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MNAAP Newsletter

Pediatricians’ Voices on Equity Needed Outside the Clinic

By Nate Chomilo, MD, Minnesota Doctors for Health Equity

Nate ChomiloHere’s a statistic that may be hard to hear: Only 10 to 20 percent of health outcomes are attributable to health care.

For all our education, training and expertise, there is only so much we as physicians can do if we choose to only work within our clinics or hospitals.

We can highlight the ongoing health disparities (health differences that arise from economic, social or environmental disadvantages) that are worse in Minnesota than almost every other state, but putting a spotlight on the problem alone is not a solution. These disparities also arise from implicit bias, explicit bias and the structural racism intrinsic to many parts of our society, our healthcare system being no different.

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Sounding the Alarm on School Start Times: Later is Attainable

By Julie Dahl, APRN, CNP, President of the MN Sleep Society, Respiratory Consultants; Julie Baughn, MD, Mayo Center for Sleep Medicine, Children’s Center; Robin Lloyd, MD, Mayo Center for Sleep Medicine, Children’s Center

It is widely known that adequate sleep is required for optimal health and learning. Yet, adolescents nationwide are sleep deprived. Why? As children transition to adolescence, their biological sleep clocks shift, with a delay in melatonin release occurring around 10:45 pm (1). With early school start times, adolescents are unable to get the quality, well-timed sleep they need.  In Minnesota, 87 percent of high schools start before 8:30 a.m. and 60 percent of adolescents report inadequate sleep (2,3).  Parents will likely turn to their pediatricians for the facts.

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Word from the President

AndrewKiraguBy Andrew Kiragu, MD, FAAP

Fall is here, and with it, bright and vibrant colors, a final burst of life before winter’s senescence. I hope that you have all been able to take some time to enjoy these changing seasons and perhaps draw lessons and some comfort from them. Lessons that beyond the dark and cold winter days ahead comes spring.

These are definitely dark and difficult times we are living in. Last month, a lone gunman shot almost 600 of his fellow human beings, killing 58 of them and himself. We may never know why. Sadly, this mass shooting incident is just one of over 299 this year. So far in 2017, there have been almost 13,000 gun related deaths including those of 599 children between 0-11 years of age and an additional 2,700 deaths of kids aged 12-17.

In response to this carnage, our members of Congress offer “thoughts and prayers” and seem unwilling and/or unable to enact any meaningful gun safety legislation that would make mass shootings like this less likely. Indeed, before the shooting, Congress was getting set to schedule a vote on the NRA-backed Sportsmen Heritage and Recreational Enhancement (SHARE) Act, which among other things would allow the purchase of silencers (apparently to “protect hunters hearing”) and armor-piercing bullets.

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Opening Vaccine Dialogue Across Cultures: Measles Outbreak in Minnesota

nusheen ameenudinBy Nusheen Ameenuddin, MD, FAAP

“Most of you already know Dr. Nusheen, because she sees your kids” is how I was introduced on my home turf at the first of a series of talks with Minnesota’s Somali community. It was during our state’s worst measles outbreak to date.

By the week before Memorial Day this year, Minnesota had already reached 69 measles cases, more than all U.S. cases in the previous year. Because the outbreak primarily affected unvaccinated Somali children, our state health department, American Academy of Pediatrics chapter and others partnered with leaders in the Somali community to train and dispatch teams of imams (religious leaders) and physicians to engage and inform the community about this threat.

I feel privileged to work with a vibrant patient population that includes many Somali-Americans. I met some families as new arrivals to this country, while others have become my second generation of patients. We are fortunate that Minnesota’s children’s health insurance coverage is at an all-time high of 97 percent, thanks to Medicaid and CHIP. But despite having some of the best health measures in the nation, we still struggle with the highest disparity in health outcomes between ethnic groups.

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Lessons Learned on Increasing MMR Vaccines During the Outbreak

By Anne Valaas-Turner, MD, FAAP

On August 25, 2017, the Minnesota Department of Health declared an end to the measles outbreak…. along with a collective, statewide sigh of relief. As part of this announcement, Commissioner of Health Dr. Ed Ehlinger thanked all of the health systems, hospitals, clinics, doctors, pediatric clinicians, clinic staff and local public health who worked so hard to contain the Spring epidemic. He also highlighted the Allina Health System, which according to MDH records, provided the most MMR vaccine during the outbreak.

Pediatric staff reflected on this news and identified several key beliefs and lessons that we learned.

Communications: We were immediately notified of the measles outbreak by the MDH vaccine preventable disease listserv. Lesson: It may be useful to include “helpful e-mail lists to join” as part of the onboarding process for new providers.
Team structure: As a pediatrician, I share work space with my assistant, two partners, and their assistants. It was easy to teach the team the new vaccine recommendation, since we all work together in the same space. I will begrudgingly admit that the daily huddle system I sometimes rail against allowed for communication up and down the leadership structure about our measles response. We also got regular updates about the number of MMR doses in clinic, which was helpful.

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