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MNAAP Newsletter

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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Sterilization of Minors — Ethical Issues and How to Proceed

By Sheldon Berkowitz, MD, FAAP

Sterilization of minors is an uncommon procedure in pediatric practices, but an important one to understand if a family requests information about it. This article will help to understand what the ethical issues are and how to proceed if it is requested for your patient. Typically, this issue is only brought up for our patients with complex health care needs for whom it is felt that pregnancy (or fatherhood) would present significant problems for your patient or the potential offspring.

The background of this subject and the main reason why there has been so much oversight provided is that in the past, eugenics and other movements to limit reproduction of certain elements of our society led to mistreatment of our most vulnerable patients. The desire to prevent patients with diagnoses such as Trisomy 21 or mental retardation from procreating and potentially bringing more children with these problems into the population resulted in young adults being sterilized, often without any oversight as to whether this was the right thing to do or not.

As a result of these abuses of the medical system, both the American Academy of Pediatrics (AAP) and the American College of OBGYN (ACOG) have published policy statements on when and how minors can undergo sterilization. The goal of these policy statements is to protect the rights of minor patients who may not be able to speak for themselves and to limit possible harm to them if the procedure is not indicated. Because minor patients cannot legally consent to invasive procedures, their parents are given the right as surrogate decision makers to make decisions for them – as long as they are acting in the best interests of their child.

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Food Insecurity Screening and Referrals

NeilBratneyNeil Bratney, MD, FAAP

Nearly 1 in 10 Minnesotans are food insecure; that’s a half-a-million Minnesotans who don’t always know where their next meal is coming from. While poverty is a common contributing factor, transportation and geographic factors may also affect families without cars or without a grocery store nearby. Many families are just above the threshold for qualifying for assistance programs and still cannot afford the nutritious food important for their families.
Screening

Screening for food insecurity can be easy, but may require small changes to your office workflow. Screening should be completed at every well child exam, and whenever concerns exist. Screening can be accomplished using a standard, validated, two-question screening tool, known as the Hunger Vital Sign.

  • Within the past 12 months, we worried whether our food would run out before we got money to buy more.
  • Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.

A patient or caregiver can respond “Often true,” “Sometimes true,” “Never true,” or “Don’t know / Refused.” An “Often true” or “Sometimes true” response is considered a positive screen and should prompt advice and referral.

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