It is often assumed that health care providers in resource-limited settings are too overwhelmed with care at the patient level to consider problems at the systems level. Perhaps this is why so many quality improvement (QI) policies in the global south have been planned centrally and implemented vertically, with only marginal participation from hospitals and clinics. But I would argue that strengthening health systems requires more than administrative determination. It requires the active participation of providers—the people most directly responsible for patient care—as common stakeholders in a problem affecting children worldwide. read more »
California currently allows parents to “opt out” of routine kindergarten vaccination for their children based on personal or religious beliefs, known as Personal Belief Exemptions (PBEs). Richard Pan, the first pediatrician elected to the CA state senate, recently introduced a bill with Senator Ben Allen that would repeal PBEs and make routine childhood vaccination mandatory for school entry, except for medical reasons. read more »
Lately, I have been receiving mixed messages about how we as Americans define tobacco.
On one hand, we seem to consider tobacco a poison. It is after all a product that, when used exactly as intended, directly causes harm and death. In the past decade I have yet to meet a single American adult, smoker or non-smoker, who denies that tobacco is bad for your health. Even the tobacco industry agrees that “there is no safe cigarette”.read more »
As all pediatricians in training come to realize, addressing behavioral problems and teaching good parenting techniques in a short clinic visit can be overwhelming. Luckily, San Francisco has a wealth of parenting classes at Family Resource Centers, community organizations that are funded partially by First 5. These classes teach evidence-based parenting strategies and are accessible to all parents at no cost. Providers can refer parents or parents can simply show up. Currently, these classes are under-utilized and often go unfilled.read more »
“We must name them and know their stories. They must not remain anonymous.”
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In the fall of 2013, a group of community leaders came together to discuss the issues of children’s oral health in the city of San Francisco. Partners included SF Department of Public Health, UCSF, SFUSD, SF Dental Society, University of the Pacific, local health centers, and many other contributors for various disciplines, and organizations throughout the city. As a result of this year-long process, a city-wide three year Strategic Plan was developed to improve the oral health of children living in San Francisco.
The data collected as part of the environmental assessment and the development of the San Francisco Children’s Oral Health (SF COH) Strategic Plan show that while there has been a marked improvement in children’s oral health status over the past 10 years (i.e. decreased rates of untreated dental problems, as well as caries experience), the Healthy People 2020 goals have not yet been met for San Francisco’s children. Furthermore, oral health disparities persist among children in low-income schools and underserved neighborhoods.read more »
The mother of a patient was recently diagnosed with a rare eye condition, requiring her to take oral steroids and other immunosuppressive medications. If left untreated, her disease would likely progress and cause vision impairment and even blindness. She had to take her medications to save her vision. My patient, a cute little 2 month-old boy, was still breastfeeding. This mother was now in a dilemma – her vision-saving medicines could pass through her breast milk and potentially harm her child. After a long discussion, she decided that while she would stop breastfeeding and pump and dump until she was done taking her medications.
She asked me, “What is the best formula for my baby?” This is a not-so-uncommon question, one that many moms ask, when they are unable to breastfeed. This is a universal question after all – Isn’t it every mother’s instinct and to feed their child the best nutrition? She was overwhelmed by the incredible number of formulas, brands, and types, non-organic vs organic, whey vs casein, cow’s milk vs soy, infant or newborn, fussy or regular baby, the list goes on.
I was able to help this mother find the best way to feed her child, but what about all the other mothers who may have the same question? In our current system, an infant has 8 visits before their first birthday. Sounds like a lot of visits, but what about the other 357 days of the year? There must be another way to stimulate the discussion between patients, providers, nurses, social workers, and any advocate of child health.read more »
Increasing the cost of sugary drinks and reducing their access in schools and community settings is an important strategy for curbing intake of these beverages, which has been linked to negative health outcomes including obesity, diabetes, and dental caries.1-4 Perhaps equally important, however, is that children have access to safe drinking water throughout the day – at home and at school – where they spend much of their time.
Across the U.S., there are emerging efforts to ensure easy access to safe and appealing drinking water. California Senate Bill 1413 and the 2010 Healthy Hunger-Free Kids Act require fresh, free drinking water to be available at school mealtimes both in California and nationally.5-6 In addition to legislation, some schools and their community partners are taking the lead in promoting drinking water access and consumption. In partnership with the San Francisco Public Utilities Commission, San Francisco Unified School District has installed appealing water stations that allow easy filling of reusable water bottles in schools as a part of the “Green the Next Gen” initiative.7 Just south of San Francisco, the Santa Clara County Water District in partnership with First 5 Santa Clara County is installing water stations in schools, parks, museums, and the San Jose airport through their “Water to Go” program.8read more »
Last fall, I went into the hospital to get my regular Solumedrol and IVIG treatment that I had been getting for about 3 years. After the treatment, I usually get a bad headache that sometimes lasts for a few days, but this time, it was different. I was discharged from the hospital on Friday, and on Saturday my headache was worse than normal, and I had new pain in my knee and back. I went to the Urgent Care because Advil and Tylenol were not working. They prescribed Vicodin, and other than me acting a little crazy and getting some short-term relief, the headache was still very bad.
That Monday, we called my doctor. He said to wait it out and maybe it was a virus. When we called back on Tuesday, he prescribed a higher dosage of steroids to take for a few days to see if that helped. Several times, we discussed going to the ER but I didn’t want to go because I knew it would mean a spinal tap.read more »
Undocumented Parents and Children with Medical Conditions: How a Health Care Provider’s Letter can Help
Have you ever been asked to write a letter describing a child’s medical condition for immigration purposes? Are these families holding out false hope or is there truth to the idea that children with special health care needs might qualify a member of the family for special immigration status? The answer is complicated. In this article, I will review three methods by which undocumented immigrants may seek legal permanent residence status in the United States. I will also explain how a letter from a physician detailing a child’s medical condition may support their application.read more »