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.


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

************************************************************

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.

************************************************************

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.

************************************************************

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.

************************************************************

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
"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

************************************************************

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
"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.

************************************************************

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 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

************************************************************

To subscribe to MCH Alert, send an e-mail message to MCHAlert-request@list.ncemch.org with SUBSCRIBE in the subject line. You do not need to enter any text in the body of the message.

To unsubscribe from MCH Alert, send an e-mail message to MCHAlert-request@list.ncemch.org with UNSUBSCRIBE in the subject line. You do not need to enter any text in the body of the message.

************************************************************

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.
 
Permission is given to forward MCH Alert, in its entirety, to others. 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 mchalert@ncemch.org.

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
Fax: (202) 784-9777
E-mail: mchalert@ncemch.org
Web site: http://www.mchlibrary.info/alert/default.html

************************************************************