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


August 21, 2009

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1. Paper Delineates Benefits of an Integrated Approach to Support Children's Emotional Well-Being
2. Guide Identifies Key Considerations for Using Predictive Modeling Within Medicaid
3. Report Reviews Evidence on Outcomes of Community Health Worker Interventions
4. Article Investigates Risks to Pregnant Women from H1N1 Virus Infection
5. Analysis Compares Sociodemographic and Clinical Patterns of Antidepressant Medication Treatment in the United States

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1. PAPER DELINEATES BENEFITS OF AN INTEGRATED APPROACH TO SUPPORT CHILDREN'S EMOTIONAL WELL-BEING

Strategies to Support the Integration of Mental Health into Pediatric Primary Care provides an overview of research advances and policy trends that support integration of mental health into primary care and explores strategies that can be employed by primary care health professionals, with support of health plans, to achieve coordinated and integrated mental health care in the pediatric primary care setting. The issue paper was published by the National Institute for Health Care Management with support from the Maternal and Child Health Bureau. Topics include the prevalence of and risk and protective factors for children's mental health problems; the current state of mental health in pediatric primary care, including the relationships between primary care and mental health services; public and private sector financing of mental health services for children and the implications for integrative approaches; federal, organizational, and foundation initiatives supporting integrative care; and considerations and strategies for health professionals and health plans to improve the delivery of mental health care in pediatric primary care. Conclusions and selected resources on children's mental health care are provided. The paper is available at http://nihcm.org/pdf/PediatricMH-FINAL.pdf

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2. GUIDE IDENTIFIES KEY CONSIDERATIONS FOR USING PREDICTIVE MODELING WITHIN MEDICAID

Predictive Modeling: A Guide for State Medicaid Purchasers outlines considerations for states to address before purchasing or building a predictive modeling (PM) tool (defined as a data-driven, decision-support tool that estimates an individual's future potential health care costs or opportunities for care management). The guide was produced by the Center for Health Care Strategies' Rethinking Care Program, with support from Kaiser Permanente and the Aetna Foundation, to help states design strategies to more effectively identify Medicaid beneficiaries who can benefit most from comprehensive care management. Topics include critical features of a predictive model; how to enhance information derived from predictive models for Medicaid populations; planning questions to guide the implementation of predictive modeling; and considerations for choosing a PM tool to identify candidates for care management. The guide is available at
http://www.chcs.org/usr_doc/Predictive_Modeling_Guide.pdf

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3. REPORT REVIEWS EVIDENCE ON OUTCOMES OF COMMUNITY HEALTH WORKER INTERVENTIONS

Outcomes of Community Health Worker Interventions examines interventions designed to address health care disparities by involving community health workers (CHWs). The report presents results from a systematic review of the evidence conducted by RTI International--University of North Carolina Evidence-Based Practice Center for the Agency for Healthcare Research and Quality. The authors (1) speak to the interaction between CHWs and participants, (2) discuss the impact of CHWs on outcomes, (3) evaluate cost information, and (4) describe CHW training. Findings are summarized by outcomes (knowledge, behavior, satisfaction, health outcomes, health care use) and by clinical context (health promotion and disease prevention, injury prevention, maternal and child health, cancer screening, chronic disease management). The report is intended to help clinicians, employers, policymakers, and others make well-informed decisions about the provision of health care services. The report is available at http://www.ahrq.gov/downloads/pub/evidence/pdf/comhealthwork/comhwork.pdf

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4. ARTICLE INVESTIGATES RISKS TO PREGNANT WOMEN FROM H1N1 VIRUS INFECTION

"This study summarises the cases of pregnant women with pandemic H1N1 virus infection in the USA and shows that this virus can cause serious illness in healthy pregnant women," write the authors of an article published in the August 8, 2009, issue of The Lancet. Pandemic H1N1 2009 influenza virus infection has been identified as the cause of a widespread outbreak of febrile respiratory infection in the United States and worldwide. Although the severity of this illness has ranged from mild to severe, little has been reported about how this outbreak has affected pregnant women. Because of concerns about the severity of disease during pregnancy, the Centers for Disease Control and Prevention (CDC) implemented enhanced surveillance for pandemic H1N1 influenza virus infections in pregnant women in the United States. This report summarizes the cases of infection with pandemic H1N1 influenza virus in pregnant women that have been reported to CDC during the first month of the outbreak (April 15 to May 18, 2009) and deaths associated with this virus during the first 2 months of the outbreak (April 15 to June 16, 2009).

After initial reports of infection in pregnant women, CDC began systematically collecting additional information about cases and deaths in pregnant women in the United States with pandemic H1N1 virus infection as part of enhanced surveillance. A confirmed case was defined as an acute respiratory illness with laboratory-confirmed pandemic H1N1 virus infection by real-time reverse-transcriptase PCR or viral culture; a probable case was defined as a person with an acute febrile respiratory illness who was positive for influenza A but negative for H1 and H3. To calculate rates of admission to hospital and illness, population estimates were derived from the 2007 census data.

The authors found that
The authors conclude that "health-care providers have to realise that pregnant women are at increased risk for severe disease and complications from pandemic H1N1 influenza virus infection, and should start treatment with anti-influenza drugs promptly."

Jamieson DM, Honein MA, Rasmussen SA, et al. 2009. H1N1 2009 influenza virus infection during pregnancy in the USA. The Lancet 374(9688):451-458. Abstract available at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961304-0/abstract

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5. ANALYSIS COMPARES SOCIODEMOGRAPHIC AND CLINICAL PATTERNS OF ANTIDEPRESSANT MEDICATION TREATMENT IN THE UNITED STATES

"Between 1996 and 2005 in the United States, the percentage of persons aged 6 years and older treated with an antidepressant medication during the course of 1 year increased from 5.8 [percent] to 10.1 [percent], or from approximately 13.3 million to 27.0 million persons," state the authors of an article published in the August 2009 issue of the Archives of General Psychiatry. Antidepressant use by children, adolescents, and adults has increased in the United States. However, earlier reports have not provided information about concomitant psychotropic medication use, psychotherapy, or the conditions for which antidepressants are prescribed. Such information would offer a clinical context in which to assess recent national trends in antidepressant use. This article examines trends in antidepressant use between 1996 and 2005 in a nationally representative sample of household members ages 6 and older.

Data were drawn from the household component of the 1996 and 2005 Medical Expenditure Panel Surveys. The analysis assessed treatment with antidepressant and other psychotropic medications, treated conditions, and mental health care. Secular trends are presented in the rate of antidepressant use stratified by sociodemographic and clinical characteristics. In antidepressant users, changes are described in their sociodemographic and clinical characteristics and in the mean annual number of filled prescriptions for antidepressants.

The authors found that
"These findings update earlier reports of increasing antidepressant use and provide new information about the changing clinical characteristics of US residents treated with antidepressants," state the authors. They conclude that the trends "illustrate the extent to which antidepressant treatment has gained acceptance in the United States and the growing emphasis on pharmacologic rather than psychologic aspects of care."

Olfson M, Marcus SC. 2009. National patterns in antidepressant medication treatment. Archives of General Psychiatry 66(8):848-856. Abstract available at http://archpsyc.ama-assn.org/cgi/content/abstract/66/8/848

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

- Depression During and After Pregnancy: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_postpartum.html

- Emotional, Behavioral, and Mental Health Challenges in Children and Adolescents at http://www.mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html

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MCH Alert © 1998-2009 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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MANAGING EDITOR: Jolene Bertness
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MCH Alert
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