News from Child Trends: April 4, 2006

Beyond Pills: Life Experiences Affect Maternal Depressive Symptoms…and Kids
Child Trends' newest research brief, Depression Among Moms: Prevalence, Predictors, and Acting Out Among Third Grade Children. examines maternal depression and complements the biomedical study just released in the March 22, 2006 issue of the Journal of the American Medical Association.NEWS RELEASE

Pregnancy & Childbirth | ACOG Releases Practice Bulletin Regarding Routine Episiotomies [Apr 03, 2006]

      The American College of Obstetricians and Gynecologists on Friday in the April issue of the journal Obstetrics & Gynecology released guidelines saying that physicians should not perform routine episiotomies -- a 3/4- to 1 1/2-inch incision performed during many deliveries to enlarge the vaginal opening and reduce the risk of uncontrolled tearing of the perineum during delivery -- unless there is a definitive reason to perform the procedure, Reuters Health reports. ACOG Fellow John Repke and colleagues reviewed recent studies and found "good and consistent" evidence that episiotomies should be recommended only in certain circumstances instead of performed on a routine basis (Reuters Health, 3/31). The rates of episiotomies vary nationwide, but physicians perform the procedure in about one-third of all vaginal deliveries, ACOG says. ACOG's guidelines do say that episiotomies might help to manage shoulder dystocia -- which occurs when infants' shoulders become stuck in the birth canal during labor and delivery -- once the condition occurs, the Baltimore Sun reports (Bor, Baltimore Sun, 3/31). Repke in a statement said, "In the case of episiotomy, as with all medical and surgical therapies, we need to continually evaluate what we do and make appropriate changes based on the best and most current evidence available," adding, "We should avoid the pitfall of letting anything in medicine become 'routine' and therefore, outside the realm of review and critical analysis" (ACOG release, 3/31).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=36364

Pregnancy & Childbirth | NBC 'Nightly News' Examines Increase in Employment Pregnancy Discrimination Claims [Apr 03, 2006]

      NBC's "Nightly News" on Friday examined the increase in U.S. women's claims that they have been fired because of pregnancy discrimination. According to the Equal Employment Opportunity Commission, claims of pregnancy discrimination have increased 31% between 1992 and 2005. More than 70 million U.S. women work, and almost three-quarters of them have children, NBC reports. The segment includes comments from Mary Jo O'Neill, an EEOC attorney in Phoenix; Jack Tuckner, a women's rights attorney; and a woman who was fired two weeks after she told her employer she was pregnant (Thompson, "Nightly News," NBC, 3/31).

A transcript of the story and video in Windows Media are available online.

Pregnancy & Childbirth | New York Times Examines Debate Over Home Births Conducted by Non-Licensed Midwives [Apr 04, 2006]

      The New York Times on Monday examined the debate among physicians, legislators, prosecutors, midwives and women over whether home births supervised by midwives who are not licensed doctors or nurses present "grave and unacceptable medical risks." The Times looks at the case of Jennifer Williams, a midwife in Shelbyville, Ind., who conducted the home birth in June 2005 of an infant who died. Williams faces charges of practicing medicine and midwifery without a license but does not face criminal charges of causing or contributing to the infant's death. Indiana and nine other states prohibit the practice of medicine and midwifery by individuals other than licensed doctors and nurses. According to the Midwives Alliance of North America, there are about 3,000 practicing midwives nationwide without formal medical training, and approximately 1,100 midwives are certified by the North American Registry of Midwives, a private agency whose evaluations are recognized by about 20 states. According to the National Center for Health Statistics, about 99% of all births occur in hospitals with nurse midwives participating in about 8% of births. Of the remaining 1% of births, two-thirds occur in homes and one-third occur in free-standing birthing centers. Indiana state Rep. Peggy Welch (D), who has introduced legislation to recognize and regulate non-licensed midwives, said that each year about 1,000 families in the state have home births -- which are legal under current law -- but many physicians and nurses do not to perform home births. Although nurse-midwives in Indiana are permitted to deliver infants at home, most work in hospitals, the Times reports. Stacey Tovino, a professor at the Health Law and Policy Institute at the University of Houston Law Center, said that prosecutions of midwives typically begin when an infant or woman dies, adding, "There has always been a tension between true quality-of-care concerns and anticompetitive concerns." Kevin Burke, president of the Indiana State Medical Association, said that the best environment for labor and delivery is in a hospital or adjoining facility "[b]ecause routine things sometimes become very un-routine." According to Burke, if women prefer a home birth over a hospital setting, "let's make the hospital a more friendly, user-comfortable environment" (Liptak, New York Times, 4/3).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=36402

Coverage & Access | Medical Errors Leading Cause of Death in Hospitals, Study Says

[Apr 05, 2006]

      Medical errors remain a leading cause of death and injury at hospitals nationwide, and the effort to improve patient safety at the facilities "is too slow and should be a cause for great alarm," according to a study released on Monday by HealthGrades, the Syracuse Post-Standard reports. For the study, researchers examined the records of Medicare beneficiaries treated at about 5,000 hospitals nationwide between 2002 and 2004 and used 13 patient safety indicators developed by the federal government to evaluate admissions (Mulder, Syracuse Post-Standard, 4/3). The study finds that about 1.24 million patient safety incidents occurred between 2002 and 2004, compared with 1.14 million between 2000 and 2002, at a cost of $9.3 billion. According to the study, failure to save the lives of Medicare beneficiaries who developed complications, bloodstream infections and bedsores accounted for almost 63% of the patient safety incidents (Nelson, Knoxville News-Sentinel, 4/3). Almost 25% of Medicare beneficiaries who experienced patient safety incidents died between 2002 and 2004, and 82% of those deaths likely were preventable, according to the study. The study finds that hospitals in Minnesota, Wisconsin, Iowa, Michigan and Kansas ranked highest on patient safety and that facilities in New York, New Jersey, Nevada, Tennessee and the District of Columbia ranked lowest (Syracuse Post-Standard, 4/3). Samantha Collier, vice president of medical affairs for HealthGrades, said, "Overall, we see the number of patient safety incidents in American hospitals continuing to increase, at an enormous cost, and we still see a large gap between the incidence rates at the nation's top-performing and worst-performing hospitals" (Knoxville News-Sentinel, 4/3).

The study is available online. Note: You must have Adobe Acrobat Reader to view the study.

*http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=36442

Public Health & Education | Panel Recommends Closely Watching Abnormal Cervical Cells, HPV as Treatment for Teens, Young Women

[Apr 06, 2006]

      Closely watching the human papillomavirus or abnormal cervical cells revealed during the Pap tests of teens and young women is the best course of treatment, an American College of Obstetricians and Gynecologists panel said in guidelines published in the April issue of the journal Obstetrics & Gynecology, Long Island Newsday reports. Panel chair Richard Guido, an associate professor of reproductive sciences at the University of Pittsburgh, said that HPV or abnormal cervical cells in teens and young women with normal immune systems often regress within 13 to 24 months without any form of treatment. As a result, there is no need for an invasive treatment that might damage the woman's cervical tissue or risk her fertility, the panel said. The panel also said that teens and young women should receive routine Pap tests when they undergo screening for sexually transmitted infections or receive contraceptive counseling. Guido said, "We felt that adolescents are a special population and our message is to make sure that clinicians who take care of them are aware of the special nature and issues that relate to adolescents," adding that the guidelines aim to prevent clinicians from overtreating teens and young women (Ricks, Long Island Newsday, 4/6).

*http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=36450

NALYSES EXAMINE HEALTH STATUS AND HEALTH SERVICE ACCESS AND USE AMONG CHILDREN IN IMMIGRANT FAMILIES

"Our results showed that [children who were U.S. citizens by birth but whose parents were born outside the United States] face health care barriers . . . similar to those faced by foreign-born children," state the authors of an article published in the April 2006 issue of the American Journal of Public Health. There is consensus among researchers that available data on patterns of health service use among children in immigrant families is scarce. The article describes analyses of data from the 1999 National Survey of America's Families to examine the health insurance status and patterns of health service use among children in U.S. immigrant families.

The analyses assessed measures of parent-reported health status and health care access and use among four subgroups of children: (1) children who were U.S.-born citizens and whose parents (one or both) were citizens (UBC group); (2) children who were U.S.-born citizens but whose parents were not (UBNC group); (3) foreign-born children who were naturalized U.S. citizens and whose parents were also naturalized citizens (FBC group); and (4) children who were foreign-born noncitizens and whose parents were also noncitizens (FBNC group). The relationship between each health access variable and child immigrant status was investigated. The same associations were assessed after adjustment for child race/ethnicity, age, and gender; parents'
education; parent-reported health status; and family poverty status.

The authors found that

* Compared with children in the UBC group, children in the FBNC group were significantly less likely to have had health insurance coverage at various times during the preceding year; children in the FBNC group were also significantly less likely than children in the UBC group to have a usual source of care and to have visited a doctor, dentist, or mental health specialist within the previous year.

* Children from families with low incomes in the FBNC group were 5 times less likely than their counterparts in the UBC group to have health insurance coverage; similarly, children from families with low incomes in the UBNC group were 1.6 times less likely to have coverage than their peers in the UBC group.

The authors conclude that "our findings point to the need for policy responses at several levels." Suggested responses include (1) outreach to encourage immigrant families to enroll their children in public insurance programs when they are eligible; (2) efforts to encourage all children to use preventive health and dental services, to educate families about the availability of health care services, and to develop services that are culturally competent and linguistically accessible; and (3) legislation to restore health insurance coverage to legal immigrant children and pregnant women.

Zhihuan J, Yu SM, Ledsky R. 2006. Health status and health service access and use among children in U.S. immigrant families. American Journal of Public Health 96(4):634-640. Abstract available at http://www.ajph.org/cgi/content/abstract/96/4/634.

* MCH Alert Tomorrow's Policy Today-April 2006

RESEARCH BRIEF EXAMINES PATHWAYS BETWEEN POLICY ANTECEDENTS, MATERNAL DEPRESSION, AND CHILDREN'S ACTING OUT BEHAVIOR

Depression Among Moms: Prevalence, Predictors, and Acting Out Among Third Grade Children examines factors related to depressive symptoms among mothers and explores the implications for acting out behavior in their third grade children. The research brief, produced by Child Trends, is based on data from the Early Longitudinal Study:
Kindergarten Class of 1998-99, a nationally representative study of children who entered kindergarten in the fall of 1998. Earlier findings on maternal depression and child outcomes are highlighted to place the new analyses in a larger context. Analyses of the prevalence of depressive symptoms among mothers, the antecedents to these symptoms, and the intersection of these antecedents and symptoms with parenting and acting out behavior are summarized. Findings from repeat analyses among a subgroup of children from families with low incomes are also presented. The brief is available at http://en.groundspring.org/EmailNow/pub.php?module=URLTracker&cmd=track&j=70
235315&u=649778

* MCH Alert Tomorrow's Policy Today-April 2006

ANALYSIS ASSESSES RECENT TRENDS IN SUDDEN, UNEXPECTED INFANT DEATHS AND CURRENT EPIDEMIOLOGY PRACTICE

"This study shows that the more recent decline in reported SIDS [sudden infant death syndrome] rates from 1999 to 2001 was likely not a true decline but related to changes in the way that these infant deaths are being reported and classified," state the authors of an article published in the April 14, 2006, issue of the American Journal of Epidemiology. Much of the decline in infant mortality due to SIDS has been attributed to a decrease in prone sleeping. However, limited evidence supports the hypothesis that the continued decline may rather be explained by a shift in reporting or diagnostic practices. The article describes a study designed to assess trends in cause-specific mortality rates for all infant deaths. Additionally, the research examines the cause-specific age at death, as well as month of death distributions.

Data were drawn from the Linked Birth/Infant Death Data Set for the period 1989-2001. The analysis focused on deaths reported as cause unknown/unspecified and the leading causes of sudden, unexplained infants deaths (SUIDs): SIDS; accidental suffocation and strangulation in bed (ASSB); other accidental suffocation and strangulation; and neglect, abandonment, and other maltreatment syndromes. The researchers estimated observed patterns over time for each cause of death.

The authors found that

* SIDS rates declined by 22% from 1995-1998 to 1999-2001, while rates of the other three major causes of SUIDs and cause unknown/unspecified, taken together, increased by 35.4%.

* From 1989-1991 to 1999-2001, there was a statistically significant change in age at death distributions for SIDS and ASSB, but not for cause unknown/unspecified; the age distribution of ASSB became more similar to that of the SIDS distribution.

* During 1989-1991, the month of death distributions for SIDS and cause unknown/unspecified were nearly identical; however, in 1999-2001, the SIDS and cause unknown/unspecified distributions no longer followed a similar pattern.

* Maternal sociodemographic risk factors for SIDS remained unchanged for all time periods, but they were neither sensitive nor specific to SIDS.

"This study offers further evidence that much of the decrease in SIDS rates since 1999 may not be a true decline but may be explained by a shift in diagnosis," state the authors. They conclude that recent national efforts to standardize data collection at infant death scenes and improve the reporting of cause of death will allow researchers to monitor trends and conduct meaningful research, so that new risk factors can be identified that will ultimately lead to activities aimed at SIDS prevention.

Shapiro-Mendoza CK, Tomashek KM, Anderson RN, et al. 2006. Recent national trends in sudden, unexpected infant deaths: More evidence supporting a change in classification or reporting. American Journal of Epidemiology 163(8):762-769. Abstract available at http://aje.oxfordjournals.org/cgi/content/abstract/163/8/762.

* MCH Alert Tomorrow's Policy Today-April 2006

Return to Latest News