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Maternal and Child Health
Section Newsletter
Summer 2006


As spring moves toward summer, the sky is brighter, things are ending, and new beginnings are in the offing. It has been a busy time this year for MCH.

We have participated in the development of the APHA resolution about the response to a possible flu pandemic to be sure MCH issues are addressed. It is interesting that this is not automatic so be sure to look into state efforts and be sure our population has a focus!!!!

The Section was instrumental in putting the Association on record in support of the ban on distribution of formula company advertising through diaper bag distribution when mothers are discharged from the hospital. Research shows this is a deterrent to breastfeeding continuation.

Preparations for the Annual Meeting have already begun, and it looks like we will have some exciting sessions. We are planning another active Membership meeting and several additional meetings to inform members about candidates and resolutions. A resolution has been submitted with Section support on reducing infant mortality and disparities. Please do look at the new resolutions submitted for this year when they come out in The Nation’s Health and are published on the Web. Send comments to our governing counselors. We need all the expertise our Section has to offer!!!

Many of our members have been involved in the rescue and recovery efforts in the areas devastated by Hurricaine Katrina. I hope individuals who have been active in this arena will submit descriptions of their experience and evaluation of what we need to do for mothers and children as the area begins to rebuild.

Our student fellowship and mentoring program has been recognized as cutting edge by the Association. We have added a second year position in order to have a student liaison to the Student Assembly. Jane Pearson and all involved in this effort have done a terrific job maintaining our high standards for student participation. It is up to each member of the section to welcome the student fellows and support them in remaining active as graduates and practicing MCH’ers. This is how we will grow our ranks.

We have a great slate for leadership positions so I hope you all have voted!!

Best wishes for an enjoyable and/or productive summer.

Jan Weingrad Smith, CLNM, MS, MPH


Editing this newsletter over the past year has made me very proud of the members of the MCH Section.  Not only do you continue to submit interesting, well-written articles on a wide variety of topics of interest to the MCH community, but you get them to me on time, which is greatly appreciated. 

I encourage you all to think about submitting an article for the next newsletter -- consider writing up your latest project or publication, publicizing your cause, posting job opportunities, summarizing interesting newspaper and journal articles, or reviewing a recent book.  I don't think I have ever turned down an article, and there is never any charge. 

The APHA deadline for the next newsletter is just before the Jewish High Holidays, so I would like to get the newsletter done a little earlier, since that is a busy time for me.  Send any articles by MONDAY, SEPT. 5, 2006, to me at  (You can certainly send them to me earlier, too!)  And if you have any questions, you are welcome to call me here in Washington, D.C. at (202) 302-1823.

I'm looking forward to hearing from you then.

Clare Feinson, JD, MPH      


This year's election day (November 7, 2006) will happen during the APHA Annual Meeting in Boston, Massachusetts. Make your voice heard in the ballot box by registering to vote and requesting an absentee ballot before your state deadline! Click here for more information:


Online Survey Will Help APHA Advocacy Efforts

As many of you know, in addition to last year's devastating cuts, the President's 2007 budget proposed cutting funding for the Centers for Disease Control and Prevention by more than 2 percent and the Health Resources Services Administration by almost 5 percent. His budget eliminated or entirely cut several important public health programs such as the National Children's Study, the Preventive Health & Health Services Block Grant, HRSA Health Professions Grant Programs, and those that address chronic disease prevention.

As we plan appropriations visits and develop materials, your answers to the questions in the online survey will help give a picture of the impact of last year's cuts on the vital public health programs we work on and with. Please take a moment to complet this online survey, which will help APHA work to head off any further cuts proposed in the future.  You can access the survey at:


Hello! I would like to introduce myself as this year's MCH section liaison from the Public Health Student Caucus. I am a doctoral student in the UCLA School of Public Health Department of Community Health Sciences. My research interests lie in racial/ethnic disparities in birth outcomes and maternal health using a life course perspective. As the MCH Section liaison, it is my role to facilitate student involvement, recognition, and leadership in the MCH Section while also promoting the MCH Section in the Public Health Student Caucus. Please feel free to contact me with any ideas, suggestions, or opportunities for students to get involved with Section activities and APHA. I look forward to working with all of you this year!

Laura Chyu


The Centers for Disease Control and Prevention, in collaboration with more than 35 federal, public and private partners, recently released national recommendations designed to encourage women to take steps toward good health before becoming pregnant. The recommendations for preconception care were published in the Morbidity and Mortality Weekly Report Recommendations and Reports.

"The child-bearing years are an exciting time in a woman’s life and there are a number of steps they can take to be healthy, benefiting both them and their future child," said CDC Director Julie Gerberding, MD, MPH. "For instance, even before pregnancy, women of child-bearing age should see their doctor about controlling existing medical conditions, such as diabetes, high blood pressure and eating disorders. They should take 400 micrograms of folic acid to help prevent neural tube defects and avoid smoking or drinking alcohol."

The recommendations on preconception health and health care identify more than a dozen risk factors and conditions that require interventions before pregnancy to be effective. Among developed nations, the United States is ranked number 26 in infant mortality.  If implemented, the recommendations can help improve the health of babies and their mothers. 

The full recommendations on preconception care are available at and for more information on preconception care, go to



The March of Dimes Florida Chapter was awarded a $2 million grant from the Florida Attorney General’s Office as a result of a settlement with multiple vitamin manufacturers.  In June 2004, as a result of this grant, the March of Dimes partnered with the Florida Department of Health, the Florida Folic Acid Coalition and the Florida Birth Defects Center to promote the use of folic acid in women of reproductive age throughout Florida.  The message of the value of folic acid is incorporated into a larger message promoting good preconception health for women of childbearing age.  To facilitate greater awareness and consumption of folic acid in women of child-bearing age, up to 450,000 multivitamins containing the recommended daily allowance of folic acid (400 micrograms) are being distributed free to non-pregnant women. The vitamins and accompanying educational materials are distributed through various sites throughout the state of Florida.  The sites selected to participate in the project were selected based upon the characteristics of the population served by the site.  The target population for the grant is women of childbearing age who are uninsured or under-served, with particular emphasis placed on reaching women of Hispanic and Haitian origin. 

To date, more than 250,000 bottles of vitamins have been provided to over 200 different programs for distribution at the local level.  These programs represent a variety of service providers, including Family Planning Clinics, WIC Clinics, Healthy Start, Early Head Start and Head Start, Community Health Centers, faith-based organizations, and other for-profit and non-profit providers serving the target population.

The project has a small evaluation component to assess behavior change and knowledge change as a result of the education and free vitamins.  All sites collaborating in distribution of the materials are provided the opportunity to receive free training on preconception health.  The project has been well-supported at the state and local level. 

For more information about the Florida VitaGrant project, contact Project Manager Elizabeth Jensen at or (850) 245-4465.


New York Times Also Covers Breastfeeding

The Public Health Council of Massachusetts, which approves regulations for the state Department of Public Health, passed the Massachusetts Perinatal Regulations in December 2005.  These included a groundbreaking rule which would have banned the distribution of free diaper discharge bags sponsored by the formula industry from all birthing hospitals in the Bay State.

These "free" diaper bags contain formula and are given out by the vast majority of hospitals in the United States.  This situation persists despite a vast body of medical research, including an extensive review by the prestigious Cochrane Collaborative, that demonstrates that this kind of formula distribution undermines the duration of exclusive breastfeeding. In addition, the bags represent marketing by the pharmaceutical industry in the hospital.

However, Massachusetts Gov. Mitt Romney (R) stepped in and pressured the PHC to reverse the ban on the formula bags, overuling the PHC in an unprecedented step which has never been taken before. However, the PHC fought back by passing the other Perinatal Regulations and including a resolution to return the diaper bag resolution to the table after "due consideration."  The PHC is headed by a Romney appointee, other members are elected for specific terms and are not appointed by the current governor.

The Massachusetts Breastfeeding Coalition is fighting this overruling of the Public Health Council with a campaign to ban these bags. On the Coalition Web site,, there is more information and a petition that interested people can sign.

New York Times Covers Benefits of Breastfeeding

Meanwhile, in other breastfeeding news, a recent New York Times article outlined the overwhelming benefits of breastfeeding, while at the same time cautioning that care must be taken not to stigmatize the few women who cannot breastfeed.  The article was part of a campaign comparing failure to breastfeed after birth with risky behavior before birth, such as a pregnant woman riding a mechanical bull.  To read the article, go to  Free registration is required to access the article.






Postpartum Depression Bill Signed!

New Jersey Gov. Jon Corzine signed the Pospartum Depression bill into law on April 13, 2006. This state law will now require health care professionals to provide pregnant women with prenatal education about the disorder and to screen all new mothers for signs of depression. Ilise Zimmerman, president and CEO of the Northern NJ Maternal/Child Health Consortium participated in this historic achievement for women’s health in New Jersey. Zimmerman addressed how caring for a new infant can be an overwhelming experience and that it is critical that our physicians know how to both recognize and treat women experiencing Postpartum Depression. The Northern Consortium offers health care providers in New Jersey training on postpartum mood disorders. For more information on this training call (201) 843-7400.



"What Do Parents Say About the Los Angeles Healthy Kids Program?" 
Authors: Ian Hill, Brigette Courtot, Patricia Barreto, Eriko Wada, Enrique Castillo

Healthy Kids of Los Angeles County extends coverage to uninsured children from birth through age 18 in families with incomes below 300 percent of the federal poverty level who are ineligible for Medicaid or SCHIP. A series of focus groups with parents of children enrolled in Healthy Kids explored parents' feelings about and experiences with the program. Researchers found that the program is providing families with a highly valued service in the form of comprehensive health insurance coverage, permitting their children easier access to care, making health services more affordable, and increasing options for where and when to obtain care.

Access the entire report at:


The Lower Hudson Valley Perinatal Network has become the newest New York State Department of Health funded Comprehensive Prenatal-Perinatal Services Network. In 2004 the Lower Hudson Valley Perinatal Network was established by the Regional Perinatal Center of Maria Fareri Children’s Hospital at Westchester Medical Center with seed money from  the March of Dimes, and in collaboration with key organizations including local county departments of health, local community hospitals and health centers, and community-based organizations. The goal of the Lower Hudson Valley Perinatal Network is to improve birth outcomes, eliminate disparities in birth outcomes and improve the health of women, children and families in Dutchess, Putnam, Rockland and Westchester counties. 


The New York State Comprehensive Prenatal-Perinatal Services Networks Program  was established in 1987. The overall mission of the program is to collaborate and coordinate work with key stakeholders to implement broad population-based interventions that will enhance, promote and improve the perinatal health care system to improve pregnancy outcomes and access to and utilization of prenatal-perinatal health care services.


Dutchess, Putnam, Rockland, and Westchester, the counties previously without a state funded Perinatal Network, have the highest number of Hudson Valley Region live births (74 percent or 21,723). Additionally, the Lower Hudson Valley Region is ethnically diverse, having the highest percentages of live births to foreign-born mothers in the entire Hudson Valley Region, with 37.4% in Westchester, 33.3 percent in Rockland, 18.5 percent in Putnam, 18.3 percent in Dutchess (NYSDOH, 1993-1998). The Lower Hudson Valley Perinatal Network counties have unique issues with racial and ethnic disparities in perinatal outcomes as well, contradicting the common belief that these are the wealthiest counties without significant perinatal issues.


Major accomplishments of the Lower Hudson Valley Perinatal Network since its inception in 2004 include the following:

·       Awarded a $1,050,000 grant over five years from the NYS Department of Health to become the newest and only state funded Comprehensive Prenatal-Perinatal Services Network Program for the Lower Hudson Valley Region.   

·       Awarded a $50,000 grant from the Westchester County Youth Bureau to develop and implement a Social Health Marketing Campaign aimed at improving birth outcomes in Mt. Vernon and Peekskill. 

·        Educated more than 710 providers and consumers through the network’s quarterly education and networking meetings.

·        Published and distributed 300 copies of the Lower Hudson Valley Perinatal Resource Directory, listing more than 290 local organizations.

·        Partnered with the United Way to promote a Perinatal Resource Line through the United Way’s Hudson Valley Regional Call Center (211) 

·        Completed a comprehensive community needs assessment.

·        Served as the co-chair of the Hudson Valley Regional Perinatal Forum and Chair of the Forum’s Access to Care Action Committee.

·        Enhanced the Lower Hudson Vally Perinatal Network’s Web presence through a new Web site, , that serves as a portal to perinatal resources in the Lower Hudson Valley

·        Gave presentations on the project at regional and national pediatric and public health meetings.

·        Expanded the Lower Hudson Valley Perinatal Network Steering Committee membership to include consumer, faith community and business representation.

·        Invited to join the Association of Perinatal Networks of NY, an organization of statewide perinatal networks.


Cheryl Hunter-Grant, LMSW, serves as the Lower Hudson Valley
Perinatal Network’s executive director, and Heather Brumberg, MD, MPH, serves
as its medical director. For more information, visit the Web site,, call (914) 493-6435, or e-mail or


Symptoms of depression can develop at any time throughout life, but women are especially vulnerable to symptoms of depression during pregnancy and after giving birth.  After having a baby, many mothers feel sad, afraid, angry, or anxious, and may also feel guilty for having these negative feelings.  These feelings or “Baby Blues” are common and usually only last a few days.    


Feelings that last for more than two weeks or get worse could be signs of postpartum depression.  According to a Grantmakers in Health Bulletin article (Oct. 18, 2004), about 10-20 percent of new mothers are depressed – yet the diagnosis may go undetected.  The Journal of Women’s Health notes that 20 percent of women screened in obstetric clinic waiting rooms scored in the depression range – with fewer than 15 percent receiving treatment.


Screening for symptoms of depression is important, particularly for women of color.  Nearly 50 percent of Latina and black mothers reported depression symptoms compared to about 31 percent of white mothers, according to a national study supported by the Agency for Healthcare Research and Quality completed in June 2005.


The Maternal and Child Health Consortium, a community-based social services organization, works to improve access to high quality health care for women and children in Chester County, Penn.  The Consortium’s Healthy Start program is a prenatal home visiting program that provides women with a diverse array of supportive services.  In 2003, the Consortium began to screen Healthy Start participants for depression using the Edinburgh Postnatal Depression Screening.  Nationally, Healthy Start programs are providing depression screening, and programs use a variety of screening tools.  MCHC’s Healthy Start staff of Family Health Advocates receive training on perinatal depression, screening procedures and follow-up protocols, from trainers at the Health Federation of Philadelphia and a psychiatrist with extensive experience treating postpartum depression.


In order to determine if a woman is experiencing symptoms of depression, Healthy Start’s Advocates (most of whom are bilingual and bicultural) screen women at least twice during the perinatal period.  The first screening takes place during the home visit by the Advocate for the prenatal needs assessment.  The second screening takes place during the home visit for the postpartum needs assessment, one month after the baby is born.  Additional screenings may be done if the participant is experiencing a stressful life event such as separation from the baby’s father, loss of a job, domestic violence, etc. 


In addition to the survey, all Healthy Start moms receive information about the symptoms and treatment of depression as well as things new moms can do to feel better.  In cases where the survey shows a woman has symptoms of depression, Healthy Start staff will provide her with emotional support and connect her (where possible) with mental health professionals for further assessment and treatment.     


To help better meet the needs of participants experiencing depression, MCHC founded a pilot support group called “Mujeres Latinas Apoyandose” (Latina Women Supporting Each Other) in 2005 in collaboration with Family Service of Chester County.  The support group helps to address the unique issues that Latina women encounter in Chester County.  Many Latina women are isolated from the community and its services due to lack of transportation, and many do not speak English.  Often, husbands work long hours and are unavailable to their families.  The support group helped to reduce the feelings of isolation experienced by the women. 


In 2005, MCHC completed an Edinburgh Postnatal Depression Screening survey for 419 (84 percent) of all pregnant participants enrolled or giving birth during 2005.  Of these, 155 (37 percent) scored positive in the range for possible or probable depression.  Healthy Start staff assisted 51 (82 percent) of pregnant participants scoring 14 or higher on the survey with receiving further assessment and treatment from a mental health provider. 


MCHC also completed an Edinburgh Postnatal Depression Screening survey for 369 participants giving birth in 2005.  Of these, 86 (23 percent) scored positive in the range for possible or probable depression.  Healthy Start staff assisted 23 (85 percent) of interconceptional participants scoring 14 or higher on the survey with receiving further assessment and treatment from a mental health provider.  Barriers faced by Healthy Start participants on obtaining mental health services for depression included: lack of health insurance, child care, and transportation.  Additionally, Healthy Start participants feared that the county’s child welfare agency would take custody of their child/ren if they received mental health treatment.


Federal funding through Healthy Start and private funding through the Chester County Fund for Women and Girls supports this work.  For more information about Maternal and Child Health Consortium, please visit


A group of physicians, nurses, lactation consultants, La Leche League leaders, mothers and others are working together to establish a non-profit community milk bank in the Boston area to serve hospitals and families in New England. We are working under guidelines and guidance of the Human Milk Bank Association of North America.

Although the first milk bank in the country was established in Boston almost 100 years ago, there is little recent experience in Boston and most of New England using banked milk for premature, NICU and other compromised babies. The Mothers Milk Bank of New England is working to educate medical practitioners, families and the community about the use of banked milk when mothers' own milk is not available.

Please join our effort to establish the Mothers' Milk Bank of New England.  We welcome your questions, skills, knowledge, time and energy.  For more information, please contact:   Naomi Bar-Yam or Ilene Fabisch at



An Oklahoma organization, joined by state and federal officials, applauded the efforts not only of mothers who provide natural nourishment for their children, but also legislators who support the rights of those mothers during a ceremony in May.

As part of celebrating Mother's Day, the Coalition of Oklahoma Breastfeeding Advocates  honored legislators who helped bring about legislation to support breastfeeding mothers. Governor Brad Henry signed the first substantial measure in 2004. HB 2102, introduced by Rep. John Carey, D-Durant, Rep. Greg Piatt, R-Ardmore, and Sen. Nancy Riley, R-Tulsa, encourages mothers to breastfeed in any location. Also, breastfeeding is not to be considered indecent exposure. The measure also exempts mothers from serving as jurors if they are breastfeeding or are unemployed and have a child who is not enrolled full time in an early childhood education program.

In 2005, the Legislature passed HCR 1015, introduced by Rep. Dale DePue, R-Edmond, which called on state employers to provide a sanitary place and refrigeration units for breastfeeding mothers to express and store milk in the workplace, using unpaid break and lunch times to do so. DePue also was part of this year's efforts for HB 2358, introduced by Sen. Susan Paddack, D-Ada, which provides guidelines for workplace policies governing breastfeeding. The governor signed HB 2358 on April 24.

DePue said HB 2358 held special importance for him because it was his first bill to pass and be signed by the governor. He also announced that the Capitol is now equipped with a designated room for breastfeeding mothers - complete with a refrigerator for mothers to store their milk.

New mothers are a growing segment of Oklahoma's workforce, and they need to be welcomed into a supportive environment, said state Secretary of Health Terry Cline. Breastfeeding yields health benefits for both mother and child, including providing biological and emotional bonding for mother and child and protection for children from infections, according to information from the Coalition of Oklahoma Breastfeeding Advocates.

In Oklahoma, breastfeeding rates have increased by more than 10 percent since 2000, said Esther Phillips, deputy regional administrator for the U.S. Department of Agriculture's Food and Nutrition Service. While legislation to support breastfeeding mothers will help protect mothers, another part of encouraging breastfeeding is to educate people about its importance. One of the USDA's campaigns is called Loving Support, to encourage the family and community to support breastfeeding mothers and to overcome cultural barriers and stigmas that may prevent mothers from breastfeeding, Phillips said.  In the black community, for instance, there remains a mentality that African-American ancestors who were slaves in the South were often charged with breastfeeding their owner's children.

That notion is coupled with thoughts that breastfeeding is a private matter, Phillips said. Also, there is the perception of breastfeeding as it relates to income - if a mother can afford formula for her children, she feels she does not have to breastfeed, she added. However, the USDA is spending millions of dollars annually to educate the public about the importance of breastfeeding. Oklahoma's legislators have helped those efforts, Phillips said, but more support is needed.


Benefits Include Reduced Risk of HIV

The divorced parents of an 8-year-old boy are fighting in a suburban Chicago court over whether the child should be circumcised.  The child suffers from recurring painful inflammation and can only wear loose-fitting pajamas.  The father, who was granted the right to participate in the child's medical decisions as part of the divorce decree, feels the operation is unnecessary and will cause his child long-term physical and psychological harm. 

The case is part of a national debate over the pros and cons of circumcision.  Although circumcision is important in Judaism and several other religions, it is not normally medically necessary, although it can be recommended in cases of recurring inflammation or infection.  The father in the Chicago case claims that his feelings about the religious implications of circumsion are not a factor in his objections.

The American Academy of Pediatrics no longer supports routine circumcision for babies, due to medical evidence that circumcised men have less penile sensitivity, although circumcised men have lower rates of urinary tract infections.  Routine circumcision rates have fallen from about 90 percent in 1970 to about 60 percent today.  About 1.2 million baby boys are circumcised every year, at an annual cost estimated between $150 million and $270 million.  Medicaid programs in sixteen states no longer reimburse for the procedure, calling it unnecessary.

French and South African Researchers Find Circumcision Reduces Risk of HIV

A controversial study conducted in South Africa demonstrated that circumcision can cut HIV infection rates by as much as 60 percent.  Although many studies have shown a relationship between existing circumcision and lower HIV rates, this is the first study that has used circumcision as an active intervention in the battle against the epidemic. 

Circumcision can be risky in the Third World, where lack of training and the risk of dirty tools could expose men to more infections.  Researchers also fear the "disinhibition" factor, which would lead circumcised men to engage in more risky behavior than might have been expected without the procedure.  However, even small reductions in the world-wide incidence of HIV could save hundreds of thousands of lives each year.

The study was published in the journal PLos Medicine, amid a storm of controversy over ethical issues of informed consent involved in the study. 

For more information on the Chicago case, go to the MSNBC report at: . For more information on how circumcision affects the HIV rate, go to the MSNBC report at:



The National SIDS/Infant Death Resource Center is developing a searchable electronic compendium of information collected from national, state, and local SIDS/Infant Death programs, and perinatal, stillbirth, MCH, and bereavement organizations. The compendium will be inclusive of resource materials such as fact sheets, brochures, booklets, posters, order forms, and electronic materials in CD/DVD/video format (including foreign-language materials).

These materials will be posted under “Topics A–Z” in June 2006 on the NSIDRC Web site at  Publications and resources will be available to download and print. This “one-stop shopping” feature will help to increase efficiency for those seeking information. Participants may also access all publications submitted by a particular organization, i.e., the National Institute of Child Health and Human Development (NICHD).

The Resource Compendium can assist you to increase the visibility of your publications! If you would like to contribute your organization's publications related to sudden infant death syndrome (SIDS), infant death, stillbirth, perinatal death, and bereavement, the link below will take you to a Web page where you can enter specific information for each publication to be submitted." href="">

In order to be included, the publication (or order form) must currently be online in HTML, PDF, or Word format.  Please contact Carol Kennedy at (866) 866-7437 (toll-free) if you have any questions.


The Bright Futures for Infants, Children, and Adolescents Initiative was launched in 1990 under the leadership of the Federal Maternal and Child Health Bureau of the Health Resources and Services Administration, to improve the quality of health services for children through health promotion and disease prevention. Bright Futures uses a developmentally based approach to address children’s physical and psychosocial needs within the context of their families and communities. It includes a set of child health supervision guidelines with accompanying materials for parents and providers on child health and special topics, such as mental health, oral health, nutrition, and physical activity.

Between 2002 and early 2006, Maternal and Child Health Bureau contracted with Health Systems Research, Inc. to conduct the first national evaluation of Bright Futures, to develop a series of case studies exploring how Bright Futures has been used in public health child health promotion efforts.  HSR will also develop a resource guide for states and communities on how to use Bright Futures in their own efforts to improve the health of children and the quality of care they receive. Brief summaries of each HSR report are provided below and are available online at or through the national Bright Futures Web site at

  • Assessing the Bright Futures for Infants, Children and Adolescents Initiative: Findings from a National Process Evaluation presents the findings of the national process evaluation conducted by HSR. The report describes the evolution of the initiative between 1990 and 2002 and assesses progress on the initiative’s objectives related to development and dissemination of Bright Futures philosophy and materials, training, partnerships, and evaluation. It includes a wide array of examples of how Bright Futures has been incorporated into clinical practice, education and training, public health programs, and policy development activities related to children’s health, as well as recommendations for the future of the initiative.

  • Using Bright Futures in Public Health Efforts to Promote Child Health: Findings from Six Case Studies includes a synthesis of case study findings as well as the individual case study reports. The synthesis addresses cross-cutting findings including why Bright Futures is used, who uses Bright Futures, and how Bright Futures is used in public health activities including policy development and planning, education and training of health and related professionals, education and outreach to families and communities, and clinical practice. Challenges faced by case study states in maintaining and enhancing their Bright Futures efforts, as well as strategies for addressing them, are also discussed. (Note individual state case study reports are also available for downloading.)

  • Promoting Utilization of Bright Futures Health Supervision Guidelines: A How-to Guide for States and Communities is a user-friendly resource guide intended to help those interested in using the Bright Futures philosophy and materials to increase health quality and well-being among children and families. This guide is intended to be used by an array of individuals, organizations, agencies, and groups. It provides concrete information on how to get the Bright Futures process started and how to sustain it.

Currently, the American Academy of Pediatrics is developing the third edition of the Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents, which will be released in 2007, and maintains the national Bright Futures Web site at


Healthy Start Supervisor, Pennsylvania:  F/T position in Kennett Square.  Manage Healthy Start outreach and home visiting program for pregnant women & infants.  Provide case management services & supervise paraprofessional outreach workers.  Bachelor’s degree with supervision experience preferred.  Bilingual in Spanish-English required.  Paid health insurance & 401K.  EOE.  Send, fax or e-mail resume to: HS Program Director, MCHC, 30 W. Barnard St., Suite #1, West Chester, PA  19382, fax (610) 344-5279,


A study appearing in the journal Pediatrics shows that, in the last decade, an apparent increase in the prevalence of children in special education programs who have been labeled as autistic has been accompanied by a decrease in the categories of mental retardation and learning disabilities during the same period.  The researchers concluded that diagnostic substitution, rather than increased prevalence, may be behind increased rates of autism today.  The research highlights the need to address the lag between scientific findings and school special education policies. 

The original journal citation is:   Shattuck PT. "The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education." Pediatrics 2006; 117: 1028-1037.

For a more detailed summary, see the report on MedPage Today at  MedPage Today(TM) provides real-time coverage of breaking medical news and the top stories in health and medicine. Physicians may also receive Category 1 CME credit as part of our news coverage. There is no cost to use the service and you can sign up for Daily Headlines e-mail. Visit MedPage Today at

ASTHMA: Recent Studies Cover Disparities, Birth Risks, Compliance with Treatment, Risks of Antibiotic Use

Asthma:  Disparities Growing Between Black Children and White

A study at Children's Memorial Hospital in Chicago showed that gaps between black and white children in treatment of asthma and mortality from the disease are growing.  Black children are hospitalized for asthma four times more frequently than white children, and are five times more likely to die, despite the establishment of several national programs to improve asthma treatment and prevention.  For more details, see MedPage at: .  The journal citation is:  Gupta RS et al. The widening black/white gap in asthma hospitalizations and mortality. Journal of Allergy and Clinical Immunology. 2006; 117(2):351-358.

Women with Asthma At Greater Risk of Premature Birth, Low Birth Weight

Preganant women with asthma in Manitoba in 1995 were three times more likely to have a premature birth and four times more likely to have a baby weighing less than 1,000 grams, even if they have no asthma symptoms in the year before giving birth.  There is evidence to suggest that airway smooth muscle hypercontractilityin the child might be related to uterine smooth muscle contractility in the mother.   These preliminary results were presented at the meeting of the American Academy of Allergy, Asthma, and Immunology in Miami Beach in March.  For more details, see MedPage at:

Asthmatic Children Don't Use Enough Medicine

When comparing patient self-reports of medication use and actual use, researchers found that children tended to use only 25 to 50 percent of the amount of medication prescribed.  Children are reluctant to use the medication because of the side effects, and parents do not enforce treatment because they are afraid the children will become dependent on the inhalers.  In addition, asthma is an intermittent disease for many, and patients are less willing to comply with prescribed medication when they have no symptoms.  These preliminary results were presented at the meeting of the American Academy of Allergy, Asthma, and Immunology in Miami Beach in March.  For more details, see MedPage at:

Antibiotics in First Twelve Months of Life Double the Risk of Later Asthma

Asthma has become the most common chronic disease of childhood, and the increase has coincided with the increased use of antibiotics in young children.  A meta-analysis of four prospective studies and four retrospective studies suggests that the two phenomena may be causally related, although it is also likely that causality may run the other way -- that is, children with asthma are more susceptible to infection, leading to greater use of antibiotics.  These preliminary results were presented at the meeting of the American Academy of Allergy, Asthma, and Immunology in Miami Beach in March.  For more details, see MedPage at:

MedPage Today(TM) provides real-time coverage of breaking medical news and the top stories in health and medicine. Physicians may also receive Category 1 CME credit as part of our news coverage.  There is no cost to use the service and you can sign up for Daily Headlines e-mail. Visit MedPage Today


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:  The journal articles include the following:  

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:  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:  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:  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:  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:  The guidelines are published as:  ACOG Committee on Practice Bulletins "Clinical Management Guidelines for Obstetrician-Gynecologists" Number 71, April 2006. 

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