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Facing ‘Newer Morbidities’ in Children and Adolescents In 2000, the U.S. Public Health Service identified "new morbidities" that have replaced infectious diseases as the major ailments of childhood—risk factors such as smoking and teen sex, for example, as well as changes in the physical environment and behavioral problems ranging from mild to severe. The American Academy of Pediatrics agreed that those "new morbidities" now make up the major part of pediatric practice But in a statement released in November, the American Academy of Pediatrics is revising the original list of "new morbidities" to include other problems that health practitioners increasingly see in young patients. Writing in the November issue of the journal Pediatrics, AAP’s Committee on Psychosocial Aspects of Child and Family Health identified the following "newer morbidities":
In addition, many children’s lives are complicated by social issues that affect their well-being, such as poverty, homelessness, single-parent families, parental divorce, and child care policy and quality, the committee pointed out. "These are the morbidities that place our patients at risk," the committee said. "The mortality of meningococcemia is appreciated by all pediatricians, but the morbidity of depression and the mortality of adolescent suicide are more appreciable. In other words, after infancy, children in the United States are more likely to die from injuries or violence than from infectious diseases." The Path Ahead The AAP statement cites some of the obstacles to recognizing and treating the new morbidities in children, including that many medical professionals have had no training in this area; the time required to discover such disorders is often not compensated by health maintenance organizations or public health services; and there is no good model for coordinating mental health services across a variety of disciplines, from the primary care provider to specialists such as psychologists, psychiatrists, and social workers. The committee also makes some recommendations for change, including:
The committee suggested that pediatricians and other health care providers need to "advocate for themselves" for payment of the "excess services" required to deal with the new morbidities, by negotiating managed care and fee-for-service contracts with third-party payers that ensure reimbursement for such services. Providers are also urged to advocate for mandatory inclusion of benefits for these services in families’ insurance contracts, "both public and private." The statement, "The New Morbidity Revisited: A Renewed Commitment to the Psychosocial Aspects of Pediatric Care" and a companion article, "The New Morbidity: Where the Rubber Hits the Road or the Practitioner’s Guide to the New Morbidity" appeared in the November issue of the journal Pediatrics. Vital Statistics of Children, Year 2000 A summary of vital statistics for Americans in the year 2000, drawn from birth and death certificates by the National Center for Health Statistics and published in the December issue of the journal Pediatrics, includes the following child-related information:
The report, "Annual Summary of Vital Statistics 2000" appeared in the December 2001 issue of the journal Pediatrics, published by the American Academy of Pediatrics. Reprints of the full text are available from DLH, National Center for Health Statistics, 6525 Belcrest Rd., Room 820, Hyattsville, MD 20782. IN THE COURTS Supreme Court Will Decide if Schools May Test for Drugs The United States Supreme Court has agreed to review a case that may help schools know when, and under what circumstances, they can require random testing of students for possible drug use, when there is no reason to suspect any individual student of using drugs. The Independent School District No.92 of Pottawatomie County in Oklahoma and its school board decided several years ago to take "vigorous measures" to deal with a long-standing practice of drug use by students in the district. But despite surveillance cameras, drug education, drug dogs, and increased security personnel, the problem persisted, and the district decided to use another tactic. Reasoning that most students participate in extracurricular activities, both before and after the regular school day, the district decided to require students to agree to random drug testing as a condition for eligibility to participate in any interscholastic secondary school competition. The district and the board were aware that the U.S. Supreme Court has allowed random, suspicionless testing of athletes in an Oregon school district in which athletes were considered by the school district to be the trend-setters in a major school drug problem. The Oklahoma district explained to the Supreme Court that it believes students participating in any kinds of extracurricular competitions—band, cheerleading, FFA, FHA, and academic teams, as well as athletics--are "envoys to the community" whose example could deter and hopefully eliminate drug use by other students. The Oklahoma program imposed no academic sanctions on students who tested positive and they were allowed to continue in interscholastic competition if they agreed to participate in drug counseling and showed no further drug use. If they refused to agree to those conditions, they were allowed to remain in the extracurricular activity but were prohibited from interscholastic competition for the rest of the year. A student who refused to take the drug test at all was prohibited from practicing for or engaging in interscholastic competition, but could remain in the extracurricular activity. The drug testing program was implemented in September 1998 and continued until a group of parents challenged it in federal court as an invasion of students’ rights to be free from unreasonable search and seizure under the Fourth Amendment to the U.S. Constitution. The Tenth U.S. Circuit Court of Appeals agreed, and required the district to cease the program. That was different from decisions that had been reached by other federal courts in similar cases, so the Pottawatomie County board and district appealed to the Supreme Court for guidance. The Supreme Court announced November 8 that it will hear the case; arguments are expected early next year. "The issue presented is of major importance … to all public schools in the nation which are responsible for the safety of students under their supervision on a daily basis and must address drug use which threatens their safety," the district told the Supreme Court in its request for a hearing. IN CONGRESS Congress Moves to Adjournment with Child- and Health-Related Bills Pending Pushing to adjourn this session of the 107th Congress, lawmakers in the U.S. House and Senate last week tried to wrap up appropriations bills for fiscal year 2002. But with major money bills still awaiting action, including the massive Labor, Health, and Education appropriation that is often the last to be passed, it seemed likely Congress would adjourn with a "continuing resolution" funding federal programs at the same levels as this year. That will leave it to the second session of this Congress to take final action on spending for health programs in the fiscal year that ends next October. Elementary/Secondary Education Act Reauthorization Among other child-related legislation still pending is a bill to reauthorize the Elementary and Secondary Education Act, which passed both houses of Congress months ago and is now in a House-Senate conference to work out differences between the two versions. One of the most controversial provisions, a proposal to mandate funding for special education for the next 10 years at 40 percent of the excess costs to school districts of providing special education classes and related services, including health services, has reportedly been rejected by the conference committee. Forty percent of what it costs a school system to educate its special ed students, over and above what is spent per-child on all children, was the funding level Congress promised when the Individuals with Disabilities Education Act was originally enacted, but that funding level has never been reached. The multi-million-dollar full-funding provision was especially controversial because it would have required the special ed money to be made available before any other education funds could be spent. Pediatric Exclusivity (Testing Drugs for Children) One child-health bill has now passed both houses of Congress but with minor differences between the two versions.. The "Best Pharmaceuticals for Children Act" (S. 838 in the Senate and H.R. 2887 in the House) would extend by six months the period of copyright exclusivity for drugs that manufacturers agree to test for use in children. During heated debate on the bill in the House, critics charged that the exclusivity arrangement gives pharmaceutical companies much more revenue than it costs to conduct the pediatric tests. After passage by the House November 15, the bill was sent back to the Senate to see if House amendments are acceptable to the senators. There has been no further action by the Senate. Dental Health S. 1626, "Children’s Dental Health Improvement Act of 2001," introduced in the Senate November 1 by Senator Jeff Bingaman (D-NM) calls for improving delivery of pediatric dental services under Medicaid and the State Children’s Health Insurance Program (SCHIP). In comments when he introduced the proposed legislation, Senator Bingaman noted recent reports that show dental caries are the major untreated disease of childhood, and he urged Congress to allow states to offer "wrap-around" dental coverage under SCHIP to children who have private health insurance that doesn’t include dental benefits. States are currently allowed to do this under Medicaid, he pointed out. S. 1626 would also provide funding for school-based or school-linked sealant programs in public elementary or secondary schools located in urban areas where more than 50 percent of the student population participates in the free or reduced-price school lunch program, or in rural areas where the median family income is at or below 235 percent of poverty. The Bingaman bill has been referred to the Senate Finance Committee. Mental Health Equity S. 543, "Mental Health Equitable Treatment Act of 2001," which would require insurance plans that offer mental health benefits to make those benefits equal to those available for other illnesses, was added as an amendment to the Senate version of the Labor-HHS-Education appropriations bill. The bill would amend the Public Health Service Act "group market" provisions to assure that any treatment limitations or financial requirements for mental illnesses are comparable to those imposed on medical or surgical benefits. SCHIP Outreach S. 1390, "Children’s Health Coverage Improvement Act of 2001," would provide grants to promote innovative outreach and enrollment efforts under SCHIP, with priority in grant applications from areas with high rates of eligible but unenrolled children and high numbers of families for whom English is not their primary language. The bill was introduced in August by Senator Bingaman and was referred to the Senate Finance Committee. Teaching CPR in Health Class? But with many bills not yet passed, one piece of health-related legislation has made it through both houses of Congress and is awaiting President Bush’s expected signature. The "Teaching Children to Save Lives Act," passed by the House in February and by the Senate November 21, authorizes grants to targeted schools or school districts for cardiopulmonary resuscitation (CPR) training for students, using nationally recognized training courses with manikins and automated external defibrillator training devices. "An important part of United States school children’s education is learning healthy behaviors," the bill notes. "This health education should also include basic emergency life-saving skills." The bill was H.R. 630 in the House and S. 727 in the Senate. WORTH NOTING No Benefit from Low-Tar Cigarettes, Cancer Institute Says It was hoped in the 1960s and 1970s that reduced-tar and –nicotine cigarettes would be less likely to cause lung cancer than regular cigarettes, and even public health officials pushed smokers to switch to "light" brands. But changes in cigarettes over the past 50 years haven’t decreased the risk of lung disease, according to the National Cancer Institute, a unit of the National Institutes of Health. In a 235-page monograph released November 27, the NCI points out that smokers "compensate" for reduced nicotine by puffing harder, inhaling more deeply, and smoking more cigarettes. Claims on cigarette packages of low amounts of tar and nicotine in the cigarettes are derived from machines that "smoke" the cigarettes, a test that doesn’t reflect the actual practices of smokers, the report points out. A summary of the monograph, Risks Associated with Smoking Cigarettes with Low Machine-Measured Yields of Tar and Nicotine, is available at http://newscenter.cancer.gov/pressreleases/lowtar.html, and copies of the full report can be ordered at www.cancer.gov/publications. Radio Campaign Aims to Close Health Gap A partnership between the federal Department of Health and Human Services and the ABC Radio Networks plans to "spread the word about good health and prevention directly to millions of African-American listeners," according to HHS Secretary Tommy Thompson. ABC Radio’s 240 Urban Advantage Network affiliates will air spots that address health conditions including heart disease and stroke, HIV/AIDS, diabetes, cancer, infant mortality, substance abuse, suicide, and violence, as part of a "Closing the Health Gap" campaign. A special one-day event in the spring will encourage people to visit a health care provider or make an appointment to see one in the near future. Information is available at website www.healthgap.omhrc.gov. Autism Fact Sheets Available
The fact sheets are available at www.nichd.nih.gov/autism or may be ordered free of charge from NICHDClearinghouse@mail.nih.gov. Contract Awarded for Smallpox Vaccine Resources The following information appeared during the past month in the News Alerts feature of this website: Pediatrics Academy Cites Role of School Nurse in Providing School
Health Services Journal Details Anthrax Symptoms New Guidelines for Hand Hygiene in Healthcare Research Grants to Prevent Adolescent STD, HIV, and Pregnancy CDC Recommends School-Based Dental Sealants
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