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Introduction Sleep-related infant deaths are major contributors to Tennessee's high infant mortality rate. The purpose of this initiative was to evaluate the impact of policy-based efforts to improve modeling of safe sleep practices by health care providers in hospital settings across Tennessee. Methods Safe sleep policies were developed and implemented at 71 hospitals in Tennessee. Policies, at minimum, were required to address staff training on the American Academy of Pediatrics' safe sleep recommendations, correct modeling of infant safe sleep practices, and parent education. Hospital data on process measures related to training and results of crib audits were compiled for analysis. Results The overall observance of infants who were found with any risk factors for unsafe sleep decreased 45.6% (p [less than or equal to] 0.001) from the first crib audit to the last crib audit. Significant decreases were noted for specific risk factors, including infants found asleep not on their back, with a toy or object in the crib, and not sleeping in a crib. Significant improvements were observed at hospitals where printed materials or video were utilized for training staff compared to face-to-face training. Discussion Statewide implementation of the hospital policy intervention resulted in significant reductions in infants found in unsafe sleep situations. The most common risk factors for sleep-related infant deaths can be modeled in hospitals. This effort has the potential to reduce sleep-related infant deaths and ultimately infant mortality., Author(s): Rachel Heitmann [sup.1] , Ester K. Nilles [sup.1] , Ashley Jeans [sup.1] , Jackie Moreland [sup.3] , Chris Clarke [sup.3] , Morgan F. McDonald [sup.1] , Michael D. Warren [...]

Workforce development is a priority across many state Maternal and Child Health (MCH) Title V programs. Three case studies were conducted to explore varied state implementations of MCH workforce development initiatives. Three states utilized the online MCH Navigator resource to support orientation and ongoing professional development for staff and other partners. Key informant interviews and surveys were utilized to gather staff feedback on practical aspects of the project and to ascertain lessons learned by state MCH leadership during project implementation. Staff impressions of the MCH Navigator were generally positive. Staff reported that Navigator modules were useful to their current work and that completion of the modules resulted in expanded knowledge in key MCH competency areas and contributed to their professional development. Many indicated that they would recommend use of the Navigator to colleagues. State leaders found that utilization of introductory training sessions or the Navigator's online orientation modules were helpful in acclimating staff to the Navigator, although some staff still experienced minor technical challenges. State leaders across all three sites reported the value of preexisting tools on the Navigator site, including core competency self-assessments and orientation bundles; the leaders also noted that the Navigator represents a useful and thorough resource that can be integrated into state efforts to enhance professional development for MCH staff. The significant variation between the three states' implementations demonstrates the flexibility of the Navigator, highlighting its utility to meet state-specific needs. Keywords Workforce development * Title V * Professional development * Education * Training, Introduction A focus on workforce development is common among state Maternal and Child Health (MCH) Title V programs. In the 2010-2015 cycle of the Title V Needs Assessment, 30 of [...]

Objective: The COVID-19 pandemic led to a substantial drop in US children's preventive care, which had not fully rebounded by the end of 2020. We sought to estimate the overall prevalence of missed, skipped, or delayed preventive checkups among households with children in the last 12 months because of the pandemic. Methods: We used data from the US Census Bureau's Household Pulse Survey, Phase 3.1 (collected April–May 2021). The analytic sample included 48 824 households with ≥1 child or adolescent aged <18 years. We estimated both national and state-level prevalences, examined associations with sociodemographic and household characteristics, and described reasons for missed or delayed preventive visits. Results: Overall, 26.4% (95% CI, 25.5%-27.2%) of households reported that ≥1 child or adolescent had missed or delayed a preventive visit because of COVID-19; percentages varied by state, from 17.9% in Wyoming to 37.0% in Vermont. The prevalence of missed or delayed preventive visits was significantly higher among respondents who reported material hardships (ie, not caught up on rent/mortgage, difficulty paying usual household expenses, children not eating enough because of lack of affordability) than among respondents who did not report material hardships. The most common reasons for missing or delaying preventive visits were concern about visiting a health care provider, limited appointment availability, and the provider's location being closed. Conclusions: Programs and policies could reduce gaps in children's preventive care caused by the pandemic, with a particular focus on addressing social determinants of health. [ABSTRACT FROM AUTHOR]

Teachers can use a range of techniques which involve student participation to explain the structure of DNA and its genetic code. The illustration of Morse code demonstrates the triplet code of DNA. Coloured toothpicks and dried peas make an engaging DNA model. Students also enjoy using role-play to demonstrate a DNA sequence. The teacher gives each student a role, possibly that of an amino acid, an ATP molecule or an mRNA codon, and the students have to act out their roles in protein synthesis.

Medical records in family practice. A review. Warren, M. D. (Health Services Research Unit, University of Kent, Canterbury, Kent, England).The organisation of general practice in England is outlined and the independent contractor basis of the family practitioner emphasised. Data from family practice, like data from hospital practice, may be used for clinical management, practice management, or research. Examples of applications in each of these fields are given. The basic records used in family practice—the medical record envelope, the prescription form and the claim for sickness benefit—are described. Some practices record morbidity (E Book or Diagnostic Index), some record systematically details of their activities (L Book or Activities Ledger) and some maintain age and sex registers and other registers of their patients; all these developments are outlined. Attention is drawn to the introduction of problem orientated records and to the use of computers in family practice, but these innovations are not discussed. Outstanding issues are the same as those in hospital record systems—accuracy, definitions, coverage, confidentiality, clerical support and costs, and the use made of the information. [ABSTRACT FROM PUBLISHER]

Leaver J M [North East Thames Regional Health Authority] Alvik A and Warren M D. Prescriptive screening for adolescent idiopathic scoliosis: a review of the evidence. International Journal of Epidemiology 1982; 11: 101–111. Published data relating to prevalence, natural history, treatment and prevention of adolescent idiopathic scoliosis (AIS) are examined. Screening programmes could lead to about 10% of 11–15 year old schoolchildren being referred for diagnosis, involving, for many, an X-ray of the spine. About 1 in 5 of the children referred would be diagnosed as having AIS; of these 1 in 10 would have treatment, either by the wearing of a brace, or in more severe cases by operation and fusion of the vertebrae. The data suggest that in most cases of AIS the spinal curve regresses or at least does not progress. Treatment, whether by brace or operation, is inerous and not always successful. Very little is known for certain about the causation of AIS and the interplay of various factors in its development and regression. The case for widespread adoption of prescriptive screenino programmes is not yet established. There is an urgent need to coordinate and Increase research designed to determine the aetiology, incidence, prevalence and course of AIS; to find factors that distinguish a rarer progressive form, commoner in girls than boys, from a more frequent and apparently benign form; to develop reliable and valid screening techniques; and to evaluate different forms of treatment. Some of these studies will have to be carried out by collaboration between a number of centres. Current screening programmes should be rigorously evaluated, all children who are referred for diagnosis and treatment should be examined in designated centres and the findings and details of treatment should be recorded systematically, using agreed definitions and criteria that will ensure that the experience of collaborating centres can be collated. [ABSTRACT FROM PUBLISHER]

Over the past thirty years two government committees, the second of them a Royal Commission which reported in 1968, have had far-reaching effects on medical education in Britain. The Commission defined community medicine as being concerned 'not with the treatment of individual patients but with broad questions of health and disease in, for example, particular geographical and occupational sections of the community and in the community at large'. It recommended that every medical school should have a department of community medicine, and that doctors working in this field should form a professional body which would accept responsibility for setting standards in specialist postgraduate education in the subject. This led to the formation of the Faculty of Community Medicine of the Royal Colleges of Physicians of the United Kingdom. The reorganization of the National Health Service which will come into effect in April 1974 depends heavily for its success on specialists in community medicine who will hold key administrative posts at district, area, regional and national level and whose competence is expected to include the ability to practise epidemiology. Details of the postgraduate training programme recommended by the Faculty are given, and steps taken to implement other relevant recommendations of the Royal Commission are described. [ABSTRACT FROM PUBLISHER]

Focuses on science activities developed to show students how deoxyribonucleic acid (DNA) stores information. Examination of DNA's structure; Importance of students understanding the triplet code.

Hepatitis C virus (HCV) affects an estimated 3.5 million persons in the United States (1), making it the most common bloodborne infection in the country. Recent surveillance data showed increased rates of HCV infection among adolescents and adults who are predominantly white, live in nonurban areas, and have a history of injection drug use.* U.S. birth certificate data were used to analyze trends and geographic variations in rates of HCV infection among women giving birth during 2009-2014. Birth certificates from Tennessee were used to examine individual characteristics and outcomes associated with HCV infection, using a multivariable model to calculate adjusted odds of HCV-related diagnosis in pregnancy among women with live births. During 2009-2014, HCV infection present at the time of delivery among pregnant women from states reporting HCV on the birth certificate increased 89%, from 1.8 to 3.4 per 1,000 live births. The highest infection rate in 2014 (22.6 per 1,000 live births) was in West Virginia; the rate in Tennessee was 10.1. In adjusted analyses of Tennessee births, the odds of HCV infection were approximately threefold higher among women residing in rural counties than among those in large urban counties, 4.5-fold higher among women who smoked cigarettes during pregnancy, and nearly 17-fold higher among women with concurrent hepatitis B virus (HBV) infection. HCV infection among pregnant women is an increasing and potentially modifiable threat to maternal and child health. Clinicians and public health officials should consider individual and population-level opportunities for prevention and risk mitigation.