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 12, 2008

1. Partners Engage in Focused Effort to Improve the Oral Health of Pregnant Women
2. Report Examines Eligibility, Participation, and Operations of the Commodity Supplemental Food Program
3. Web Site Highlights Initiative to Examine the Social Mission of Medical Education
4. Article Assesses Awareness and Use of California's Paid Family Leave Insurance Program Among Parents of CSHCN
5. Analysis Provides Evidence Against Association of Autism with MMR Exposure

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1. PARTNERS ENGAGE IN FOCUSED EFFORT TO IMPROVE THE ORAL HEALTH OF PREGNANT WOMEN

The National Maternal and Child Oral Health Resource Center (OHRC) has announced the availability of three new publications that provide ways to improve access to oral health services for pregnant women as well as oral-health-promotion and disease-prevention information for women and their families. The publications were developed with support from the Health Resources and Services Administration's Maternal and Child Health Bureau (MCHB) in follow-up to MCHB's Research to Policy and Practice Forum: Periodontal Health and Birth Outcomes, held on December 11-12, 2006, in Washington, DC. Forum participants concluded that while scientific evidence on the periodontal-preterm birth relationship remains inconclusive, sufficient information and interest exists to warrant pursuing periodontal health strategies that improve the oral health of pregnant women. Partners from the Altarum Institute, the American Academy of Pediatric Dentistry, the American College of Obstetricians and Gynecologists, the American Dental Association, the American Dental Education Association, the Association of Maternal and Child Health Programs, the Children's Dental Health Project, OHRC, and the National Oral Health Policy Center met regularly over the past year and prepared the following documents:

* Access to Oral Health Care During the Perinatal Period: A Policy Brief provides an overview of the major barriers to addressing women's oral health needs during the perinatal period. Specific examples of strategies to promote the use of guidelines during the perinatal period, expand opportunities for professional and consumer education, increase dental insurance coverage, and integrate oral health care as a part of routine perinatal care are included. Evidence from the professional, peer-reviewed literature is cited throughout the document. The policy brief is available at http://www.mchoralhealth.org/PDFs/PerinatalBrief.pdf.

* Oral Health Care During Pregnancy: A Summary of Practice Guidelines summarizes the New York State Department of Health's publication, Oral Health Care During Pregnancy and Early Childhood: Practice Guidelines, which is geared toward prenatal and oral health professionals. The guidelines, intended to bring about changes in the health care delivery system and to improve the overall standard of care for pregnant women, are available at http://www.mchoralhealth.org/PDFs/Summary_PracticeGuidelines.pdf.

* Two Healthy Smiles: Tips to Keep You and Your Baby Healthy (brochure) is designed to educate women about the importance of oral hygiene and oral health care during pregnancy. Topics include brushing, flossing, eating healthy foods, and getting dental checkups and treatment. Additional topics include the impact of hormonal changes during pregnancy on gum health, caring for an infant's gums and teeth, and finding a dentist. The content is available electronically as an 8-1/2 x 11" fact sheet at http://www.mchoralhealth.org/PDFs/PregnancyBrochure.pdf.

Readers: The above-mentioned publications are also available in hard copy at no charge from the HRSA Information Center at http://www.ask.hrsa.gov. Additional resource materials on pregnancy and oral health are available from OHRC at http://www.mchoralhealth.org/materials/perinatal.html.

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2. REPORT EXAMINES ELIGIBILITY, PARTICIPATION, AND OPERATIONS OF THE COMMODITY SUPPLEMENTAL FOOD PROGRAM

The Role of the Commodity Supplemental Food Program (CSFP) in Nutritional Assistance to Mothers, Infants, Children, and Seniors presents findings from the first field-based, in-depth study of CSFP since 1982. Each month, CSFP provides about half a million low-income pregnant and postpartum women, children ages 6 and younger, and adults ages 60 and older with food packages designed to provide nutritionally balanced supplements to their monthly intake. The report, produced by the U. S. Department of Agriculture's Economic Research Service, looks at how CSFP fits into the overall food assistance landscape; how state and local agencies administer CSFP; who participates in CSFP; and state expectations for future use of CSFP, in relation to other food assistance programs and target populations. Highlights include issues of concern for mothers who choose CSFP over the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), such as geographic accessibility and ease of participation. Other topics include lessons learned, coordination with other programs, and the role of CSFP in nutrition education. The report is available at http://www.ers.usda.gov/Publications/CCR48/CCR48.pdf.

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3. WEB SITE HIGHLIGHTS INITIATIVE TO EXAMINE THE SOCIAL MISSION OF MEDICAL EDUCATION

The Medical Education Futures Study (MEFS) highlights the need to create a more ethnically and racially diverse physician work force, to train physicians for primary care, and to ensure a more equitable geographic distribution of physicians during the current period of medical school expansion. The MEFS Web site, developed by the George Washington University School of Public Health and Health Services with support from the Macy Foundation, examines the social mission of medical education from retrospective and prospective points of view and serves as a vehicle of information and data dissemination for students, educators, practitioners, researchers, policymakers, and the press. Content includes two policy briefs: (1) Underrepresented Minorities in Medicine: The Need for a Diverse Physician Workforce and (2) Medical Education Expansion and the Future of Primary Care. Legislative and other news, new school tracking, featured publications, related links, and a periodic newsletter covering relevant news and articles on physician work force, the social mission of medical education issues, and MEFS products are also provided. The Web site is available at http://www.medicaleducationfutures.org/index.html.

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4. ARTICLE ASSESSES AWARENESS AND USE OF CALIFORNIA'S PAID FAMILY LEAVE INSURANCE PROGRAM AMONG PARENTS OF CSHCN

"Initial implementation of the nation's first paid family leave law failed to reach a large and vulnerable constituency: parents of children with special health care needs," state the authors of an article published in the September 3, 2008, issue of JAMA, the Journal of the American Medical Association. Chronically ill children or children with special health care needs (CSHCN) constitute 13%-17% of children in the United States. CSHCN average three times as many medical encounters as other children and miss nearly three times as much school, creating pressure on parents to miss work. The 1993 Federal Family and Medical Leave Act guarantees eligible workers up to 12 weeks of unpaid leave with job protection to care for themselves or ill family members; however, only 47% of employees are eligible, and many cannot afford unpaid leave. Consequently, several states have passed paid family leave legislation, and others are considering it. California's Paid Family Leave Insurance program (PFLI) provides 6 weeks of non-job-protected paid leave for most part-time and full-time employees at approximately 55% of salary. The authors of this article surveyed employed parents of CSHCN and examined parents' reports of taking leave and need for leave before and after PFLI, PFLI awareness and use, and PFLI's effect on taking leave.

The authors sampled children receiving care at two large tertiary-care referral centers (both major referral centers for CSHCN), one in Chicago, IL, and one in Los Angeles, CA. Before PFLI (November 21, 2003, to January 31, 2004; wave I) the authors interviewed 562 parents at the California site and 554 at the Illinois site. Approximately 18 months after PFLI (wave 2), they interviewed 583 parents at the California site and 512 parents at the Illinois site.

The authors found that
The authors conclude that "our findings . . . highlight both the need for paid leave options among parents of children with special health care needs in our sample and the initial failure of California's PFLI program to meet that need."

Schuster MA, Chung PJ, Elliot MN, et al. 2008. Awareness and use of California's paid family leave insurance among parents of chronically ill children. JAMA, the Journal of the American Medical Association 3(9):1047-1055. Abstract available at http://jama.ama-assn.org/cgi/content/short/300/9/1047.

Readers: More information is available from the following MCH Library resources:

- Children and Adolescents with Special Health Care Needs: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_CSHCN.html

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5. ANALYSIS PROVIDES EVIDENCE AGAINST ASSOCIATION OF AUTISM WITH MMR EXPOSURE

"We found . . . the temporal order of MMR [measles, mump, rubella] administration, GI [gastrointestinal] episodes, and AUT [autistic disorder] onset in cases to be inconsistent with a causal role for MMR vaccine as a trigger or exacerbator of either GI disturbances or autism," state the authors of an article published in PLos ONE online on September 4, 2008. A group of researchers first reported intestinal abnormalities in children with autism and other developmental disturbances in 1998. These findings, combined with parent-reported associations of timing of onset of behavioral abnormalities with MMR vaccine administration, led to the hypothesis that MMR may contribute to autism pathogenesis. Subsequent studies from this group reported measles virus (MV) RNA in bowel biopsies and blood cells from children with autism spectrum disorder (ASD). However, three other studies found no MV RNA in the blood cells of children with ASD. No published studies have addressed whether MV RNA is present in bowel biopsies of ASD children with GI disturbance. The article reports independent, blinded analysis of children with ASD and GI disturbances (cases) and children with GI disturbances but no neurological deficits (controls) to determine whether MV sequences were more likely to be found in biopsy tissues of cases than controls. The researchers also examined whether the time between MMR exposure and onset of GI episodes differed for cases and controls and whether older age at biopsy was associated with longer MMR biopsy intervals, independent of case status.

Children ages 3-10 were serially and prospectively recruited from clinics in 2003 and 2005 into two groups if they had clinically significant GI disturbances requiring ileocolonoscopic examination and either (1) presence of autistic disorder (AUT-GI cases) or (2) absence of known or suspected developmental disturbances (GI controls). Eligible children had received at least one prior immunization containing MV vaccine strain. Total RNA from bowel biopsies was obtained and prepared to ensure sufficient material for primary analysis at each of three laboratory sites and for repeated analyses in the event that results were discordant.

The authors found that
"We found no differences between AUT-GI and GI control groups in detection of MV sequences in RNA extracted from ileal or cecal biopsy specimens," state the authors. They conclude that "the work reported here eliminates the remaining support for the hypothesis that ASD with GI complaints is related to MMR exposure."

Hornig M, Briese T, Buie T, et al. 2008. Lack of association between measles virus vaccine and autism with enteropathy: A case-control study. PLos ONE 3(9):e3140. Available at http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0003140.

Readers: More information is available from the following MCH Library resources:

- Autism Spectrum Disorders: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_autism.html

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MCH Alert © 1998-2008 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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MCH Alert
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