented by ethnographic observations of two
childbirth-education trainings, photos of classrooms and teaching
tools, hospital tours, a review of printed and online program
materials, and immersion in the childbirth-education scene at
conferences, community events, and social gatherings.
The five dilemmas that the authors identified are as follows:
- Essential rite of passage vs. extra burden. Although childbirth
educators viewed classes as important sources of credible information,
they were aware that this vision was not always shared by the public in
general or by pregnant women in particular.
- Information overload vs. the "necessary" information. Today,
birth-related information is widely available via the Internet, books,
and mass media. Childbirth educators describe the challenges of
debunking misinformation and providing all the "necessary" information.
- Building community vs. just the facts. The shorter class sessions
preferred by most women today affected the amount of time people had to
socialize and bond with one another, which was a central feature of
early Lamaze classes.
- Negotiating evidence, beliefs, and experiences within the
framework of "unbiased information" and "choice." Childbirth educators
viewed evidence-based information as an authoritative source for
determining and evaluating maternity-care practices on the population
level and also as the starting point for their own personal beliefs.
- Empowerment vs. birth advocacy. Many childbirth educators said
that, in contrast to when they began teaching, their goal today is to
empower women to have a satisfying birth rather than to advocate
unmedicated, vaginal birth.
The authors conclude that "articulating how culture shapes the
presentation, content, and format of childbirth classes is an important
step in understanding and advancing the place and relevance of this
experience for all birthing women."
Morton CH, Hsu C. 2007. Contemporary dilemmas in American childbirth
education: Findings from a comparative ethnographic study. Journal of
Perinatal Education 16(4):25-37. Abstract available at http://www.ingentaconnect.com/content/lamaze/jpe/2007/00000016/00000004/art00007.
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4. STUDY EVALUATES PEDIATRIC AUTOPSIES USING FAMILY-CENTERED CRITERIA
This study provides "a set of family-centered criteria that can be used
to evaluate autopsy programs in terms that are relevant to the parents
of dying children," state the authors of an article published in the
December 2007 issue of the Archives of Pediatrics and Adolescent
Medicine. Studies of pediatric autopsies have traditionally focused on
the accuracy of pre-mortem diagnoses. None have evaluated the new
information yielded by pediatric autopsy using criteria that explicitly
aim to classify autopsy findings in terms of their potential pertinence
to the parents and siblings of dying children. The article presents
findings from a study designed to provide both families and clinicians
with empirical data about types of information that may or may not be
discovered by a pediatric autopsy. The authors investigate the new
information gained from autopsy using a family-centered perspective as
well as the traditional classification scheme.
The researchers first conducted a PubMed review of pediatric and adult
literature to identify types of information that might be important to
the families of dying children. The classes of new information were
then presented to an expert panel to confirm their scope and
appropriateness. A clinician reviewed the hospital records of all
pediatric autopsy cases performed at the Children's Hospital of
Philadelphia between 2003 and 2004 (N=100) and created a pre-mortem
clinical summary for each case. Simultaneously and independently, a
pathologist reviewed each final autopsy case. For each case, the
clinical and pathological causes of death were independently compared,
as were any diagnoses unrelated to the cause of death. All pre- and
post-mortem discrepancies were classified according to the
traditionally reported criteria. Additional information provided by the
autopsy report was also scored using the family-centered
new-information criteria.
- Using traditional criteria, major unexpected findings related to
death occurred in 28% of the autopsies.
- Using a novel, family-centered new-information classification
scheme, the researchers found that new information provided by autopsy
had the potential to further explain the causes of the child’s death
(53% of cases), inform the future reproductive choices of parents (10%)
or siblings (8%), affect the future health care provided to siblings
(6%), or contribute to patient-care quality control (36%) or
publishable knowledge (7%).
"By shifting the paradigm of autopsy program evaluation from using
institution-centered criteria to using family-centered criteria,
institutions will empower both clinicians and the parents of dying
children to make better informed decisions regarding autopsy," conclude
the authors.
Feinstein JA, Ernst LM, Ganesh J, et al. 2007. What new information
pediatric autopsies can provide: A retrospective evaluation of 100
consecutive autopsies using family-centered criteria. Archives of
Pediatrics and Adolescent Medicine 161(12):1190-1196. Abstract
available at http://archpedi.ama-assn.org/cgi/content/abstract/161/12/1190.
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