[NFIMR] May 19th 2009 NFIMR Listsev

Kathleen Buckley KBuckley at acog.org
Tue May 19 11:56:59 EDT 2009

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From ACOG New Releases: Bad Economy Blamed for Women Delaying Pregnancy and Annual Check-Up. New Gallup Survey Reveals Disturbing Trends 
As a result of the economy, women are delaying pregnancy as well as their annual well-woman exam, according to a new Gallup Organization survey conducted for The American College of Obstetricians and Gynecologists (ACOG). These significant trends attest to the toll that the economy is taking on women's reproductive health, yet it is not clear whether there will be long-term health consequences for women, according to ob-gyns.  The troubled economy is greatly influencing a woman's decision about when to become pregnant and how many children to have. Overall, 14% of women ages 18-44 who were surveyed said that the economy has had an effect on their plans to increase the size of their family; among married women, this increased to 17%. As for delaying pregnancy, 12% of the women surveyed know someone who has postponed a planned pregnancy because of the economy. Nearly one in 10 married women (9%) indicated that the economy was a factor in their decision to postpone a planned pregnancy. Compared to a year ago, the survey found that one in five women (20%) is more concerned today about having an unintended pregnancy, and similarly, about one in five women (19%) is more conscientious about using birth control to avoid pregnancy. Today, worries are even higher among women who are in a relationship but not married—one-third (33%) are more concerned about an unintended pregnancy, and 32% are more mindful of their contraceptive use so as not to get pregnant. According to the ACOG survey, two-thirds of women (66%) ages 18-44 report that they have been affected by the country's economy. 
In addition, according to the survey: 
·                     Two-thirds of women (66%) ages 18-44 report that they have been affected, at least to some extent, by the country's economy, including 18% who say the nation's economy has affected them a great deal and 48% who say they have been personally affected to some extent. 
·                     More specifically, 
o        One in eight women (12%) says they have experienced a job loss as a result of the economy. 
o        Six percent of women report having lost their health insurance. 
o        Nine percent of women report they have taken on an extra job. 
o        One in seven (14%) says they have postponed an annual ob-gyn check-up. 
o        Fifteen percent report having cut back or stopped taking some medications because of the cost.
For more information about this important study, go to http://www.acog.org/from_home/publications/press_releases/nr05-05-09-1.cfm 
Quick Health Data Online
Curious about the rates of disease in your area compared to the national average? Working on a presentation requiring prevention, chronic disease or mortality data? Check out Quick Health Data Online (www.womenshealth.gov/quickhealthdata), a free health statistic database provided by the U.S. Department of Health and Human Services' Office on Women's Health.  
Quick Health Data Online provides state- and country-level data for all 50 states, the District of Columbia, and U.S. territories and possessions. The system is organized into 11 main categories, including prevention, chronic and infectious diseases, mortality, access to care, reproductive and maternal health, mental health, Healthy People 2010 targets and more. Quick Health Data Online allows users to easily generate maps as well as charts and tables-perfect for your presentations, reports or articles. You can also use this database as an in-class resource, or incorporate it as part of assigned projects or presentations. 
The Office on Women's Health regularly develops new tools for the system, most recently the 2009 Edition of the Women's Health and Mortality Chartbook, which presents 27 health indicators related to women's health, and the Health Disparities Profile. Check out Quick Health Data Online at www.womenshealth.gov/quickhealthdata.
Two Large Recalls: 
1)The U.S. Consumer Product Safety Commission and Health Canada, in cooperation with Build-A-Bear Workshop®, of St. Louis, Mo announced a voluntary recall of about 260,000 Folding Toy Beach Chair for Stuffed Animals in the US and 9,700 in Canada This toy is made in China and has chair legs can bruise, pinch or cut fingers if caught while folding. There have been eight injuries reported. Consumers should stop using recalled products immediately unless otherwise instructed. To learn more or to view the chair, go to http://www.cpsc.gov/cpscpub/prerel/prhtml09/09220.html 
2)The U.S. Consumer Product Safety Commission and Health Canada, in cooperation with Dorel Juvenile Group Inc., of Columbus, Ind. announced a voluntary recall of about 71,000 Eddie Bauer Soothe & Sway Play Yards in the United States and about 5,600 in Canada. Consumers should stop using recalled products immediately unless otherwise instructed. The play yard’s rocking bassinet attachment can tilt even when secured by straps in the non-rocking mode or can stay tilted without returning to a level sleeping surface while in the rocking mode, causing an infant to roll to the corner or side of the bassinet. The infant can then become wedged in the corner or pressed against the side or bottom of the bassinet, posing a risk of suffocation or positional asphyxiation. This toy was made in China. For more information about this product or to view the toy go to http://www.cpsc.gov/cpscpub/prerel/prhtml09/09219.html 
New consumer program for child safety seats: A future NHTSA project
U.S. DOT Announces New Consumer Program for Child Safety Seats

The U.S. Department of Transportation recently announced that it will create a new consumer program to help parents and caregivers find a child seat that fits in their vehicle. The new program is the result of a comprehensive review ordered by the new Transportation Secretary Ray LaHood to improve child passenger safety and Federal child seat standards. Secretary LaHood also ordered the National Highway Traffic Safety Administration to develop a new side impact safety standard for car seats. Side impact crashes account for one-third of all highway deaths among children under thirteen years old. The internal review found that current standards, which require child seats to withstand forces that are more severe than 99.5 percent of real-world crashes, are effective. This new National Highway Traffic Safety Administration (NHTSA) program, planned to be implemented beginning the year 2011, will help parents to choose the most effective child safety seats by recommending specific seats in various price ranges that fit individual vehicles. For more information, go to 
How Healthy Is the Air You Breathe? For six out of ten Americans, the news isn’t good. American Lung Association’s tenth annual State of the Air Report shows what’s in our air—by location— and how the air we breathe continues to threaten the lives and health of millions of Americans. The State of the Air report offers local air quality rankings, including the 25 dirtiest cities.  It also offers hope—showing progress made in the fight for clean air, and an action plan to help clean the air and protect our lungs. You can get the grade for your community by typing in your zip code.  The 10th annual State of the Air report presents a wealth of data and paints a revealing picture of the air we breathe:
· Air pollution itself remains a real and urgent threat to public health. 
· Some cities have made steady progress to clean up their air, while others have had mixed results or gotten worse since our last report. 
· Six out of ten Americans live in areas with unhealthy levels of air pollution.
· 40.5 million Americans live in counties where the outdoor air failed all three tests.
· Only one city—Fargo, N.D.—ranked among the cleanest in all three air pollution categories covered in State of the Air.
· Certain people are especially vulnerable to the effects of air pollution, including infants and children, older adults, people with lung diseases like asthma, people with heart disease or diabetes, in addition to anyone who works or exercises outdoors.
· Minorities and lower income groups are disproportionately affected by illnesses caused by air pollution. 
To learn more or to see the air quality in your county, go to http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=3961901&content_id={21D9BC9E-F987-4EF7-9DCF-374114F9D135}&notoc=1 
Novel influenza A (H1N1) activity is now being detected through CDC’s routine influenza surveillance systems and reported weekly in FluView. CDC tracks U.S. influenza activity through multiple systems across five categories. The fact that novel H1N1 activity is now detected through seasonal surveillance systems is an indication that there are higher levels of influenza-like illness in the United States than is normal for this time of year. About half of all influenza viruses being detected are novel H1N1 viruses. To access the official site, go to http://www.cdc.gov/h1n1flu/ 
As the nation monitors the intensifying “swine flu” outbreak, the United States Breastfeeding Committee (USBC) recommends breastfeeding as a critical strategy to prevent infection. The Centers for Disease Control and Prevention (CDC) issued updated guidance on H1N1 (swine) flu considerations for pregnancy and breastfeeding, stating that: “Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness. Women who deliver should be encouraged to initiate breastfeeding early and feed frequently.” http://www.usbreastfeeding.org/NewsInformation/NewsRoom/200905BreastfeedingandSwineFlu/tabid/144/Default.aspx 
Also see MMWR’s report: Novel Influenza A (H1N1) Virus Infections in Three Pregnant Women --- United States, April--May 2009 at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5818a3.htm  and CDC’s information about pregnant women and H1N1 at http://www.cdc.gov/h1n1flu/pregnancy/ 
Challenge in Curbing the Spread of Swine Flu: Half of Workforce Lacks Paid Sick Days. The U.S. government has declared a public health emergency, allowing the distribution of antiviral drugs from a federal stockpile. The Centers for Disease Control (CDC) has recommended that those who are sick should stay home from work or school to avoid infecting others. However, analyses of Bureau of Labor Statistics and other data conducted by the Institute for Women's Policy Research (IWPR) have found that less than half of workers have paid sick days, and only one in three are able to utilize sick days to care for sick children. Workers without paid sick days lose wages if they stay home, and many workers risk losing their jobs. As a result, workers who lack paid sick time are more likely to go to work with a communicable illness, and parents who cannot stay home with a sick child are more likely to send sick children to school or day care. Workers who work in direct contact with the public, such as restaurant workers, child care workers, and hotel employees, are among the least likely to have paid sick days. People who go to work or school while sick may infect coworkers, customers, and classmates, resulting in even more infections. With seasonal influenza, this pattern of infection is a serious problem, costing employers and families millions of dollars a year and sometimes causing serious illness or death, especially among infants and the elderly. The deaths among young, healthy individuals in Mexico (identified as a serious cause for concern by the CDC and WHO) suggest that the swine flu has the potential to be much more costly and dangerous than typical seasonal influenza.
The swine flu situation raises the question of the public health costs of failing to provide paid sick days. Despite the public health implications and popular support - four of five Americans think that paid sick days should be a basic labor standard - no national or state laws require that workers have paid sick days.
For more information on paid sick days, visit www.iwpr.org.
NB: Another problem about the H1N1 flu outbreak that has been unnoticed and unreported is that many people or their children cannot afford any care because they have lost their health insurance. Thus they wait until they are very, very ill before seeking medical care.

From the American Academy of Pediatrics: Evaluating Your Community-Based Program This is a two-part guide to program evaluation for pediatricians and others implementing community-based health initiatives. 

Part I: Designing Your Evaluation

This resource will help pediatricians implementing community-based programs learn strategies for setting measurable objectives, identifying realistic outcomes, and developing logic models for health initiatives. The guide is designed in a workbook format, which allows it to be used by planning committees when developing program proposals or as an evaluation training tool for project staff.

NEW Part II: Putting Your Evaluation Plan to Work 
This is the follow up publication to Part I: Designing Your Evaluation. This guide takes the evaluation plan you developed for your community-based health initiative from the planning to the implementation stage. The guide goes through steps in a workbook format to help you decide how to measure progress on your objectives and collect, analyze, and present the resulting data meaningfully and efficiently.
To download these resources or to order a hard copy, go to http://www.aap.org/commpeds/htpcp/EvalResources.html 

Hasan, R et al. Self-reported Vitamin Supplementation in Early Pregnancy and Risk of Miscarriage American Journal of Epidemiology 2009 169(11):1312-1318
Between 2000 and 2008, the authors found that 4,752 US women were prospectively enrolled in Right From the Start. Information about vitamin use was obtained from a first-trimester interview. Discrete-time hazard models were used, candidate confounders were assessed, and the following variables were included in the model: study site, maternal age, gravidity, marital status, education, race/ethnicity, smoking, and use of progesterone in early pregnancy.The authors found that  approximately 95% of participants reported use of vitamins during early pregnancy. A total of 524 women had a miscarriage. In the final adjusted model, any use of vitamins during pregnancy was associated with decreased odds of miscarriage in comparison with no exposure. The authors conclude that these findings should be viewed in the context of a potentially preventive biologic mechanism  mitigated by possible confounding by healthy behaviors and practices that are also associated with vitamin supplement use during pregnancy. 
Oplar MGA et al.Prenatal Exposure to Lead, δ-Aminolevulinic Acid, and Schizophrenia: Further Evidence Environmental Health Perspectives Volume 116, Number 11, November 2008 
The authors report a previously conducted study of prenatal lead exposure and schizophrenia using δ-aminolevulinic acid, a biologic marker of lead (Pb) exposure, in archived maternal serum samples collected from subjects enrolled in the Childhood Health and Development Study (1959–1966) based in Oakland, California, suggested a possible association between prenatal Pb exposure and the development of schizophrenia in later life. In the present study they set out to extend these results using samples collected from the New England cohort of the National Collaborative Perinatal Project (1959–1966). The authors pooled matched sets of cases and controls from both the California and New England sites using a multilevel random-intercept logistic regression model, accounting for matching and site structure as well as adjusting for maternal age at delivery and maternal education. The authors found that estimated odds ratio for schizophrenia associated with exposure corresponding to 15 µg/dL of blood Pb was 1.92 (95% confidence interval, 1.05–3.87 ; p = 0.03) . Although several limitations constrain generalizability, the authors conclude that these results are consistent with previous findings and provide further evidence for the role of early environmental exposures in the development of adult-onset psychiatric disorders. 

Stroud LR et al. Maternal Smoking During Pregnancy and Neonatal Behavior: A Large-Scale Community Study PEDIATRICS Vol. 123 No. 5 May 2009, pp. e842-e848
The authors set out to investigate the influence of prospectively measured smoking during pregnancy on aspects of neonatal behavior in a large community sample. 
Participants were mothers and infants from the Providence, Rhode Island, cohort of the National Collaborative Perinatal Project enrolled between 1960 and 1966. Mothers with pregnancy/medical complications and infants with medical complications and/or born premature or of low birth weight were excluded. The final sample included 962 mother-infant pairs, 23% of whom were black. Maternal smoking was measured prospectively at each prenatal visit. Neonatal behavior was assessed by using the Graham-Rosenblith Behavioral Examination of the Neonate.. 
The authors found that Sixty-two percent of the sample reported smoking during pregnancy, with 24% of smokers reporting smoking 1 pack per day or more. They found a significant influence of maternal smoking exposure (none, moderate/less than 1 pack per day, heavy/1 pack per day or more) on irritability and muscle tone in the neonate, with exposed infants showing greater irritability and hypertonicity. Effects remained significant after controlling for significant covariates: maternal socioeconomic status, age, and race and infant birth weight and age. Posthoc tests suggested particular effects of heavy smoking on increased infant irritability and both moderate and heavy smoking exposure on increased muscle tone. 
In a large community sample, the authors conclude that exposure to maternal smoking was associated with increased irritability and hypertonicity in neonates. Exposure to maternal smoking did not influence neonatal response to respiratory challenge. This study is the largest-scale investigation to date of the effects of maternal smoking (heavy and moderate) on examiner-assessed neonatal behavior. Given the associations between both maternal smoking and infant irritability and later behavioral dysregulation, the authors say that their results have important implications for early identification and intervention with at-risk offspring. 

Quote sent from our readers:
“Our lives begin to end the day we become silent about things that matter.”
Rev. Martin Luther King, Jr
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The National Fetal and Infant Mortality Review Program is a partnership between ACOG and federal MCHB.
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