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Volume 5, No. 2, February 2007
From Your Colleagues
Steve Holve, Tuba City
New Children's Health Services Fellowship available
This was forwarded by David Grossman. The fellowship includes a stipend and other support
More information http://www.ichsr.org/Fellowship E-mail contact fellowship@ichsr.org
Sunnah Kim, AAP
2nd International Meeting on Indigenous Child Health in Montreal
Do you plan to attend the 2nd International Meeting on Indigenous Child Health in Montreal on April 20-22, 2007? If so, and if you are an IHS/federal employee, an important deadline is approaching. . .
Due to the Canadian location, all US federal employees will need to obtain a travel order and a federal passport (ie. red passport) to receive reimbursement. It is noted that one requirement for obtaining a federal passport is to have a current US passport. The IHS has developed resource materials outlining the necessary steps to obtain the special federal passport. While the process is not difficult, it does take about 3 months to process (meaning the deadline is January 20!!). Therefore, federal employees are encouraged to begin this process ASAP, if you plan to attend! For instructions on obtaining this passport and a travel order, see the attached Word document or visit www.aap.org/nach/2InternationalMeeting.htm
FOR ALL US ATTENDEES: As of January 1, 2007, those traveling by air or sea to and from Canada will be required to have a passport or other secure, accepted document to enter or re-enter the United States. Therefore, it is strongly recommended that all potential International Meeting attendees obtain a US passport if they do not already have one. Additional information on obtaining a US passport, including application materials, can be found at the link above.
The International Meeting will be a great opportunity for health professionals working with or interested in AI/AN child health to learn from the experiences of others who work with indigenous populations in both the US and Canada. The theme of this conference will be "Solutions, Not Problems". Additional information about the conference will be forthcoming via a conference brochure which will be sent to all IH-SIG members. Information can also be found on the conference Web pages (via the link above).
We hope to see you in Montreal!
Sunnah
Judy Thierry, HQE
How do you manage STI treatment for partners? AIAN and non beneficiary?
Partner Management: Once cases are found, they must be interviewed to identify recent sex partners so that those partners can also be treated. Partner management services such as this are usually handled by the state department of health Disease Intervention Specialist (DIS) and sometimes in collaboration with the Public Health Nursing (PHN) staff, or tribal STD/HIV program staff. How are they managed at your facility? How can they be managed better?
Contact Judith.Thierry@ihs.gov
Training and course work on epidemiology summer-institute
Thinking of summertime ? Oregon ???
The Summer institute curriculum is designed to meet the needs of professionals who work in diverse areas of American Indian and Alaska Native health, from administrators to community health workers, physicians, nurses, researchers, and program managers.
Courses are presented in a modular one-week format for three weeks.
Courses will be held on two campuses in downtown Portland, Oregon. Most
courses will meet on the campus of Oregon Health & Science University in
Portland, Oregon. A few courses will be hosted nearby at The Northwest Portland
Area Indian Health Board, located on the campus of Portland State University
. The registration deadline is May 15th, 2006.
http://www.ohsu.edu/summer-institute/
Consumer Reports: Only 2 out of 12 infant car seats tested performed well in crash tests
Consumer’s Union, publisher of Consumer Reports, conducted crash tests on 12 infant car seats at 35 mph (frontal crash) and 38 mph (side-impact crash), the speeds currently used to crash test most new cars and minivans. Base-mounted, rear-facing seats, suitable for children under one year and 22 lbs according to the manufacturers, were found to detach from their bases or twist violently, damaging test dummies in some cases. While the federal New Car Assessment Program scores crash safety in the form of highly publicized “star” ratings, no similar for score is used to rate infant and child safety seats. Manufacturers have improved car designs based on star ratings but there is no such incentive for car seat manufacturers. The tests also highlighted on-going problems with the federally-mandated LATCH system, where most car seats performed less well using LATCH than when attached with vehicle safety belts. A NHTSA report issued late last month stated that 40% of parents use safety belts instead of the LATCH system because of confusion about the system.
Press release from Consumer’s Union:
NHTSA report, Child Restraint Use Survey: LATCH Use and Misuse:
American Academy of Pediatrics Jan 2007 posting AAP infant passenger seat – guide to parents:
http://www.aap.org/family/infantpassengersafety.htm
SEAT sold in Europe top performer in crash tests:
AI / AN SIDS kits from CJ foundation available
Produced by the CJ foundation in collaboration with Aberdeen Area Tribal Chairman's Health Board (AATCHB) and the Great Lakes Inter Tribal Council (GLITC) these kits provide videos, posters, pamphlets for patient and community education. Training materials, PSA’s are included. Kits focus on sensitive risk reduction messages for moms, cover infant sleep positioning and ‘back to sleep’ messaging, use intergenerational messages, integrate parent and father focus, cover teen pregnancy psycho-social aspects. Materials are based on stages of change theory. Materials are derived from the communities themselves and can be adapted (with acknowledgement of CJfoundation). Katproductions provided the technical aspects of production, filming and hard print materials.
A mass mail-out in 2003 to distributed kits to all tribes, federal and urban programs.
KITS WILL ONLY BE AVAILABLE THROUGH JANUARY 2007!
The American Indian & Alaska Native SIDS Risk Reduction Resource Kit - order in as small or large a quantity as needed (and while supplies last). To place your order, please email: David Mayer with subject line: AI KITS. Include name, complete mailing address and the number of kits to be delivered. Emails with incomplete mailing addresses will not be processed. The kits and shipping are offered free of charge through the CJ Foundation for SIDS. Please allow 3-4 weeks for delivery. http://www.cjsids.com/
Overweight in toddlers breastfeeding protective dose dependent effect
Like the chicken and the egg – the question of when does obesity start and where to tackle it is provoking. This Medscape/ article/cme is a great 10 to 15 minute read taking you through the evidence behind toddler obesity and what WIC, health care workers of all professions and parents need to do. – Medscape CEU – integrates interview, history, and measures to address healthy weight and age appropriate activities for children. I highly recommend reading this!
A few excerpts to wet your appetite:
… Recent meta-analysis…studies on breast-feeding effects on future weight outcome … breast-feeding is significantly related to a lower risk for the development of obesity and that there is a dose-dependent effect. That is, for each month of breast-feeding, there is an associated 4% decrease in the risk of developing obesity. The odds ratio (OR) for obesity in infants breast-fed longer than 9 months was 0.68, indicating a decrease in the likelihood of being obese if an infant was breast-fed for more than 9 months.
Harder T, Bergmann R, Kallischnigg G, Plagemann A. Duration of breastfeeding and risk of overweight: A meta-analysis. J Epidemiol. 2005; 162:397-403.
AND
… intake patterns during toddlerhood foreshadow shortcomings of children's diets noted in later developmental periods in that fruit and vegetable intake is notably low, even absent in some children. Among toddlers aged 1 year and older, 18% to 23% consumed no vegetables, and between 25% to 33% consumed no fruit. By the age 15 months, french fries were the most commonly consumed vegetable and 44% of toddlers consumed a sweetened beverage daily. Skinner JD, Ziegler P, Pac S, DeVaney B. Meal and snack patterns of infants and toddlers. J Am Diet Assoc. 2004; 104:S65-S70.
AND
… children learn to prefer the familiar, so that the foods caregivers purchase for the home and send in prepared lunches, and the types of foods children consume outside the home, provide a foundation for children's later food preferences. In one study, preschool-aged children were given either a sweet, salty or plain version of a novel food as a series of snacks. Regardless of their assigned version, over time children showed higher preference for the food they were repeatedly served (5 to 10 times) as compared to the unfamiliar versions.
Sullivan SA, Birch LL. Pass the sugar, pass the salt: experience dictates preference. Dev Psychol. 1990;26:546-551.
AND
Pressuring children to eat can also undermine the child's own sense of fullness as the sign to stop eating. Birch and colleagues also found that focusing children on the amount of food remaining on the plate, the time on the clock, or rewarding for finishing the food on their plate disrupted the child's ability to self-regulate energy intake at a meal.
Birch LL, McPhee L, Shoba BC, Steinberg L, Krehbiel R. "Clean up your plate": effects of child feeding practices on the conditioning of meal size. Learning and motivation. Learning Motivation. 1987;18:301-317.
http://www.medscape.com/viewarticle/520834?sssdmh=dm1.237155&src=top10#
New Child Health USA Report Released
A recently published HRSA report indicates that prenatal care and breastfeeding rates are improving, but that low birth weight rates are increasing and the U.S. infant mortality rate remains high compared to other developed nations.
Key findings from Child Health USA 2005, the 16th annual assessment of the health status and service needs of America's children, include:
- The rate of first-trimester prenatal care has been increasing steadily since the early 1990s. The proportion of non-Hispanic black, Hispanic and American Indian women receiving early prenatal care has increased by 20 percent or more since 1990, and 84.1 percent of pregnant women received early prenatal care in 2003. Non-Hispanic white women had the highest rates of prenatal care at 89.0 percent, followed by Asian-Pacific Islander women at 85.4 percent, Hispanic women at 77.5 percent, non-Hispanic black women at 75.9 percent, and American Indian women at 70.8 percent.
- Breastfeeding, which enhances the health of mothers and infants, has been steadily on the rise since the beginning of the 1990s. In 2003, 70.9 percent of mothers started breastfeeding when their babies were born, the highest rate yet recorded. While 36.2 percent of mothers were still breastfeeding their infants at 6 months, only 14.2 percent were breastfeeding their 6-month-olds without any other form of nourishment. Many government and international initiatives promote breastfeeding as the best way to feed a baby. [initiation, exclusivity, duration- Thierry]
- A 2002-03 CDC survey shows that 80.5 percent of children ages 19 to 35 months received the recommended series of vaccines. As a result of increased immunization, the number of reported cases of vaccine-preventable diseases continues to decrease. In 2003, there were no reported cases of diphtheria, tetanus, rubella or polio among children under 5 years of age, and very few cases of hepatitis B, measles and mumps. HHS’ Healthy People 2010 objective is to immunize at least 90 percent of children in this age group.
- Despite improved rates of prenatal care, the rate of low-birth-weight births (less than 2,500 grams or 5 pounds, 8 ounces) is currently at the highest level in the past three decades. In 2003, 7.9 percent of all births were considered low birth weight, rising steadily from a low of 6.7 percent in 1984. Very low birth weight (less than 1,500 grams or 3 pounds 4 ounces) is also increasing, representing 1.4 percent of all live births in 2003, compared to approximately 1 percent in 1980. Low birth weight babies are significantly more likely to die in the first year of life than babies of normal birth weight, and those who survive are at risk for severe physical, developmental and cognitive problems. [see Kay Tomashek et al. article in Dec 06 APHA AIAN low birth weight – also mentioned in the Chief Clinical Consultant Corner*]
- Although rates of maternal and infant mortality have dropped in the past century, the U.S. still has one of the higher rates of infant death in the industrialized world. Seven out of every 1,000 babies born alive in 2003 died in their first year, according to the report.
Child Health USA 2005 provides the most current information available for public health professionals, policy makers and others on more than 50 health and health care indicators. Data are drawn mainly from 2003-04 surveys and reports supported by federal agencies and non-profit organizations, and are depicted in easy-to-use bar graphs and pie charts, with trend analyses, when applicable. http://www.mchb.hrsa.gov/mchirc/chusa_05/index.htm
* Kay Tomashek et al. article in Dec 06 APHA AIAN low birth weight in December CCC Corner
http://www.ihs.gov/MedicalPrograms/MCH/M/obgyn1206_HT.cfm#child
The infant mortality rate for 2004 was 6.79 infant deaths per 1,000 live births
The 10 leading causes of infant mortality for 2004
- Congenital malformations, deformations and chromosomal abnormalities (congenital malformations);
- Disorders related to short gestation and low birth weight, not elsewhere classified (low birthweight);
- Sudden infant death syndrome (SIDS);
- Newborn affected by maternal complications of pregnancy (maternal complications);
- Accidents (unintentional injuries);
- Newborn affected by complications of placenta, cord and membranes (cord and placental complications);
- Respiratory distress of newborn;
- Bacterial sepsis of newborn;
- Neonatal hemorrhage; and
- Diseases of the circulatory system
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/finaldeaths04/finaldeaths04.htm
Genomics: study of gene to gene and gene to environment interactions
Genomics is the study of the entire genome, including all genes and their interactions with each other and with the environment. The scope of public health genomics is even broader, encompassing genetic variation in populations, both human and microbial. Molecular typing of pathogens---a mainstay of infectious disease surveillance, prevention, and control---already is used to trace epidemics, provide information for vaccine development, and monitor drug resistance. Now genomic research is producing powerful new tools for public health; for example, a newly described, microchip-based method promises to diagnose influenza infection, distinguish among viruses of human or animal origin, and detect mutations that suggest increasing virulence---all in a matter of hours .
Until recently, public health applications of human genetics were limited largely to state-mandated programs that screened newborn infants and ensured access to genetic services for affected children and families. Now genomic research and technology have generated new molecular targets and new tests for newborn screening, kindling renewed debate on their relative benefits, risks, and costs. Public health investigations of diseases with infectious and environmental causes also are beginning to evaluate the contribution of human genetic variation to susceptibility and natural history.
Most population-based research in genetic epidemiology has focused on common, chronic diseases, as reflected in approximately 22,000 scientific publications during the last 5 years (9). The results point to complex interactions among multiple genes and environmental factors, which remain poorly understood. However, small successes in translation illustrate the potential for public health genomics in three areas:
- stratifying risk to guide multilevel interventions,
- understanding environmental causes of disease, and
- identifying new opportunities for prevention.
Family health history, which captures information about shared inherited and environmental factors, is a simple and inexpensive genomic tool for identifying persons and families at high risk. For example, a Utah study indicated that the 14% of families with positive family histories for coronary heart disease (CHD) accounted for 48% of all persons with CHD and for 72% of CHD events occurring before age 55 years. Population-based data and careful cost-effectiveness analysis are needed to determine whether combining traditional, population-level prevention strategies with more intensive interventions for families at increased risk will improve the return on investment in prevention.
Public health interventions are based on understanding and modifying environmental risk factors. For example, recognition of inadequate folate status as a cause of neural tube defects led to an effective public health intervention to increase folic acid intake among reproductive-aged women. A systematic review of epidemiologic data on birth defects in relation to folic acid intake and variation in the methylenetetrahydrofolate reductase (MTHFR) gene illustrates "Mendelian randomization", in which the effects of specific environmental exposures, such as dietary elements, drugs or toxins, are either accentuated or mitigated in persons with different variants of genes involved in physiologic response. Because genotype is "randomized" at birth, biologic information thus can strengthen evidence obtained from traditional environmental risk factor studies and provide a less biased framework for interpreting data on gene-environment interactions.
Public health genomics can provide information about population-level interventions that do not depend on knowledge of individual genotypes. For example, a study in Mexico of children with asthma found that supplementation with the antioxidant vitamins C and E improved lung function in children with a common polymorphism of glutathione S-transferase M1 (GSTM1) who are exposed to ozone. If confirmed by other studies, this finding might suggest a simple intervention---antioxidant vitamin supplementation---for children with asthma who are exposed to ozone. Without genotype-specific analysis, a potentially important population-level intervention could have been overlooked.
Just as genomics will enhance the knowledge base for public health research and practice, public health principles and methods can provide information for genomics research and translation. Rigorous application of population-based methods for collecting, evaluating, and interpreting the evidence on genetic variation in relation to health and disease will improve research quality, promote knowledge synthesis, and help identify research gaps. By keeping the focus on population-level implications, the public health perspective helps ensure the entire population benefits from public investment in genomics research.
http://www.cdc.gov/mmwr/preview/mmwrhtml/su5502a8.htm?s_cid=su5502a8_e
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OB/GYN
Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.
