MCH Alert March 22, 2002

MCH Alert

National Center for Education in Maternal and Child Health
Search past issues of the MCH Alert at http://www.ncemch.org:8080/mchalert.html

March 22, 2002

1. Bright Futures in Practice: Mental Health Guide / Tool Kit Now Available in PDF Format

2. Proceedings Available on Promoting the Oral Health of Children with Special Health Care Needs

3. New Online Tools Available for Economic Analysis in MCH and Measuring Maternal Morbidity

4. Article Examines Changes in Risk Factors for Twin Preterm Births Over Time

5. Researchers Investigate Prevalence of and Risk Factors Associated with Glucose Intolerance in Obese Children and Adolescents

6. Study Finds Lung Tissue Concentrations of Nicotine Are Higher in Infants Who Die from SIDS

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1. BRIGHT FUTURES IN PRACTICE: MENTAL HEALTH GUIDE / TOOL KIT NOW AVAILABLE IN PDF FORMAT

The recently released Bright Futures in Practice: Mental Health is now available in pdf format at the Bright Futures Web site. The guide synthesizes and makes information available to primary care health professionals and families on healthy emotional, behavioral, and cognitive development and early recognition and intervention for mental health problems and mental disorders. The guide is available at http://www.brightfutures.org/mentalhealth/pdf/index.html. The tool kit is available at http://www.brightfutures.org/mentalhealth/pdf/tools.html.

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2. PROCEEDINGS AVAILABLE ON PROMOTING THE ORAL HEALTH OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS

Promoting Oral Health of Children with Neurodevelopmental Disabilities and Other Special Health Needs documents the proceedings of a conference to develop training and research agendas related to oral health promotion for children with special health care needs (CSHCN). Conference participants included health professionals, educators, policymakers, researchers, and parents. The publication was supported by a grant from the Maternal and Child Health Bureau, Health Resources and Services Administration; by the Comprehensive Center for Oral Health Research through its grant from the National Institute for Dental and Craniofacial Research; and by contributions from Oral Health America, Philips Oral Healthcare, and Washington Dental Service. In addition to discussing key conference themes and recommendations, the publication includes information on the following topics: the health promotion framework, oral disease and care for CSHCN, data and demonstration projects, health-promoting behaviors, interdisciplinary issues, oral-systemic health interactions, and access. The conference agenda, a list of faculty and attendees, a list of federal training and research centers, selected recent articles and reports, and the full text of conference papers are included as appendices. The proceedings are available at http://depts.washington.edu/ccohr/resource/3sub/3res.htm.

For more information on oral health, see Bright Futures in Practice: Oral Health at http://www.brightfutures.org/oralhealth/about.html; the Maternal and Child Oral Health Resource Center at http://www.mchoralhealth.org; and NCEMCH's knowledge path, Oral Health and Children, at ../KnowledgePaths/kporalhealth.html.

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3. NEW ONLINE TOOLS AVAILABLE FOR ECONOMIC ANALYSIS IN MCH AND MEASURING MATERNAL MORBIDITY

The Data Skills Online project, part of the Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, has added two new tools to its Web site: (1) Economic Analysis in Maternal and Child Health and (2) Measuring Maternal Morbidity. These and 11 other distance-learning tools were developed with a grant from the Division of Research, Training, and Education; Maternal and Child Health Bureau; Health Resources and Services Administration. The tools are designed to help users work with population-based data, develop and report measures for the Title V Block Grant application, monitor and evaluate program activities, and develop strategies to meet the needs of the maternal and child health population. Each tool takes an average of 3 hours to complete. The tools are entirely self-instructional; users assess their performance through quizzes and mock calculations with links to appropriate answers. Information about the Data Skills Online project, as well as the tools themselves, are available at http://www.sph.unc.edu/toolbox.

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4. ARTICLE EXAMINES CHANGES IN RISK FACTORS FOR TWIN PRETERM BIRTHS OVER TIME

"The increase in twin preterm births [between 1981-1982 and 1996-1997] does not appear to reflect a rise in higher risk twin pregnancies, [but rather] more aggressive clinical practice resulting in earlier therapeutic intervention," according to an article published in the March issue of the Maternal and Child Health Journal. The authors' previous research shows that infant mortality among twins in the United States fell substantially between 1983 and 1996; however, the preterm birth rate for twins rose markedly during this period. This rise in twin preterm births was associated with increasing levels of prenatal care utilization. Noting the impact of sociodemographic factors on prenatal care utilization, as well as the impact of changes in childbearing patterns on the multiple birth rate, this study sought to determine whether risk factors for twin preterm births had changed over time.

Using data from the National Center for Health Statistics natality files in 1981-1982, 1989-1990, and 1996-1997, the authors computed the rates of twin preterm births for less than 33, 33 through 34, and 35 through 36 weeks of gestation. Next, they examined associations between sociodemographic and obstetric variables (race/ethnicity, maternal age, marital status, maternal education, nativity, live birth order, and level of prenatal care) and the three measures of twin preterm birth for the time periods 1981-1982 and 1996-1997.

Between 1981-1982 and 1996-1997 the authors found that

The rate of preterm twin births increased, while the rate of term twin births decreased;
The greatest increase in twin birth rates was among women ages 35 and older;
The rate of preterm twin births increased in all three gestational age categories, with the greatest increase among those delivered between 35 and 36 weeks (a 51% increase);
Although African Americans, teenagers, unmarried women, women with less education, and primiparas were more likely to deliver preterm across all three levels of preterm birth in both time periods, the odds ratios for these types of risk factors were often substantially smaller in 1996-1997 when compared with 1981-1982;
Only two factors exerted a greater influence on the rate of preterm twin births in 1996-1997 compared with 1981-1982: women born in the United States and women who were intensive users of prenatal care.

"In all, these findings indicate that adequate and intensive prenatal care use are significant indicators of delivering twins prior to term and suggest that this relationship reflects attributes of changing obstetric practice aimed at improving the outcomes of twin pregnancies," the authors conclude. They also point out that this study illustrates the impact of changing medical practice on public health issues and that further monitoring and investigation of twin birth rates and outcomes are warranted.

Kogan MD, Alexander GR, Kotelchuck M. 2002. A comparison of risk factors for twin preterm birth in the United States between 1981-82 and 1996-97. Maternal and Child Health Journal 6(1):29-35.

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5. RESEARCHERS INVESTIGATE PREVALENCE OF AND RISK FACTORS ASSOCIATED WITH GLUCOSE INTOLERANCE IN OBESE CHILDREN AND ADOLESCENTS

"In a multiethnic cohort of obese children and adolescents, we found a high prevalence of impaired glucose tolerance" state the authors of an article published in the March 14, 2002, issue of the New England Journal of Medicine. Although research has shown that severe obesity plays a prominent role in the development of type 2 diabetes in children and adolescents, it is unknown whether severe obesity is a risk factor for impaired glucose tolerance, a potential precursor of diabetes. This study sought to determine the prevalence of glucose intolerance in a multiethnic cohort of 167 obese children (ages 4 through 10) and adolescents (ages 11 through 18). The study also examined risk factors associated with impaired glucose tolerance.

Study findings include the following:

A total of 25% of the children and 21% of the adolescents had impaired glucose tolerance;
There were more girls than boys among the children with impaired glucose tolerance, whereas there was a similar number of boys and girls among the adolescents with impaired glucose tolerance;
Previously undiagnosed type 2 diabetes was detected only among adolescents (4%), and all four subjects with diabetes were members of minority groups;
Insulin resistance was a strong predictor of the 2-hour plasma glucose levels in the children and adolescents;
Impaired glucose tolerance was found in some adolescents with the polycystic ovary syndrome; and
Family history of type 2 diabetes was not a significant risk factor for impaired glucose tolerance, nor was the degree of obesity, perhaps because the majority of the subjects were severely obese.

The authors note that "although children and adolescents with mildly impaired glucose tolerance provide a unique model that can help us identify the early events that lead to diabetes without the confounding effects of aging and hyperglycemia, there is little information available about risk factors associated with impaired glucose tolerance in young persons." In summarizing the findings of this study, they state that "insulin resistance . . . is the most important risk factor linked to the development of impaired glucose tolerance in severe childhood obesity." They assert that fasting glucose levels represent a very insensitive method for detecting impaired glucose tolerance, while the oral glucose-tolerance test can reliably establish a diagnosis of impaired glucose tolerance.

Sinha R, Fisch G, Teague B, et al. 2002. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. New England Journal of Medicine 346(11):802-810.

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6. STUDY FINDS LUNG TISSUE CONCENTRATIONS OF NICOTINE ARE HIGHER IN INFANTS WHO DIE FROM SIDS

"Within both reportedly smoking and nonsmoking families, children who die of SIDS have higher concentrations [of nicotine] in their lungs than control children who die of other causes," state the authors of an article published in the February 2002 issue of the Journal of Pediatrics. The authors hypothesize that measurements of nicotine and/or its metabolite -- cotinine -- in lung tissue samples from pediatric patients may contribute to the understanding of the role of environmental tobacco smoke (ETS) in SIDS. This article reports on a comparison of lung tissue analysis of nicotine and cotinine in SIDS and non-SIDS cases and on stratification according to the smoking status of the household.

The authors analyzed 44 infants and neonates with SIDS identified between 1992 and 1995 at the Office of the Chief Medical Examiner in Baltimore, MD, and compared them with 29 non-SIDS controls. Exposure to ETS was verified by a history determined during the autopsy.

Results of the study include the following:

Forty-three of the lung samples came from cases from a smoking household environment and 30 came from cases from a nonsmoking environment;
When all the SIDS and non-SIDS cases were compared, regardless of smoking-environment status, there was significantly higher nicotine concentration in the lung tissue of the SIDS cases than in that of the non-SIDS cases; however, there was no significant difference in cotinine concentrations between the two groups; and
When all the cases were compared, regardless of SIDS status, there was significantly more nicotine and cotinine in the lung tissue of cases from a smoking environment than in the lung tissue of cases from a nonsmoking environment.

Exposure to tobacco smoke is an important environmental risk factor for SIDS. The authors assert that "families may not volunteer accurate information about cigarette smoking" and that these findings highlight "the need for an objective, biologic marker, independent of parental reports."

McMartin KI, Platt MS, Hackman R, et al. 2002. Lung tissue concentrations of nicotine in sudden infant death syndrome (SIDS). Journal of Pediatrics 140(2):205-209.

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MCH Alert © 2002 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by MCH Library Services at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02 MC 0001-01) 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.

Permission is given to forward MCH Alert to individual colleagues. For all other uses, requests for permission to duplicate and use all or part of the information contained in this publication should be sent to MCH Alert Editor, National Center for Education in Maternal and Child Health at mchalert@ncemch.org.

The editors welcome your submissions, suggestions, and questions. Please contact us at the address below.

EDITORS: Jolene Bertness, Tracy Lopez
COPYEDITOR: Ruth Barzel

National Center for Education in Maternal and Child Health
Georgetown University
2000 15th Street, North, Suite 701
Arlington, VA 22201
(703) 524-7802
(703) 524-9335 (fax)
E-mail: mchalert@ncemch.org
Web site: http://www.ncemch.org

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