Hospitals, Health Plans Fail to Require Board Certification for Pediatricians

Hospitals frequently do not require pediatricians to be board certified when privileges are originally granted, according to a series of recent journal articles.  Many do not specify a time limit to reach certification, and recertification requirements tend to be sketchy.  In several separate studies, health plans fared no better, and researchers speculate that studies of other primary care disciplines may turn up similar findings.  A contributing factor may be the difficulty in recruiting pediatric subspecialists.  For more details see MedPage at:   http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/2729.  The journal articles include the following:  

• Freed, Gary L, et al, "Policies and Practices Related to the Role of Board Certification and Recertification of Pediatricians in Hospital Privileging." Journal of the American Medical Association Feb. 22, 2006-Vol 295, no 8, 905-912
  
• Freed, Gary L, et al, "Use of Board Certification and Recertification of Pediatricians in Health Plan Credentialing Policies." Journal of the American Medical Association Feb. 22, 2006-Vol 295, no 8, 913-918
  
• Cassel Christine K and Holmboe, E., "Credentialing and Public Accountability: A Central Role for Board Certification" Journal of the American Medical Association Feb. 22, 2006-Vol 295, no 8, 939-940

Connection Between Stress and Miscarriage Not a Myth

In a study conducted by the National Institute of Environmental Health Sciences, women with high levels of cortisol in their urine soon after conception were more likely to have a spontaneous abortion.  Cortisol is a hormone associated with stress, and its presence in early pregnancy may interfere with production of maternal hormones required to sustain a pregnancy as it develops from the embryonic to the fetal stage.  For more details, see MedPage at:  http://www.medpagetoday.com/OBGYN/Pregnancy/tb2/2730.  The citation for the original study is:  Nepomnaschy PA et al. Cortisol levels and very early pregnancy loss in humans. DOI/10.1073/pnas.0511183103.   Proceedings of the National Academy of Sciences early edition.

Brains of Adolescents Born Preterm May Still Show Signs of Developmental Deficits

Some children who were born prematurely may need extra assistance in adolescence because the negative effects of preterm birth persist.  Children with a high rate of medical complications at birth or a poor post-natal environment may have trouble making the transition from "child pattern" brain activation to an "adult pattern."  Medical complications were linked to decreased motor function (left brain function,) and a deficient post-natal environment was linked to problems with cognitive abilities and social development (right brain function.)  For more information, see MedPage at:  http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/2905.  The journal citation is:  Lewis M et al. Early risk, attention, and brain activation in adolescents born preterm. Child Development. 2006; 77(2).

Treatment of Depression in Mothers Helps Children As Well

Vigorous treatment of depressed mothers whose medication brings relief after three months see significant reductions in anxiety and disruptive behaviors on the part of their children.  The research is part of the STAR*D study (Sequenced Treatment Alternatives to Relieve Depression,) a multi-site study of outpatients with nonpsychotic depressive disorders. The study is designed to determine how factors in the home environment affect depression in children.  For more details, see MedPage at:  http://www.medpagetoday.com/tbindex2.cfm?tbid=2897.  The study is published at:  Weissman MM et al. Remissions in Maternal Depression and Child Psychopathology. A STAR*D-Child Report JAMA. 2006;295:1389-1398. 

Looking for Depression, Clinicians May Miss Anxiety, Stress in Postpartum Patients

The Edinburgh Postnatal Depression Scale, used to diagnose post-partum depression, does not detect clinically significan levels of anxiety and stress in new mothers when these symptoms are unrelated to depression.  Researchers recommended the DASS-21 as a more effective evaluation tool.  For more details, see MedPage at:  http://www.medpagetoday.com/tbindex2.cfm?tbid=2926.  For the journal article on the study, see:  Miller RL et al. "Anxiety and stress in postpartum: is there more to postnatal distress than depression?" BMC Psychiatry. Advanced online publication March 23, 2006.

ACOG Recommends No More Routine Episiotomies

A new clinical management guideline from ACOG recommends that the use of episiotomies be more restricted than in current practice.  Review of the literature found no evidence that episiotomy either lowers the risk of incontinence or reduces the rate and severity of perineal lacerations.  Episiotomy is currently performed in an estimated one out of three vaginal births.  ACOG recommended that physicians who perform episiotomies should include in their delivery notes information about how often the procedure is indicated, to help develop better performance measures.  For more details, see MedPage at:   http://www.medpagetoday.com/tbindex2.cfm?tbid=2969.  The guidelines are published as:  ACOG Committee on Practice Bulletins "Clinical Management Guidelines for Obstetrician-Gynecologists" Number 71, April 2006. 

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