
Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
July 18, 2008
1. Fact Sheet on Adolescent and Young Adult Population
Demographics Released
2. Brief Examines What Is Known About the Use of
Colocation and Its Benefits
3. Report Presents Findings From Analysis of State
Fluoridation Data for 1992-2006
4. Study Assesses Pediatricians' Involvement in Community
Child Health Activities
5. Article Examines Impact of Early Weaning on HIV-Free
Survival of Children in Zambia
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Special Notice: National Teen Driver Safety Week (October 19-25, 2008)
will focus on increasing awareness of the deadly combination of novice
adolescent drivers and peer passengers. The campaign, conducted by the
Children’s Hospital of Philadelphia and State Farm Insurance Companies,
will offer informational webinars in late July to help health
professionals and others plan for the campaign. A set of tools will be
available in September. Maternal and child health (MCH) professionals
from the nine states that currently have Title V state performance
measures related to adolescent driver safety, and those involved in the
prevention of traffic-related injuries among adolescents, are
encouraged to participate in the campaign. Assistance is also available
to help MCH programs in other states develop and address state
performance measures on safe adolescent driving. More information is
available at http://www.chop.edu/consumer/jsp/division/generic.jsp?id=86589.
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1. FACT SHEET ON ADOLESCENT AND YOUNG ADULT POPULATION DEMOGRAPHICS
RELEASED
The 2008 Fact Sheet on Demographics: Adolescents and Young Adults
contains the most recent available data on the U.S. adolescent and
young adult population (ages 10-24) through 2006. The updated fact
sheet, produced by the National Adolescent Health Information Center at
the University of California, San Francisco, with support from the
Maternal and Child Health Bureau, highlights trends and presents data
on racial and ethnic make-up, poverty rates, family structure types,
school-enrollment rates, the median age of first marriage, and
childbearing among unmarried young adult females. Information on data
and figure sources is included. The fact sheet is available at http://nahic.ucsf.edu/download.php?f=/downloads/Demographics08.pdf.
A list of other NAHIC-produced briefs and fact sheets is available at http://nahic.ucsf.edu/index.php/data/article/briefs_fact_sheets.
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2. BRIEF EXAMINES WHAT IS KNOWN ABOUT THE USE OF COLOCATION AND ITS
BENEFITS
Colocating Health Services: A Way to Improve Coordination of Children's
Heath Care? explores what is currently known about specific colocation
strategies (strategies that place multiple services in the same
physical space) used in pediatric primary care settings, as well as
strategies with potential application to those settings. The issue
brief, published by the Commonwealth Fund, is based on a systematic
search of the literature and interviews with key stakeholders. Topics
include the types of services that have colocated with pediatric
practices, the objectives of efforts to colocate with pediatric
practices and approaches used to achieve them, the benefits of
colocation, and the barriers and implementation issues associated with
different colocation strategies. Conclusions and implications are
provided. The brief is available at http://www.commonwealthfund.org/usr_doc/Ginsburg_Colocation_Issue_Brief.pdf?section=4039.
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3. REPORT PRESENTS FINDINGS FROM ANALYSIS OF STATE FLUORIDATION DATA
FOR 1992-2006
"The percentage of the U.S. population served by community water
systems who received optimally fluoridated water increased from 62.1%
in 1992, to 65.0% in 2000, and 69.2% in 2006, and those percentages
varied substantially by state," state the authors of a report published
in the July 11, 2008, issue of Morbidity and Mortality Weekly Reports.
A Healthy People 2010 objective is to increase to 75% the proportion of
the U.S. population served by community water systems who receive
optimally fluoridated water. The report updates and revises previous
reports on fluoridation in the United States and describes progress
toward the Healthy People 2010 objective.
In March 2007, CDC asked state dental directors and drinking water
administrators to validate their state data reported to the Water
Fluoridation Reporting System (WFRS) for 2006. Estimates of the
population served by community water systems were based on the number
of households served (service connections) and the number of
individuals in each household. Some states supplemented population data
in WFRS with population data from the Environmental Protection Agency's
Safe Drinking Water Information System, which only tracks fluoride
concentrations in water systems with naturally occurring fluoride
levels above the established regulatory maximum contaminant level (4.0
ppm). The researchers calculated the percentage of the population
served by community water systems that received optimally fluoridated
water (population served by community water systems with optimal
fluoride levels divided by the total population served by community
water systems).
Fluoridation data for the period 1992-2006 from the 50 states and the
District of Columbia were analyzed. The authors found that
- In 2006, 69.2% of the U.S. population served by community water
systems received optimally fluoridated water, an increase from 62.1% in
1992 and from 65.0% in 2000.
- State-specific percentages in 2006 ranged from 8.4% in Hawaii to
100% in the District of Columbia (median: 77.0%).
- In 2006, the Healthy People 2010 target of 75% had been met by 25
states and the District of Columbia.
- Overall, approximately 184 million persons served by community
water systems received fluoridated water; of that number, approximately
8 million received water with sufficient naturally occurring fluoride
concentrations.
- During 1992-2006, 39 states reported increases in the percentage
of their populations served by community water systems who received
optimally fluoridated water; percentage-point increases ranged from 0.3
in Alabama to 69.9 in Nevada (median: 6.2). Ten states had decreases;
percentage-point decreases ranged from 0.2 in Kentucky and North Dakota
to 17.0 in Idaho (median: 4.3) (Table 2). Throughout 1992-2006, 100% of
the District of Columbia population served by community water systems
received optimally fluoridated water.
"Public health officials and policymakers in states with lower
percentages of residents receiving optimal water fluoridation should
consider increasing their efforts to promote fluoridation of community
water systems to prevent dental caries," conclude the authors.
Bailey W, Barker L, Duchon K, et al. 2008. Populations receiving
optimally fluoridated public drinking water -- United States,
1992-2006. Morbidity and Mortality Weekly Reports 57(27):737-741.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5727a1.htm.
Readers: More information is available from the following MCH Library
resource:
- Oral Health and Pregnant Women, Infants, Children, and Adolescents:
Knowledge Path
http://www.mchlibrary.info/KnowledgePaths/kp_oralhealth.html
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4. STUDY ASSESSES PEDIATRICIANS' INVOLVEMENT IN COMMUNITY CHILD HEALTH
ACTIVITIES
"Although pediatricians have a strong sense of responsibility for
promoting children's health, they report declining current involvement
in community activities, particularly with regard to paid
opportunities," state the authors of an article published in the July
2008 issue of Archives of Pediatric and Adolescent Medicine. To promote
children’s well-being, pediatricians increasingly are encouraged to
engage in community partnerships to address social and environmental
factors that contribute to children’s health. As such, residency
training places a growing emphasis on acquiring skills in community
pediatrics, regardless of specialization. Despite this emphasis, little
is known about the ongoing involvement of pediatricians in community
activities. The article presents findings from a study to (1) describe
pediatricians' current involvement in community child health
activities, (2) examine trends in community involvement from 1989 to
2004, and (3) compare perspectives and skills related to community
involvement among those who currently do and do not participate in
community activities.
Data for the study were drawn from the American Academy of Pediatrics'
Periodic Surveys of Fellows conducted in 1989, 1993, and 2004, each of
which included questions on involvement in community child health
activities. The study sample included 637 pediatricians in 1989 (88.5%
of respondents), 865 pediatricians in 1993 (81.6% of respondents), and
881 pediatricians in 2004 (83.7% of respondents). The analyses assessed
differences in responses between surveys. Additional analyses of the
2004 respondents included a comparison of demographic and practice
characteristics, community child health perspectives, and skill level
by participation in community child health activities in the past year.
The authors found that
- During the past 15 years, the percentage of pediatricians
involved in community child health activities in the preceding year
rose from 56.6% in 1989 to 59.4% in 1993 but declined to 45.1% in 2004.
- Among those who participate in community activities, more
pediatricians in 2004 compared with preceding years reported that their
community participation was voluntary (79.6% in 2004 vs. 57.8% in 1993
vs. 48.6% in 1989); however, the percentage of all pediatricians
engaged in volunteer activities from 1993 to 2004 was consistent (34.3%
in 1993 vs. 35.9% in 2004).
- In 2004, more participants than nonparticipants reported that
their level of involvement was “just right” (52.5% vs. 24.9%), felt
moderately or very responsible for improving child health in their
community at a population level (84.2% vs. 69.4%), expected that their
community work in the next 5 years would increase (63.5% vs. 54.1%),
and reported higher levels of community pediatrics skills.
"Whether acquisition of new skills during residency translates to
increased participation in community activities may depend on whether
activities are structured to meet the realities of the busy lives of
pediatricians and whether opportunities are sufficiently valued by
employers to encourage involvement as part of professional
responsibilities," conclude the authors.
Minkovitz CS, O’Connor KG, Grason H, et al. 2008. Pediatricians’
involvement in community child health from 1989 to 2004. Archives of
Pediatric and Adolescent Medicine 162(7):658-664. Abstract available at
http://archpedi.ama-assn.org/cgi/content/abstract/162/7/658.
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5. ARTICLE EXAMINES IMPACT OF EARLY WEANING ON HIV-FREE SURVIVAL OF
CHILDREN IN ZAMBIA
"There was no significant benefit in HIV-free survival to 24 months
among the infants of HIV-infected mothers who were encouraged to stop
breast-feeding abruptly at 4 months as compared with the infants of
mothers who were encouraged to wean their infants according to the
standard practice and who continued breast-feeding for a median of 16
months," write the authors of an article published in the July 10,
2008, issue of The New England Journal of Medicine. Breastfeeding poses
a dilemma for women who live in low-resource settings and who are
infected with the human immunodeficiency virus (HIV) because the
practice can transmit HIV but is the source of optimal nutrition and
protection against other serious infectious diseases. Early cessation
of breastfeeding has been recommended to balance these competing risk
factors. In the study described in this article, the authors conducted
a randomized trial among HIV-infected women in Lusaka, Zambia, to
evaluate whether exclusive breastfeeding to age 4 months, followed by
abrupt weaning, would reduce the postnatal transmission of HIV and
mortality through the first 2 years of life.
HIV-infected women were recruited between May 2001 and September 2004
from two prenatal clinics that offered voluntary HIV testing and
counseling and single-dose nevirapine prophylaxis. Women could
volunteer to participate in the study if they intended to breastfeed
for any length of time, accepted treatment with nevirapine, and agreed
to be randomly assigned to the intervention or control group. The
experimental intervention encouraged women to breastfeed exclusively
for 4 months and then to stop abruptly. Women in the control group were
encouraged to breastfeed exclusively for 6 months, gradually introduce
complementary foods, and continue to breastfeed for a duration of their
own choice. Of 1,435 HIV-infected pregnant women and their infants
enrolled in the study, 958 were randomly assigned to a study group. Of
these, 84% in the intervention group and 86% in the control group were
followed to 24 months or reached the study endpoints of HIV infection
or death.
The authors found that
- The median duration of breastfeeding was 4 months in the
intervention group and 16 months in the control group.
- There was no significant difference in HIV-free survival between
the two groups; at age 24 months, 68.4% of the children in the
intervention group, compared with 64.0% in the control group, were
alive and not infected with HIV.
- Among 152 children with confirmed HIV infection before age 4
months, cumulative mortality rates by age 24 months were 77.1% in the
intervention group and 61.1% in the control group.
The authors conclude that "These results suggest that early, abrupt
cessation of breast-feeding for HIV-infected women in low-resource
settings should be avoided."
Kuhn L, Aldrovandi GM, Sinkala M, et al. Effects of early, abrupt
weaning on HIV-free survival of children in Zambia. The New England
Journal of Medicine 359(2):130-141. Abstract available at http://content.nejm.org/cgi/content/abstract/359/2/130.
Readers: An article by Kumwenda, NI, Hoover, DR, Mofenson, LM, et al,
published in the same issue of The New England Journal of Medicine,
provides additional information about reducing HIV transmission through
breastmilk in resource-limited settings. The article discusses a study
in which infants whose mothers were HIV-1 positive were randomly
assigned to one of three regimens: single-dose nevirapine plus 1 week
of zidovudine (control regimen) or the control regimen plus daily
extended prophylaxis either with nevirapine (extended nevirapine) or
with nevirapine plus zidovudine (extended dual prophylaxis) until age
14 weeks. The article is available at http://content.nejm.org/cgi/content/abstract/359/2/119.
Readers: More information is available from the following MCH Library
resources:
- AIDS/HIV in Pregnancy: Bibliography at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_aidspreg.html&-MaxRecords=all&-DoScript=auto_search_aidspreg&-search
- Breastfeeding: Selected Resources
http://www.mchlibrary.info/guides/breastfeeding.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
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The editors welcome your submissions, suggestions, and questions.
Please contact us at the address below.
MANAGING EDITOR: Jolene Bertness
CO-EDITOR: Tracy Lopez
COPYEDITOR/WRITER: Ruth Barzel
LIST ADMINISTRATOR: Beth DeFrancis Sun
MCH Alert
Maternal and Child Health Library
National Center for Education in Maternal and Child Health
Georgetown University
Box 571272
Washington, DC 20057-1272
Phone: (202) 784-9770
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E-mail: mchalert@ncemch.org
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