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 13, 2010

Readers: The next issue of MCH Alert will be published on September 1, 2010.

Special Notice: In recognition of the 75th Anniversary of Title V of the Social Security Act (August 14, 1935), MCH Alert is pleased to feature an excerpt from the Maternal and Child Health (MCH) Library's historical collection:

Wisdom from the Field is a series of stories from people in the MCH field. The series includes reflections on the history and future of MCH as shared by past, current, and future leaders. The stories are as follows:

More information on the history of MCH is available from the MCH Library at http://mchlibrary.info/history/index.html

Additional resources for commemorating the 75th Anniversary of Title V of the Social Security Act are available from the MCH Library at http://www.mchlibrary.info/anniversary

1. Resource Center Launches Portal to Provide Data About Medical Homes
2. Journal Supplement Highlights Progress and Challenges of the Early Hearing Detection and Intervention System
3. Article Explores Effects of Residency Curriculum on Breastfeeding Care and Rates
4. Authors Identify Prevalence and Determinants of Antepartum Mental Health Problems

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1. RESOURCE CENTER LAUNCHES PORTAL TO PROVIDE DATA ABOUT MEDICAL HOMES

The Data Resource Center for Child and Adolescent Health recently retooled its Web site to help state and family leaders access data on how children and adolescents in each state experience receiving care within medical homes. The Medical Home State Data Pages are a project of the Child and Adolescent Health Measurement Initiative at the Oregon Health and Science University and were produced with support from the Health Resources and Services Administration's Maternal and Child Health Bureau. The portal allows users to see a state's medical home performance profile for all children and adolescents or for those with special health care needs. Visitors can also compare across all states or view state ranking maps. Additional tools for searching for more medical home data and learning about medical homes are provided. Resources on medical home measurement in states and practices, policy and data in action, and medical home measurement for families are also included. The portal is available at http://www.medicalhomedata.org/content/Default.aspx

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2. JOURNAL SUPPLEMENT HIGHLIGHTS PROGRESS AND CHALLENGES OF THE EARLY HEARING DETECTION AND INTERVENTION SYSTEM

The supplement to the August 2010 issue of Pediatrics focuses on improving the system of care for infants and children with early hearing loss. The first article reports the work and recommendations for action of national experts on transforming the system of care. The second article reports the types of barriers to system performance, including lack of service-system capacity, lack of provider knowledge, family challenges in obtaining services, and data systems that are inaccessible to clinicians. Other topics include federal privacy regulations and the provision of early hearing detection and intervention programs, Medicaid reimbursement of hearing services for infants and young children, ensuring financial access to hearing aids for infants and young children, teleintervention for infants and young children who are deaf or hard of hearing, and improving follow-up to newborn hearing screening. The supplement is available at http://pediatrics.aappublications.org/content/vol126/Supplement_1

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3. ARTICLE EXPLORES EFFECTS OF RESIDENCY CURRICULUM ON BREASTFEEDING CARE AND RATES

"Our results demonstrate that a targeted breastfeeding curriculum for residents in pediatrics, family medicine, and obstetrics and gynecology improves knowledge, PPs [practice patterns], and confidence in breastfeeding management in the residents and leads to increases in exclusive breastfeeding in their patients," write the authors of an article published in the August 2010 issue of Pediatrics. Increasing the breastfeeding rate has been a public health priority in the United States for more than a century. In 1974, when breastfeeding rates were recovering from an all-time low, only 30 percent of physicians routinely encouraged breastfeeding, and only 52 percent said that they would encourage breastfeeding if the mother was already interested. Attitudes about breastfeeding have improved 20 years later, with 90 percent of physicians indicating that they encouraged breastfeeding but only 50 percent saying that they felt confident in their ability to counsel breastfeeding patients. The study described in this article evaluates the impact of a curriculum on breastfeeding knowledge, PPs, and confidence among participating medical residents, as well as the impact of the curriculum on breastfeeding rates.

The curriculum was developed by the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the Association of Pediatric Program Directors, and other professional organizations. The curriculum included seven major sections: advocacy, community outreach and coordination of care, anatomy and physiology, basic skills, peripartum support, ambulatory management, and cultural competency. AAP selected 13 residency programs (six intervention and seven control) with a total of 417 enrolled residents for participation in the study. Enrolled residents completed pretests before implementation and posttests after completion of the curriculum.

The authors found that
Compared with 6-month-old infants at intervention sites, those at control sites were half as likely to be exclusively breastfeeding after the intervention period.

The authors conclude that "training residents to improve care of breastfeeding patients influences practices throughout the medical institution, which leads to increased rates of breastfeeding."

Feldman-Winter L, Barone L, Milcarek B, et al. 2010. Residency curriculum improves breastfeeding care. Pediatrics 126(2):289-297. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/126/2/289

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

- Breastfeeding: Resource Brief at
http://mchlibrary.info/guides/breastfeeding.html

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4. AUTHORS IDENTIFY PREVALENCE AND DETERMINANTS OF ANTEPARTUM MENTAL HEALTH PROBLEMS

"Our study highlights the strong association between a history of mental health problems and antepartum mental health problems," state the authors of an article published in the Archives of Women's Mental Health online (ahead of print) on July 29, 2010. Studies of antepartum mental health problems have varied greatly in the specific outcomes, correlates, and confounders that were included in analyses, as well as in the measurement and sampling methods used. Additional research is needed to estimate the national prevalence in the United States of antepartum mental health problems across the pregnancy period and to identify risk factors associated with antepartum mental health problems. The article describes a study to estimate national prevalence and investigates the independent associations of a variety of risk factors with poor antepartum mental health, while also examining the effects of mental health before pregnancy.

Data for the study were drawn from the household component of the 1996-2006 Medical Expenditure Panel Survey (MEPS). Women included in the pregnancy detail files who had pre-pregnancy and antepartum data were eligible for the analysis. Women were excluded from the dataset if they had missing information on age, race or ethnicity, education, marital or partner status, poverty threshold categories, physical health status during pregnancy, or weight. Furthermore, women who reported mental health conditions other than depression or anxiety and those who did not report depression, anxiety, or poor mental health were excluded from the analysis. The final sample included 3,051 pregnant women. The analyses tested for differences in sociodemographic and health characteristics by antepartum mental health status. The research also identified factors associated with poor antepartum mental health status stratified by history of pre-pregnancy mental health problems.

The authors found that
The findings suggest "the need for greater focus on mental health screening for all women of reproductive age regardless of pregnancy status, but especially for women before they become pregnant," conclude the authors. The results, the authors add, also "highlight the importance of directing policy efforts toward providing pregnant women with ample social support as well as appropriate health care to deal with their physical and mental health problems."

Witt WP, DeLeire T, Hagen EW, et al. 2010. The prevalence and determinants of antepartum mental health problems among women in the USA: A nationally representative population-based study. Archives of Women's Mental Health [published online ahead of print on July 29, 2010]. Abstract available at http://www.springerlink.com/content/t3082442272v4667

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

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

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MCH Alert © 1998-2010 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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EDITOR/ADMINISTRATOR: Jolene Bertness, M.Ed.
CO-EDITOR: Tracy Lopez, M.S.L.S.
COPYEDITOR/WRITER: Ruth Barzel, M.A.
WRITER: Beth DeFrancis, M.L.S.

MCH Alert
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